{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T02:44:24Z","timestamp":1779158664636,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"1-2","license":[{"start":{"date-parts":[[2016,6,14]],"date-time":"2016-06-14T00:00:00Z","timestamp":1465862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In recent years, patients with primary hyperparathyroidism (PHPT) are being diagnosed earlier, with milder elevations in parathyroid hormone (PTH) and serum calcium. We aimed to investigate whether adenoma size reflects biochemical severity of presentation and influences localization of pre\u2010operative scans.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 630 consecutive patients undergoing parathyroidectomy for PHPT were recruited into either the microadenoma (\u2264200 mg) or macroadenoma (&gt;200 mg) group. Pre\u2010operative serum calcium, PTH, rates of minimally invasive parathyroidectomy and bilateral neck exploration, localization of adenomas with pre\u2010operative ultrasound and sestamibi (MIBI) scans, cure rates and other demographic parameters were compared. The data were analysed using Student's <jats:italic>t<\/jats:italic>\u2010test, Chi\u2010squared test, linear and multiple regression analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients in the microadenoma group had significantly lower pre\u2010operative serum calcium (<jats:italic>P<\/jats:italic> &lt; 0.001) and PTH (<jats:italic>P<\/jats:italic> &lt; 0.001), less accurate MIBI (<jats:italic>P<\/jats:italic> &lt; 0.001) and ultrasound (<jats:italic>P<\/jats:italic> &lt; 0.001), lower cure rates (<jats:italic>P<\/jats:italic> = 0.04) and were more likely to undergo bilateral neck exploration (<jats:italic>P<\/jats:italic> = 0.001). However, multivariate analysis revealed that microadenomas are most strongly associated with the findings of less accurate MIBI (<jats:italic>P<\/jats:italic> = 0.03) and lower pre\u2010operative calcium (<jats:italic>P<\/jats:italic> = 0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, smaller adenomas are strongly associated with biochemically milder PHPT and less accurate localization studies. Therefore, microadenomas continue to present as a challenge in both diagnosis and management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.13654","type":"journal-article","created":{"date-parts":[[2016,6,15]],"date-time":"2016-06-15T12:41:16Z","timestamp":1465994476000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surgery for parathyroid microadenomas: patient characteristics, localization success and operative cures"],"prefix":"10.1111","volume":"88","author":[{"given":"Katherine J. L.","family":"Suter","sequence":"first","affiliation":[{"name":"Monash University Endocrine Surgery Unit The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Johnson","sequence":"additional","affiliation":[{"name":"Monash University Endocrine Surgery Unit The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meei","family":"Yeung","sequence":"additional","affiliation":[{"name":"Monash University Endocrine Surgery Unit The Alfred Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Serpell","sequence":"additional","affiliation":[{"name":"Monash University Endocrine Surgery Unit The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Department of Surgery Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James C.","family":"Lee","sequence":"additional","affiliation":[{"name":"Monash University Endocrine Surgery Unit The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Department of Surgery Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Grodski","sequence":"additional","affiliation":[{"name":"Monash University Endocrine Surgery Unit The Alfred Hospital  Melbourne Victoria Australia"},{"name":"Department of Surgery Monash University  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,6,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.143.3.260"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-014-2450-1"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2008.07.022"},{"key":"e_1_2_6_5_1","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1001\/archsurg.2010.104","article-title":"Operative failure in the era of focused parathyroidectomy","volume":"145","author":"Lew JI","year":"2010","journal-title":"Arch. 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