{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T22:42:57Z","timestamp":1770417777425,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T00:00:00Z","timestamp":1574726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T00:00:00Z","timestamp":1574726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T00:00:00Z","timestamp":1574726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>We investigated outcomes in a cohort of patients with a biochemical diagnosis of primary hyperparathyroidism (pHPT) undergoing surgery for asymptomatic disease or target organ damage, where a focussed or four\u2010gland operation was undertaken and the histopathology only reported a \u201clarge normal\u201d parathyroid gland (LNP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and materials<\/jats:title>\n                    <jats:p>Patients subjected to a parathyroidectomy for pHPT between 2012 and 2018 with a pathology of LNP were included. Patients with fat depletion or additional histological features of adenoma or hyperplasia in any of the resected glands were excluded. A control group was formed from 50 consecutive patients with the histological finding of adenoma or hyperplasia during the same study period. The primary outcome was biochemical normalisation of pHPT at 1\u20132 weeks and after 6\u00a0months post\u2010operatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010eight LNP patients (2% of all parathyroidectomies) were included in the study group with 50\u00a0matched controls. LNP patients had a lower biochemical cure rate (81% vs. 98%\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05) and a higher risk of recurrence (10% vs. 0%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.06). LNP patients had a milder form of pHPT (Ca\n                      <jats:sup>2+<\/jats:sup>\n                      2.63 vs. 2.68\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05) with a smaller PTH and Ca\n                      <jats:sup>2+<\/jats:sup>\n                      drop post\u2010operatively. For LNP patients with failure, a definite additional cause of pHPT was found in only two patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study highlights a controversial area in pHPT and reports LNP as a cause of pHPT. The biochemical analysis of this LNP group supports a benefit in resection in the setting of pHPT, although the risk of failure (persistence\/recurrence) is higher than those with adenoma or hyperplasia. Stricter post\u2010operative follow\u2010up of LNP patients should be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00268-019-05302-6","type":"journal-article","created":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T15:03:17Z","timestamp":1574780597000},"page":"1149-1155","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Significance of Histologically \u201cLarge Normal\u201d Parathyroid Glands in Primary Hyperparathyroidism"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0011-1953","authenticated-orcid":false,"given":"Russel","family":"Krawitz","sequence":"first","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Glover","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sireesha","family":"Koneru","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Jiang","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aimee","family":"Di Marco","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony J.","family":"Gill","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney Sydney NSW Australia"},{"name":"NSW Health Pathology, Department of Anatomical Pathology Royal North Shore Hospital St Leonards NSW Australia"},{"name":"Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research Royal North Shore Hospital St Leonards NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Aniss","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Sywak","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leigh","family":"Delbridge","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stan","family":"Sidhu","sequence":"additional","affiliation":[{"name":"University of Sydney Endocrine Surgical Unit Royal North Shore Hospital, Northern Sydney Local Health District Sydney NSW Australia"},{"name":"Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health University of Sydney Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,11,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\/books\/12798_51"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978\u20101\u20104377\u20102227\u20107.00070\u20108"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000715"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\/books\/12798_57"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010012\u20101438\u2010y"},{"key":"e_1_2_6_7_1","unstructured":"SchneiderDF BurkeJF OjomoKAet al. 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Parafibromin\u2010deficient (HPT\u2010JT type CDC73 mutated) parathyroid tumors demonstrate distinctive morphologic features.Am J Surg Pathol(2019)10.1097\/PAS.000000000000101731876586"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/014556131209101009"},{"key":"e_1_2_6_12_1","unstructured":"G\u00f3mez\u2010ram\u00edrezJ MihaiRNormocalcemic primary hyperparathyroidism: a diagnostic and therapeutic algorithm.Langenbeck\u2019s Arch Surg(2017)10.1007\/s00423\u2010017\u20101617\u20102"},{"key":"e_1_2_6_13_1","first-page":"35","article-title":"Molecular pathogenesis of primary hyperparathyroidism","volume":"34","author":"Cetani F","year":"2011","journal-title":"J Endocrinol Investig"},{"key":"e_1_2_6_14_1","unstructured":"KruijffS SidhuSB SywakMS SciM GillAJ DelbridgeLWNegative parafibromin staining predicts malignant behavior in atypical parathyroid adenomas.Ann Surg Oncol(2014)10.1245\/s10434\u2010013\u20103288\u2010824806117"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445\u20102197.2010.05488.x"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010016\u20103716\u20106"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1510167"},{"key":"e_1_2_6_18_1","doi-asserted-by":"crossref","unstructured":"ChamS SepahdariAR HallKE YehMW HarariADynamic Parathyroid Computed Tomography (4DCT) facilitates reoperative parathyroidectomy and enables cure of missed hyperplasia.Ann Surg Oncol(2015)10.1245\/s10434\u2010014\u20104331\u2010025691276","DOI":"10.1245\/s10434-014-4331-0"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-019-05302-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00268-019-05302-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-019-05302-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-019-05302-6","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T05:47:49Z","timestamp":1766468869000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-019-05302-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,26]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1007\/s00268-019-05302-6"],"URL":"https:\/\/doi.org\/10.1007\/s00268-019-05302-6","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,26]]},"assertion":[{"value":"26 November 2019","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"There were no conflicts of interest declared by any of the authors.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the relevant Human Research Ethics Committee.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}