European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders in 2019 were discussed during two virtual workshops in 2021 and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosis of familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represents areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborn children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed at a broader clinical audience and were developed with the focus on endocrinologists in training.

[1]  L. McLeod,et al.  Psychometric validation of the Hypoparathyroidism Patient Experience Scales (HPES) , 2021, Journal of Patient-Reported Outcomes.

[2]  O. Mäkitie,et al.  Women with chronic hypoparathyroidism have low risk of adverse pregnancy outcomes. , 2021, The Journal of clinical endocrinology and metabolism.

[3]  H. Tilg,et al.  Calprotectin: from biomarker to biological function , 2021, Gut.

[4]  B. Clarke,et al.  Normocalcemic Primary Hyperparathyroidism: Need for a Standardized Clinical Approach , 2021, Endocrinology and metabolism.

[5]  S. Bhadada,et al.  Fracture risk in hypoparathyroidism: a systematic review and meta-analysis , 2021, Osteoporosis International.

[6]  J. Braithwaite,et al.  Patient‐reported outcome measures (PROMs): A review of generic and condition‐specific measures and a discussion of trends and issues , 2021, Health expectations : an international journal of public participation in health care and health policy.

[7]  R. Yeh,et al.  Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review , 2021, Biomedicines.

[8]  C. McCollough,et al.  Basal ganglia calcification is associated with local and systemic metabolic mechanisms in adult hypoparathyroidism. , 2021, The Journal of clinical endocrinology and metabolism.

[9]  L. Rejnmark,et al.  Determinants of hypercalciuria and renal calcifications in chronic hypoparathyroidism: A cross‐sectional study , 2021, Clinical endocrinology.

[10]  M. Brandi,et al.  Hormonal regulation of biomineralization , 2021, Nature Reviews Endocrinology.

[11]  E. Gosmanova,et al.  Risk of Nephrolithiasis and Nephrocalcinosis in Patients with Chronic Hypoparathyroidism: A Retrospective Cohort Study , 2021, Advances in Therapy.

[12]  R. Chai,et al.  Primary Hyperparathyroidism During Pregnancy Treated With Parathyroidectomy: A Systematic Review , 2021, The Laryngoscope.

[13]  E. Gosmanova,et al.  Renal complications in patients with chronic hypoparathyroidism on conventional therapy: a systematic literature review , 2021, Reviews in Endocrine and Metabolic Disorders.

[14]  M. Zillikens,et al.  Hypercalcemia during pregnancy: management and outcomes for mother and child , 2021, Endocrine.

[15]  A. Sitges-Serra.  Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy , 2021, Journal of clinical medicine.

[16]  U. Saikia,et al.  Primary hyperparathyroidism in pregnancy: observations from the Indian PHPT registry , 2020, Journal of Endocrinological Investigation.

[17]  R. Eastell,et al.  Reference interval for albumin‐adjusted calcium based on a large UK population , 2020, Clinical endocrinology.

[18]  C. Kovacs,et al.  Maternal and fetal vitamin D and their roles in mineral homeostasis and fetal bone development , 2020, Journal of Endocrinological Investigation.

[19]  P. Gauger,et al.  Early biochemical response to parathyroidectomy for primary hyperparathyroidism and its predictive value for recurrent hypercalcemia and recurrent primary hyperparathyroidism. , 2020, Surgery.

[20]  Jing Zhao,et al.  Five-year Estimated Glomerular Filtration Rate in Patients With Hypoparathyroidism Treated With and Without rhPTH(1–84) , 2020, The Journal of clinical endocrinology and metabolism.

[21]  C. V. van Eijck,et al.  Postoperative parathyroid hormone levels as a predictor for persistent hypoparathyroidism. , 2020, European journal of endocrinology.

[22]  B. Clarke,et al.  Normocalcemic Hyperparathyroidism: A Heterogeneous Disorder Often Misdiagnosed? , 2020, JBMR plus.

[23]  Xiaofeng Han,et al.  Measurement of serum intact parathyroid hormone concentration 1 day after total thyroidectomy to assess risk of permanent hypoparathyroidism , 2020, The Journal of international medical research.

[24]  N. Bonnet,et al.  Pregnancy and lactation, a challenge for the skeleton , 2020, Endocrine connections.

[25]  D. Carey,et al.  Familial Hypocalciuric Hypercalcemia Type 1 and Autosomal-Dominant Hypocalcemia Type 1: Prevalence in a Large Healthcare Population , 2020, American journal of human genetics.

[26]  A. Tabarin,et al.  Clinical Characteristics of Familial Hypocalciuric Hypercalcaemia Type 1: A Multicentre Study of 77 Adult Patients. , 2020, Clinical Endocrinology.

[27]  L. Rejnmark,et al.  Changes in treatment needs of hypoparathyroidism during pregnancy and lactation: a case series. , 2020, Clinical endocrinology.

[28]  Alicia R. Jones,et al.  Familial Hypocalciuric Hypercalcemia in Pregnancy: Diagnostic Pitfalls , 2020, JBMR plus.

[29]  P. Chanson,et al.  Treating hypoparathyroidism with recombinant human parathyroid hormone (1–34): long-term safety concerns , 2020, The Lancet.

[30]  J. Bilezikian,et al.  Clinical, biochemical and radiological profile of normocalcemic primary hyperparathyroidism. , 2020, The Journal of clinical endocrinology and metabolism.

[31]  A. Malinowski,et al.  Impact of Perinatal Primary Hyperparathyroidism on Maternal and Fetal and Neonatal Outcomes: Retrospective Case Series. , 2020, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.

[32]  M. Cirillo,et al.  25-Hydroxyvitamin D, 1,25-Dihydroxyvitamin D, and Peripheral Bone Densitometry in Adults with Celiac Disease , 2020, Nutrients.

[33]  Y. Suh,et al.  INCIDENCE, RISK FACTORS, AND CLINICAL IMPLICATIONS OF DELAYED HYPOPARATHYROIDISM ON POSTOPERATIVE DAY TWO FOLLOWING TOTAL THYROIDECTOMY FOR PAPILLARY THYROID CARCINOMA. , 2020, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[34]  T. Fahey,et al.  The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. , 2020, Annals of surgery.

[35]  F. Singer.  Faculty Opinions recommendation of Parathyroid surgery: an evidence-based volume-outcomes analysis : European Society of Endocrine Surgeons (ESES) positional statement. , 2020 .

[36]  A. Leha,et al.  Quantification of Symptom Load by a Disease‐Specific Questionnaire HPQ 28 and Analysis of Associated Biochemical Parameters in Patients With Postsurgical Hypoparathyroidism , 2020, JBMR plus.

[37]  V. Sreenivas,et al.  Nephrocalcinosis, renal dysfunction and calculi in patients with primary hypoparathyroidism on long-term conventional therapy. , 2020, The Journal of clinical endocrinology and metabolism.

[38]  A. Leha,et al.  The HPQ—Development and First Administration of a Questionnaire for Hypoparathyroid Patients , 2019, JBMR plus.

[39]  D. Karpf,et al.  A Randomized Double‐Blind Placebo‐Controlled First‐In‐Human Phase 1 Trial of TransCon PTH in Healthy Adults , 2019, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[40]  M. Hočevar,et al.  18F-Fluorocholine PET/CT in Primary Hyperparathyroidism: Superior Diagnostic Performance to Conventional Scintigraphic Imaging for Localization of Hyperfunctioning Parathyroid Glands , 2020, The Journal of Nuclear Medicine.

[41]  S. Shapses,et al.  LOW FREE BUT NOT TOTAL 25-HYDROXYVITAMIN D LEVELS IN SUBJECTS WITH NORMOCALCEMIC HYPERPARATHYROIDISM. , 2020, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[42]  C. Kovacs,et al.  Calciotropic and phosphotropic hormones in fetal and neonatal bone development. , 2019, Seminars in fetal & neonatal medicine.

[43]  D. Karpf,et al.  Design and Preclinical Development of TransCon PTH, an Investigational Sustained‐Release PTH Replacement Therapy for Hypoparathyroidism , 2019, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[44]  D. Ward,et al.  Phosphate acts directly on the calcium-sensing receptor to stimulate parathyroid hormone secretion , 2019, Nature Communications.

[45]  P. Hodges,et al.  Potential Unintended Effects of Standardized Pain Questionnaires: A Qualitative Study. , 2019, Pain medicine.

[46]  F. Palazzo,et al.  Parathyroid surgery: an evidence-based volume—outcomes analysis , 2019, Langenbeck's Archives of Surgery.

[47]  J. Rubin,et al.  Persistently elevated PTH after parathyroidectomy at one year: experience in a tertiary referral center. , 2019, The Journal of clinical endocrinology and metabolism.

[48]  D. Karpf,et al.  Assessing the Patient Experience of Hypoparathyroidism Symptoms: Development of the Hypoparathyroidism Patient Experience Scale-Symptom (HPES-Symptom) , 2019, The Patient - Patient-Centered Outcomes Research.

[49]  T. Acar,et al.  Parathyromatosis: a very rare cause of recurrent primary hyperparathyroidism - case report and review of the literature. , 2019, Annals of the Royal College of Surgeons of England.

[50]  F. Glowacki,et al.  Calcium state estimation by total calcium: the evidence to end the never-ending story , 2019, Clinical chemistry and laboratory medicine.

[51]  Z. Belaya,et al.  Non-lethal Raine Syndrome in a Middle-Aged Woman Caused by a Novel FAM20C Mutation , 2019, Calcified Tissue International.

[52]  M. Nie,et al.  PRIMARY HYPERPARATHYROIDISM DURING PREGNANCY: A CASE SERIES OF EIGHT PATIENTS. , 2019, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[53]  C. Kovacs,et al.  The puzzle of lactational bone physiology: osteocytes masquerade as osteoclasts and osteoblasts. , 2019, The Journal of clinical investigation.

[54]  M. Zappia,et al.  Basal ganglia calcifications (Fahr’s syndrome): related conditions and clinical features , 2019, Neurological Sciences.

[55]  L. Rejnmark,et al.  MANAGEMENT OF ENDOCRINE DISEASE: Unmet therapeutic, educational and scientific needs in parathyroid disorders. , 2019, European journal of endocrinology.

[56]  Soo-Mi Park,et al.  Management of primary hyperparathyroidism in pregnancy: a case series , 2019, Endocrinology, diabetes & metabolism case reports.

[57]  P. Chanson,et al.  Hyperparathyroidism in patients with X-linked hypophosphatemia , 2019, Endocrine Abstracts.

[58]  J. Serrano González,et al.  Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism , 2019, Endocrinología, Diabetes y Nutrición (English ed.).

[59]  N. Gittoes,et al.  Mild primary hyperparathyroidism—to treat or not to treat? , 2018, British medical bulletin.

[60]  N. Tolley,et al.  Seventeen Cases of Primary Hyperparathyroidism in Pregnancy: A Call for Management Guidelines , 2019, Journal of the Endocrine Society.

[61]  L. Rejnmark,et al.  Huge variations in definition and reported incidence of postsurgical hypoparathyroidism: a systematic review , 2019, Endocrine.

[62]  L. Rejnmark,et al.  MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management. , 2019, European journal of endocrinology.

[63]  X. Qu,et al.  Effect of Sodium-Glucose Co-transporter 2 Inhibitors on Bone Metabolism and Fracture Risk , 2019, Front. Pharmacol..

[64]  G. Laverman,et al.  Effects of Dapagliflozin on Circulating Markers of Phosphate Homeostasis. , 2018, Clinical journal of the American Society of Nephrology : CJASN.

[65]  H. Barrett,et al.  Primary Hyperparathyroidism in Pregnancy: Maternofetal Outcomes at a Quaternary Referral Obstetric Hospital, 2000 Through 2015 , 2018, The Journal of clinical endocrinology and metabolism.

[66]  Susan A. Martin,et al.  Development of a Patient-Reported Outcome Measure for Chronic Hypoparathyroidism , 2016, Advances in Therapy.

[67]  E. Berber,et al.  Autofluorescence imaging of parathyroid glands: An assessment of potential indications. , 2019, Surgery.

[68]  A. Bajwa,et al.  Active surveillance of low-risk papillary thyroid cancer: A meta-analysis. , 2019, Surgery.

[69]  J. Serrano González,et al.  Serum levels of intact parathyroid hormone on the first day after total thyroidectomy as predictor of permanent hypoparathyroidism. , 2019, Endocrinologia, diabetes y nutricion.

[70]  L. Rejnmark,et al.  Standards of care for hypoparathyroidism in adults: a Canadian and International Consensus , 2018, European journal of endocrinology.

[71]  B. Clarke,et al.  Epidemiology and Complications of Hypoparathyroidism. , 2018, Endocrinology and metabolism clinics of North America (Print).

[72]  J. Seckl,et al.  Presentation, diagnostic assessment and surgical outcomes in primary hyperparathyroidism: a single centre’s experience , 2018, Endocrine connections.

[73]  S. Wiseman,et al.  American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. , 2018, Thyroid : official journal of the American Thyroid Association.

[74]  L. Rejnmark,et al.  Pro-FHH: A Risk Equation to Facilitate the Diagnosis of Parathyroid-Related Hypercalcemia , 2018, The Journal of clinical endocrinology and metabolism.

[75]  W. H. Pearse,et al.  American College of Obstetricians and Gynecologists , 2018, Definitions.

[76]  O. Mäkitie,et al.  Diagnosis and management of pseudohypoparathyroidism and related disorders: first international Consensus Statement , 2018, Nature Reviews Endocrinology.

[77]  L. Rejnmark,et al.  Long‐Term Complications in Patients With Hypoparathyroidism Evaluated by Biochemical Findings: A Case‐Control Study , 2018, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[78]  E. Baudin,et al.  Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-Fluorocholine PET/CT , 2018, European Journal of Nuclear Medicine and Molecular Imaging.

[79]  Simeon I. Taylor,et al.  Canagliflozin triggers the FGF23/1,25-dihydroxyvitamin D/PTH axis in healthy volunteers in a randomized crossover study. , 2018, JCI insight.

[80]  A. Sitges-Serra,et al.  Parathyroid autotransplantation in thyroid surgery , 2018, Langenbeck's Archives of Surgery.

[81]  F. Ris,et al.  Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery , 2018, The British journal of surgery.

[82]  B. Niederle,et al.  Primary hyperparathyroidism: Dynamic postoperative metabolic changes , 2018, Clinical endocrinology.

[83]  R. Gullo,et al.  Surgeon volume and hospital volume in endocrine neck surgery: how many procedures are needed for reaching a safety level and acceptable costs? A systematic narrative review. , 2018, Il Giornale di chirurgia.

[84]  P. Pietschmann,et al.  The impact of vitamin D status on hungry bone syndrome after surgery for primary hyperparathyroidism. , 2018, European Journal of Endocrinology.

[85]  E. Winter,et al.  Parathyroid Hormone-Related Protein-Induced Hypercalcemia of Pregnancy Successfully Reversed by a Dopamine Agonist. , 2017, The Journal of clinical endocrinology and metabolism.

[86]  T. Nickolas,et al.  KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). , 2017, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[87]  Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the detection of calcifications: A systematic review and meta-analysis , 2017, Scientific Reports.

[88]  S. Minisola,et al.  Effect of a single intravenous zoledronic acid administration on biomarkers of acute kidney injury (AKI) in patients with osteoporosis: a pilot study , 2017, British journal of clinical pharmacology.

[89]  Yupei Zhao,et al.  Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism during Pregnancy , 2017, International journal of endocrinology.

[90]  Chutintorn Sriphrapradang,et al.  Single measurement of intact parathyroid hormone after thyroidectomy can predict transient and permanent hypoparathyroidism: a prospective study. , 2017, Asian journal of surgery.

[91]  A. Sitges-Serra.  The PGRIS and parathyroid splinting concepts for the analysis and prognosis of protracted hypoparathyroidism. , 2017, Gland surgery.

[92]  F. Sebag,et al.  Persistent and recurrent hyperparathyroidism , 2017, Updates in Surgery.

[93]  V. Sreenivas,et al.  Vertebral Fractures and Bone Mineral Density in Patients With Idiopathic Hypoparathyroidism on Long-Term Follow-Up , 2016, The Journal of clinical endocrinology and metabolism.

[94]  S. Ghaznavi,et al.  The Biochemical Profile of Familial Hypocalciuric Hypercalcemia and Primary Hyperparathyroidism during Pregnancy and Lactation: Two Case Reports and Review of the Literature , 2016, Case reports in endocrinology.

[95]  M. Tublin,et al.  The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. , 2016, JAMA surgery.

[96]  R. Rizzoli,et al.  Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus , 2016, Osteoporosis International.

[97]  G. Woodward.  Management of hypoparathyroidism: summary statement and guidelines , 2016, Annals of clinical biochemistry.

[98]  J. Svartberg,et al.  Epidemiology and Health-Related Quality of Life in Hypoparathyroidism in Norway , 2016, The Journal of clinical endocrinology and metabolism.

[99]  C. Kovacs.  Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. , 2016, Physiological reviews.

[100]  M. Polak,et al.  Familial Hypocalciuric Hypercalcemia Types 1 and 3 and Primary Hyperparathyroidism: Similarities and Differences. , 2016, The Journal of clinical endocrinology and metabolism.

[101]  O. Husson,et al.  The development and validation of the Leiden Bother and Needs Questionnaire for patients with pituitary disease: the LBNQ-Pituitary , 2016, Pituitary.

[102]  S. Cremers,et al.  Therapy of Hypoparathyroidism With PTH(1-84): A Prospective Six Year Investigation of Efficacy and Safety. , 2016, The Journal of clinical endocrinology and metabolism.

[103]  N. Tolley,et al.  Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy. , 2015, Annals of the Royal College of Surgeons of England.

[104]  B. Stack,et al.  Hyperparathyroidism Associated with Long‐Term Proton Pump Inhibitors Independent of Concurrent Bisphosphonate Therapy in Elderly Adults , 2015, Journal of the American Geriatrics Society.

[105]  O. Dekkers,et al.  European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults. , 2015, European journal of endocrinology.

[106]  U. Albert,et al.  Effects of maintenance lithium treatment on serum parathyroid hormone and calcium levels: a retrospective longitudinal naturalistic study , 2015, Neuropsychiatric disease and treatment.

[107]  P. Ebeling,et al.  Management of hypoparathyroidism in pregnancy and lactation — A report of 10 cases , 2015, Bone reports.

[108]  J. Connell,et al.  Adaptor protein-2 sigma subunit mutations causing familial hypocalciuric hypercalcaemia type 3 (FHH3) demonstrate genotype–phenotype correlations, codon bias and dominant-negative effects , 2015, Human molecular genetics.

[109]  A. Lindahl,et al.  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 , 2015, Clinical endocrinology.

[110]  R. Wong,et al.  AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: POSTOPERATIVE HYPOPARATHYROIDISM--DEFINITIONS AND MANAGEMENT. , 2015, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[111]  D. Felsenberg,et al.  Normocalcaemic hypoparathyroidism: prevalence and effect on bone status in older women. The OPUS study , 2015, Clinical endocrinology.

[112]  Li Gao,et al.  Association between Decreased Serum Parathyroid Hormone after Total Thyroidectomy and Persistent Hypoparathyroidism , 2015, Medical science monitor : international medical journal of experimental and clinical research.

[113]  M. Boniardi,et al.  Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience , 2015, Langenbeck's Archives of Surgery.

[114]  C. Kovacs,et al.  Characteristics of hyperparathyroid states in the Canadian multicentre osteoporosis study (CaMos) and relationship to skeletal markers , 2015, Clinical endocrinology.

[115]  S. Marx.  Letter to the editor: Distinguishing typical primary hyperparathyroidism from familial hypocalciuric hypercalcemia by using an index of urinary calcium. , 2015, The Journal of clinical endocrinology and metabolism.

[116]  M. Barczyński,et al.  Reoperations for Persistent or Recurrent Primary Hyperparathyroidism: Results of a Retrospective Cohort Study at a Tertiary Referral Center , 2014, Medical science monitor : international medical journal of experimental and clinical research.

[117]  Y. Ji,et al.  Relationship between hypoparathyroidism and the number of parathyroid glands preserved during thyroidectomy , 2014, World Journal of Surgical Oncology.

[118]  David F. Schneider,et al.  Recurrent and persistence primary hyperparathyroidism occurs more frequently in patients with double adenomas. , 2014, The Journal of surgical research.

[119]  P. Vestergaard,et al.  Pregnancy outcomes in women with primary hyperparathyroidism. , 2014, European journal of endocrinology.

[120]  S. Bhadada,et al.  Effect of 25 (OH) D replacements in patients with primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency on serum 25(OH) D, calcium and PTH levels: a meta‐analysis and review of literature , 2014, Clinical endocrinology.

[121]  P. Hallgrimsson,et al.  Prediction of Permanent Hypoparathyroidism after Total Thyroidectomy , 2014, World Journal of Surgery.

[122]  U. Knigge,et al.  Primary hyperparathyroidism in young people. When should we perform genetic testing for multiple endocrine neoplasia 1 (MEN-1)? , 2014, The Journal of clinical endocrinology and metabolism.

[123]  A. Terkawi,et al.  Factors Predicting Post-thyroidectomy Hypoparathyroidism Recovery , 2014, World Journal of Surgery.

[124]  R. Eastell,et al.  Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. , 2014, The Journal of clinical endocrinology and metabolism.

[125]  L. Mosekilde,et al.  Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. , 2013, The lancet. Diabetes & endocrinology.

[126]  D. Borderie,et al.  Bone mineral density evolution after successful parathyroidectomy in patients with normocalcemic primary hyperparathyroidism. , 2013, The Journal of clinical endocrinology and metabolism.

[127]  S. Polyzos,et al.  Parathyroid hormone changes following denosumab treatment in postmenopausal osteoporosis , 2013, Clinical endocrinology.

[128]  J. Romijn,et al.  Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. , 2013, European journal of endocrinology.

[129]  S. Silverberg,et al.  Normocalcemic primary hyperparathyroidism. , 2013, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[130]  V. Sreenivas,et al.  Prevalence and progression of basal ganglia calcification and its pathogenic mechanism in patients with idiopathic hypoparathyroidism , 2012, Clinical endocrinology.

[131]  J. Connell,et al.  Identification of 70 calcium-sensing receptor mutations in hyper- and hypo-calcaemic patients: evidence for clustering of extracellular domain mutations at calcium-binding sites. , 2012, Human molecular genetics.

[132]  A. Sindoni,et al.  Parathyroid carcinoma presenting as normocalcemic hyperparathyroidism , 2012, Journal of Bone and Mineral Metabolism.

[133]  L. Mosekilde,et al.  Current evidence for recommendation of surgery, medical treatment and vitamin D repletion in mild primary hyperparathyroidism. , 2011, European journal of endocrinology.

[134]  R. Udelsman.  Approach to the patient with persistent or recurrent primary hyperparathyroidism. , 2011, The Journal of clinical endocrinology and metabolism.

[135]  L. Mosekilde,et al.  Vitamin D treatment in primary hyperparathyroidism. , 2011, Current drug safety.

[136]  A. Carr,et al.  The routine use of patient reported outcome measures in healthcare settings , 2010, BMJ : British Medical Journal.

[137]  A. Malabanan,et al.  Decreased calcitriol requirement during pregnancy and lactation with a window of increased requirement immediately post partum. , 2010, Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists.

[138]  H. Randeva,et al.  Postoperative hypocalcemia—The difference a definition makes , 2009, Head & neck.

[139]  J. Henry.  Reoperation for primary hyperparathyroidism: tips and tricks , 2010, Langenbeck's Archives of Surgery.

[140]  P. Vestergaard,et al.  Skeletal consequences of familial hypocalciuric hypercalcaemia vs. primary hyperparathyroidism , 2009, Clinical endocrinology.

[141]  J. Norman,et al.  Hyperparathyroidism during pregnancy and the effect of rising calcium on pregnancy loss: a call for earlier intervention , 2009, Clinical endocrinology.

[142]  B. Eisner,et al.  Differentiating primary from secondary hyperparathyroidism in stone patients: the "thiazide challenge". , 2009, Journal of endourology.

[143]  J. Bilezikian,et al.  Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. , 2009, The Journal of clinical endocrinology and metabolism.

[144]  Marta Roqué i Figuls,et al.  Pharmacological interventions for preventing complications in idiopathic hypercalciuria. , 2009, The Cochrane database of systematic reviews.

[145]  Supplemental Tables,et al.  KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). , 2009, Kidney international. Supplement.

[146]  D. Farley,et al.  Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring. , 2008, American journal of surgery.

[147]  P. Vestergaard,et al.  Discriminative power of three indices of renal calcium excretion for the distinction between familial hypocalciuric hypercalcaemia and primary hyperparathyroidism: a follow‐up study on methods , 2008, Clinical endocrinology.

[148]  F. Arrieta,et al.  Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion , 2008, Journal of endocrinological investigation.

[149]  F. Coe,et al.  New insights into the pathogenesis of idiopathic hypercalciuria. , 2008, Seminars in nephrology.

[150]  T. Dunning,et al.  Long-Term Complications , 2008 .

[151]  M. Rubin,et al.  Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. , 2007, The Journal of clinical endocrinology and metabolism.

[152]  P. Miller,et al.  Denosumab in Postmenopausal Women with Low Bone Mineral Density , 2007 .

[153]  S. Wiseman,et al.  World Journal of Surgical Oncology Open Access Normocalcemic Parathyroid Carcinoma: an Unusual Clinical Presentation , 2022 .

[154]  G. Sigurdsson,et al.  Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. , 2005, JAMA.

[155]  X. Badia,et al.  Quality of life (QOL) in patients with acromegaly is severely impaired: use of a novel measure of QOL: acromegaly quality of life questionnaire. , 2005, The Journal of clinical endocrinology and metabolism.

[156]  V. Vallon,et al.  Enhanced passive Ca2+ reabsorption and reduced Mg2+ channel abundance explains thiazide-induced hypocalciuria and hypomagnesemia. , 2005, The Journal of clinical investigation.

[157]  P. Vestergaard,et al.  Effects of long‐term treatment with loop diuretics on bone mineral density, calcitropic hormones and bone turnover , 2005, Journal of internal medicine.

[158]  R. England,et al.  Primary hyperparathyroidism in pregnancy , 2004, The Journal of Laryngology & Otology.

[159]  S. Silverberg,et al.  "Incipient" primary hyperparathyroidism: a "forme fruste" of an old disease. , 2003, The Journal of clinical endocrinology and metabolism.

[160]  L. Gerber,et al.  Long-term treatment of hypoparathyroidism: a randomized controlled study comparing parathyroid hormone-(1-34) versus calcitriol and calcium. , 2003, The Journal of clinical endocrinology and metabolism.

[161]  M. Hediger,et al.  The calcium-sensing receptor is required for normal calcium homeostasis independent of parathyroid hormone. , 2003, The Journal of clinical investigation.

[162]  J. Rastad,et al.  Primary Hyperparathyroidism Revisited in Menopausal Women with Serum Calcium in the Upper Normal Range at Population-based Screening 8 Years Ago , 2002, World Journal of Surgery.

[163]  J. Renner,et al.  Abnormal Bone Turnover in Cystic Fibrosis Adults , 2002, Osteoporosis International.

[164]  S. Vasikaran.  Bisphosphonates: an overview with special reference to alendronate , 2001, Annals of clinical biochemistry.

[165]  P. Vestergaard,et al.  Effects of thiazide‐ and loop‐diuretics, alone or in combination, on calcitropic hormones and biochemical bone markers: a randomized controlled study , 2001, Journal of internal medicine.

[166]  B. Allolio,et al.  Management of hypoparathyroidism during pregnancy--report of twelve cases. , 1998, European journal of endocrinology.

[167]  J. King,et al.  A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. , 1998, The American journal of clinical nutrition.

[168]  A. Stoll,et al.  Alterations in parathyroid dynamics in lithium-treated subjects. , 1997, The Journal of clinical endocrinology and metabolism.

[169]  J. Norton,et al.  A prospective trial evaluating a standard approach to reoperation for missed parathyroid adenoma. , 1996, Annals of surgery.

[170]  H. Genant,et al.  Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. , 1995, The American journal of medicine.

[171]  S. Nagataki,et al.  Attenuation of postmenopausal high turnover bone loss in patients with hypoparathyroidism. , 1995, The Journal of clinical endocrinology and metabolism.

[172]  M. Ranney,et al.  Beyond the bedside: Clinicians as guardians of public health, medicine and science , 2020, The American Journal of Emergency Medicine.

[173]  S. Khosla,et al.  Calcium infusion suggests a "set-point" abnormality of parathyroid gland function in familial benign hypercalcemia and more complex disturbances in primary hyperparathyroidism. , 1993, The Journal of clinical endocrinology and metabolism.

[174]  J. Monchik,et al.  Role of the oral calcium-loading test with measurement of intact parathyroid hormone in the diagnosis of symptomatic subtle primary hyperparathyroidism. , 1992, Surgery.

[175]  E. Haug,et al.  [Familial hypocalciuric hypercalcemia]. , 1992, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke.

[176]  H. Heath,et al.  Plasma intact parathyroid hormone (PTH) and PTH-related peptide in familial benign hypercalcemia: greater responsiveness to endogenous PTH than in primary hyperparathyroidism. , 1991, The Journal of clinical endocrinology and metabolism.

[177]  R. Eastell,et al.  Prolonged hypoparathyroidism presenting eventually as second trimester abortion. , 1985, British medical journal.

[178]  B. Roos,et al.  Secondary hyperparathyroidism in X-linked hypophosphatemic mice. , 1982, Endocrinology.

[179]  A. Parfitt.  Equilibrium and disequilibrium hypercalcemia new light on an old concept , 1979 .

[180]  E. Brown,et al.  Divalent cation metabolism. Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism. , 1978, The American journal of medicine.

[181]  J. Firpo,et al.  Evidence for secondary hyperparathyroidism in idiopathic hypercalciuria. , 1973, The Journal of clinical investigation.

[182]  A. Parfitt.  The interactions of thiazide diuretics with parathyroid hormone and vitamin D. Studies in patients with hypoparathyroidism. , 1972, The Journal of clinical investigation.

[183]  B. Landing,et al.  Congenital hyperparathyroidism secondary to maternal hypoparathyroidism. , 1970, The Journal of pediatrics.