{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T22:59:50Z","timestamp":1776553190618,"version":"3.51.2"},"reference-count":49,"publisher":"The Endocrine Society","issue":"4","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Musculoskeletal manifestations in primary hyperparathyroidism (PHPT) range from 13% to 93% encompassing pseudogout, vertebral fracture, myopathy, and cord compression. Though pseudogout has been the most prevalent musculoskeletal condition in PHPT, rarely reports of acute gouty attacks in large joints including the knee have been reported in the literature. Here we detail a unique case of PHPT presenting with acute severe bilateral knee joint inflammatory arthritis accompanied by occasional abdominal pain. Joint aspiration fluid study revealed extracellular monosodium urate crystals exhibiting strong negative birefringence on polarized light microscopy suggestive of acute gouty arthritis. Hypercalcemia and hypophosphatemia with high intact parathyroid hormone (iPTH) confirmed the diagnosis of PHPT and a right inferior parathyroid adenoma was localized. Parathyroidectomy resulted in statistically significant clinical improvement of the debilitating joint manifestations, and the patient was able to walk again without support. Although the incidence of gout is increasing because of an overall increase in metabolic syndrome prevalence, a higher prevalence than in the general population is reported in PHPT. Serum uric acid levels positively correlate with serum iPTH levels in PHPT, and parathyroidectomy leads to a reduction in levels. Acute inflammatory joint pain due to urate crystal deposition in a large joint like the knee is an uncommonly reported condition in PHPT. Identifying the correct etiology in such a case can result in marked clinical improvement in the joint manifestations following surgical cure of hyperparathyroidism.<\/jats:p>","DOI":"10.1210\/jendso\/bvac018","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T18:02:42Z","timestamp":1644429762000},"source":"Crossref","is-referenced-by-count":4,"title":["Gout in Primary Hyperparathyroidism, Connecting Crystals to the Minerals"],"prefix":"10.1210","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6919-5614","authenticated-orcid":false,"given":"Madhukar","family":"Mittal","sequence":"first","affiliation":[{"name":"Department of Endocrinology & Metabolism, AIIMS, Jodhpur, Rajasthan, 342005, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinjan","family":"Patra","sequence":"additional","affiliation":[{"name":"Department of Endocrinology & Metabolism, AIIMS, Jodhpur, Rajasthan, 342005, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3511-9303","authenticated-orcid":false,"given":"Suvinay","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, AIIMS, Jodhpur, Rajasthan, 342005, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4419-9376","authenticated-orcid":false,"given":"Ayan","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Endocrinology & Metabolism, AIIMS, Jodhpur, Rajasthan, 342005, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taruna","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, AIIMS, Jodhpur, Rajasthan, 342005, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Vedant","sequence":"additional","affiliation":[{"name":"Department of Pathology, AIIMS, Jodhpur, Rajasthan, 342005, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"issue":"2","key":"2022030515324110500_CIT0001","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/00005792-197403000-00002","article-title":"Primary hyperparathyroidism: clinical and biochemical features","volume":"53","author":"Mallette","year":"1974","journal-title":"Medicine (Baltimore)."},{"issue":"12","key":"2022030515324110500_CIT0002","doi-asserted-by":"crossref","first-page":"3081","DOI":"10.1007\/s10067-016-3450-3","article-title":"Musculoskeletal manifestations of primary hyperparathyroidism","volume":"35","author":"Pappu","year":"2016","journal-title":"Clin Rheumatol."},{"key":"2022030515324110500_CIT0003","first-page":"148","article-title":"Primer on the metabolic bone diseases and disorders of mineral metabolism","volume-title":"The Endocrinologist","author":"Favus","year":"1994"},{"issue":"16","key":"2022030515324110500_CIT0004","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1001\/jama.1934.02750160010003","article-title":"Hyperparathyroidism: a common and polymorphic condition as illustrated by seventeen proved cases from one clinic","volume":"102","author":"Albright","year":"1934","journal-title":"JAMA"},{"issue":"4","key":"2022030515324110500_CIT0005","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1056\/NEJM198001243020402","article-title":"Primary hyperparathyroidism. Incidence, morbidity, and potential economic impact in a community","volume":"302","author":"Heath","year":"1980","journal-title":"N Engl J Med."},{"issue":"3","key":"2022030515324110500_CIT0006","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/S0889-8529(05)70145-6","article-title":"Natural history of primary hyperparathyroidism","volume":"29","author":"Silverberg","year":"2000","journal-title":"Endocrinol Metab Clin North Am."},{"key":"2022030515324110500_CIT0007","first-page":"N68","article-title":"Clinical presentation of primary hyperparathyroidism in Europe\u2014nationwide cohort analysis on mortality from nonmalignant causes","volume":"17","author":"Nilsson","year":"2002","journal-title":"J Bone Miner 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center","volume":"98","author":"Zhao","year":"2013","journal-title":"J Clin Endocrinol Metab."},{"issue":"Suppl 1","key":"2022030515324110500_CIT0011","doi-asserted-by":"crossref","first-page":"S209","DOI":"10.4103\/2230-8210.119574","article-title":"Primary hyperparathyroidism in India: a cocktail of contemporary and classical presentations: lesson from 47 cases","volume":"17","author":"Maskey","year":"2013","journal-title":"Indian J Endocrinol Metab."},{"issue":"1","key":"2022030515324110500_CIT0012","doi-asserted-by":"crossref","first-page":"80","DOI":"10.4103\/2230-8210.172237","article-title":"Primary hyperparathyroidism: a changing scenario in India","volume":"20","author":"Jha","year":"2016","journal-title":"Indian J Endocrinol Metab"},{"issue":"2","key":"2022030515324110500_CIT0013","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s00774-020-01142-w","article-title":"Progressive rise in the prevalence of asymptomatic primary hyperparathyroidism in India: data from PHPT registry","volume":"39","author":"Arya","year":"2021","journal-title":"J Bone Miner Metab."},{"issue":"3","key":"2022030515324110500_CIT0014","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1136\/ard.22.3.171","article-title":"Joint lesions of hyperparathyroidism","volume":"22","author":"Bywaters","year":"1963","journal-title":"Ann Rheum Dis."},{"issue":"3","key":"2022030515324110500_CIT0015","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1002\/art.1780050304","article-title":"Articular manifestations in primary hyperparathyroidism","volume":"5","author":"Zvaifler","year":"1962","journal-title":"Arthritis Rheum."},{"issue":"690","key":"2022030515324110500_CIT0016","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1136\/pgmj.59.690.236","article-title":"Rheumatic symptoms in primary hyperparathyroidism","volume":"59","author":"Helliwell","year":"1983","journal-title":"Postgrad Med J."},{"issue":"4","key":"2022030515324110500_CIT0017","first-page":"460","article-title":"Calcium pyrophosphate crystal deposition disease and hyperparathyroidism: a controlled, prospective study","volume":"5","author":"Rynes","year":"1978","journal-title":"J Rheumatol."},{"issue":"4","key":"2022030515324110500_CIT0018","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1136\/ard.41.4.377","article-title":"Pyrophosphate arthropathy: a study of metabolic associations and laboratory data","volume":"41","author":"Alexander","year":"1982","journal-title":"Ann Rheum Dis."},{"issue":"2-3","key":"2022030515324110500_CIT0019","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/0009-8981(87)90128-8","article-title":"Primary hyperparathyroidism and hyperuricaemia are associated but not correlated with indicators of bone turnover","volume":"170","author":"Broulik","year":"1987","journal-title":"Clin Chim 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Int."},{"issue":"9","key":"2022030515324110500_CIT0033","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.3390\/nu11092111","article-title":"The paradoxical role of uric acid in osteoporosis","volume":"11","author":"Lin","year":"2019","journal-title":"Nutrients."},{"issue":"2","key":"2022030515324110500_CIT0034","first-page":"263","article-title":"Tophaceous gout of the patella with primary hyperparathyroidism","volume":"13","author":"Thomas","year":"1995","journal-title":"Clin Exp Rheumatol."},{"issue":"1","key":"2022030515324110500_CIT0035","first-page":"8","article-title":"A rare presentation of a rare disease\u2014primary hyperparathyroidism presenting as polyarthritis\u2014a case report","volume":"2","author":"Madegedara","year":"2018","journal-title":"Endocrinol Res Metab."},{"issue":"19","key":"2022030515324110500_CIT0036","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1056\/NEJM200105103441904","article-title":"Effect of parathyroid hormone (1-34) on 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XXV. Sonographic assessment of the knee in patients with gout and calcium pyrophosphate deposition disease","volume":"28","author":"Filippucci","year":"2010","journal-title":"Clin Exp Rheumatol."},{"issue":"20","key":"2022030515324110500_CIT0038","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1056\/NEJMoa071408","article-title":"Teriparatide or alendronate in glucocorticoid-induced osteoporosis","volume":"357","author":"Saag","year":"2007","journal-title":"N Engl J Med."},{"issue":"1","key":"2022030515324110500_CIT0039","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s00198-006-0189-8","article-title":"Teriparatide in postmenopausal women with osteoporosis and mild or moderate renal impairment","volume":"18","author":"Miller","year":"2007","journal-title":"Osteoporos Int."},{"issue":"6","key":"2022030515324110500_CIT0040","doi-asserted-by":"crossref","first-page":"807","DOI":"10.2169\/internalmedicine.31.807","article-title":"Renal handling of urate in two patients with hyperuricemia and primary hyperparathyroidism","volume":"31","author":"Hisatome","year":"1992","journal-title":"Intern Med."},{"issue":"6","key":"2022030515324110500_CIT0041","doi-asserted-by":"crossref","first-page":"e1000504","DOI":"10.1371\/journal.pgen.1000504","article-title":"Meta-analysis of 28,141 individuals identifies common variants within five new loci that influence uric acid concentrations","volume":"5","author":"Kolz","year":"2009","journal-title":"PLoS Genet."},{"issue":"2","key":"2022030515324110500_CIT0042","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1097\/BOR.0b013e32833645e8","article-title":"Genetics of gout","volume":"22","author":"Choi","year":"2010","journal-title":"Curr Opin Rheumatol."},{"issue":"6","key":"2022030515324110500_CIT0043","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1172\/JCI42344","article-title":"Uric acid transport and disease","volume":"120","author":"So","year":"2010","journal-title":"J Clin Invest."},{"issue":"5","key":"2022030515324110500_CIT0044","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1038\/ki.2010.206","article-title":"\u201ccomplexity\u201d of urate transporters","volume":"78","author":"Wright","year":"2010","journal-title":"Kidney Int."},{"issue":"3","key":"2022030515324110500_CIT0045","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1001\/jama.1993.03510030078038","article-title":"Uric acid metabolism and tubular sodium handling. Results from a population-based study","volume":"270","author":"Cappuccio","year":"1993","journal-title":"JAMA."},{"issue":"41","key":"2022030515324110500_CIT0046","doi-asserted-by":"crossref","first-page":"31601","DOI":"10.1074\/jbc.M000600200","article-title":"Acute regulation of Na+\/H+ exchanger NHE3 by parathyroid hormone via NHE3 phosphorylation and dynamin-dependent endocytosis","volume":"275","author":"Collazo","year":"2000","journal-title":"J Biol Chem."},{"issue":"7","key":"2022030515324110500_CIT0047","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1007\/s00268-007-9091-6","article-title":"Serum levels of uric acid and diabetes mellitus influence survival after surgery for primary hyperparathyroidism: a prospective cohort study","volume":"31","author":"Bergenfelz","year":"2007","journal-title":"World J Surg."},{"issue":"4","key":"2022030515324110500_CIT0048","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/BF01655570","article-title":"Decrease in serum uric acid level following parathyroidectomy in patients with primary hyperparathyroidism","volume":"10","author":"Duh","year":"1986","journal-title":"World J Surg."},{"issue":"11","key":"2022030515324110500_CIT0049","first-page":"1738","article-title":"Parathyroid function and uric acid metabolism [article in Japanese]","volume":"59","author":"Yoneda","year":"1983","journal-title":"Nihon Naibunpi Gakkai Zasshi."}],"container-title":["Journal of the Endocrine Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jes\/advance-article-pdf\/doi\/10.1210\/jendso\/bvac018\/42448735\/bvac018.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/6\/4\/bvac018\/42747321\/bvac018.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jes\/article-pdf\/6\/4\/bvac018\/42747321\/bvac018.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T15:33:26Z","timestamp":1646494406000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jes\/article\/doi\/10.1210\/jendso\/bvac018\/6525332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":49,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jendso\/bvac018","relation":{},"ISSN":["2472-1972"],"issn-type":[{"value":"2472-1972","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,4,1]]},"published":{"date-parts":[[2022,2,9]]},"article-number":"bvac018"}}