{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T21:43:33Z","timestamp":1777585413607,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Endocrinol Diabetes"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Hypercalcemia can result from either hyperparathyroidism or non-parathyroid conditions. When hypercalcemia is accompanied by undetectable parathyroid hormone (PTH) levels, hyperparathyroidism is rarely considered the diagnosis. Herein, we report the case of a 65-year-old Caucasian woman referred to our hospital for further evaluation of hypercalcemia. Her symptoms included fatigue and brain fog, with undetectable PTH levels. A comprehensive workup, including a series of laboratory and imaging tests, excluded common non-parathyroid causes such as malignancy and familial hypocalciuric hypercalcemia. Ultrasound identified a likely enlarged parathyroid gland, which was further confirmed by a sestamibi scan. After 2\u2009weeks of cinacalcet treatment, the patient\u2019s calcium levels decreased, indicating the parathyroid gland as the likely source of hypercalcemia. Parathyroidectomy was subsequently performed, revealing a 1927\u2009mg adenoma. Postoperatively, the patient\u2019s calcium levels normalized, PTH levels became detectable within the normal range, and her symptoms resolved, with a marked improvement in energy. This case demonstrates that primary hyperparathyroidism can present with hypercalcemia and undetectable PTH. A genetic mutation in the PTH gene within the adenoma may explain the undetectable PTH levels preoperatively.<\/jats:p>","DOI":"10.1177\/11795514241290125","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T08:37:35Z","timestamp":1728376655000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Primary Hyperparathyroidism With Undetectable Intact Parathyroid Hormone"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9306-8909","authenticated-orcid":false,"given":"Zhixing","family":"Song","sequence":"first","affiliation":[{"name":"Department of Surgery, Section of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"McMullin","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Utah, Salt Lake City, UT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Forest","family":"Huls","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Laboratory Medicine, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2682-3409","authenticated-orcid":false,"given":"Sravani","family":"Bantu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herbert","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenessa","family":"Lindeman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"bibr1-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4022"},{"key":"bibr2-11795514241290125","first-page":"9","volume":"13","author":"Catalano A","year":"2018","journal-title":"J Clin Transl Endocrinol"},{"key":"bibr3-11795514241290125","first-page":"10","author":"Ramonell KM","year":"2024","journal-title":"Ann Surg"},{"key":"bibr4-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1002\/wjs.12285"},{"key":"bibr5-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2024.04.002"},{"key":"bibr6-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2723"},{"key":"bibr7-11795514241290125","first-page":"e42405","volume":"15","author":"Magacha HM","year":"2023","journal-title":"Cureus"},{"key":"bibr8-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2023.12.026"},{"key":"bibr9-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2023.10.041"},{"key":"bibr10-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1016\/j.ando.2015.03.018"},{"key":"bibr11-11795514241290125","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v4.i3.71"},{"key":"bibr12-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc0802570"},{"key":"bibr13-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1210\/endo.131.5.1425431"},{"key":"bibr14-11795514241290125","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2020.35.1.64"},{"key":"bibr15-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-031184"},{"key":"bibr16-11795514241290125","doi-asserted-by":"publisher","DOI":"10.33145\/2304-8336-2023-28-316-328"},{"key":"bibr17-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1104982"},{"key":"bibr18-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfac029"},{"key":"bibr19-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2021-1288"},{"key":"bibr20-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0247"},{"key":"bibr21-11795514241290125","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2008.03225.x"}],"container-title":["Clinical Medicine Insights: Endocrinology and Diabetes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795514241290125","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11795514241290125","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11795514241290125","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:00:11Z","timestamp":1777406411000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11795514241290125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":21,"alternative-id":["10.1177\/11795514241290125"],"URL":"https:\/\/doi.org\/10.1177\/11795514241290125","relation":{},"ISSN":["1179-5514","1179-5514"],"issn-type":[{"value":"1179-5514","type":"print"},{"value":"1179-5514","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1]]},"article-number":"11795514241290125"}}