{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:27:55Z","timestamp":1789576075309,"version":"build-2803163510"},"reference-count":33,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Serafimerlasarettet foundation","award":["2025-003"],"award-info":[{"award-number":["2025-003"]}]},{"name":"Region Stockholm FoUI","award":["RS2021-0855"],"award-info":[{"award-number":["RS2021-0855"]}]},{"name":"Region Stockholm FoUI","award":["1023791"],"award-info":[{"award-number":["1023791"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Primary hyperparathyroidism (PHPT) prevalence appears to be rising, but substantial underdiagnosis persists. Accurate epidemiological data are needed, requiring population-based studies using strict biochemical criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine incidence and prevalence of biochemically confirmed PHPT in Stockholm and characterize clinical recognition and surgical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a population-based healthcare cohort study using prespecified biochemical diagnostic algorithms in the Stockholm Region, Sweden, 2006-2020, using the Stockholm CREAtinine Measurements database which covers two-thirds of the adult population, including \u226590% of individuals \u226565 years. Adults aged \u226520 years with paired calcium and parathyroid hormone (PTH) measurements meeting biochemical criteria for PHPT were included. Individuals with estimated glomerular filtration rate \u226430 mL\/min\/1.73 m2, secondary hyperparathyroidism, or prior parathyroid surgery were excluded. Main outcome measures were the annual incidence rate and point prevalence of biochemically confirmed PHPT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 176 780 individuals contributing 578 227 PTH measurements, 10 190 patients fulfilling biochemical PHPT criteria were identified. Age- and sex-adjusted incidence rate increased from 2.81 (95% CI, 2.55-3.09) to 4.28 (95% CI, 3.98-4.59) per 10 000 person-years between 2009 and 2020, with the steepest increase among women aged \u226570 years. Prevalence increased from 0.35 to 4.76 per 1000 individuals. Median ionized calcium was 1.39 mmol\/L. Clinical diagnosis of PHPT was documented in 5346 (52%) patients, of which 2800 (52%) underwent parathyroidectomy, with surgery rates stabilizing after 2013 at 4% to 5% annually.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Using a large healthcare database, we observed substantially increasing PHPT incidence and prevalence, predominantly in older individuals. Only 52% received clinical diagnosis, underscoring the need for studies evaluating the long-term clinical burden of undiagnosed PHPT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag162","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:47:36Z","timestamp":1775821656000},"page":"e2086-e2095","source":"Crossref","is-referenced-by-count":2,"title":["Increasing incidence and prevalence of biochemically confirmed primary hyperparathyroidism in Stockholm, 2006-2020"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1043-1733","authenticated-orcid":false,"given":"David","family":"Thorsteinsson","sequence":"first","affiliation":[{"name":"Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital , Stockholm 171 76 ,","place":["Sweden"]},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 171 76 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9606-2094","authenticated-orcid":false,"given":"Fredrik","family":"Granath","sequence":"additional","affiliation":[{"name":"Department of Medicine Solna, Division of Clinical Epidemiology, Karolinska Institutet , Stockholm 171 77 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6245-7223","authenticated-orcid":false,"given":"Robert","family":"Br\u00e4nstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital , Stockholm 171 76 ,","place":["Sweden"]},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 171 76 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2833-3758","authenticated-orcid":false,"given":"Jan","family":"Zedenius","sequence":"additional","affiliation":[{"name":"Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital , Stockholm 171 76 ,","place":["Sweden"]},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 171 76 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4763-2024","authenticated-orcid":false,"given":"Juan-Jesus","family":"Carrero","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm 171 77 ,","place":["Sweden"]},{"name":"Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital , Stockholm 182 88 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8966-3729","authenticated-orcid":false,"given":"Inga-Lena","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital , Stockholm 171 76 ,","place":["Sweden"]},{"name":"Department of Molecular Medicine and Surgery, Karolinska Institutet , Stockholm 171 76 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,4,11]]},"reference":[{"issue":"1","key":"2026081219572867700_dgag162-B1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s12022-022-09709-1","article-title":"Overview of the 2022 WHO classification of parathyroid tumors","volume":"33","author":"Erickson","year":"2022","journal-title":"Endocr Pathol"},{"issue":"10116","key":"2026081219572867700_dgag162-B2","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(17)31430-7","article-title":"Hyperparathyroidism","volume":"391","author":"Bilezikian","year":"2018","journal-title":"Lancet"},{"issue":"1","key":"2026081219572867700_dgag162-B3","doi-asserted-by":"crossref","first-page":"16033","DOI":"10.1038\/nrdp.2016.33","article-title":"Primary hyperparathyroidism","volume":"2","author":"Bilezikian","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"2","key":"2026081219572867700_dgag162-B4","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/joim.12840","article-title":"Primary hyperparathyroidism: should surgery be performed on all patients? 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