{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:37:13Z","timestamp":1791463033647,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"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":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the diagnostic performance of biochemical markers in normocalcemic primary hyperparathyroidism (nPHPT), analyse their temporal variations, and assess their correlation with adenoma localisation and size.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this multicenter retrospective study\u2014the largest patient cohort reported in the literature to date (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009474) we comprehensively profiled normocalcemic patients diagnosed with primary hyperparathyroidism nPHPT was diagnosed based on persistently elevated PTH levels with normal serum calcium after excluding secondary causes such as vitamin D deficiency, renal impairment, and other conditions. This retrospective multicenter study included a large cohort of patients whose biochemical markers\u2014including serum calcium, phosphorus, magnesium, vitamin D, parathyroid hormone (PTH), and glomerular filtration rate (GFR)\u2014were measured at three time points, using standardised laboratory protocols. Although in routine clinical practice these measurements are typically performed at regular intervals of 3\u22126 months, resulting in approximately three assessments during an 18\u2010month follow\u2010up period. Urinary calcium and creatinine levels were also determined, and imaging modalities (ultrasonography, sestamibi scintigraphy, and computed tomography) were employed for adenoma detection. Statistical analyses comprised repeated measures ANOVA, logistic regression, correlation analysis, and ROC analysis, performed using Jamovi software.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Serial evaluations revealed significant temporal changes in key biochemical parameters, including a significant decline in serum calcium and PTH levels alongside a significant increase in urinary calcium excretion. Logistic regression analysis identified higher PTH levels, higher corrected calcium, and larger adenoma size as independent predictors of adenoma localisation, while ROC analysis confirmed that PTH exhibited the highest diagnostic accuracy (AUC\u2009=\u20090.91, 95% CI: 0.84\u20130.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The large scale of our patient cohort reinforces the robustness of our statistical analyses and provides comprehensive insight into the dynamic nature of nPHPT.<\/jats:p>\n                    <jats:p>Our findings demonstrate that, even in normocalcemic patients, higher PTH levels and relatively higher calcium levels within the normal range are important indicators of parathyroid adenoma. Integrating serial biochemical measurements with targeted imaging can facilitate earlier diagnosis, potentially preventing future complications and informing more tailored management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70024","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T07:09:54Z","timestamp":1756796994000},"page":"805-814","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Temporal Variation of Biochemical Markers and Adenoma Predictors in Normocalcemic Primary Hyperparathyroidism: A Multicenter Retrospective Analysis"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7085-5846","authenticated-orcid":false,"given":"Ber\u00e7em","family":"Ay\u00e7i\u00e7ek","sequence":"first","affiliation":[{"name":"Istinye University Faculty of Medicine Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazhar M\u00fcsl\u00fcm","family":"Tuna","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism University of Health Sciences, Umraniye Training and Research Hospital Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Engin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism University of Health Sciences, Umraniye Training and Research Hospital Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Ankara University, School of Medicine Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayid","family":"Zuhur","sequence":"additional","affiliation":[{"name":"Tekirdag Nam\u0131k Kemal University Faculty of Medicine Tekirdag Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ne\u015fe Ers\u00f6z","family":"G\u00fcl\u00e7elik","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Gulhane Training and Research Hospital University of Health Sciences Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fcseyin","family":"Ya\u011fc\u0131","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism University of Health Sciences Turkey, Ankara Training and Research Hospital Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersen","family":"Karak\u0131l\u0131\u00e7","sequence":"additional","affiliation":[{"name":"Canakkale Onsekiz Mart University Faculty of Medicine Canakkale Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evin","family":"Bozkur","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Bakirkoy Dr. Sadi Konuk Training and Research Hospital Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bekir","family":"\u00c7ak\u0131r","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Ankara City Hospital, and Y\u0131ld\u0131r\u0131m Beyaz\u0131t University Faculty of Medicine Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif","family":"G\u00fcne\u015f","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism, Bursa City Hospital Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00fcleyman","family":"Baldane","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Selcuk University Faculty of Medicine Konya Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zen \u00d6z","family":"G\u00fcl","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Uludag University Bursa Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulhan","family":"Akbaba","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Mugla Sitki Kocman University Mugla Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cevdet","family":"Duran","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Usak Training and Research Hospital Usak Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faruk","family":"K\u0131l\u0131n\u00e7","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Firat University Elazig Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcven Bar\u0131\u015f","family":"Cansu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Metabolism Kutahya Health Sciences University Kutahya 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