{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:01:49Z","timestamp":1791576109840,"version":"4.3.4"},"reference-count":145,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T00:00:00Z","timestamp":1729641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Asymptomatic primary hyperparathyroidism (PHPT) involves 80\u201390% of the parathyroid tumor-associated cases of PHPT in the modern medical era, while normocalcemic PHPT (NPHPT) has a prevalence of 0.1\u201311%. We aimed to analyze the bone status and mineral metabolism in NPHPT amid conservative or surgical management. In this narrative review, we searched PubMed (between January 2020 and July 2024) via different keywords. Fourteen studies from the final analysis (388 patients with NPHPT; 1188 with PHPT; and 803 controls) showed that mean serum calcium levels varied between 2.57 and 2.26 mmol\/L in NPHPT. Ten studies identified a similar 24 h urinary calcium in NPHPT versus hypercalcemic PHPT (HPHPT). Except for one study, a mandatory vitamin D analysis was performed, but the 25-hydroxyvitamin D cut-offs varied. Osteoporosis (n = 6 studies; N = 172 with NPHPT) was confirmed in 41.7\u2013100% of NPHPT subjects. In surgery candidates, this rate might be overestimated. A DXA analysis was performed in eight studies (235 subjects with NPHPT, and 455 patients with HPHPT); two studies identified a lower BMD in HPHPT &lt; NPHPT, but the results were not homogenous. A single study analyzed the TBS and found similar results in NPHPT. The prevalence of fractures (n = 9) varied between 7.4% and 42.8% in NPHPT. Bone turnover markers (N = 262 patients, n = 8 studies) showed lower bone formation markers in NPHPT versus PHPT (n = 3). Two studies analyzed the BMD and bone turnover markers following parathyroidectomy (161 patients, including 30 patients with NPHPT; mean ages over 60 years). To conclude, given the wide spectrum of complications associated with PHPT, an early diagnosis and proper management is essential. A more extensive screening in patients with osteoporosis and kidney stones might lead to the discovery of NPHPT, a more recently described form of PHPT. While it is still unclear whether NPHPT is an early stage of HPHPT or a separate entity, recent findings show similar osteoporosis and fracture occurrence, and an improvement in bone metabolism, following parathyroidectomy. More extensive prospective studies are crucial to understand the natural course of the disease, to reach a consensus regarding parathyroidectomy indications and surgery candidates\u2019 selection, and to ensure proper personalized management for these patients. With the evolving diagnosis methods, PHPT has become a condition with a changing clinical presentation, which now requires modern evaluation and treatment approaches.<\/jats:p>","DOI":"10.3390\/jcm13216325","type":"journal-article","created":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T04:28:43Z","timestamp":1729657723000},"page":"6325","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Osteoporosis and Normocalcemic Primary Hyperparathyroidism (Conservatively or Surgically Managed)"],"prefix":"10.3390","volume":"13","author":[{"given":"Ana-Maria","family":"Gheorghe","sequence":"first","affiliation":[{"name":"PhD Doctoral School, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 0505474 Bucharest, Romania"},{"name":"Department of Clinical Endocrinology V, \u201cC.I. Parhon\u201d National Institute of Endocrinology, 011863 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2274-5666","authenticated-orcid":false,"given":"Claudiu","family":"Nistor","sequence":"additional","affiliation":[{"name":"Department 4\u2014Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 0505474 Bucharest, Romania"},{"name":"Thoracic Surgery Department, \u201cDr. Carol Davila\u201d Central Emergency University Military Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurelian-Emil","family":"Ranetti","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Endocrinology Department, \u201cDr. Carol Davila\u201d Central Emergency University Military Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Ciuche","sequence":"additional","affiliation":[{"name":"Department 4\u2014Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 0505474 Bucharest, Romania"},{"name":"Thoracic Surgery Department, \u201cDr. Carol Davila\u201d Central Emergency University Military Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4402-7194","authenticated-orcid":false,"given":"Mihai-Lucian","family":"Ciobica","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Gastroenterology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Internal Medicine I and Rheumatology, \u201cDr. Carol Davila\u201d Central Military University Emergency Hospital, 010825 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Stanciu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550024 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa","family":"Tanasescu","sequence":"additional","affiliation":[{"name":"Medical Clinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florina Ligia","family":"Popa","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550024 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8585-3835","authenticated-orcid":false,"given":"Mara","family":"Carsote","sequence":"additional","affiliation":[{"name":"Department of Clinical Endocrinology V, \u201cC.I. Parhon\u201d National Institute of Endocrinology, 011863 Bucharest, Romania"},{"name":"Department of Endocrinology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"260","DOI":"10.5603\/EP.a2020.0028","article-title":"Primary hyperparathyroidism","volume":"71","author":"Kowalski","year":"2020","journal-title":"Endokrynol. Pol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1002\/jbmr.4665","article-title":"Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism","volume":"37","author":"Minisola","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_3","unstructured":"Carpentier, L., and Bouillet, B. Primary hyperparathyroidism: From diagnosis to treatment, Rev. Med. Interne 2024, Online ahead of print."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s11154-024-09899-5","article-title":"Primary hyperparathyroidism: From guidelines to outpatient clinic","volume":"25","author":"Palermo","year":"2024","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5348","DOI":"10.1210\/jc.2003-031014","article-title":"\u201cIncipient\u201d primary hyperparathyroidism: A \u201cforme fruste\u201d of an old disease","volume":"88","author":"Silverberg","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_6","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","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1210\/jc.2008-1763","article-title":"Third International Workshop on the Management of Asymptomatic Primary Hyperthyroidism. Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the third international workshop","volume":"94","author":"Bilezikian","year":"2009","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3993","DOI":"10.1210\/jc.2018-01225","article-title":"Primary Hyperparathyroidism","volume":"103","author":"Bilezikian","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101247","DOI":"10.1016\/j.beem.2018.09.013","article-title":"Primary hyperparathyroidism","volume":"38","author":"Silva","year":"2024","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"666","DOI":"10.20945\/2359-3997000000556","article-title":"Normocalcemic primary hyperparathyroidism","volume":"66","author":"Cusano","year":"2022","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/cen.12819","article-title":"Normocalcaemic, vitamin D-sufficient hyperparathyroidism-high prevalence and low morbidity in the general population: A long-term follow-up study, the WHO MONICA project, Gothenburg, Sweden","volume":"83","author":"Kontogeorgos","year":"2015","journal-title":"Clin. Endocrinol."},{"key":"ref_12","first-page":"47","article-title":"The Link Between Bone Osteocalcin and Energy Metabolism in a Group of Postmenopausal Women","volume":"45","author":"Dumitru","year":"2019","journal-title":"Curr. Health Sci. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1002\/jbmr.4677","article-title":"International Workshop on Primary Hyperparathyroidism. 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 Miner. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1159\/000491041","article-title":"Secondary and Tertiary Hyperparathyroidism","volume":"51","author":"Messa","year":"2019","journal-title":"Front. Horm. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1159\/000486077","article-title":"Vitamin D and Secondary Hyperparathyroid States","volume":"50","author":"Cipriani","year":"2018","journal-title":"Front. Horm. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jamasurg.2016.2310","article-title":"The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism","volume":"151","author":"Wilhelm","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_17","first-page":"345","article-title":"Analysis of the efficacy and safety of bone disease treatment in patients with newly diagnosed multiple myeloma treated with denosumab or zoledronic acid","volume":"45","author":"Ma","year":"2024","journal-title":"Zhonghua Xue Ye Xue Za Zhi"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1177\/1078155218820927","article-title":"Effect of denosumab versus zoledronic acid on calcium levels in cancer patients with bone metastasis: A retrospective cohort study","volume":"25","author":"Nasser","year":"2019","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ciacci, C., Bilancio, G., Russo, I., Iovino, P., Cavallo, P., Santonicola, A., Bucci, C., Cirillo, M., and Zingone, F. (2020). 25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D, and Peripheral Bone Densitometry in Adults with Celiac Disease. Nutrients, 12.","DOI":"10.3390\/nu12040929"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/nrendo.2017.104","article-title":"Primary hyperparathyroidism","volume":"14","author":"Walker","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"105129","DOI":"10.1016\/j.jbspin.2021.105129","article-title":"Bone and primary hyperparathyroidism","volume":"89","author":"Cormier","year":"2022","journal-title":"Jt. Bone Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1055\/a-0859-1020","article-title":"Normocalcemic Primary Hyperparathyroidism in Adults without a History of Nephrolithiasis or Fractures: A Prospective Study","volume":"51","author":"Calsolari","year":"2019","journal-title":"Horm. Metab. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1007\/s12020-012-9694-z","article-title":"Normocalcemic primary hyperparathyroidism: One-year follow-up in one hundred postmenopausal women","volume":"42","year":"2012","journal-title":"Endocrine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1177\/0194599818793879","article-title":"Surgical Management of Normocalcemic Primary Hyperparathyroidism and the Impact of Intraoperative Parathyroid Hormone Testing on Outcome","volume":"159","author":"Trinh","year":"2018","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"262","DOI":"10.23736\/S2724-6507.20.03215-0","article-title":"Normocalcemic primary hyperparathyroidism: An update","volume":"46","author":"Salcuni","year":"2021","journal-title":"Minerva Endocrinol."},{"key":"ref_26","first-page":"2330","article-title":"Classical and Nonclassical Manifestations of Primary Hyperparathyroidism","volume":"37","author":"Chakhtoura","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1159\/000491036","article-title":"Normocalcemic Hyperparathyroidism","volume":"51","author":"Corbetta","year":"2019","journal-title":"Front. Horm. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s00774-015-0673-3","article-title":"Normocalcemic hyperparathyroidism is associated with complications similar to those of hypercalcemic hyperparathyroidism","volume":"34","author":"Tuna","year":"2016","journal-title":"J. Bone Miner. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1210\/jc.2014-4432","article-title":"Is Normocalcemic Primary Hyperparathyroidism Harmful or Harmless?","volume":"100","author":"Chen","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"107985","DOI":"10.1016\/j.diabres.2019.107985","article-title":"Increased parathyroid hormone is associated with higher fasting glucose in individuals with normocalcemic primary hyperparathyroidism and prediabetes: A pilot study","volume":"160","author":"Karras","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"bvad013","DOI":"10.1210\/jendso\/bvad013","article-title":"The Eucalcemic Patient with Elevated Parathyroid Hormone Levels","volume":"7","author":"Shaker","year":"2023","journal-title":"J. Endocr. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2478\/bjmg-2023-0003","article-title":"The Predisposition for Type 2 Diabetes Mellitus and Metabolic Syndrome","volume":"26","author":"Berca","year":"2023","journal-title":"Balk. J. Med Genet."},{"key":"ref_33","first-page":"25","article-title":"Contrast-enhanced ultrasound-clinical applications","volume":"114","author":"Anghel","year":"2011","journal-title":"Rom. J. Mil. Med."},{"key":"ref_34","first-page":"9","article-title":"The role of contrast-enhanced ultrasound in risk assessment of carotid atheroma","volume":"119","author":"Stanciu","year":"2016","journal-title":"Rom. J. Mil. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1210\/clinem\/dgae162","article-title":"Comparison of normocalcemic versus hypercalcemic primary hyperparathyroidism in a hypercalciuric renal stone population","volume":"109","author":"Halimi","year":"2024","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s12020-024-03768-6","article-title":"Biochemical characteristics and clinical manifestation of normocalcemic primary hyperparathyroidism","volume":"85","author":"Yankova","year":"2024","journal-title":"Endocrine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.surg.2022.05.042","article-title":"Phenotypes of primary hyperparathyroidism: Does parathyroidectomy improve clinical outcomes for all?","volume":"173","author":"Armstrong","year":"2023","journal-title":"Surgery"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Chertok Shacham, E., Maman, N., Lazareva, T., Masalha, R., Mahagna, L., Sela, G., and Ishay, A. (2023). Normocalcemic primary hyperparathyroidism is an early stage of primary hyperparathyroidism according to fibroblast growth factor 23 level. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1152464"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1210\/clinem\/dgad073","article-title":"FCH-PET\/CT in Primary Hyperparathyroidism with Discordant\/Negative MIBI Scintigraphy and Ultrasonography","volume":"108","author":"Koumakis","year":"2023","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1007\/s00198-023-06669-y","article-title":"DXA-based bone strain index in normocalcemic primary hyperparathyroidism","volume":"34","author":"Tabacco","year":"2023","journal-title":"Osteoporos. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e99","DOI":"10.3346\/jkms.2022.37.e99","article-title":"Comparisons Between Normocalcemic Primary Hyperparathyroidism and Typical Primary Hyperparathyroidism","volume":"37","author":"Choi","year":"2022","journal-title":"J. Korean Med Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.surg.2021.08.047","article-title":"What happens to the bone structure after normocalcemic primary hyperparathyroidism surgery?","volume":"171","year":"2022","journal-title":"Surgery"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.amjsurg.2019.10.032","article-title":"Comparative prospective study on the presentation of normocalcemic primary hyperparathyroidism. Is it more aggressive than the hypercalcemic form?","volume":"219","author":"Luengo","year":"2020","journal-title":"Am. J. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1080\/00365513.2019.1683763","article-title":"Hyperparathyroidism in men\u2014Morbidity and mortality during 21 years\u2019 follow-up","volume":"80","author":"Kontogeorgos","year":"2020","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/s40618-019-01128-0","article-title":"Cognition and cerebrovascular function in primary hyperparathyroidism before and after parathyroidectomy","volume":"43","author":"Liu","year":"2020","journal-title":"J. Endocrinol. Investig."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"dgaa174","DOI":"10.1210\/clinem\/dgaa174","article-title":"Clinical, Biochemical, and Radiological Profile of Normocalcemic Primary Hyperparathyroidism","volume":"105","author":"Palermo","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e1171","DOI":"10.1210\/clinem\/dgaa084","article-title":"Normocalcemic Hyperparathyroidism: Study of its Prevalence and Natural History","volume":"105","author":"Schini","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"115583","DOI":"10.1016\/j.bone.2020.115583","article-title":"Impaired physical function and evaluation of quality of life in normocalcemic and hypercalcemic primary hyperparathyroidism","volume":"141","author":"Voss","year":"2020","journal-title":"Bone"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.surg.2021.04.055","article-title":"Is routine 24-hour urine calcium measurement useful during the evaluation of primary hyperparathyroidism?","volume":"171","author":"Li","year":"2022","journal-title":"Surgery"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"3561","DOI":"10.1210\/jc.2014-1413","article-title":"Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the Fourth International Workshop","volume":"99","author":"Bilezikian","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clinbiochem.2022.09.002","article-title":"Current use of bone turnover markers in the management of osteoporosis","volume":"109\u2013110","author":"Brown","year":"2022","journal-title":"Clin. Biochem."},{"key":"ref_52","first-page":"476","article-title":"Metastases in daily endocrine practice","volume":"51","author":"Carsote","year":"2016","journal-title":"Arch. Balk. Med. Union."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"317","DOI":"10.21614\/chirurgia.2719","article-title":"Cervico-Thoracic Air Collections in COVID-19 Pneumonia Patients\u2014Our Experience and Brief Review","volume":"117","author":"Nistor","year":"2022","journal-title":"Chirurgia"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jocd.2012.12.001","article-title":"Normocalcemic primary hyperparathyroidism","volume":"16","author":"Cusano","year":"2013","journal-title":"J. Clin. Densitom."},{"key":"ref_55","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","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e10391","DOI":"10.1002\/jbm4.10391","article-title":"Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed?","volume":"4","author":"Zavatta","year":"2020","journal-title":"JBMR Plus"},{"key":"ref_57","first-page":"163","article-title":"Clinical Expression of Calcium Sensing Receptor Polymorphism (A986S) in Normocalcemic and Asymptomatic Hyperparathyroidism","volume":"48","author":"Romero","year":"2016","journal-title":"Horm. Metab. Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"174","DOI":"10.4158\/EP-2019-0325","article-title":"Low free (but not total) 25-hydroxyvitamin D levels in subjects with normocalcemic hyperpaathyoidism","volume":"26","author":"Wang","year":"2020","journal-title":"Endocr. Pract."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Nistor, C.E., G\u0103van, C.S., Ciritel, A.A., Nemes, A.F., and Ciuche, A. (2022). The Association of Minimally Invasive Surgical Approaches and Mortality in Patients with Malignant Pleuropericarditis-A 10 Year Retrospective Observational Study. Medicina, 58.","DOI":"10.3390\/medicina58060718"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1016\/j.cca.2011.01.004","article-title":"Ionized calcium","volume":"412","author":"Baird","year":"2011","journal-title":"Clin. Chim. Acta"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"James, M.T., Zhang, J., Lyon, A.W., and Hemmelgarn, B.R. (2008). Derivation and internal validation of an equation for albumin-adjusted calcium. BMC Clin. Pathol., 8.","DOI":"10.1186\/1472-6890-8-12"},{"key":"ref_62","first-page":"395","article-title":"Albumin adjusted calcium: Study in a tertiary care hospital","volume":"42","author":"Jamaluddin","year":"2020","journal-title":"Malays. J. Pathol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"117353","DOI":"10.1016\/j.cca.2023.117353","article-title":"Reconsideration of \u201cAlbumin corrected total calcium\u201d Determinations: Potential errors in the Clinical management of disorders of calcium metabolism","volume":"544","author":"Albert","year":"2023","journal-title":"Clin. Chim. Acta"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1515\/cclm-2019-0568","article-title":"Calcium state estimation by total calcium: The evidence to end the never-ending story","volume":"58","author":"Pekar","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.amjsurg.2013.01.017","article-title":"Ionized vs serum calcium in the diagnosis and management of primary hyperparathyroidism: Which is superior?","volume":"205","author":"Tee","year":"2013","journal-title":"Am. J. Surg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/cen.14326","article-title":"Reference interval for albumin-adjusted calcium based on a large UK population","volume":"94","author":"Schini","year":"2021","journal-title":"Clin. Endocrinol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/joim.12840","article-title":"Primary hyperparathyroidism: Should surgery be performed on all patients? Current evidence and residual uncertainties","volume":"285","author":"Nilsson","year":"2019","journal-title":"J. Intern. Med."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1210\/jcem-70-1-252","article-title":"Episodic fluctuation in serum intact parathyroid hormone concentration in men","volume":"70","author":"Kitamura","year":"1990","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"K7","DOI":"10.1530\/EJE-20-0634","article-title":"Normocalcaemic hyperparathyroidism and primary hyperparathyroidism: Least significant change for adjusted serum calcium","volume":"184","author":"Schini","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1055\/a-1856-4900","article-title":"The Diagnosis of Normocalcaemic Hyperparathyroidism is Strikingly Dissimilar Using Different Commercial Laboratory Assays","volume":"54","author":"Kalaria","year":"2022","journal-title":"Horm. Metab. Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.ando.2015.03.018","article-title":"Problems with the PTH assays","volume":"76","author":"Cavalier","year":"2015","journal-title":"Ann. Endocrinol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s11154-017-9421-4","article-title":"Secondary Hyperparthyroidism: Pathogenesis, Diagnosis, Preventive and Therapeutic Strategies","volume":"18","author":"Portillo","year":"2017","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_73","first-page":"294","article-title":"Primary hyperparathyroidism, with a focus on management of the normocalcemic form: To treat or not to treat?","volume":"22","year":"2016","journal-title":"Pract."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Delrue, C., and Speeckaert, M.M. (2023). Vitamin D and Vitamin D-Binding Protein in Health and Disease. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054642"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Rochel, N. (2022). Vitamin D and Its Receptor from a Structural Perspective. Nutrients, 14.","DOI":"10.3390\/nu14142847"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"30573","DOI":"10.1074\/jbc.M115.693614","article-title":"Mechanisms of Enhancer-mediated Hormonal Control of Vitamin D Receptor Gene Expression in Target Cells","volume":"290","author":"Lee","year":"2015","journal-title":"J. Biol. Chem."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.mce.2011.05.031","article-title":"Vitamin D metabolism and activity in the parathyroid gland","volume":"347","author":"Friedlander","year":"2011","journal-title":"Mol. Cell Endocrinol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.otc.2023.07.010","article-title":"Secondary Hyperparathyroidism","volume":"57","author":"Stack","year":"2024","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.1002\/jbmr.4687","article-title":"Methodology for the Guidelines on Evaluation and Management of Hypoparathyroidism and Primary Hyperparathyroidism","volume":"37","author":"Yao","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s40618-021-01633-1","article-title":"Total and free vitamin D metabolites in patients with primary hyperparathyroidism","volume":"45","author":"Meng","year":"2022","journal-title":"J. Endocrinol. Investig."},{"key":"ref_81","first-page":"45","article-title":"Vitamin D deficiency and primary hyperparathyroidism","volume":"34","author":"Nuti","year":"2011","journal-title":"J. Endocrinol. Investig."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1169249","DOI":"10.1155\/2023\/1169249","article-title":"Vitamin D Deficiency and the Presentation of Primary Hyperparathyroidism: A Mini Review","volume":"2023","author":"Yedla","year":"2023","journal-title":"Int. J. Endocrinol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"3570","DOI":"10.1210\/jc.2014-1414","article-title":"Diagnosis of asymptomatic primary hyperparathyroidism: Proceedings of the Fourth International Workshop","volume":"99","author":"Eastell","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/cen.13056","article-title":"Elevated PTH with normal serum calcium level: A structured approach","volume":"84","author":"Crowley","year":"2016","journal-title":"Clin. Endocrinol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"101837","DOI":"10.1016\/j.beem.2023.101837","article-title":"Phosphate: An underrated component of primary hyperparathyroidism","volume":"38","author":"Bhadada","year":"2024","journal-title":"Best. Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e612","DOI":"10.1210\/clinem\/dgab676","article-title":"Serum Phosphate: A Neglected Test in the Clinical Management of Primary Hyperparathyroidism","volume":"107","author":"Castellano","year":"2022","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_87","first-page":"e44378","article-title":"Incidental Normocalcemic Primary Hyperparathyroidism Presenting With Symptomatic Hypophosphatemia: A Case Report","volume":"15","author":"Tabbikha","year":"2023","journal-title":"Cureus"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1007\/s12020-021-02806-x","article-title":"DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis","volume":"74","author":"Shevroja","year":"2021","journal-title":"Endocrine"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s00198-022-06629-y","article-title":"Danish Primary Hyperparathyroidism Study Group. Primary hyperparathyroidism and fracture probability","volume":"34","author":"Kanis","year":"2023","journal-title":"Osteoporos. Int."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1007\/s00198-021-05822-9","article-title":"Risk of fractures in primary hyperparathyroidism: A systematic review and meta-analysis","volume":"32","author":"Rolighed","year":"2021","journal-title":"Osteoporos. Int."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s40520-019-01432-y","article-title":"A decade of FRAX: How has it changed the management of osteoporosis?","volume":"32","author":"Kanis","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s40618-023-02219-9","article-title":"An overview of the use of the fracture risk assessment tool (FRAX) in osteoporosis","volume":"47","author":"Schini","year":"2024","journal-title":"J. Endocrinol. Investig."},{"key":"ref_93","first-page":"17455057241231387","article-title":"Use of Fracture Risk Assessment Tool in clinical practice and Fracture Risk Assessment Tool future directions","volume":"20","author":"Zerikly","year":"2024","journal-title":"Womens Health"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1002\/jbmr.4682","article-title":"Management of Primary Hyperparathyroidism","volume":"37","author":"Bilezikian","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_95","first-page":"S3","article-title":"Parathyroid Hormone-Related Changes of Bone Structure","volume":"70","author":"Jackuliak","year":"2021","journal-title":"Physiol. Res."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"694","DOI":"10.20945\/2359-3997000000559","article-title":"Update on trabecular bone score","volume":"66","author":"Palomo","year":"2022","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"350","DOI":"10.5603\/EP.a2019.0022","article-title":"Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders","volume":"70","author":"Gojny","year":"2019","journal-title":"Endokrynol. Pol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jocd.2018.06.005","article-title":"Usefulness of Trabecular Bone Score (TBS) to Identify Bone Fragility in Patients with Primary Hyperparathyroidism","volume":"22","year":"2019","journal-title":"J. Clin. Densitom."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Jones, A.R., Simons, K., Harvey, S., and Grill, V. (2022). Bone Mineral Density Compared to Trabecular Bone Score in Primary Hyperparathyroidism. J. Clin. Med., 11.","DOI":"10.3390\/jcm11020330"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.eprac.2021.08.006","article-title":"Bone Analysis Using Trabecular Bone Score and Dual-Energy X-Ray Absorptiometry-Based 3-Dimensional Modeling in Postmenopausal Women with Primary Hyperparathyroidism","volume":"28","year":"2022","journal-title":"Endocr. Pract."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"20221016","DOI":"10.1259\/bjr.20221016","article-title":"High-resolution peripheral quantitative computed tomography: Research or clinical practice?","volume":"96","author":"Gazzotti","year":"2023","journal-title":"Br. J. Radiol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00198-019-05186-1","article-title":"Impaired geometry, volumetric density, and microstructure of cortical and trabecular bone assessed by HR-pQCT in both sporadic and MEN1-related primary hyperparathyroidism","volume":"31","author":"Wang","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Ulivieri, F.M., and Rinaudo, L. (2021). Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index. Front. Med., 7.","DOI":"10.3389\/fmed.2020.590139"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s00198-020-05620-9","article-title":"Prediction of osteoporotic fragility re-fracture with lumbar spine DXA-based derived bone strain index: A multicenter validation study","volume":"32","author":"Messina","year":"2021","journal-title":"Osteoporos. Int."},{"key":"ref_105","first-page":"116348","article-title":"The bone strain index predicts fragility fractures","volume":"157","author":"Duboeuf","year":"2022","journal-title":"OFELY Study. Bone"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1210\/clinem\/dgab317","article-title":"DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism","volume":"106","author":"Tabacco","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1210\/endrev\/bnac031","article-title":"Bone Turnover Markers: Basic Biology to Clinical Applications","volume":"44","author":"Schini","year":"2023","journal-title":"Endocr. Rev."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/S2213-8587(17)30184-5","article-title":"Use of bone turnover markers in postmenopausal osteoporosis","volume":"5","author":"Eastell","year":"2017","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S8756-3282(97)00078-1","article-title":"Primary hyperparathyroidism: Biochemical markers and bone mineral density at multiple skeletal sites in Danish patients","volume":"21","author":"Christiansen","year":"1997","journal-title":"Bone"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jocd.2012.11.004","article-title":"Bone turnover markers in primary hyperparathyroidism","volume":"16","author":"Costa","year":"2013","journal-title":"J. Clin. Densitom."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1308\/rcsann.2017.0092","article-title":"Changes in bone turnover markers in primary hyperparathyroidism and response to surgery","volume":"99","author":"Rajeev","year":"2017","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_112","first-page":"3487","article-title":"Longitudinal changes in bone mineral density and bone turnover in postmenopausal women with primary hyperparathyroidism","volume":"81","author":"Guo","year":"1996","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"4641","DOI":"10.1210\/jc.2002-021404","article-title":"Normocalcemic primary hyperparathyroidism: Evidence for a generalized target-tissue resistance to parathyroid hormone","volume":"88","author":"Maruani","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1002\/bjs.7044","article-title":"Effect of parathyroidectomy for primary hyperparathyroidism on bone mineral density in postmenopausal women","volume":"97","author":"Prieto","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s00423-012-1026-5","article-title":"BMD improvements after operation for primary hyperparathyroidism","volume":"398","author":"Rolighed","year":"2013","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"678","DOI":"10.20945\/2359-3997000000557","article-title":"Surgery for primary hyperparathyroidism","volume":"66","author":"Santos","year":"2022","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s12020-021-02845-4","article-title":"A practical approach to normocalcemic primary hyperparathyroidism","volume":"74","year":"2021","journal-title":"Endocrine"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"3213","DOI":"10.1210\/jc.2013-1518","article-title":"Bone mineral density evolution after successful parathyroidectomy in patients with normocalcemic primary hyperparathyroidism","volume":"98","author":"Koumakis","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1007\/s00198-014-2689-2","article-title":"Individual site-specific bone mineral density gain in normocalcemic primary hyperparathyroidism","volume":"25","author":"Koumakis","year":"2014","journal-title":"Osteoporos. Int."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.surg.2018.04.065","article-title":"Bone mineral density changes after parathyroidectomy are dependent on biochemical profile","volume":"165","author":"Lee","year":"2019","journal-title":"Surgery"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1245\/s10434-018-6998-0","article-title":"Biochemical and Skeletal Outcomes of Parathyroidectomy for Normocalcemic (Incipient) Primary Hyperparathyroidism","volume":"26","author":"Sho","year":"2019","journal-title":"Ann. Surg. Oncol."},{"key":"ref_122","first-page":"370","article-title":"Emergency surgical tracheal decompression in a huge retrosternal goiter","volume":"13","author":"Nistor","year":"2017","journal-title":"Acta Endocrinol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1308\/rcsann.2021.0220","article-title":"Safe provision of elective endocrine surgery operations amid the COVID-19 crisis","volume":"104","author":"Christakis","year":"2022","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Aojula, N., Ready, A., Gittoes, N., and Hassan-Smith, Z. (2021). Management of Parathyroid Disease during the COVID-19 Pandemic. J. Clin. Med., 10.","DOI":"10.3390\/jcm10050920"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.clinthera.2021.02.003","article-title":"Management of Primary Hyperparathyroidism with Severe Hypercalcemia During the COVID-19 Pandemic","volume":"43","author":"Alfadhli","year":"2021","journal-title":"Clin. Ther."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"112","DOI":"10.4323\/rjlm.2022.112","article-title":"Pneumothorax on COVID-19 patients-retrospective clinical observations","volume":"30","author":"Nistor","year":"2022","journal-title":"Rom. J. Leg. Med."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"3319","DOI":"10.1210\/jc.2003-030908","article-title":"Alendronate in primary hyperparathyroidism: A double-blind, randomized, placebo-controlled trial","volume":"89","author":"Khan","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S2213-8587(20)30063-2","article-title":"Denosumab and cinacalcet for primary hyperparathyroidism (DENOCINA): A randomised, double-blind, placebo-controlled, phase 3 trial","volume":"8","author":"Leere","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1210\/jc.2013-3978","article-title":"Vitamin D treatment in primary hyperparathyroidism: A randomized placebo controlled trial","volume":"99","author":"Rolighed","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s11154-021-09694-6","article-title":"The efficacy and safety of cinacalcet in primary hyperparathyroidism: A systematic review and meta-analysis of randomized controlled trials and cohort studies","volume":"23","author":"Chandran","year":"2022","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1007\/s00198-014-3000-2","article-title":"Effects of alendronate and vitamin D in patients with normocalcemic primary hyperparathyroidism","volume":"26","author":"Cesareo","year":"2015","journal-title":"Osteoporos. Int."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1111\/imj.13508","article-title":"Denosumab-induced hypophosphataemia in a case of normocalcaemic primary hyperparathyroidism","volume":"47","author":"Konrade","year":"2017","journal-title":"Intern. Med. J."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.medcli.2017.07.020","article-title":"Primary hyperparathyroidism","volume":"150","year":"2018","journal-title":"Med. Clin."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s42000-018-0069-6","article-title":"Part of the COMBO ENDO TEAM: 2017. Asymptomatic and normocalcemic hyperparathyroidism, the silent attack: A combo-endocrinology overview","volume":"18","author":"Anastasilakis","year":"2019","journal-title":"Hormones"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.ijcard.2016.11.080","article-title":"Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample","volume":"227","author":"Kalla","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.atherosclerosis.2011.05.010","article-title":"Large-artery stiffness: A reversible marker of cardiovascular risk in primary hyperparathyroidism","volume":"218","author":"Schillaci","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.surg.2019.05.094","article-title":"Coronary artery disease is more severe in patients with primary hyperparathyroidism","volume":"167","author":"Koubaity","year":"2020","journal-title":"Surgery"},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1159\/000486003","article-title":"Metabolic Syndrome in Parathyroid Diseases","volume":"49","author":"Corbetta","year":"2018","journal-title":"Front. Horm. Res."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"117130","DOI":"10.1016\/j.bone.2024.117130","article-title":"Association between primary hyperparathyroidism and cardiovascular outcomes: A systematic review and meta-analysis","volume":"185","author":"Kong","year":"2024","journal-title":"Bone"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.numecd.2020.12.029","article-title":"Impact of parathyroidectomy on cardiovascular risk in primary hyperparathyroidism: A narrative review","volume":"31","author":"Frey","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"67","DOI":"10.5603\/EP.a2023.0010","article-title":"B-mode ultrasound assessment of carotid artery structural features in patients with normocalcaemic hyperparathyroidism","volume":"74","author":"Elbuken","year":"2023","journal-title":"Endokrynol. Pol."},{"key":"ref_142","doi-asserted-by":"crossref","unstructured":"Beysel, S., Caliskan, M., Kizilgul, M., Apaydin, M., Kan, S., Ozbek, M., and Cakal, E. (2019). Parathyroidectomy improves cardiovascular risk factors in normocalcemic and hypercalcemic primary hyperparathyroidism. BMC Cardiovasc. Disord., 19.","DOI":"10.1186\/s12872-019-1093-4"},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1507\/endocrj.EJ15-0392","article-title":"Patients with normocalcemic primary hyperparathyroidism may have similar metabolic profile as hypercalcemic patients","volume":"63","author":"Erol","year":"2016","journal-title":"Endocr. J."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"5628","DOI":"10.2174\/1381612824999201105165642","article-title":"Cardiovascular Risk in Patients with Primary Hyperparathyroidism","volume":"26","author":"Tournis","year":"2020","journal-title":"Curr. Pharm. Des."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"R297","DOI":"10.1530\/EJE-17-0485","article-title":"Cardiovascular manifestations of primary hyperparathyroidism: A narrative review","volume":"177","author":"Pepe","year":"2017","journal-title":"Eur. J. Endocrinol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6325\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:18:20Z","timestamp":1760113100000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,23]]},"references-count":145,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13216325"],"URL":"https:\/\/doi.org\/10.3390\/jcm13216325","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,23]]}}}