{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T01:06:29Z","timestamp":1772759189105,"version":"3.50.1"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Exp Clin Endocrinol Diabetes"],"published-print":{"date-parts":[[2026,2]]},"abstract":"Abstract<\/jats:title>\n Primary hyperparathyroidism (PHPT) is a prevalent endocrine disorder\n characterized by disrupted calcium\u2013phosphorus homeostasis. Accurate\n biochemical assessment, including albumin-corrected calcium, and\n preoperative localization of parathyroid adenomas are essential for optimal\n management. This study aimed to evaluate temporal changes in imaging\n detectability, biochemical markers, and adenoma size, and to assess novel\n biochemical indices in patients with asymptomatic PHPT (aPHPT).<\/jats:p>\n In this multicenter retrospective study, 416 aPHPT patients underwent\n clinical, biochemical, and radiological evaluation at three time points.\n Biochemical parameters included albumin-corrected calcium, phosphorus,\n parathyroid hormone (PTH), 25-hydroxyvitamin D, alkaline phosphatase (ALP),\n and 24-hour urinary calcium. Novel indices\u2014calcium\/phosphorus (Ca\/P),\n PTH\/phosphorus (PTH\/P), and calcium\u00d7chloride\/phosphorus (Ca\u00d7Cl\/P)\u2014were\n calculated to evaluate diagnostic and predictive value. Imaging included\n high-resolution neck ultrasonography, 99mTc-sestamibi SPECT\/CT, and\n four-dimensional CT to assess adenoma detectability and size changes.\n Statistical analyses included repeated-measures ANOVA or Friedman tests for\n temporal comparisons, correlation analyses, logistic regression for\n predictors of adenoma detection, and ROC curves to evaluate diagnostic\n accuracy. A p-value<0.05 was considered significant.<\/jats:p>\n Among 416 patients (87% female), ultrasound-detected adenomas decreased over\n time due to surgery of clearly visible lesions. CT and SPECT\/CT initially\n improved localization, with later decline in CT but continued gains in\n SPECT\/CT. Adenoma size increased, and the PTH\/phosphorus ratio changed\n significantly. Baseline albumin-corrected calcium, phosphorus, and adenoma\n size predicted radiological detectability, with ROC AUCs of 0.78 for adenoma\n size and 0.72 for phosphorus. Surgically treated patients exhibited more\n pronounced biochemical abnormalities and superior CT-based localization.<\/jats:p>\n Following imaging and biochemical assessments, including albumin-corrected\n calcium, improve detection, monitoring, and management of aPHPT. Novel\n indices such as PTH\/phosphorus and Ca\/P ratios provide practical, low-cost\n tools for early disease identification and risk stratification. Integrating\n dynamic biochemical markers with imaging supports individualized,\n evidence-based clinical decision-making.<\/jats:p>","DOI":"10.1055\/a-2804-1682","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:17:30Z","timestamp":1772756250000},"page":"53-62","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Analysis of Biochemical, Imaging, and Adenoma Size\n Changes in Primary Hyperparathyroidism"],"prefix":"10.1055","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7085-5846","authenticated-orcid":false,"given":"Ber\u00e7em","family":"Ay\u00e7i\u00e7ek","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism, Istinye University,\n Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mazhar M\u00fcsl\u00fcm","family":"Tuna","sequence":"additional","affiliation":[{"name":"Endocrinology and Metabolism Disease, Umraniye Training\n and Research Hospital, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6493-9194","authenticated-orcid":false,"given":"\u0130smail","family":"Engin","sequence":"additional","affiliation":[{"name":"Endocrinology, \u00dcmraniye E\u011fitim Ve Ara\u015ft\u0131rma Hastanesi,\n Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asena","family":"G\u00f6k\u00e7ay Canpolat","sequence":"additional","affiliation":[{"name":"Ankara University, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ekin","family":"Yi\u011fit","sequence":"additional","affiliation":[{"name":"Yildirim Beyazit University, Ankara,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sevde Nur","family":"F\u0131rat","sequence":"additional","affiliation":[{"name":"Ankara Diskapi Yildirim Beyzat Training and Research\n Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuf","family":"K\u0131r","sequence":"additional","affiliation":[{"name":"TC Saglik Bakanligi Ankara Gulhane Egitim ve Arastirma\n Hastanesi, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Ye\u015filtepe","sequence":"additional","affiliation":[{"name":"Dumlupinar University, K\u00fctahya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ne\u015fe","family":"\u00c7\u0131nar","sequence":"additional","affiliation":[{"name":"Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University, Mugla,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenan","family":"Sakar","sequence":"additional","affiliation":[{"name":"Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University, Mugla,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c7i\u011fdem Tura","family":"Bahad\u0131r","sequence":"additional","affiliation":[{"name":"Amasya University, Amasya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u015eevkican","family":"G\u00fcne\u015f","sequence":"additional","affiliation":[{"name":"Istanbul University, Fatih, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayse","family":"Kubat","sequence":"additional","affiliation":[{"name":"Istanbul University, Fatih, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ceren","family":"Tufan","sequence":"additional","affiliation":[{"name":"Canakkale Onsekiz Mart Universitesi, \u00c7anakkale,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emre Sedar","family":"Saygili","sequence":"additional","affiliation":[{"name":"\u00c7anakkale Onsekiz Mart University, \u00c7anakkale,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dilek K\u0131l\u0131n\u00e7","family":"Candemir","sequence":"additional","affiliation":[{"name":"Firat University, El\u00e2z\u0131\u011f, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aysenur","family":"Karahan","sequence":"additional","affiliation":[{"name":"Hatay Mustafa Kemal University, Antakya,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet","family":"G\u00f6rgel","sequence":"additional","affiliation":[{"name":"Sel\u00e7uk University, Konya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziynet \u00dc\u00e7","family":"Alphan","sequence":"additional","affiliation":[{"name":"Usak University, Usak, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yudum Yaprak Usda","family":"Konak","sequence":"additional","affiliation":[{"name":"Trabzon University, Trabzon, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Semin","family":"Fenkci","sequence":"additional","affiliation":[{"name":"Pamukkale University, Pamukkale, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Aydemir","sequence":"additional","affiliation":[{"name":"Endocrinology, Akdeniz Universitesi Tip Fakultesi,\n Antalya, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kadircan","family":"Karatoprak","sequence":"additional","affiliation":[{"name":"Bursa Uludag University, Nil\u00fcfer, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6zge","family":"\u015eahin Kimyon","sequence":"additional","affiliation":[{"name":"Istanbul Bakirkoy Dr Sadi Konuk Training and Research\n Hospital, Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O\u011fulcan","family":"Boz","sequence":"additional","affiliation":[{"name":"Ankara Diskapi Yildirim Beyzat Training and Research\n Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alper","family":"G\u00fcrlek","sequence":"additional","affiliation":[{"name":"Hacettepe University, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00d6zden","family":"Uzun","sequence":"additional","affiliation":[{"name":"Tekirdag Namik Kemal University, Tekirda\u011f,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00dcmit Nur","family":"\u00d6zbay","sequence":"additional","affiliation":[{"name":"Kahramanmaras Sutcu Imam University, Kahramanmaras,\n Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00fcl\u015fah","family":"Elb\u00fcken","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Tekirdag\n Namik Kemal University, S\u00dcLEYMANPA\u015eA, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"16033","DOI":"10.1038\/nrdp.2016.33","article-title":"Primary hyperparathyroidism","volume":"2","author":"J P Bilezikian","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"ref2","first-page":"597","article-title":"Primary hyperparathyroidism: review and management","volume":"5","author":"A A Khan","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.123.266350","article-title":"Preoperative localization of parathyroid adenomas: a comparative study of\n multimodal imaging techniques","author":"A Miller","year":"2023","journal-title":"J Nucl Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"25","DOI":"10.3390\/diagnostics14010025.","article-title":"Diagnostic performance of magnetic resonance 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Chowdary","year":"2015","journal-title":"J Med Sci Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s13304-025-02086-4","article-title":"Correlation between parathyroid adenoma volume and preoperative biochemical\n parameters in primary hyperparathyroidism","volume":"77","author":"J Gonzalez","year":"2025","journal-title":"Updates Surg"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1530\/EC-21-0267","article-title":"Diagnostic performance of the calcium\/phosphate ratio for primary\n hyperparathyroidism in southwest China","volume":"10","author":"M Yin","year":"2021","journal-title":"Endocr Connect"},{"key":"ref10","first-page":"5","article-title":"Utility of the parathyroid hormone-to-phosphorus ratio in differentiating\n primary from secondary hyperparathyroidism","volume":"22","author":"Y Guo","year":"2022","journal-title":"BMC Endocr 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primary hyperparathyroidism: a clinical\n review","volume":"9","author":"D Tay","year":"2021","journal-title":"Biomedicines"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/jbm4.10019","article-title":"Serum calcium to phosphorous (Ca\/P) ratio is a simple, inexpensive, and accurate\n tool in the diagnosis of primary hyperparathyroidism","volume":"2","author":"B Madeo","year":"2018","journal-title":"JBMR Plus"},{"key":"ref16","first-page":"2456","article-title":"Impact of adenoma size on the preoperative localization and surgical outcomes in\n primary hyperparathyroidism","volume":"34","author":"S Lee","year":"2020","journal-title":"Surg Endosc"},{"key":"ref17","first-page":"1552","article-title":"Serum phosphorus levels as a predictor of disease severity in primary\n hyperparathyroidism","volume":"106","author":"X Chen","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"ref18","first-page":"197","article-title":"Role of corrected calcium levels in the diagnostic algorithm of primary\n hyperparathyroidism","volume":"99","author":"N Patel","year":"2023","journal-title":"Clin Endocrinol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"3570","DOI":"10.1210\/jc.2014-1414","article-title":"Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth\n International Workshop","volume":"99","author":"R Eastell","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"R33","DOI":"10.1530\/EJE-21-1044.","article-title":"European expert consensus on practical management of specific aspects of\n parathyroid disorders in adults and in pregnancy: recommendations of the ESE\n Educational Program of Parathyroid Disorders (PARAT)","volume":"186","author":"J Bollerslev","year":"2022","journal-title":"Eur J Endocrinol"}],"container-title":["Experimental and Clinical Endocrinology & Diabetes"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2804-1682.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:17:42Z","timestamp":1772756262000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2804-1682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":20,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,3,5]]},"published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2804-1682","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0947-7349","1439-3646"],"issn-type":[{"value":"0947-7349","type":"print"},{"value":"1439-3646","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}