{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T04:33:17Z","timestamp":1768451597635,"version":"3.49.0"},"reference-count":52,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,2,8]],"date-time":"2014-02-08T00:00:00Z","timestamp":1391817600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Over decades, improvements in presymptomatic screening and awareness of surgical benefits have changed the presentation and management of primary hyperparathyroidism (PHPT). Unrecognized multiglandular disease (MGD) remains a major cause of operative failure. We hypothesized that during parathyroid surgery the initial finding of a mildly enlarged gland is now frequent and predicts both MGD and failure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective database was queried to examine the outcomes of initial exploration for sporadic PHPT using intraoperative PTH monitoring (IOPTH) over 15 years. All patients had follow\u2010up \u22656\u00a0months (mean = 1.8 years). Cure was defined by normocalcemia at 6\u00a0months and microadenoma by resected weight of &lt;200\u00a0mg.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 1,150 patients, 98.9 % were cured and 15 % had MGD. The highest preoperative calcium level decreased over time (<jats:italic>p<\/jats:italic> &lt; 0.001) and varied directly with adenoma weight (<jats:italic>p<\/jats:italic> &lt; 0.001). Over time, single adenoma weight dropped by half (<jats:italic>p<\/jats:italic> = 0.002) and microadenoma was increasingly common (<jats:italic>p<\/jats:italic> &lt; 0.01). MGD risk varied inversely with weight of first resected abnormal gland. Microadenoma required bilateral exploration more often than macroadenoma (48 vs. 18 %, <jats:italic>p<\/jats:italic> &lt; 0.01). When at exploration the first resected gland was &lt;200\u00a0mg, the rates of MGD (40 vs. 11 %, <jats:italic>p<\/jats:italic> = 0.001), inadequate initial IOPTH drop (67 vs. 79 %, <jats:italic>p<\/jats:italic> = 0.002), operative failure (6.6 vs. 0.7 %, <jats:italic>p<\/jats:italic> &lt; 0.001), and long\u2010term recurrence (1.6 vs. 0.3 %, <jats:italic>p<\/jats:italic> = 0.007) were higher.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Single parathyroid adenomas are smaller than in the past and require more complex pre\u2010 and intraoperative management. During exploration for sporadic PHPT, a first abnormal gland &lt;200\u00a0mg should heighten suspicion of MGD and presages a tenfold higher failure rate.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-014-2450-1","type":"journal-article","created":{"date-parts":[[2014,2,7]],"date-time":"2014-02-07T20:49:10Z","timestamp":1391806150000},"page":"1274-1281","source":"Crossref","is-referenced-by-count":44,"title":["The Small Abnormal Parathyroid Gland is Increasingly Common and Heralds Operative Complexity"],"prefix":"10.1002","volume":"38","author":[{"given":"Kelly L.","family":"McCoy","sequence":"first","affiliation":[{"name":"Division of Endocrine Surgery University of Pittsburgh 3471 Fifth Avenue, Kaufmann Building, Suite 101 15213 Pittsburgh PA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi H.","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Endocrine Surgery University of Pittsburgh 3471 Fifth Avenue, Kaufmann Building, Suite 101 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