{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:49:36Z","timestamp":1792147776735,"version":"4.4.0"},"reference-count":15,"publisher":"The Endocrine Society","issue":"12","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Persistently elevated parathyroid hormone (PTH) after parathyroidectomy is often attributed to residual disease but may reflect altered calcium (Ca) homeostasis. The impact of denosumab on perioperative PTH interpretation remains unclear. A 77-year-old woman presented with a hypercalcemic crisis and was initially managed at another hospital. During treatment with hydration and elcatonin (40 units twice daily), denosumab (60\u2005mg) was administered, resulting in a rapid decline in corrected Ca (c-Ca). Eleven days later, at presentation to our institution, her c-Ca was 9.9\u2005mg\/dL (SI: 2.48\u2005mmol\/L; reference range, 8.8-10.1\u2005mg\/dL [SI: 2.20-2.53\u2005mmol\/L]), and intact PTH was 195\u2005pg\/mL (SI: 20.7\u2005pmol\/L; reference range, 10-65\u2005pg\/mL [SI: 1.1-6.9\u2005pmol\/L]). At admission, c-Ca decreased further while PTH increased. The patient had chronic kidney disease and vitamin D deficiency. A focused parathyroidectomy was performed for a single adenoma. Thirty minutes after excision, PTH remained above the surgical success threshold and increased further the morning after surgery, while c-Ca levels decreased. Calcium and vitamin D supplementation subsequently normalized both parameters. Denosumab exposure, together with vitamin D deficiency and renal impairment, may cause transient postoperative PTH elevation despite successful parathyroidectomy. Persistent disease should not be assumed when Ca declines despite elevated PTH.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag165","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:49:49Z","timestamp":1780487389000},"source":"Crossref","is-referenced-by-count":1,"title":["Early parathyroid hormone elevation after denosumab therapy following parathyroidectomy: a diagnostic pitfall"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0805-8886","authenticated-orcid":false,"given":"Hiroyuki","family":"Yamashita","sequence":"first","affiliation":[{"name":"Department of Surgery, Yamashita Thyroid Hospital , Fukuoka 812-0034 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1424-620X","authenticated-orcid":false,"given":"Hisakazu","family":"Shindo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yamashita Thyroid Hospital , Fukuoka 812-0034 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9802-3697","authenticated-orcid":false,"given":"Daisuke","family":"Tatsushima","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yamashita Thyroid Hospital , Fukuoka 812-0034 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4297-134X","authenticated-orcid":false,"given":"Yusuke","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yamashita Thyroid Hospital , Fukuoka 812-0034 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2844-1823","authenticated-orcid":false,"given":"Kento","family":"Katsuyama","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yamashita Thyroid Hospital , Fukuoka 812-0034 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0761-6209","authenticated-orcid":false,"given":"Shinya","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yamashita Thyroid Hospital , Fukuoka 812-0034 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"issue":"6","key":"2026101606195766500_luag165-B1","first-page":"1019","article-title":"Clinical usefulness of an intraoperative \u201cquick parathyroid hormone\u201d assay","volume":"114","author":"Irvin","year":"1993","journal-title":"Surgery"},{"issue":"1","key":"2026101606195766500_luag165-B2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1097\/00000658-200207000-00016","article-title":"Role of cyclase activating parathyroid hormone (1-84 PTH) measurements during parathyroid surgery: potential improvement of intraoperative PTH assay","volume":"236","author":"Yamashita","year":"2002","journal-title":"Ann Surg"},{"issue":"2","key":"2026101606195766500_luag165-B3","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1007\/s00268-002-6600-5","article-title":"Patients with elevated serum parathyroid hormone levels after parathyroidectomy: showing signs of decreased peripheral parathyroid hormone sensitivity","volume":"27","author":"Nordenstr\u00f6m","year":"2003","journal-title":"World J Surg"},{"issue":"4","key":"2026101606195766500_luag165-B4","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.surg.2004.12.009","article-title":"Reelevation of parathyroid hormone level after parathyroidectomy in patients with primary hyperparathyroidism: importance of decreased renal parathyroid hormone sensitivity","volume":"137","author":"Yamashita","year":"2005","journal-title":"Surgery"},{"issue":"2","key":"2026101606195766500_luag165-B5","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1245\/s10434-011-1846-5","article-title":"Eucalcemic parathyroid hormone elevation after parathyroidectomy for primary sporadic hyperparathyroidism: risk factors, trend, and outcome","volume":"19","author":"Lang","year":"2012","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"2026101606195766500_luag165-B6","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4174\/astr.2022.103.1.12","article-title":"Analysis of the cause and management of persistent laboratory abnormalities occurring after the surgical treatment of primary hyperparathyroidism","volume":"103","author":"Lee","year":"2022","journal-title":"Ann Surg Treat Res"},{"issue":"21","key":"2026101606195766500_luag165-B7","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.2217\/fon.15.232","article-title":"Denosumab a new agent in the management of hypercalcemia of malignancy","volume":"11","author":"Thosani","year":"2015","journal-title":"Future Oncol"},{"issue":"7","key":"2026101606195766500_luag165-B8","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1359\/JBMR.040305","article-title":"A single-dose placebo-controlled study of AMG 162, a fully human monoclonal antibody to RANKL, in postmenopausal women","volume":"19","author":"Bekker","year":"2004","journal-title":"J Bone Miner Res"},{"issue":"4","key":"2026101606195766500_luag165-B9","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1111\/cen.12188","article-title":"Parathyroid hormone changes following denosumab treatment in postmenopausal osteoporosis","volume":"79","author":"Makras","year":"2013","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"1","key":"2026101606195766500_luag165-B10","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s40792-024-01903-z","article-title":"Intraoperative parathyroid hormone measurement pitfalls: parathyroid hormone spikes with carboxyl-terminal parathyroid hormone fragments in primary hyperparathyroidism-a case report","volume":"10","author":"Yamashita","year":"2024","journal-title":"Surg Case Rep"},{"issue":"8","key":"2026101606195766500_luag165-B11","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00268-002-6622-z","article-title":"Vitamin D status in Japanese patients with hyperparathyroidism: seasonal changes and effect on clinical presentation","volume":"26","author":"Yamashita","year":"2002","journal-title":"World J Surg"},{"issue":"6","key":"2026101606195766500_luag165-B12","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1530\/eje.0.1480597","article-title":"Influence of renal function on clinico-pathological features of primary hyperparathyroidism","volume":"148","author":"Yamashita","year":"2003","journal-title":"Eur J Endocrinol"},{"issue":"4","key":"2026101606195766500_luag165-B13","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1530\/eje.0.1490301","article-title":"Large carboxy-terminal parathyroid hormone (PTH) fragment with a relatively longer half-life than 1-84 PTH is secreted directly from the parathyroid gland in humans","volume":"149","author":"Yamashita","year":"2003","journal-title":"Eur J Endocrinol"},{"key":"2026101606195766500_luag165-B14","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12902-025-02140-7","article-title":"Postoperative hungry bone syndrome in primary hyperparathyroidism: risk factors and outcomes at a South African tertiary centre","volume":"26","author":"Paruk","year":"2026","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"2026101606195766500_luag165-B15","doi-asserted-by":"crossref","DOI":"10.1155\/ije\/8285521","article-title":"Bisphosphonate therapy and the occurrence of the hungry bone syndrome after surgery for primary hyperparathyroidism","volume":"2025","author":"Etemadi","year":"2025","journal-title":"Int J Endocrinol"}],"container-title":["JCEM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/12\/luag165\/72036972\/luag165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcemcr\/article-pdf\/4\/12\/luag165\/72036972\/luag165.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:20:05Z","timestamp":1792146005000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcemcr\/article\/doi\/10.1210\/jcemcr\/luag165\/8931452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":15,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026,10,16]]}},"URL":"https:\/\/doi.org\/10.1210\/jcemcr\/luag165","relation":{},"ISSN":["2755-1520"],"issn-type":[{"value":"2755-1520","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,12]]},"published":{"date-parts":[[2026,10,16]]},"article-number":"luag165"}}