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International Journal of Nutrology
Review
DOI: 10.1055/s-0038-1668120
Submitted: 03-05-2022
Published: 03-06-2022

Epidemiology and Clinical Forms of Primary Hyperparathyroidism: A Review

Universidade Federal da Paraíba, João Pessoa, PB, Brazil / Hospital Universitário Lauro Wanderley, João Pessoa, PB, Brazil
Instituto Francisco Bandeira, Recife, PE, Brazil
Universidade de Pernambuco, Recife, PE, Brazil
Hospital Geral Ernesto Simões Filho, Salvador, BA, Brazil
Hospital Agamenon Magalhães, Recife, PE, Brazil
Universidade Federal da Paraíba, João Pessoa, PB, Brazil
Universidade Federal da Paraíba, João Pessoa, PB, Brazil
classic primary hyperparathyroidism non-classic primary hyperparathyroidism normocalcemic primary hyperparathyroidism

Abstract

Primary hyperparathyroidism (PHPT) is a disease caused by overactive parathyroid glands with consequent hypercalcemia. However, its presentation is variable, with patients demonstrating a range from normocalcemia to severe hypercalcemic PHPT. The present study aims to perform a literature review on the epidemiology and the clinical forms of PHPT using information published in the PubMed and Cochrane databases. It describes data about prevalence, etiology, diagnosis, classic and non-classic manifestations, providing updated information on classical hypercalcemic hyperthyroidism, in addition to its normocalcemic variant.

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References

  1. Bandeira F, Griz L, Caldas G, Bandeira C, Freese E. From mild to severe primary hyperparathyroidism: The Brazilian experience. Arq Bras Endocrinol Metabol 2006;50(04):657–663 10.1590/S0004-27302006000400011
  2. Jorde R, Bønaa KH, Sundsfjord J. Primary hyperparathyroidism detected in a health screening. The Trømsø study. J Clin Epidemiol 2000;53(11):1164–1169 10.1016/S0895-4356(00)00239-0
  3. Silverberg SJ, Clarke BL, Peacock M, et al. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 2014;99(10):3580–3594 10.1210/jc.2014-1415
  4. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 2013;98(03):1122–1129 10.1210/jc.2012-4022
  5. Bilezikian JP, Cusano NE, Khan AA, Liu JM, Marcocci C, Bandeira F. Primary hyperparathyroidism. Nat Rev Dis Primers 2016; 2:16033 10.1038/nrdp.2016.33
  6. Brandi ML, Falchetti A. Genetics of primary hyperparathyroidism. Urol Int 2004;72(01, Suppl 1):11–16 10.1159/000076584
  7. Yu N, Donnan PT, Murphy MJ, Leese GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol (Oxf) 2009;71(04):485–493 10.1111/j.1365-2265.2008.03520.x
  8. Bandeira L, Bilezikian J. Primary Hyperparathyroidism. F1000 Res 2016;5:1
  9. Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab 2014;99(10):3561–3569 10.1210/jc.2014-1413
  10. Pepe J, Cipriani C, Sonato C, Raimo O, Biamonte F, Minisola S. Cardiovascular manifestations of primary hyperparathyroidism: a narrative review. Eur J Endocrinol 2017;177(06):R297–R308
  11. Pawlowska M, Cusano NE. An overview of normocalcemic primary hyperparathyroidism. Curr Opin Endocrinol Diabetes Obes 2015;22(06):413–421 10.1097/MED.0000000000000198
  12. Khan AA, Hanley DA, Rizzoli R, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 2017;28(01):1–19 10.1007/s00198-016-3716-2
  13. Wermers RA, Khosla S, Atkinson EJ, Hodgson SF, O’Fallon WM, Melton LJ III. The rise and fall of primary hyperparathyroidism: a population-based study in Rochester, Minnesota, 1965-1992. Ann Intern Med 1997;126(06):433–440
  14. Coker LH, Rorie K, Cantley L, et al. Primary hyperparathyroidism, cognition, and health-related quality of life. Ann Surg 2005; 242(05):642–650
  15. Abood A, Vestergaard P. Increasing incidence of primary hyperparathyroidism in Denmark. Dan Med J 2013;60(02):A4567
  16. Collier A, Portelli M, Ghosh S, Nowell S, Clark D. Primary hyperparathyroidism: Increasing prevalence, social deprivation, and surgery. Endocr Res 2017;42(01):31–35 10.3109/07435800.2016.1169545
  17. Siilin H, Lundgren E, Mallmin H, et al. Prevalence of primary hyperparathyroidism and impact on bone mineral density in elderly men: MrOs Sweden. World J Surg 2011;35(06):1266–1272 10.1007/s00268-011-1062-2
  18. Eufrazino C, Veras A, Bandeira F, Bandeira FA. Epidemiology of Primary Hyperparathyroidism and its Non-classical Manifestations in the City of Recife, Brazil. Clin Med Insights Endocrinol Diabetes 2013;6:69–74 10.4137/CMED.S13147
  19. Bandeira F, Griz L, Chaves N, et al; Sociedade Brasileira de Endocrinologia e Metabologia. Diagnosis and management of primary hyperparathyroidism–a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism. Arq Bras Endocrinol Metabol 2013; 57(06):406–424 10.1590/S0004-27302013000600002
  20. Rodgers SE, Lew JI, Solórzano CC. Primary hyperparathyroidism. Curr Opin Oncol 2008;20(01):52–58 10.1097/CCO.0b013e3282f2838f
  21. Eastell R, Brandi ML, Costa AG, D’Amour P, Shoback DM, Thakker RV. Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 2014;99(10):3570–3579 10.1210/jc.2014-1414
  22. Brandi ML, Gagel RF, Angeli A, et al. Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab 2001; 86(12):5658–5671 10.1210/jcem.86.12.8070
  23. Simonds WF, James-Newton LA, Agarwal SK, et al. Familial isolated hyperparathyroidism: clinical and genetic characteristics of 36 kindreds. Medicine (Baltimore) 2002;81(01):1–26
  24. Guarnieri V, Seaberg RM, Kelly C, et al. Large intragenic deletion of CDC73 (exons 4-10) in a three-generation hyperparathyroidism-jaw tumor (HPT-JT) syndrome family. BMC Med Genet 2017;18(01):83 10.1186/s12881-017-0445-0
  25. Hemmer S, Wasenius VM, Haglund C, et al. Deletion of 11q23 and cyclin D1 overexpression are frequent aberrations in parathyroid adenomas. Am J Pathol 2001;158(04):1355–1362 10.1016/S0002-9449(10)64086-2
  26. Vasef MA, Brynes RK, Sturm M, Bromley C, Robinson RA. Expression of cyclin D1 in parathyroid carcinomas, adenomas, and hyperplasias: a paraffin immunohistochemical study. Mod Pathol 1999;12(04):412–416
  27. Pausova Z, Soliman E, Amizuka N, et al. Role of the RET protooncogene in sporadic hyperparathyroidism and in hyperparathyroidism of multiple endocrine neoplasia type 2. J Clin Endocrinol Metab 1996;81(07):2711–2718 10.1210/jcem.81.7.8675600
  28. Carling T, Correa P, Hessman O, et al. Parathyroid MEN1 gene mutations in relation to clinical characteristics of nonfamilial primary hyperparathyroidism. J Clin Endocrinol Metab 1998; 83(08):2960–2963 10.1210/jcem.83.8.4977
  29. Boehm BO, Rosinger S, Belyi D, Dietrich JW. The parathyroid as a target for radiation damage. N Engl J Med 2011;365(07):676–678 10.1056/NEJMc1104982
  30. Schneider AB, Gierlowski TC, Shore-Freedman E, Stovall M, Ron E, Lubin J. Dose-response relationships for radiation-induced hyperparathyroidism. J Clin Endocrinol Metab 1995;80(01):254–257 10.1210/jcem.80.1.7829622
  31. Samander EH, Arnold A. Mutational analysis of the vitamin D receptor does not support its candidacy as a tumor suppressor gene in parathyroid adenomas. J Clin Endocrinol Metab 2006;91 (12):5019–5021 10.1210/jc.2006-1543
  32. Björklund P, Lindberg D, Akerström G, Westin G. Stabilizing mutation of CTNNB1/beta-catenin and protein accumulation analyzed in a large series of parathyroid tumors of Swedish patients. Mol Cancer 2008;7:53 10.1186/1476-4598-7-53
  33. Tezelman S, Rodriguez JM, Shen W, Siperstein AE, Duh QY, Clark OH. Primary hyperparathyroidism in patients who have received radiation therapy and in patients who have not received radiation therapy. J Am Coll Surg 1995;180(01):81–87
  34. Wilson SD, Doffek KM, Wang TS, Krzywda EA, Evans DB, Yen TW. Primary hyperparathyroidism with a history of head and neck irradiation: the consequences of associated thyroid tumors. Surgery 2011;150(04):869–877 10.1016/J.SURG.2011.07.046
  35. Fjälling M, Dackenberg A, Hedman I, Tisell LE. An evaluation of the risk of developing hyperparathyroidism after 131I treatment for thyrotoxicosis. Acta Chir Scand 1983;149(07):681–686
  36. Spivacow FR, Palumbo C. [Asymptomatic primary hyperparathyroidism in women]. Medicina (B Aires) 2017;77(03):196–200
  37. Rubin MR, Bilezikian JP, McMahon DJ, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab 2008;93(09):3462–3470 10.1210/jc.2007-1215
  38. Nuti R, Merlotti D, Gennari L. Vitamin D deficiency and primary hyperparathyroidism. J Endocrinol Invest 2011;34(7, Suppl) 45–49
  39. Bilezikian JP, Silverberg SJ. Normocalcemic primary hyperparathyroidism. Arq Bras Endocrinol Metabol 2010;54(02):106–109 10.1590/S0004-27302010000200004
  40. Rejnmark L, Vestergaard P, Mosekilde L. Nephrolithiasis and renal calcifications in primary hyperparathyroidism. J Clin Endocrinol Metab 2011;96(08):2377–2385 10.1210/jc.2011-0569
  41. Guyton & Hall. Hotmônio paratireóideo, calcitonina, metabolismo do cálcio e fosfato, Vitamina D, ossos e dentes. In: tratado de fisiologia médica 12 a Ed. Rio de Janeiro:Elsevier, 2011
  42. Suh JM, Cronan JJ, Monchik JM. Primary hyperparathyroidism: is there an increased prevalence of renal stone disease? AJR Am J Roentgenol 2008;191(03):908–911 10.2214/AJR.07.3160
  43. Mishra SK, Agarwal G, Kar DK, Gupta SK, Mithal A, Rastad J. Unique clinical characteristics of primary hyperparathyroidismin India. Br J Surg 2001;88(05):708–714 10.1046/j.0007-1323.2001.01775.x
  44. Zanocco KA, Yeh MW. Primary Hyperparathyroidism: Effects on Bone Health. Endocrinol Metab Clin North Am 2017;46(01):87–104
  45. Ma YL, Cain RL, Halladay DL, et al. Catabolic effects of continuous human PTH (1–38) in vivo is associated with sustained stimulation of RANKL and inhibition of osteoprotegerin and geneassociated bone formation. Endocrinology 2001;142(09):4047–4054 10.1210/endo.142.9.8356
  46. Stein EM, Silva BC, Boutroy S, et al. Primary hyperparathyroidism is associated with abnormal cortical and trabecular microstructure and reduced bone stiffness in postmenopausal women. J Bone Miner Res 2013;28(05):1029–1040 10.1002/jbmr.1841
  47. Dempster DW, Müller R, Zhou H, et al. Preserved three-dimensional cancellous bone structure in mild primary hyperparathyroidism. Bone 2007;41(01):19–24 10.1016/j.bone.2007.03.020
  48. Vu TD, Wang XF, Wang Q, et al. New insights into the effects of primary hyperparathyroidism on the cortical and trabecular compartments of bone. Bone 2013;55(01):57–63 10.1016/j.bone.2013.03.009
  49. Broulik PD, Haas T, Adámek S. Analysis of 645 patients with primary hyperparathyroidism with special references to cholelithiasis. Intern Med 2005;44(09):917–921
  50. Bhadada SK, Bhansali A, Shah VN, Behera A, Ravikiran M, Santosh R. High prevalence of cholelithiasis in primary hyperparathyroidism: a retrospective analysis of 120 cases. Indian J Gastroenterol 2011;30(02):100–101
  51. Christensson T, Einarsson K. Cholelithiasis in subjects with hypercalcaemia and primary hyperparathyroidism detected in a health screening. Gut 1977;18(07):543–546
  52. Jacob JJ, John M, Thomas N, et al. Does hyperparathyroidism cause pancreatitis? A South Indian experience and a review of published work. ANZ J Surg 2006;76(08):740–744 10.1111/j.1445-2197.2006.03845.x
  53. Khoo TK, Vege SS, Abu-Lebdeh HS, Ryu E, Nadeem S, Wermers RA. Acute pancreatitis in primary hyperparathyroidism: a population-based study. J Clin Endocrinol Metab 2009;94(06):2115–2118 10.1210/jc.2008-1965
  54. Shah VN, Bhadada SK, Bhansali A, et al. Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism. Indian J Med Res 2014;139(02):279–284
  55. Chan AK, Duh QY, Katz MH, Siperstein AE, Clark OH. Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy. A case-control study. Ann Surg 1995; 222(03):402–412, discussion 412–414
  56. Silverberg SJ. Non-classical target organs in primary hyperparathyroidism. J Bone Miner Res 2002;17(Suppl 2):N117–N125
  57. Bhadada SK, Udawat HP, Bhansali A, Rana SS, Sinha SK, Bhasin DK. Chronic pancreatitis in primary hyperparathyroidism: comparison with alcoholic and idiopathic chronic pancreatitis.J Gastroenterol Hepatol 2008;23(06):959–964 10.1111/j.1440-1746.2007.05050.x
  58. Bhadada SK, Bhansali A, Dutta P, Behera A, Chanukya GV, Mittal BR. Characteristics of primary hyperparathyroidism in adolescents. J Pediatr Endocrinol Metab 2008;21(12):1147–1153
  59. Norton JA, Venzon DJ, Berna MJ, et al. Prospective study of surgery for primary hyperparathyroidism (HPT) in multiple endocrine neoplasia-type 1 and Zollinger-Ellison syndrome: long-term outcome of a more virulent form of HPT. Ann Surg 2008;247(03):501–510 10.1097/SLA.0b013e31815efda5
  60. Bolland MJ, Grey AB, Gamble GD, Reid IR. Association between primary hyperparathyroidism and increased body weight: a meta-analysis. J Clin Endocrinol Metab 2005;90(03):1525–1530 10.1210/jc.2004-1891
  61. Lind L, Jacobsson S, Palmér M, Lithell H, Wengle B, Ljunghall S. Cardiovascular risk factors in primary hyperparathyroidism: a 15-year follow-up of operated and unoperated cases. J Intern Med 1991;230(01):29–35 10.1111/j.1365-2796.1991.tb00403.x
  62. Smith JC, Page MD, John R, et al. Augmentation of central arterial pressure in mild primary hyperparathyroidism. J Clin Endocrinol Metab 2000;85(10):3515–3519 10.1210/jcem.85.10.6880
  63. Procopio M, Magro G, Cesario F, et al. The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed Type 2 diabetes mellitus in primary hyperparathyroidism. Diabet Med 2002;19(11):958–961 10.1046/j.1464-5491.2002.00809.x
  64. Valdemarsson S, Lindblom P, Bergenfelz A. Metabolic abnormalities related to cardiovascular risk in primary hyperparathyroidism: effects of surgical treatment. J Intern Med 1998;244(03):241–249 10.1046/j.1365-2796.1998.00366.x
  65. Sun G, Vasdev S, Martin GR, Gadag V, Zhang H. Altered calcium homeostasis is correlated with abnormalities of fasting serum glucose, insulin resistance, and beta-cell function in the Newfoundland population. Diabetes 2005;54(11):3336–3339
  66. Yamaguchi T, Kanazawa I, Takaoka S, Sugimoto T. Serum calcium is positively correlated with fasting plasma glucose and insulin resistance, independent of parathyroid hormone, in male patients with type 2 diabetes mellitus. Metabolism 2011;60 (09):1334–1339 10.1016/j.metabol.2011.02.003
  67. Tassone F, Procopio M, Gianotti L, et al. Insulin resistance is not coupled with defective insulin secretion in primary hyperparathyroidism. Diabet Med 2009;26(10):968–973 10.1111/j.1464-5491.2009.02804.x
  68. Cakir I, Unluhizarci K, Tanriverdi F, Elbuken G, Karaca Z, Kelestimur F. Investigation of insulin resistance in patients with normocalcemic primary hyperparathyroidism. Endocrine 2012;42(02):419–422 10.1007/s12020-012-9627-x
  69. Khaleeli AA, Johnson JN, Taylor WH. Prevalence of glucose intolerance in primary hyperparathyroidism and the benefit of parathyroidectomy. Diabetes Metab Res Rev 2007;23(01):43–48 10.1002/dmrr.637
  70. Luboshitzky R, Chertok-Schaham Y, Lavi I, Ishay A. Cardiovascular risk factors in primary hyperparathyroidism. J Endocrinol Invest 2009;32(04):317–321 10.1007/BF03345719
  71. Yu N, Donnan PT, Leese GP. A record linkage study of outcomes in patients with mild primary hyperparathyroidism: the Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol (Oxf) 2011;75(02):169–176 10.1111/j.1365-2265.2010.03958.x
  72. Yu N, Donnan PT, Flynn RW, et al; The Parathyroid Epidemiology and Audit Research Study (PEARS). Increased mortality and morbidity in mild primary hyperparathyroid patients. Clin Endocrinol (Oxf) 2010;73(01):30–34 10.1111/j.1365-2265.2009.03766.x
  73. Schlüter KD, Piper HM. Cardiovascular actions of parathyroid hormone and parathyroid hormone-related peptide. Cardiovasc Res 1998;37(01):34–41
  74. Rashid G, Bernheim J, Green J, Benchetrit S. Parathyroid hormone stimulates endothelial expression of atherosclerotic parameters through protein kinase pathways. Am J Physiol Renal Physiol 2007;292(04):F1215–F1218 10.1152/ajprenal.00406.2006
  75. Persson A, Bollerslev J, Rosen T, et al; SIPH Study Group. Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism. Clin Endocrinol (Oxf) 2011;74(02):174–180 10.1111/j.1365-2265.2010.03909.x
  76. Heyliger A, Tangpricha V, Weber C, Sharma J. Parathyroidectomy decreases systolic and diastolic blood pressure in hypertensive patients with primary hyperparathyroidism. Surgery 2009;146 (06):1042–1047 10.1016/j.surg.2009.09.024
  77. Piovesan A, Molineri N, Casasso F, et al. Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy. Clin Endocrinol (Oxf) 1999;50(03):321–328
  78. Farahnak P, Ring M, Caidahl K, Farnebo LO, Eriksson MJ, Nilsson IL. Cardiac function in mild primary hyperparathyroidism and the outcome after parathyroidectomy. Eur J Endocrinol 2010; 163(03):461–467 10.1530/EJE-10-0201
  79. Marini C, Giusti M, Armonino R, et al. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 2010;37(12):2256–2263 10.1007/s00259-010-1599-6
  80. Farahnak P, Lärfars G, Sten-Linder M, Nilsson IL. Mild primary hyperparathyroidism: vitamin D deficiency and cardiovascular risk markers. J Clin Endocrinol Metab 2011;96(07):2112–2118 10.1210/jc.2011-0238
  81. Rydberg E, Birgander M, Bondeson AG, Bondeson L, Willenheimer R. Effect of successful parathyroidectomy on 24-hour ambulatory blood pressure in patients with primary hyperparathyroidism. Int J Cardiol 2010;142(01):15–21 10.1016/j.ijcard.2008.12.027
  82. Karakose M, Caliskan M, Arslan MS, Demirci T, Karakose S, Cakal E. The impact of parathyroidectomy on serum ADAMTS1, ADAMTS4 levels, insulin resistance, and subclinical cardiovascular disease in primary hyperparathyroidism. Endocrine 2017; 55(01):283–288 10.1007/s12020-016-1175-3
  83. Nilsson IL, Aberg J, Rastad J, Lind L. Maintained normalization of cardiovascular dysfunction 5 years after parathyroidectomy in primary hyperparathyroidism. Surgery 2005;137(06):632–638 10.1016/j.surg.2005.02.001
  84. Espiritu RP, Kearns AE, Vickers KS, Grant C, Ryu E, Wermers RA. Depression in primary hyperparathyroidism: prevalence and benefit of surgery. J Clin Endocrinol Metab 2011;96(11):E1737–E1745 10.1210/jc.2011-1486
  85. Babińska D, Barczyński M, Stefaniak T, et al. Evaluation of selected cognitive functions before and after surgery for primary hyperparathyroidism. Langenbecks Arch Surg 2012;397(05):825–831 10.1007/s00423-011-0885-5
  86. Walker MD, McMahon DJ, Inabnet WB, et al. Neuropsychological features in primary hyperparathyroidism: a prospective study. J Clin Endocrinol Metab 2009;94(06):1951–1958 10.1210/jc.2008-2574
  87. Roman SA, Sosa JA, Pietrzak RH, et al. The effects of serum calcium and parathyroid hormone changes on psychological and cognitive function in patients undergoing parathyroidectomy for primary hyperparathyroidism. Ann Surg 2011;253(01):131–137 10.1097/SLA.0b013e3181f66720
  88. Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab 2009;94(02):351–365 10.1210/jc.2008-1760
  89. Silverberg SJ, Bilezikian JP. “Incipient” primary hyperparathyroidism: a “forme fruste” of an old disease. J Clin Endocrinol Metab 2003;88(11):5348–5352 10.1210/jc.2003-031014
  90. Cusano NE, Silverberg SJ, Bilezikian JP. Normocalcemic primary hyperparathyroidism. J Clin Densitom 2013;16(01):33–39 10.1016/j.jocd.2012.12.001
  91. Chesnut CH III, McClung MR, Ensrud KE, et al. Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med 1995;99(02):144–152
  92. Makras P, Polyzos SA, Papatheodorou A, Kokkoris P, Chatzifotiadis D, Anastasilakis AD. Parathyroid hormone changes following denosumab treatment in postmenopausal osteoporosis. Clin Endocrinol (Oxf) 2013;79(04):499–503 10.1111/cen.12188
  93. Spivacow FR, Durán AS, Zanchetta MB. Hiperparatireoidismo primário normocalcêmico. MEDICINA (Buenos Aires) 2014; 74:457–461
  94. Amaral LMB, Queiroz DC, Marques TF, Mendes M, Bandeira F. Normocalcemic versus Hypercalcemic Primary Hyperparathyroidism: more stone than bone? J Osteoporos 2012;2012:12835210.1155/2012/128352
  95. Marques TF, Vasconcelos R, Diniz E, Rêgo D, Griz L, Bandeira F. Normocalcemic primary hyperparathyroidism in clinical practice: an indolent condition or a silent threat? Arq Bras Endocrinol Metabol 2011;55(05):314–317
  96. Maruani G, Hertig A, Paillard M, Houillier P. Normocalcemic primary hyperparathyroidism: evidence for a generalized target-tissue resistance to parathyroid hormone. J Clin Endocrinol Metab 2003;88(10):4641–4648 10.1210/jc.2002-021404
  97. Tordjman KM, Yaron M, Izkhakov E, et al. Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism. Eur J Endocrinol 2010;162(05):925–933 10.1530/EJE-09-1067
  98. Tordjman KM, Greenman Y, Osher E, Shenkerman G, Stern N. Characterization of normocalcemic primary hyperparathyroidism. Am J Med 2004;117(11):861–863 10.1016/j.amjmed.2004.06.037
  99. Lowe H, McMahon DJ, Rubin MR, Bilezikian JP, Silverberg SJ. Normocalcemic primary hyperparathyroidism: further characterization of a new clinical phenotype. J Clin Endocrinol Metab 2007;92(08):3001–3005 10.1210/jc.2006-2802
  100. Temizkan S, Kocak O, Aydin K, et al. Normocalcemic hyperparathyroidism and insulin resistance. Endocr Pract 2015;21(01):23–29 10.4158/EP14195.OR
  101. Hagström E, Lundgren E, Rastad J, Hellman P. Metabolic abnormalities in patients with normocalcemic hyperparathyroidism detected at a population-based screening. Eur J Endocrinol 2006;155(01):33–39 10.1530/eje.1.02173
  102. Chen G, Xue Y, Zhang Q, et al. Is normocalcemic primary hyperparathyroidism harmful or harmless? J Clin Endocrinol Metab 2015;100(06):2420–2424 10.1210/jc.2014-4432

How to Cite

Carvalho, N. N. C., Almeida, J. M. C. M., Oliveira, P. A. P. de, Meneses, R. B., Mesquita, P., Pimenta, F. C. F., & Alves, J. L. de B. (2022). Epidemiology and Clinical Forms of Primary Hyperparathyroidism: A Review. International Journal of Nutrology, 11(2), 33–41. https://doi.org/10.1055/s-0038-1668120