{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T23:02:05Z","timestamp":1785193325916,"version":"3.55.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Horm Metab Res"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Normocalcemic primary hyperparathyroidism is thought to be an early form of\n                    hypercalcemic primary hyperparathyroidism. However, some studies have\n                    shown progression to hypercalcemia, hypercalciuria or kidney stones, bone loss\n                    and fractures in a proportion of patients over time, whereas other studies have\n                    not observed such outcomes. The aim of this study was to investigate the\n                    clinicopathological features and natural history of the disease in a large\n                    patient population and to provide clinicians with strong evidence-based\n                    recommendations. This is a nationwide, multicenter, observational, retrospective\n                    cohort study. Tertiary healthcare endocrinology departments were the setting for\n                    this study. Data from different regions of Turkey, including 527 patients, were\n                    included in this study. A total of 123 patients were not eligible for inclusion,\n                    and the remaining 404 patients were included in the final analysis. All\n                    laboratory assessments, dual-energy X-ray absorptiometry and renal ultrasound\n                    were performed locally at each center at baseline and several times during\n                    follow-up. The mean age was 54.63\u00b111.41 years. As expected, there was a female\n                    predominance of 362 (89.4%). A total of 376 patients were followed up for 1 year\n                    and 252 patients for 3 years. Forty-seven out of 404 patients (11.6%) developed\n                    hypercalcemia within 3 years. Twenty-eight patients became hypercalcemic within\n                    the 1st year, and 19 patients became hypercalcemic within 3 years.\n                    Among the 47 patients, only four patients had a calcium level above 11 mg\/dL\n                    during the follow-up. Nephrolithiasis was detected in 50 patients (12.6%). There\n                    was no significant difference in calcium, parathyroid hormone, 25-hydroxyvitamin\n                    D, or urinary calcium levels or the presence of nephrolithiasis. Bone mineral\n                    density assessments revealed that only 90 patients (28.5%) had normal bone\n                    mineral density. A total of 135 (42.7%) patients had osteopenia, and 91 (28.8%)\n                    patients had osteoporosis at least one site at presentation. This study revealed\n                    that patients with normocalcemic primary hyperparathyroidism have significant\n                    adverse skeletal outcomes, a slight increase in kidney stones. Only a small\n                    proportion of patients develop hypercalcemia, and the risk of developing\n                    significant hypercalcemia that would alter the patient\u2019s treatment management is\n                    much lower.<\/jats:p>","DOI":"10.1055\/a-2812-1864","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:29:57Z","timestamp":1772152197000},"page":"163-170","source":"Crossref","is-referenced-by-count":2,"title":["The Fate of Normocalcemic Hyperparathyroidism: Insights from a 3-Year\n                    Multicenter Follow-Up"],"prefix":"10.1055","volume":"58","author":[{"given":"Mazhar M\u00fcsl\u00fcm","family":"Tuna","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health\n                    Sciences, Umraniye Training and Research Hospital, Istanbul,\n                    T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ber\u00e7em","family":"Ay\u00e7i\u00e7ek","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Istinye University, Faculty\n                    of Medicine, Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130smail","family":"Engin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health\n                    Sciences, Umraniye Training and Research Hospital, Istanbul,\n                    T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asena","family":"G\u00f6k\u00e7ay Canpolat","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara University, Faculty\n                    of Medicine, Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"K\u0131r","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health\n                    Sciences, Gulhane Training and Research Hospital, Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceren","family":"Tufan","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Canakkale Onsekiz Mart\n                    University, Faculty of Medicine, Canakkale, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekin Yi\u011fit","family":"K\u00f6ro\u011flu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara City Hospital,\n                    Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenan","family":"Sakar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Mugla Sitki Kocman\n                    University, Faculty of Medicine, Mugla, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"G\u00f6rgel","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Selcuk University, Faculty\n                    of Medicine, Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u0131lek","family":"K\u0131l\u0131n\u00e7 Candem\u0131r","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Firat University, Faculty\n                    of Medicine, Elazig, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudum Yaprak Usda","family":"Konak","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Karadeniz Technical\n                    University, Faculty of Medicine, Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Aydem\u0131r","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Akdeniz University, Faculty\n                    of Medicine, Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"\u015eah\u0131n","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara University, Faculty\n                    of Medicine, Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ne\u015fe Ers\u00f6z","family":"G\u00fcl\u00e7el\u0131k","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, University of Health\n                    Sciences, Gulhane Training and Research Hospital, Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersen","family":"Karakili\u00e7","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Canakkale Onsekiz Mart\n                    University, Faculty of Medicine, Canakkale, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bek\u0131r","family":"\u00c7ak\u0131r","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara City Hospital,\n                    Ankara, T\u00fcrkiye"},{"name":"Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit\n                    University, Faculty of Medicine, Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fclhan","family":"Akbaba","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Mugla Sitki Kocman\n                    University, Faculty of Medicine, Mugla, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00fcleyman","family":"Baldane","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Selcuk University, Faculty\n                    of Medicine, Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faruk","family":"Kilin\u00e7","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Firat University, Faculty\n                    of Medicine, Elazig, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00fcneyt","family":"B\u0131lg\u0131ner","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Karadeniz Technical\n                    University, Faculty of Medicine, Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramazan","family":"Sari","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Akdeniz University, Faculty\n                    of Medicine, Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1210\/jc.2008-1760","article-title":"Presentation of asymptomatic primary hyperparathyroidism: Proceedings of the\n                    third international workshop","volume":"94","author":"S J Silverberg","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"3561","DOI":"10.1210\/jc.2014-1413","article-title":"Consensus statement: Guidelines for the management of asymptomatic primary\n                    hyperparathyroidism: summary statement from the fourth international\n                    workshop","volume":"99","author":"J P Bilezikian","year":"2014","journal-title":"J Clin Endocrinol Metab"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"666","DOI":"10.20945\/2359-3997000000556","article-title":"Normocalcemic primary hyperparathyroidism","volume":"66","author":"N E Cusano","year":"2022","journal-title":"Arch Endocrinol Metab"},{"issue":"13","key":"ref4","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.3346\/jkms.2022.37.e99","article-title":"Comparisons between normocalcemic primary hyperparathyroidism and typical\n                    primary hyperparathyroidism","volume":"37","author":"H R Choi","year":"2022","journal-title":"J Korean Med Sci"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"115812","DOI":"10.1016\/j.amjsurg.2024.115812","article-title":"Normocalcemic primary hyperparathyroidism: from pathophysiology to clinical\n                    management","volume":"235","author":"C Wu","year":"2024","journal-title":"Am J Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s00774-015-0673-3","article-title":"Normocalcemic hyperparathyroidism is associated with complications similar to\n                    those of hypercalcemic hyperparathyroidism","volume":"34","author":"M M Tuna","year":"2016","journal-title":"J Bone Miner Metab"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/SLA.0b013e31825ffbe1","article-title":"Creation of a \u201cWisconsin index\u201d nomogram to predict the likelihood of additional\n                    hyperfunctioning parathyroid glands during parathyroidectomy","volume":"257","author":"H Mazeh","year":"2013","journal-title":"Ann Surg"},{"key":"ref8","first-page":"1","article-title":"New parathyroid function index for the differentiation of primary and secondary\n                    hyperparathyroidism: A case control study","volume":"20","author":"Y Guo","year":"2020","journal-title":"BMC Endocr Disord"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1210\/jc.2010-2704","article-title":"The 2011 report on dietary reference intakes for calcium and vitamin D from the\n                    institute of medicine: What clinicians need to know","volume":"96","author":"A C Ross","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"ref10","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"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","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 2021)","volume":"186","author":"J Bollerslev","year":"2022","journal-title":"Eur J Endocrinol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1590\/S0004-27302010000200004","article-title":"Normocalcemic primary hyperparathyroidism","volume":"54","author":"J P Bilezikian","year":"2010","journal-title":"Arq Bras Endocrinol Metabol"},{"issue":"11","key":"ref13","doi-asserted-by":"crossref","first-page":"5348","DOI":"10.1210\/jc.2003-031014","article-title":"\u201cIncipient\u201d primary hyperparathyroidism: A \u201cforme fruste\u201d of an old disease","volume":"88","author":"S J Silverberg","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jocd.2012.12.001","article-title":"Normocalcemic primary hyperparathyroidism","volume":"16","author":"N E Cusano","year":"2013","journal-title":"J Clinical Densitom"},{"issue":"11","key":"ref15","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1001\/jama.2017.1620","article-title":"The definitive management of primary hyperparathyroidism: Who needs an\n                    operation?","volume":"317","author":"M J Campbell","year":"2017","journal-title":"Jama"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1007\/s40618-019-01075-w","article-title":"Parathyroid hormone reference ranges in healthy individuals classified by\n                    vitamin D status","volume":"42","author":"N Yalla","year":"2019","journal-title":"J Endocrinol Invest"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.ando.2015.03.005","article-title":"How to manage an isolated elevated PTH?","volume":"76","author":"J C Souberbielle","year":"2015","journal-title":"Ann Endocrinol (Paris)"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s00774-010-0200-5","article-title":"Vitamin D insufficiency defined by serum 25-hydroxyvitamin D and parathyroid\n                    hormone before and after oral vitamin D 3 load in Japanese subjects","volume":"29","author":"R Okazaki","year":"2011","journal-title":"J Bone Miner Metab"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.archger.2007.12.005","article-title":"Responses of parathyroid hormone to vitamin D supplementation: A systematic\n                    review of clinical trials","volume":"48","author":"M Bj\u00f6rkman","year":"2009","journal-title":"Arch Gerontol Geriatrics"},{"issue":"07","key":"ref20","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1002\/jbmr.2536","article-title":"Serum 25-hydroxyvitamin D levels: Variability, knowledge gaps, and the concept\n                    of a desirable range","volume":"30","author":"G El-Hajj Fuleihan","year":"2015","journal-title":"J Bone Miner Res"},{"issue":"08","key":"ref21","first-page":"e10391","article-title":"Normocalcemic hyperparathyroidism: A heterogeneous disorder often\n                    misdiagnosed?","volume":"4","author":"G Zavatta","year":"2020","journal-title":"J Bone Miner Res Plus"},{"issue":"06","key":"ref22","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.beem.2018.09.009","article-title":"Management of normocalcemic primary hyperparathyroidism","volume":"32","author":"N E Cusano","year":"2018","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"294","DOI":"10.4158\/EP15704.OR","article-title":"Primary hyperparathyroidism, with a focus on management of the normocalcemic\n                    form: To treat or not to treat?","volume":"22","author":"H \u0160iprov\u00e1","year":"2016","journal-title":"Endocr Pract"},{"key":"ref24","first-page":"1","article-title":"Biochemical characteristics and clinical manifestation of normocalcemic primary\n                    hyperparathyroidism","author":"I Yankova","year":"2024","journal-title":"Endocrine"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.surg.2022.05.042","article-title":"Phenotypes of primary hyperparathyroidism: Does parathyroidectomy improve\n                    clinical outcomes for all?","volume":"173","author":"V L Armstrong","year":"2023","journal-title":"Surgery"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"115583","DOI":"10.1016\/j.bone.2020.115583","article-title":"Impaired physical function and evaluation of quality of life in normocalcemic\n                    and hypercalcemic primary hyperparathyroidism","volume":"141","author":"L Voss","year":"2020","journal-title":"Bone"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"239","DOI":"10.5505\/amj.2022.82231","article-title":"Normocalcemic primary hyperparathyroidism is not innocent as it sounds","volume":"22","author":"\u015eB Polat","year":"2022","journal-title":"Ankara Med J"},{"issue":"04","key":"ref28","doi-asserted-by":"crossref","first-page":"e1171","DOI":"10.1210\/clinem\/dgaa084","article-title":"Normocalcemic hyperparathyroidism: study of its prevalence and natural\n                    history","volume":"105","author":"M Schini","year":"2020","journal-title":"J Clin Endocrinol Metab"}],"container-title":["Hormone and Metabolic Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2812-1864.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T22:40:55Z","timestamp":1778280055000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2812-1864"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":28,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,5,8]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2812-1864","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0018-5043","1439-4286"],"issn-type":[{"value":"0018-5043","type":"print"},{"value":"1439-4286","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}