{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:00:17Z","timestamp":1780639217816,"version":"3.54.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the diagnostic performance of the calcium-chloride\/phosphorus ratio (([Ca]\u00d7[Cl])\/P) combined with alkaline phosphatase (ALP) in primary hyperparathyroidism (PHPT) and its subtypes\u2014hypercalcemic PHPT (HPHPT) and normocalcemic PHPT (NPHPT)\u2014for accurate clinical differentiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data of 135 surgically confirmed patients with PHPT (77 HPHPT, 58 NPHPT) and 135 age- and sex-matched healthy controls from Taizhou Enze Medical Center (Jan 2017\u2013Dec 2024) were retrospectively analyzed. Serum ALP, Ca\/P, Cl\/P, and ([Ca]\u00d7[Cl])\/P were measured; ROC curves assessed the diagnostic performance of single and combined indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most patients with PHPT were female. Adenoma prevalence was higher in the HPHPT group (83.12%) than in the NPHPT group (60.34%). ALP, parathyroid hormone (PTH), Ca\/P, Cl\/P, and ([Ca]\u00d7[Cl])\/P levels were elevated in the HPHPT group compared with both the NPHPT and control groups, while serum phosphorus was lower (P&amp;lt;0.001). The area under the ROC curve (AUC) for ([Ca]\u00d7[Cl])\/P in diagnosing PHPT was 0.960. Combined detection of ([Ca]\u00d7[Cl])\/P (250.67 mmol\/L) and ALP (93.50 U\/L) yielded an AUC of 0.983 (sensitivity: 94.8%, specificity: 98.5%, accuracy: 95.0%), comparable to that of PTH (AUC\u00a0=\u00a00.997). The AUC for differentiating HPHPT from NPHPT was 0.881, and for distinguishing adenomas from hyperplasia was 0.677, demonstrating superior subtype discrimination compared with other indicators, including PTH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The combination of ([Ca]\u00d7[Cl])\/P and ALP demonstrates favorable sensitivity and specificity for the diagnosis of PHPT and the differentiation of HPHPT from NPHPT, and exhibits clinical practicality. In addition, it provides supplementary value in distinguishing parathyroid adenoma from hyperplasia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1790881","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:05:32Z","timestamp":1780635932000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic efficacy of ([Ca]\u00d7[Cl])\/P combined with ALP in the diagnosis and subtype differentiation of primary hyperparathyroidism"],"prefix":"10.3389","volume":"17","author":[{"given":"Jingxian","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University","place":["Taizhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University","place":["Taizhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianping","family":"Lao","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University","place":["Taizhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donglian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University","place":["Taizhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University","place":["Taizhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2025.101986","article-title":"Persistence and recurrence of primary hyperparathyroidism","volume":"39","author":"Alnajmi","year":"2025","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4679","article-title":"Classical and nonclassical manifestations of primary hyperparathyroidism","volume":"37","author":"El-Hajj Fuleihan","year":"2022","journal-title":"J Bone Mineral Research: Off J Am Soc For Bone Mineral Res"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(80)91791-2","article-title":"Guidelines for the diagnosis and treatment of primary hyperparathyroidism","volume":"7","year":"2014","journal-title":"Chin J Osteoporosis Bone Mineral Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2023.12.004","article-title":"The Ca\u2217Cl\/P ratio: a novel and more appropriate screening tool for normocalcaemic or overt primary hyperparathyroidism","volume":"30","author":"Yu","year":"2024","journal-title":"Endocrine Practice: Off J Am Coll Endocrinol Am Assoc Clin Endocrinologists"},{"key":"B5","doi-asserted-by":"publisher","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"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4677","article-title":"Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the fifth international workshop","volume":"37","author":"Bilezikian","year":"2022","journal-title":"J Bone Mineral Research: Off J Am Soc For Bone Mineral Res"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.0538","article-title":"Diagnosis and management of primary hyperparathyroidism","volume":"323","author":"Zhu","year":"2020","journal-title":"JAMA"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.19538\/j.cjps.issn1005-2208.2021.08.01","article-title":"Chinese expert consensus on surgical practice of secondary hyperparathyroidism in chronic kidney disease (2021 edition)","volume":"41","author":"He","year":"2021","journal-title":"Chin J Pract Surg"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-84367-0_21","article-title":"Clinical practice. 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