{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T20:05:53Z","timestamp":1696017953429},"reference-count":12,"publisher":"FapUNIFESP (SciELO)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Bras Endocrinol Metab"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:p>Normocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg\/mL, with total serum calcium of 9.6 mg\/dL, albumin 4.79 g\/dL, phosphorus 2.8 mg\/dL, and 25OHD after supplementation was 34.6 ng\/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg\/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications.<\/jats:p>","DOI":"10.1590\/0004-2730000003367","type":"journal-article","created":{"date-parts":[[2014,8,20]],"date-time":"2014-08-20T14:57:26Z","timestamp":1408546646000},"page":"583-586","source":"Crossref","is-referenced-by-count":5,"title":["Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas"],"prefix":"10.1590","volume":"58","author":[{"given":"Larissa","family":"Pimentel","sequence":"first","affiliation":[{"name":"Agamenon Magalhaes Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sirley","family":"Portela","sequence":"additional","affiliation":[{"name":"Agamenon Magalhaes Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyne","family":"Loureiro","sequence":"additional","affiliation":[{"name":"Agamenon Magalhaes Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Bandeira","sequence":"additional","affiliation":[{"name":"Agamenon Magalhaes Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","reference":[{"issue":"2","key":"ref1","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1210\/jc.2008-1763","article-title":"Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Third International Workshop","volume":"94","author":"Bilezikian JP","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"ref2","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1590\/S0004-27302010000200004","article-title":"Normocalcemic primary hyperparathyroidism","volume":"54","author":"Bilezikian JP","year":"2010","journal-title":"Arq Bras Endocrinol Metabol"},{"issue":"1","key":"ref3","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jocd.2012.12.001","article-title":"Normocalcemic primary hyperparathyroidism","volume":"16","author":"Cusano NE","year":"2013","journal-title":"J Clin Densit"},{"issue":"7","key":"ref4","doi-asserted-by":"crossref","first-page":"2734","DOI":"10.1210\/jc.2013-1300","article-title":"Normocalcemic hyperparathyroidism and hypoparathyroidism in two community-based nonreferral populations","volume":"98","author":"Cusano NE","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"ref5","first-page":"128","article-title":"Normocalcemic versus hypercalcemic primary hyperparathyroidism: more stone than bone?","volume":"3","author":"Amaral LM","year":"2012","journal-title":"J Osteoporos"},{"issue":"8","key":"ref6","doi-asserted-by":"crossref","first-page":"3001","DOI":"10.1210\/jc.2006-2802","article-title":"Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype","volume":"92","author":"Lowe H","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.amjmed.2004.06.037","article-title":"Characterization of normocalcemic primary hyperparathyroidism","volume":"117","author":"Tordjman KM","year":"2004","journal-title":"Am J Med"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s12020-012-9627-x","article-title":"Investigation of insulin resistance in patients with normocalcemic primary hyperparathyroidism","volume":"42","author":"Cakir I","year":"2012","journal-title":"Endoc"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1007\/s00268-012-1438-y","article-title":"Surgical management of normocalcemic primary hyperparathyroidism","volume":"36","author":"Wade TJ","year":"2012","journal-title":"World J Surg"},{"issue":"6","key":"ref10","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1590\/S0004-27302013000600002","article-title":"Diagnosis and management of primary hyperparathyroidism ? A scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism","volume":"57","author":"Bandeira F","year":"2013","journal-title":"Arq Bras Endocrinol Metab"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"83","DOI":"10.3803\/EnM.2012.27.1.83","article-title":"Primary hyperaparathyroidism due to cystic parathyroid adenoma not detected on<sup> 99m<\/sup>Tc-Sestamibi scan","volume":"27","author":"Khang AR","year":"2012","journal-title":"Endocrinol Metab"},{"issue":"3","key":"ref12","doi-asserted-by":"crossref","first-page":"429","DOI":"10.3174\/ajnr.A2805","article-title":"Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia","volume":"33","author":"Chazen JL","year":"2012","journal-title":"Am J Neuroradiol"}],"container-title":["Arquivos Brasileiros de Endocrinologia &amp; Metabologia"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/abem\/v58n5\/0004-2730-abem-58-5-0583.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,5,27]],"date-time":"2017-05-27T16:57:48Z","timestamp":1495904268000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0004-27302014000500583&lng=en&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,7]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,7]]}},"alternative-id":["S0004-27302014000500583"],"URL":"https:\/\/doi.org\/10.1590\/0004-2730000003367","relation":{},"ISSN":["0004-2730"],"issn-type":[{"value":"0004-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,7]]}}}