{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T10:05:11Z","timestamp":1779962711953,"version":"3.53.1"},"reference-count":9,"publisher":"Charles University in Prague, Karolinum Press","issue":"4","license":[{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"vor","delay-in-days":405,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"tdm","delay-in-days":405,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["actamedica.lfhk.cuni.cz"],"crossmark-restriction":true},"short-container-title":["Acta Med. (Hradec Kralove, Czech Repub.)"],"published-print":{"date-parts":[[2019]]},"abstract":"<jats:p>\n                    A nonagenarian hypertensive man with chronic kidney disease (CKD) was admitted to the emergency department for gastrointestinal symptoms and worsening symptoms of depression. Severe hypercalcemia (15.3 mg\/dL) was found and he was hospitalized. Fluids, loop diuretics and glucocorticoids were administered intravenously, which partially reduced calcium levels over a few days and improved his clinical condition. PTH levels proved increased (306 pg\/mL) and 25-OHD levels were reduced; primary hyperparathyroidism (PHPT) was diagnosed. Neck ultrasonography (USG) did not show parathyroid enlargement, nor did\n                    <jats:sup>99m<\/jats:sup>\n                    Technetium-sestamibi (SESTAMIBI) scintigraphy reveal hyperfunctioning parathyroid glands. By contrast,\n                    <jats:sup>18<\/jats:sup>\n                    F-choline PET\/CT evidenced a nodule located close to the oesophagus, behind the right thyroid lobe, which proved compatible with a hyperfunctioning parathyroid gland. Since the patient declined surgery, and zoledronate was unfit owing to areas of rarefaction of the jaw, the calcimimetic cinacalcet was started; the dosage was progressively titrated up to 120 mg\/day with normalisation of calcium levels over time. PTH levels, however, proved erratic and showed an upward trend over the first year of therapy; however its levels partially decreased following increase of vitamin D levels by replacement therapy. Cinacalcet is a useful and safe drug, which can normalise calcium levels and improve the clinical condition, even in very old patients with severe PHPT who decline or are unfit for surgery.\n                  <\/jats:p>","DOI":"10.14712\/18059694.2020.5","type":"journal-article","created":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T04:09:16Z","timestamp":1581307756000},"page":"156-160","update-policy":"https:\/\/doi.org\/10.14712\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Primary Hyperparathyroidism Manifesting with Severe Hypercalcemia in a Nonagenarian Man: Pitfall of Common Imaging Techniques, Localization by 18F-Choline Positron Emission Tomography\/Computed Tomography and Successful Management with Calcimimetics"],"prefix":"10.14712","volume":"62","author":[{"given":"Luca","family":"Foppiani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Bottoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnoldo","family":"Piccardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5727","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"18059694.2020.5_1","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1210\/jc.2012-4022","volume":"98","author":"Yeh","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"18059694.2020.5_2","doi-asserted-by":"crossref","first-page":"1179551418815916","DOI":"10.1177\/1179551418815916","volume":"11","author":"Dombrowsky","year":"2018","journal-title":"Clin Med Insights Endocrinol Diabetes"},{"key":"18059694.2020.5_3","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1056\/NEJMcp1714213","volume":"379","author":"Insogna","year":"2018","journal-title":"N Engl J Med"},{"key":"18059694.2020.5_4","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1007\/s00259-018-3980-9","volume":"45","author":"Beheshti","year":"2018","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"18059694.2020.5_5","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1007\/s40618-018-0879-z","volume":"41","author":"Saponaro","year":"2018","journal-title":"J Endocrinol Invest"},{"key":"18059694.2020.5_6","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1016\/j.ajem.2012.11.010","volume":"31","author":"Lindner","year":"2013","journal-title":"Am J Emerg Med"},{"key":"18059694.2020.5_7","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/0885066613507530","volume":"30","author":"Maier","year":"2015","journal-title":"J Intensive Care Med"},{"key":"18059694.2020.5_8","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.2214\/AJR.06.0938","volume":"188","author":"Johnson","year":"2007","journal-title":"Am J Roentgenol"},{"key":"18059694.2020.5_9","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1530\/EJE-14-0877","volume":"172","author":"Khan","year":"2015","journal-title":"Eur J Endocrinol"}],"container-title":["Acta Medica (Hradec Kralove, Czech Republic)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/actamedica.lfhk.cuni.cz\/media\/pdf\/am_2019062040156.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/actamedica.lfhk.cuni.cz\/media\/pdf\/am_2019062040156.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T09:31:37Z","timestamp":1779960697000},"score":1,"resource":{"primary":{"URL":"https:\/\/actamedica.lfhk.cuni.cz\/62\/4\/0156\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019]]}},"alternative-id":["am_2019062040156"],"URL":"https:\/\/doi.org\/10.14712\/18059694.2020.5","relation":{},"ISSN":["1211-4286","1805-9694"],"issn-type":[{"value":"1211-4286","type":"print"},{"value":"1805-9694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019]]}}}