{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T19:50:17Z","timestamp":1790970617007,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"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":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Differentiating primary hyperparathyroidism (PHPT), normocalcemic PHPT (NPHPT), and vitamin D deficiency\u2010related secondary hyperparathyroidism (VDSHPT) remains a diagnostic challenge. This study evaluated the utility of biochemical markers in distinguishing these conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this cross\u2010sectional study, 437 participants were categorised into PHPT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009161), NPHPT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200997), VDSHPT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200989), and control (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200990) groups. Serum calcium, phosphate, chloride, PTH, and vitamin D levels were analysed, along with indices such as Ca\/P, Cl\/P, Ca\u2009\u00d7\u2009Cl\/P, and the PF Index (Ca\u2009\u00d7\u2009PTH\/P).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Calcium levels were highest in PHPT (2.73\u2009\u00b1\u20090.17\u2009mmol\/L), while phosphate levels were lowest (0.70\u2009\u00b1\u20090.19\u2009mmol\/L) both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001. PTH levels were significantly elevated in PHPT, NPHPT, and VDSHPT versus controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Ca\/P ratio was significantly higher in PHPT (4.17\u2009\u00b1\u20091.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), as was the Ca\u2009\u00d7\u2009Cl\/P ratio (448.5\u2009\u00b1\u2009133.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). No significant difference was found between NPHPT and VDSHPT groups in Ca\/P (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.63) and Ca\u2009\u00d7\u2009Cl\/P (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.74) ratios. Ca\u2009\u00d7\u2009Cl\/P ratio exhibited the highest diagnostic accuracy for PHPT with a specificity of 89.2% and PPV of 82.2%. Ca\/P ratio had the highest sensitivity (77.6%) and an NPV of 86.6%. PF Index (AUC: 0.851, 95% CI: 0.816\u20130.886) and Cl\/P ratio (0.766, 95% CI: 0.711\u20130.820) showed moderate accuracy. In NPHPT, all markers had high sensitivity but poor specificity (1.6%\u201323.2%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The Ca\u2009\u00d7\u2009Cl\/P and Ca\/P ratios demonstrate substantial diagnostic value for PHPT, while biochemical markers exhibited limited specificity in NPHPT. These findings highlight their role in screening but emphasize the need for additional diagnostic approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70052","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T12:43:06Z","timestamp":1761309786000},"page":"19-26","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biochemical Ratios for Predicting Primary Hyperparathyroidism: Revisiting Simple yet Powerful Diagnostic Tools"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0277-737X","authenticated-orcid":false,"given":"Fatma Tu\u011f\u00e7e","family":"\u015eah \u00dcnal","sequence":"first","affiliation":[{"name":"Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism Ankara Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6555-3579","authenticated-orcid":false,"given":"\u00d6zg\u00fcr","family":"Demir","sequence":"additional","affiliation":[{"name":"Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism Ankara Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5732-2284","authenticated-orcid":false,"given":"R\u0131fat","family":"Emral","sequence":"additional","affiliation":[{"name":"Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism Ankara Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1186-2960","authenticated-orcid":false,"given":"Asena","family":"G\u00f6k\u00e7ay Canpolat","sequence":"additional","affiliation":[{"name":"Ankara University Faculty of Medicine, Department of Endocrinology and Metabolism Ankara Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP15704.OR"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10391"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S128084"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4677"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2004.02139.x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820947009"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10019"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02276-7"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02260-8"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-019-0487-8"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2023.12.004"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-019-01025-6"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-197809000-00047"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.33"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2013.03.009"},{"issue":"8","key":"e_1_2_12_17_1","first-page":"801","article-title":"Performance of Chloride\/Phosphate Test in Patients With Primary Hyperparathyroidism. Is it Related to Calcium Level?","volume":"34","author":"Mismar A. A.","year":"2013","journal-title":"Saudi Medical Journal"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313480407000105"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12062"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2018.09.009"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0385"},{"issue":"5","key":"e_1_2_12_22_1","first-page":"1","article-title":"Alkaline Phosphatase (AL(P) Activity as a Marker for Vitamin D Deficiency","volume":"3","author":"Al\u2010Jurayyan N. 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