{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T07:35:53Z","timestamp":1782459353882,"version":"3.54.5"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T00:00:00Z","timestamp":1600732800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Context<\/jats:title><jats:p>Primary hyperparathyroidism is a common condition and results in hypercalcaemia, especially in older women. Thus, it is critical to obtain a robust estimate for the upper limit of the reference interval for albumin\u2010adjusted serum calcium in the general population. The current reference interval in use in the UK (Pathology Harmony range, 2.20 to 2.60\u00a0mmol\/L) was based on a consensus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To establish a reference interval for albumin\u2010adjusted serum calcium in men and women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional study of men and women who did not have chronic kidney disease or vitamin D deficiency; outliers were identified statistically and then rejected and then a 99% reference interval was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>502\u00a0524 men and women aged 40 to 69\u00a0years from the UK Biobank Study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Serum total calcium, albumin, 25\u2010hydroxyvitamin D, estimated glomerular function (eGFR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We developed an equation for albumin\u2010adjusted serum calcium and applied it to 178\u00a0377 men and women who did not have chronic kidney disease or vitamin D deficiency. We identified 2962 (1.7%) as outliers, and when excluded, we report a 99% reference interval of 2.19 to 2.56\u00a0mmol\/L (8.76 to 10.24\u00a0mg\/dL). We found that for older (55\u201069\u00a0years) and younger women (40\u201055\u00a0years) the upper limits were 2.59\u00a0mmol\/L and 2.57\u00a0mmol\/L and that for all men, the upper limit was 2.55\u00a0mmol\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We have established an upper limit of the reference range for older women that would identify all high outliers (2.60\u00a0mmol\/L and above). The upper limit for young women and for men is lower, at 2.57 and 2.55\u00a0mmol\/L respectively. The current reference interval in use has to be updated and improved based on these findings. These upper limits may prove helpful for identifying hypercalcaemic disorders like primary hyperparathyroidism in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14326","type":"journal-article","created":{"date-parts":[[2020,9,6]],"date-time":"2020-09-06T03:24:19Z","timestamp":1599362659000},"page":"34-39","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Reference interval for albumin\u2010adjusted calcium based on a large UK population"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2204-2095","authenticated-orcid":false,"given":"Marian","family":"Schini","sequence":"first","affiliation":[{"name":"Department of Oncology and Metabolism University of Sheffield Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadil M.","family":"Hannan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s &amp; Reproductive Health University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Oncology and Metabolism University of Sheffield Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0323-3366","authenticated-orcid":false,"given":"Richard","family":"Eastell","sequence":"additional","affiliation":[{"name":"Department of Oncology and Metabolism University of Sheffield Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,9,22]]},"reference":[{"issue":"3","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"287","DOI":"10.7861\/clinmedicine.13-3-287","article-title":"How to approach hypercalcaemia","volume":"13","author":"Crowley R","year":"2013","journal-title":"Clin Med (London, England)"},{"issue":"3","key":"e_1_2_8_3_1","first-page":"89","article-title":"The approach to pathology harmony in the UK","volume":"33","author":"Berg J","year":"2012","journal-title":"Clin Biochem Rev"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2013.10.019"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118453926.ch22"},{"key":"e_1_2_8_6_1","unstructured":"NICE.Hyperparathyroidism (primary): diagnosis assessment and initial management. In: National Institute for Health and Care Excellence (UK);2019.https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK542087\/. Accessed September 14 2020."},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/000456329603300108"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6890-8-12"},{"key":"e_1_2_8_9_1","unstructured":"UKBiobank.https:\/\/www.ukbiobank.ac.uk. Accessed September 14 2020."},{"key":"e_1_2_8_10_1","unstructured":"KhanAA HanleyDA RizzoliR et al.Primary hyperparathyroidism: review and recommendations on evaluation diagnosis and management. A Canadian and international consensus;2017."},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0628"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afu093"},{"key":"e_1_2_8_13_1","unstructured":"KDIGO.KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. 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