1299:, between one and four per thousand people are affected. Primary hyperparathyroidism is the most common type. Certain exposures increase the risk of developing primary hyperparathyroidism such as sex and age. It occurs three times more often in women than men and is often diagnosed between the ages of 50 and 60 but is not uncommon before then. The disease was first described in the 1700s. In the late 1800s, it was determined to be related to the parathyroid. Surgery as a treatment was first carried out in 1925. The United States prevalence of primary hyperparathyroidism from 2010 was 233 per 100,000 women and 85 per 100,000 men. Black and white women aged 70β79 have the highest overall prevalence. Secondary hyperparathyroidism is most commonly caused by
493:
922:
1100:
late-stage kidney disease have an increased likelihood of developing tertiary hyperparathyroidism if not promptly corrected. In patients with late-stage kidney disease phosphate levels are elevated which directly affects the parathyroid glands and increases PTH production. Additionally, studies have shown that even in the absence of secondary hyperparathyroidism, those with X-Linked hypophosphatemia rickets who are on phosphate treatment are more susceptible to developing tertiary hyperparathyroidism.
1283:) is a potential therapy for some people with severe hypercalcemia and primary hyperparathyroidism who are unable to undergo parathyroidectomy, and for secondary hyperparathyroidism on dialysis. Treatment of secondary hyperparathyroidism with a calcimimetic in those on dialysis for CKD does not alter the risk of early death; however, it does decrease the likelihood of needing a parathyroidectomy. Treatment carries the risk of low blood calcium levels and
616:
624:
837:, which detects only relatively intact and biologically active PTH molecules. Older tests often detected other, inactive fragments. Even intact PTH may be inaccurate in patients with kidney dysfunction. Intact PTH blood tests may be falsely low if biotin has been ingested in the previous few days prior to the blood test.
34:
347:
Causes of primary hyperparathyroidism include parathyroid adenoma (80% of patients), multiglandular disease usually seen as hyperplasia of the 4 parathyroid glands (15-20% of patients), parathyroid carcinoma (less than 1% of patients). Primary hyperparathyroidism occurs sporadically and most patients
1343:
the rate of urinary calcium excretion, its effect is only noticeable at any given plasma ionized calcium concentration. The primary determinant of the amount of calcium excreted into the urine per day is the plasma ionized calcium concentration. Thus, in primary hyperparathyroidism, the quantity of
264:
In primary hyperparathyroidism, about 75% of people are "asymptomatic". While most primary patients are asymptomatic at the time of diagnosis, 'asymptomatic' is poorly defined and represents only those without "obvious clinical sequelae" such as kidney stones, bone disease, or hypercalcemic crisis.
1025:
treatment are at increased risk for hyperparathyroidism. Elevated calcium levels are found in 15% to 20% of patients who have been taking lithium long-term. However, only a few of these patients have significantly elevated levels of parathyroid hormone and clinical symptoms of hyperparathyroidism.
730:
level. Secondary hyperparathyroidism has low serum calcium and vitamin D levels, and high phosphate and PTH levels. Tertiary hyperparathyroidism has high serum calcium, phosphate, and PTH and low vitamin D levels. Tertiary hyperparathyroidism is differentiated from primary hyperparathyroidism by a
1083:
Lack of vitamin D leads to reduced calcium absorption by the intestine leading to hypocalcemia and increased parathyroid hormone secretion. This increases bone resorption. In chronic kidney failure the problem is more specifically failure to convert vitamin D to its active form in the kidney. The
1099:
is seen in those with long-term secondary hyperparathyroidism, which eventually leads to hyperplasia of the parathyroid glands and a loss of response to serum calcium levels. This disorder is most often seen in patients with end-stage kidney disease and is an autonomous activity. Patients with
832:
In primary hyperparathyroidism, parathyroid hormone (PTH) levels are either elevated or "inappropriately normal" in the presence of elevated calcium. Typically, PTH levels vary greatly over time in the affected patient and (as with Ca and Ca++ levels) must be retested several times to see the
3155:"Stones" refers to kidney stones, "bones" to associated destructive bone changes, "groans" to the pain of stomach and peptic ulcers that occur in some cases, and "moans" to the depression that frequently accompanies the disease and is often its first and most prominent manifestation.
204:
excreted from the bones and flowing into the blood stream in response to increased production of parathyroid hormone. In healthy people, when blood calcium levels are high, parathyroid hormone levels should be low. With long-standing hyperparathyroidism, the most common symptom is
448:
which responds to fluctuations in serum calcium levels. Alternatively, prolonged changes in serum calcium influences mRNA-binding proteins altering the encoding of PTH mRNA. There are also calcium independent mechanisms which include repression of PTH transcription through
256:. Low vitamin D should be corrected in those with secondary hyperparathyroidism but low Vitamin D pre-surgery is controversial for those with primary hyperparathyroidism. Low vitamin D levels should be corrected post-parathyroidectomy.
746:
loss, which may result in a normal anion gap metabolic acidosis. ALP level can be elevated due to bone turnover. Additionally further tests can be completed to rule out other causes and complications of hyperparathyroidism including a
1239:
may be used. Vitamin D deficiency may be treated with vitamin D supplementation. However in patients with CKD, patients should not receive vitamin D supplementation if they are elevated serum phosphate levels or have hypercalcemia.
432:(Ca) concentration in the blood and secrete parathyroid hormone accordingly; if the ionized calcium rises above normal, the secretion of PTH is decreased, whereas when the Ca level falls, parathyroid hormone secretion is increased.
880:
levels are usually high in hyperparathyroidism due to high bone turn over. In primary hyperparathyroidism, levels may remain within the normal range, but this is inappropriately normal given the increased levels of plasma calcium.
243:
Primary hyperparathyroidism may only be cured by removing the adenoma or overactive parathyroid glands. In asymptomatic patients who present with mildly elevated blood calcium levels, with otherwise normal kidneys, and with normal
265:
These "asymptomatic" patients may have other symptoms such as depression, anxiety, gastrointestinal distress, and neuromuscular problems that are not counted as symptoms. The problem is often picked up incidentally during
864:
In primary hyperparathyroidism, serum phosphate levels are abnormally low as a result of decreased reabsorption of phosphate in the kidney tubules. However, this is only present in about 50% of cases. This contrasts with
416:( C-cells) are derived when the ultimopharyngeal bodies fuse with the posterolateral thyroid. The parathyroid glands separates from the pharyngeal wall and attaches to the posterior thyroid during the 7th week of
4412:
4397:
4382:
3118:
his constellation of symptoms has led to the mnemonic "Stones, bones, abdominal moans, and psychic groans," which is used to recall the signs and symptoms of hypercalcemia, particularly as a result of primary
3626:"Minimally invasive parathyroidectomy guided by intraoperative parathyroid hormone monitoring (IOPTH) and preoperative imaging versus bilateral neck exploration for primary hyperparathyroidism in adults"
327:
In secondary hyperparathyroidism due to lack of vitamin D absorption, the parathyroid gland is behaving normally; clinical problems are due to bone resorption and manifest as bone syndromes such as
1508:
560:
Secondary hyperparathyroidism occurs if the calcium level is abnormally low. The normal glands respond by secreting parathyroid hormone at a persistently high rate. This typically occurs when the
1076:
causes. Other causes include decreased skin synthesis of vitamin D such as decreased exposure to sunlight and skin disorders. Insufficient vitamin D synthesis such as defective 25-hydroxylation,
376:
although a causal link has not yet been established. The most common causes for secondary hyperparathyroidism include vitamin D deficiency, chronic kidney disease, inadequate calcium intake,
635:. Once an elevated PTH has been confirmed, the goal of diagnosis is to determine the type of hyperparathyroidism (primary, secondary, or tertiary hyperparathyroidism) by obtaining a serum
252:
may also be used to decrease PTH levels in those unable to have surgery although it is not a cure. In patients with very high blood calcium levels, treatment may include large amounts of
1219:
In patients with secondary hyperparathyroidism, the high PTH levels are an appropriate response to low calcium and treatment must be directed at the underlying cause of this (usually
2717:
Minisola S, Arnold A, Belaya Z, Brandi ML, Clarke BL, Hannan FM, Hofbauer LC, Insogna KL, Lacroix A, Liberman U, Palermo A, Pepe J, Rizzoli R, Wermers R, Thakker RV (November 2022).
1364:
excretion (a direct result of the high plasma PTH levels). Together, the calcium and phosphate tend to precipitate out as water-insoluble salts, which readily form solid βstonesβ.
4175:
819:
can present with similar lab changes. In this condition, the calcium creatinine clearance ratio, however, is typically under 0.01 due to the low levels urine calcium.
2655:
324:. Parathyroid adenomas are very rarely detectable on clinical examination. Surgical removal of a parathyroid tumor eliminates the symptoms in most patients.
321:
4125:
Zink AR, Panzer S, Fesq-Martin M, Burger-Heinrich E, Wahl J, Nerlich AG (January 2005). "Evidence for a 7000-year-old case of primary hyperparathyroidism".
1307:. The prevalence of vitamin D deficiency is about 50% of the world population and chronic kidney disease prevalence is 15% of the United States population.
4200:
3393:"KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)"
529:
reabsorption to lower the serum phosphate. This decreases formation of insoluble calcium phosphate salts leading to an increase in serum ionized calcium.
1500:
1235:
may be treated by decreasing dietary intake of phosphate. If phosphate remains persistently elevated above 5.5 mg/dL with dietary restriction, then
3673:
Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, Moe SM, Shroff R, Tonelli MA, Toussaint ND, Vervloet MG, Leonard MB (July 2017).
1649:
Randle RW, Balentine CJ, Wendt E, Schneider DF, Chen H, Sippel RS (July 2016). "Should vitamin D deficiency be corrected before parathyroidectomy?".
595:) by the liver, from where it is transported via the circulation to the kidneys, and it is converted into the active hormone, 1,25 dihydroxyvitamin D
3882:
3675:"Executive summary of the 2017 KDIGO Chronic Kidney DiseaseβMineral and Bone Disorder (CKD-MBD) Guideline Update: what's changed and why it matters"
1263:, bone pain, or pathological fracture. A systematic review found surgical treatment to be superior regarding cure rates than medical therapy with
4519:
845:
In cases of primary hyperparathyroidism or tertiary hyperparathyroidism, heightened PTH leads to increased serum calcium (hypercalcemia) due to:
388:
The parathyroid is composed of 4 glands with 2 located superiorly and 2 located inferiorly. The parathyroid glands are located on the posterior
1204:
and classically used bilateral neck exploration, however it did not find one approach to be superior to the other in either benefits or risks.
457:. Furthermore, 1Ξ±,25-dihydroxyvitamin D also has an impact on the expression of calcium-sensing receptors, indirectly affecting PTH secretion.
3297:"Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications"
4274:
1360:
are, therefore, often a first indication of hyperparathyroidism, especially since the hypercalcuria is accompanied by an increase in urinary
3281:
2938:
Waghray A, Milas M, Nyalakonda K, Siperstein AE (2013). "Falsely low parathyroid hormone secondary to biotin interference: a case series".
1906:"Secondary Hyperparathyroidism: What is Secondary Hyperparathyroidism? Secondary Hyperparathyroidism Symptoms, Treatment, Diagnosis - UCLA"
816:
209:. Other symptoms may include bone pain, weakness, depression, confusion, and increased urination. Both primary and secondary may result in
4180:
2974:
791:
Differential diagnoses of hypercalcemia include humoral hypercalcemia of malignancy, renal failure, malignant bone destruction (such as
2883:
2703:
4192:
1786:
1147:, and memory. While parathyroidectomy is recommended for all patients with hyperparathyroidism who are symptomatic, indications of
579:, or from a lack of exposure of the skin to sunlight, so the body cannot make its own vitamin D from cholesterol. The resulting
3522:"Prolonged high-dose phosphate treatment: a risk factor for tertiary hyperparathyroidism in X-linked hypophosphatemic rickets"
3148:
2697:
2632:
361:
2238:
2262:
989:
365:
3113:
3624:
Ahmadieh H, Kreidieh O, Akl EA, El-Hajj
Fuleihan G (2020-10-21). Cochrane Metabolic and Endocrine Disorders Group (ed.).
979:
892:
imaging methods are used by surgeons to locate which parathyroid gland is responsible for hyperparathyroidism or to find
320:(brachyonychia) may be indicative of bone resorption. Radiographically, hyperparathyroidism has a pathognomic finding of
269:
for other reasons, and the test results show a higher amount of calcium in the blood than normal. Many people only have
1769:
Harrison TR, Adams RD, Bennett Jr IL, Resnick WH, Thorn GW, Wintrobe MM (1958). "Metabolic and
Endocrine Disorders.".
4267:
2598:
869:
and tertiary hyperparathyroidism, in which serum phosphate levels are generally elevated because of kidney disease.
3726:"Comments on 'KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease'"
3043:
Schweighofer-Zwink G, Hehenwarter L, Rendl G, Rettenbacher L, Langsteger W, Beheshti M, Pirich C (February 2019).
510:
2038:"Thiazide-Associated Hypercalcemia: Incidence and Association With Primary Hyperparathyroidism Over Two Decades"
485:
differentiation. 3) PTH will also directly activate osteoclasts to cause bone resorption through degradation of
4514:
4304:
4327:
2884:"A condition that causes an imbalance of calcium in the body-Hyperparathyroidism - Diagnosis & treatment"
1891:
1034:
866:
397:
197:
1905:
4332:
4260:
1096:
975:
546:
4322:
3875:
2835:"Diagnosis of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Fourth International Workshop"
932:
417:
405:
401:
240:. The diagnosis of primary hyperparathyroidism is made by finding elevated calcium and PTH in the blood.
193:
2834:
352:. Radiation exposure increases the risk of primary hyperparathyroidism. Additional risk factors include
3521:
901:
506:
441:
2327:
1804:
968:
542:
157:
4220:
2191:"Environmental chemicals and metabolic disruption in primary and secondary human parathyroid tumors"
4427:
4337:
4299:
1783:
1602:"Should Symptoms Be Considered an Indication for Parathyroidectomy in Primary Hyperparathyroidism?"
1568:
Allerheiligen DA, Schoeber J, Houston RE, Mohl VK, Wildman KM (April 1998). "Hyperparathyroidism".
1009:
514:
445:
380:. Tertiary hyperparathyroidism most commonly occurs from prolonged secondary hyperparathyroidism.
4009:
Yeh MW, Ituarte PH, Zhou HC, Nishimoto S, Amy Liu IL, Harari A, Haigh PI, Adams AL (2013-03-01).
2151:
1194:
1119:
is a curative therapy for symptomatic hyperparathyroidism. Additionally, it decrease the risk of
1064:. Vitamin D deficiency can result from malabsorption or decreased vitamin D intake such as with
948:
550:
450:
78:
3269:
1002:. Other mutations that have been linked to parathyroid neoplasia include mutations in the genes
4215:
3140:
2366:
1300:
1224:
1065:
1061:
732:
600:
554:
518:
233:
201:
129:
4467:
2982:
1227:). If this is successful, PTH levels return to normal levels, unless PTH secretion has become
952:
812:
409:
270:
3820:
Dulfer RR, Franssen GJ, Hesselink DA, Hoorn EJ, van Eijck CH, van
Ginhoven TM (2017-05-18).
3132:
2908:
2687:
4391:
1989:"Lithium-associated hyperparathyroidism: report of four cases and review of the literature"
1892:"Rugger jersey spine (hyperparathyroidism) | Radiology Reference Article | Radiopaedia.org"
1685:
1304:
1220:
1168:
1120:
1085:
1057:
1022:
877:
808:
465:
PTH stimulates the bones to release calcium through multiple mechanisms. 1) PTH stimulates
336:
229:
224:. Most of the remainder are due to several of these adenomas. Very rarely it may be due to
125:
4189:
2998:"Will 18F-fluorocholine PET/CT replace other methods of preoperative parathyroid imaging?"
2036:
Griebeler ML, Kearns AE, Ryu E, Thapa P, Hathcock MA, Melton LJ, Wermers RA (March 2016).
1026:
Lithium-associated hyperparathyroidism is usually caused by a single parathyroid adenoma.
8:
4416:
4283:
3821:
3435:
2540:
1336:
1158:
24-hour urinary calcium >250 mg/day in women and >300 mg/day in men (see
1128:
1077:
1038:
944:
925:
764:
723:
538:
413:
369:
221:
181:
113:
4011:"Incidence and Prevalence of Primary Hyperparathyroidism in a Racially Mixed Population"
3986:
3959:
3216:
Sulaiman L, Nilsson IL, Juhlin CC, Haglund F, HΓΆΓΆg A, Larsson C, Hashemi J (June 2012).
2753:
2718:
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4291:
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4045:
4010:
3937:
3857:
3650:
3625:
3601:
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3557:
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3373:
3242:
3217:
3193:
3168:
2997:
2810:
2785:
2766:
2689:
Primary, Secondary and
Tertiary Hyperparathyroidism: Diagnostic and Therapeutic Updates
2505:
2480:
2451:
2215:
2190:
2127:
2094:
2070:
2037:
1969:
1832:
1746:
1721:
1626:
1601:
1449:
1208:
1069:
993:
940:
893:
454:
357:
225:
117:
64:
4492:
4421:
3822:"Systematic review of surgical and medical treatment for tertiary hyperparathyroidism"
1949:
1437:
4438:
4245:
4233:
4142:
4099:
4091:
4050:
4032:
3991:
3929:
3849:
3841:
3802:
3794:
3755:
3747:
3706:
3655:
3606:
3549:
3541:
3537:
3506:
3494:
3486:
3414:
3403:(113). Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group: S1β130.
3365:
3357:
3337:
3318:
3247:
3198:
3144:
3133:
3105:
3074:
3066:
3025:
3017:
2955:
2920:
2862:
2854:
2815:
2770:
2758:
2740:
2693:
2628:
2594:
2568:
2560:
2510:
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2438:
2394:
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2347:
2300:
2220:
2171:
2132:
2114:
2075:
2057:
2018:
2010:
1973:
1961:
1953:
1873:
1836:
1824:
1751:
1697:
1666:
1631:
1577:
1550:
1453:
1441:
1248:
1232:
1201:
1197:
1144:
1116:
1042:
936:
580:
253:
189:
140:
52:
4478:
3960:"Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients"
3941:
3861:
3561:
3377:
2418:
1348:
despite the high levels of PTH in the blood, because hyperparathyroidism results in
4225:
4134:
4111:
4081:
4040:
4022:
3981:
3976:
3971:
3919:
3833:
3786:
3737:
3696:
3686:
3645:
3641:
3637:
3596:
3588:
3533:
3476:
3404:
3349:
3308:
3237:
3229:
3188:
3180:
3056:
3045:"Darstellung und Lokalisation von NebenschilddrΓΌsenadenomen mit Fβ18 Cholin PET/CT"
3009:
2947:
2846:
2805:
2797:
2748:
2730:
2552:
2500:
2492:
2446:
2430:
2378:
2339:
2210:
2202:
2189:
Hu X, Saunders N, Safley S, Smith MR, Liang Y, Tran V, et al. (January 2021).
2163:
2122:
2106:
2065:
2049:
2000:
1945:
1863:
1816:
1741:
1733:
1658:
1621:
1613:
1433:
1236:
1178:
1073:
1018:
999:
921:
889:
792:
780:
772:
2833:
Eastell R, Brandi ML, Costa AG, D'Amour P, Shoback DM, Thakker RV (October 2014).
2382:
1135:. Studies have also found that parathyroidectomy for hyperparathyroidism improves
4432:
4353:
4196:
4170:
4086:
4069:
1790:
1339:(PTH) promotes the reabsorption of calcium from the kidneys' tubular fluid, thus
1296:
1084:
bone disease in secondary hyperparathyroidism caused by kidney failure is termed
804:
776:
748:
588:
492:
478:
429:
541:
in the proximal convoluted tubule. This enzyme activation hydroxylates inactive
4481:
4443:
3691:
3674:
3093:
3013:
2801:
2623:
Le T, Bhushan V, Sochat M, Kallianos K, Chavda Y, Zureick AH, Kalani M (2017).
2496:
2343:
2292:
2206:
1820:
1256:
739:
489:
and organic material. This then causes bone to release calcium into the blood.
486:
349:
3353:
3270:"Hyperparathyroidism Resulting From Lithium Treatment Remains Underrecognized"
3061:
3044:
3042:
2110:
1662:
4508:
4165:
4095:
4036:
3958:
Ballinger AE, Palmer SC, Nistor I, Craig JC, Strippoli GF (9 December 2014).
3845:
3798:
3751:
3545:
3490:
3481:
3464:
3361:
3070:
3021:
2858:
2744:
2564:
2442:
2390:
2351:
2118:
2061:
2014:
1957:
1617:
1353:
1349:
1260:
796:
377:
145:
57:
4406:
4138:
3908:"Calcimimetics--new drugs with the potential to control hyperparathyroidism"
2907:
Allerheiligen DA, Schoeber J, Houston RE, Mohl VK, Wildman KM (1998-04-15).
2719:"Epidemiology, Pathophysiology, and Genetics of Primary Hyperparathyroidism"
1933:
1080:, and 1-alpha 25-hydroxylation can also contribute to vitamin D deficiency.
908:
tend to be more and more performed due to excellent diagnostic performance.
4237:
4146:
4103:
4054:
3995:
3924:
3907:
3853:
3806:
3759:
3710:
3659:
3610:
3553:
3498:
3418:
3369:
3322:
3313:
3296:
3251:
3202:
3109:
3078:
3029:
2959:
2866:
2819:
2762:
2514:
2460:
2434:
2398:
2304:
2224:
2175:
2136:
2079:
2022:
1965:
1877:
1828:
1755:
1701:
1670:
1635:
1554:
1445:
1357:
1276:
1132:
1124:
1046:
964:
960:
756:
568:
332:
317:
313:
305:
293:
277:
245:
237:
217:
210:
206:
200:). Symptoms of hyperparathyroidism are caused by inappropriately normal or
133:
83:
70:
33:
4229:
3933:
2924:
2572:
1793:. National Endocrine and Metabolic Diseases Information Service. May 2006.
1581:
1251:
is indicated in tertiary hyperparathyroidism for patients who have severe
849:
increased bone resorption, allowing the flow of calcium from bone to blood
4462:
4027:
3790:
3592:
2850:
2053:
1737:
897:
743:
632:
45:
4374:
3742:
3725:
3463:
van der Plas WY, Noltes ME, van
Ginhoven TM, Kruijff S (December 2020).
3409:
3392:
3233:
2005:
1988:
904:
was the main method used or this indication. Recently 18F-fluorocholine
4487:
3774:
3430:
3428:
3184:
2951:
2167:
1805:"Otoconia degeneration as a consequence of primary hyperparathyroidism"
1773:(Third ed.). New York: McGraw-Hill Book Company. pp. 575β578.
1280:
1264:
1252:
760:
561:
482:
466:
309:
301:
284:, weakness, lethargy, fatigue, depression, bone pain, muscle soreness (
266:
249:
161:
4252:
3837:
3701:
2735:
2656:"Primary Hyperparathyroidism: A Case-based Review | Clinician Reviews"
1868:
1851:
4473:
3462:
2481:"Parathyroid hormone: anabolic and catabolic actions on the skeleton"
1361:
1316:
752:
727:
719:
592:
576:
526:
474:
4124:
3425:
2790:
Best
Practice & Research Clinical Endocrinology & Metabolism
2593:(Fourth ed.). New York: W.H. Freeman and Company. p. 707.
2239:"Secondary Hyperparathyroidism - an overview | ScienceDirect Topics"
627:
Pepper & Salt, classical X-Ray appearance of hyperparathyroidism
3623:
2996:
Giovanella L, Bacigalupo L, Treglia G, Piccardo A (February 2021).
2995:
2367:"Extracellular Calcium Sensing and Extracellular Calcium Signaling"
2263:"Tertiary Hyperparathyroidism - an overview | ScienceDirect Topics"
1284:
1228:
1140:
800:
615:
393:
297:
281:
1108:
Treatment depends on the type of hyperparathyroidism encountered.
623:
583:
is usually due to a partial combination of both factors. Vitamin D
73:, weakness, depression, bone pains, confusion, increased urination
1148:
1136:
1053:
768:
715:
636:
522:
389:
353:
328:
285:
41:
3465:"Secondary and Tertiary Hyperparathyroidism: A Narrative Review"
3169:"Hyperparathyroid genes: sequences reveal answers and questions"
2937:
2906:
1722:"Renal control of calcium, phosphate, and magnesium homeostasis"
1567:
216:
In 80% of cases, primary hyperparathyroidism is due to a single
4401:
4386:
4184:
2419:"The Regulation of Parathyroid Hormone Secretion and Synthesis"
2325:
905:
289:
4070:"Secondary Hyperparathyroidism: Pathophysiology and Treatment"
3672:
1856:
Journal of the
European Academy of Dermatology and Venereology
1852:"Acquired racquet nails: a useful sign of hyperparathyroidism"
1768:
525:. PTH also acts on the proximal convoluted tubule to decrease
412:
is derived from the 4th pharyngeal pouch ventral wing and the
368:, neonatal severe hyperparathyroidism also increase the risk.
3577:"Clinical practice. Asymptomatic primary hyperparathyroidism"
2832:
1648:
1541:
Michels TC, Kelly KM (August 2013). "Parathyroid disorders".
1050:
1004:
470:
185:
4206:
3819:
3215:
2786:"Familial hypocalciuric hypercalcemia and related disorders"
2332:
Operative
Techniques in Otolaryngology-Head and Neck Surgery
2326:
Scharpf J, Kyriazidis N, Kamani D, Randolph G (2016-09-01).
2095:"Hyperparathyroidism jaw tumour syndrome: a pictoral review"
2093:
du Preez H, Adams A, Richards P, Whitley S (December 2016).
2092:
1931:
1177:
Bone density > 2.5 standard deviations below peak (i.e.,
1155:
Asymptomatic hyperparathyroidism with any of the following:
3135:
The Nature of
Disease: Pathology for the Health Professions
1932:
Bilezikian JP, Bandeira L, Khan A, Cusano NE (2018-01-13).
1315:
The oldest known case was found in a cadaver from an Early
1165:
serum calcium > 1 mg/dl above upper limit of normal
984:
408:
are derived from the 4th pharyngeal pouch dorsal wing. The
3957:
2716:
2685:
1174:
Estimated glomerular filtration rate <60 mL/min/1.73 m2
896:
parathyroid adenomas, most commonly found in the anterior
599:. Thus, a third cause of secondary hyperparathyroidism is
549:). Active vitamin D allows for calcium absorption through
2538:
603:. Here the ability to manufacture 1,25 dihydroxyvitamin D
373:
248:, monitoring may be all that is required. The medication
3338:"Vitamin D and the Bariatric Surgical Patient: A Review"
3335:
3218:"Genetic characterization of large parathyroid adenomas"
2622:
1060:(caused by lack of sunlight, diet or malabsorption) and
1037:
is due to physiological (i.e. appropriate) secretion of
228:. Secondary hyperparathyroidism typically occurs due to
4008:
3458:
3456:
3336:
Compher CW, Badellino KO, Boullata JI (February 2008).
2035:
1200:
compared the surgical procedures of minimally invasive
4015:
The Journal of Clinical Endocrinology & Metabolism
2839:
The Journal of Clinical Endocrinology & Metabolism
2042:
The Journal of Clinical Endocrinology & Metabolism
1726:
Clinical Journal of the American Society of Nephrology
1606:
Clinical Medicine Insights. Endocrinology and Diabetes
1151:
for those who are asymptomatic include the following:
440:
Rapid PTH regulation is controlled by the parathyroid
3772:
2188:
1352:, which increases the urinary calcium concentration (
955:. This disease is often characterized by the quartet
619:
Calcification in the brain due to hyperparathyroidism
473:
which causes differentiation of the osteoblasts into
4364:
4201:
Endocrine and Metabolic Diseases Information Service
4074:
The Journal of the American Board of Family Medicine
3912:
The Journal of Clinical Endocrinology and Metabolism
3574:
3453:
2539:
Arnaud CD, Tenenhouse AM, Rasmussen H (March 1967).
2149:
1802:
998:), which is also associated with the adrenal tumor
360:exposure. A number of genetic conditions including
16:
Increase in parathyroid hormone levels in the blood
3519:
1927:
1925:
1849:
1719:
1187:Nephrolithiasis seen on imaging (ultrasound or CT)
404:are derived from the 3rd pharyngeal pouch and the
3953:
3951:
3876:"Sensipar: Highlights of Prescribing Information"
3263:
3261:
2328:"Anatomy and embryology of the parathyroid gland"
1986:
1561:
974:In a minority of cases, this occurs as part of a
943:themselves. The oversecretion of PTH is due to a
811:, multiple endocrine adenomatosis syndromes, and
4506:
2681:
2679:
2677:
2675:
957:stones, bones, groans, and psychiatric overtones
833:pattern. The currently accepted test for PTH is
803:), thiazide diuretics, lithium, immobilization,
188:. This occurs from a disorder either within the
4067:
3568:
3520:MΓ€kitie O, Kooh SW, Sochett E (February 2003).
2478:
2321:
2319:
2299:, Treasure Island (FL): StatPearls Publishing,
1922:
1850:Baran R, Turkmani MG, Mubki T (February 2014).
1803:McKenna K, Rahman K, Parham K (November 2020).
288:), joint pain, decreased appetite, feelings of
276:Common manifestations of hypercalcemia include
3948:
3773:Palumbo V, Damiano G, Messina M (2021-04-30).
3390:
3258:
3124:
2584:
2582:
1987:Szalat A, Mazeh H, Freund HR (February 2009).
1536:
1534:
1532:
1530:
1528:
1526:
1424:Fraser WD (July 2009). "Hyperparathyroidism".
1419:
1417:
1415:
1413:
1411:
1409:
1407:
1405:
1403:
1401:
575:can result from a deficient dietary intake of
505:Calcium reabsorption in the nephron occurs in
4268:
3209:
3139:. Lippincott Williams & Wilkins. p.
3091:
2686:Gasparri G, Camandona M, Palestini N (2015).
2672:
2423:Journal of the American Society of Nephrology
2416:
2334:. Surgical Treatment of Hyperparathyroidism.
2286:
2284:
2282:
2152:"Benign Familial Hypocalciuric Hypercalcemia"
1715:
1713:
1711:
1495:
1493:
1491:
1489:
1487:
1485:
1483:
1399:
1397:
1395:
1393:
1391:
1389:
1387:
1385:
1383:
1381:
571:is present. A lack of 1,25 dihydroxyvitamin D
2972:
2364:
2316:
2290:
2150:Varghese J, Rich T, Jimenez C (March 2011).
1762:
1595:
1593:
1591:
1540:
1481:
1479:
1477:
1475:
1473:
1471:
1469:
1467:
1465:
1463:
3964:The Cochrane Database of Systematic Reviews
3575:Bilezikian JP, Silverberg SJ (April 2004).
2579:
1599:
1523:
817:familial benign hypocalciuric hypercalcamia
607:is compromised, resulting in hypocalcemia.
4275:
4261:
2783:
2618:
2616:
2614:
2612:
2610:
2279:
1720:Blaine J, Chonchol M, Levi M (July 2015).
1708:
1378:
751:for familial hypocalciuric hypercalcemia,
631:The gold standard of diagnosis is the PTH
591:) is converted to 25-hydroxyvitamin D (or
364:, hyperparathyroidism-jaw tumor syndrome,
32:
4219:
4118:
4085:
4044:
4026:
3985:
3975:
3923:
3741:
3700:
3690:
3649:
3600:
3480:
3408:
3312:
3288:
3267:
3241:
3192:
3160:
3130:
3060:
2809:
2752:
2734:
2504:
2450:
2214:
2126:
2069:
2004:
1867:
1745:
1625:
1588:
1460:
1344:calcium excreted in the urine per day is
786:
4174:) is being considered for deletion. See
3775:"Tertiary hyperparathyroidism: a review"
3723:
1683:
920:
622:
614:
521:to increase calcium reabsorption in the
491:
4282:
4205:
3630:Cochrane Database of Systematic Reviews
3094:"A practical approach to hypercalcemia"
2607:
1171:> 30% below normal for patient's age
872:
855:increased intestinal calcium absorption
4520:Endocrine-related cutaneous conditions
4507:
3391:Eckardt KU, Kasiske BL (August 2009).
2588:
2417:Kumar R, Thompson JR (February 2011).
1423:
767:, and genetic testing. Additionally a
533:Effects of PTH on the Small Intestines
428:Normal parathyroid glands measure the
362:multiple endocrine neoplasia syndromes
196:) or as response to external stimuli (
4256:
3116:from the original on 21 August 2014.
2966:
2878:
2876:
2650:
2648:
2646:
2644:
2534:
2532:
2530:
2528:
2526:
2524:
2479:Silva BC, Bilezikian JP (June 2015).
2474:
2472:
2470:
2412:
2410:
2408:
714:Primary hyperparathyroidism has high
259:
4068:Saliba W, El-Haddad B (2009-09-01).
3440:The Lecturio Medical Concept Library
3294:
3166:
2723:Journal of Bone and Mineral Research
1056:levels). The most common causes are
435:
366:familial hypocalciuric hypercalcemia
4208:The New England Journal of Medicine
3905:
3581:The New England Journal of Medicine
2784:Lee JY, Shoback DM (October 2018).
2627:. New York: Mcgraw-Hill Education.
2625:First aid for the USMLE step 1 2017
2557:10.1146/annurev.ph.29.030167.002025
2365:Brown EM, MacLeod RJ (2001-01-01).
1511:from the original on 4 October 2016
963:, hypercalcemia, constipation, and
884:
852:reduced kidney clearance of calcium
735:and secondary hyperparathyroidism.
13:
3092:Carroll MF, Schade DS (May 2003).
2873:
2641:
2521:
2467:
2405:
1600:McDow AD, Sippel RS (2018-01-01).
1267:with lower risk of complications.
992:(caused by a mutation in the gene
982:(caused by a mutation in the gene
859:
14:
4531:
4178:to help reach a consensus. βΊ
4157:
3049:Wiener Medizinische Wochenschrift
2979:BrighamRAD Teaching Case Database
1993:European Journal of Endocrinology
1231:(tertiary hyperparathyroidism).
911:
902:technetium sestamibi scintigraphy
840:
537:PTH stimulates the production of
3538:10.1046/j.1365-2265.2003.01685.x
3397:Kidney International Supplements
3284:from the original on 2010-07-01.
2706:from the original on 2017-09-08.
1651:The Journal of Surgical Research
1270:
567:levels in the blood are low and
4061:
4002:
3899:
3888:from the original on 2014-10-05
3868:
3813:
3766:
3717:
3666:
3617:
3513:
3469:Scandinavian Journal of Surgery
3384:
3329:
3085:
3036:
2989:
2973:Neish AS, Nagel JS, Holman BL.
2931:
2900:
2826:
2777:
2710:
2485:Current Opinion in Pharmacology
2358:
2255:
2231:
2182:
2143:
2086:
2029:
1980:
1898:
1884:
1843:
1796:
1777:
1771:Principles of Internal Medicine
1329:
1319:cemetery in southwest Germany.
1290:
547:(1, 25 dihydroxycholecalciferol
477:. 2) PTH inhibits secretion of
4305:Pseudopseudohypoparathyroidism
3977:10.1002/14651858.CD006254.pub2
3724:Andrassy KM (September 2013).
3642:10.1002/14651858.CD010787.pub2
1677:
1642:
1214:
822:
738:Hyperparathyroidism can cause
691:Secondary hyperparathyroidism
496:Effects of PTH bone resorption
383:
1:
4163:
2383:10.1152/physrev.2001.81.1.239
1950:10.1016/S0140-6736(17)31430-7
1501:"Primary Hyperparathyroidism"
1438:10.1016/S0140-6736(09)60507-9
1371:
1243:
1207:Surgery can rarely result in
1035:Secondary hyperparathyroidism
959:referring to the presence of
867:secondary hyperparathyroidism
827:
708:Tertiary hyperparathyroidism
639:, phosphate, and PTH levels.
501:Effects of PTH on the Kidneys
469:which increase expression of
198:secondary hyperparathyroidism
4087:10.3122/jabfm.2009.05.090026
2291:Rosen RD, Bordoni B (2023),
1111:
1103:
1097:Tertiary hyperparathyroidism
1029:
1021:who are receiving long-term
976:multiple endocrine neoplasia
783:if there is concern for it.
674:Primary hyperparathyroidism
610:
423:
7:
2545:Annual Review of Physiology
1091:
933:Primary hyperparathyroidism
461:Effects of PTH on the Bones
418:human embryonic development
406:superior parathyroid glands
402:inferior parathyroid glands
194:primary hyperparathyroidism
10:
4536:
3826:British Journal of Surgery
3692:10.1016/j.kint.2017.04.006
3014:10.1007/s12020-020-02487-y
2802:10.1016/j.beem.2018.05.004
2497:10.1016/j.coph.2015.03.005
2344:10.1016/j.otot.2016.06.003
2207:10.1016/j.surg.2020.06.010
1821:10.1016/j.mehy.2020.109982
1684:Taniegra ED (2004-01-15).
1310:
1159:
916:
775:can be done to assess for
507:proximal convoluted tubule
213:(weakening of the bones).
116:, multiple benign tumors,
4453:
4368:
4346:
4313:
4290:
3354:10.1007/s11695-007-9289-6
3098:American Family Physician
3062:10.1007/s10354-018-0660-0
2913:American Family Physician
2293:"Embryology, Parathyroid"
2111:10.1007/s13244-016-0519-0
1690:American Family Physician
1663:10.1016/j.jss.2016.04.022
1570:American Family Physician
1543:American Family Physician
543:25-hydroxycholecalciferol
446:calcium sensing receptors
392:and are derived from the
342:
254:intravenous normal saline
167:
158:intravenous normal saline
152:
139:
105:
97:
89:
77:
63:
51:
40:
31:
26:
4338:Osteitis fibrosa cystica
4300:Pseudohypoparathyroidism
4176:templates for discussion
3482:10.1177/1457496919866015
3222:Endocrine-Related Cancer
1618:10.1177/1179551418785135
1322:
1259:(>11.0 mg/ dL),
515:distal convoluted tubule
451:1Ξ±,25-dihydroxyvitamin D
316:. A history of acquired
304:, cognitive impairment,
4139:10.1001/jama.293.1.40-c
1576:(8): 1795β802, 1807β8.
1068:, small bowel disease,
978:(MEN) syndrome, either
949:parathyroid hyperplasia
749:24-hour urinary calcium
562:1,25 dihydroxyvitamin D
511:ascending Loop of Henle
3925:10.1210/jcem.83.4.4799
3779:La Clinica Terapeutica
3526:Clinical Endocrinology
3314:10.1210/edrv.22.4.0437
3295:Lips P (August 2001).
2435:10.1681/ASN.2010020186
1301:chronic kidney disease
1225:chronic kidney failure
1062:chronic kidney failure
929:
813:granulomatous diseases
787:Differential diagnosis
733:chronic kidney failure
628:
620:
601:chronic kidney disease
497:
372:have been linked with
234:chronic kidney disease
202:elevated blood calcium
130:chronic kidney disease
4515:Parathyroid disorders
4230:10.1056/NEJMcp1714213
3906:Ott SM (April 1998).
3436:"Hyperparathyroidism"
3268:Pomerantz JM (2010).
3131:McConnell TH (2007).
2975:"Parathyroid Adenoma"
2909:"Hyperparathyroidism"
2541:"Parathyroid Hormone"
2371:Physiological Reviews
2267:www.sciencedirect.com
2243:www.sciencedirect.com
2099:Insights into Imaging
1934:"Hyperparathyroidism"
1686:"Hyperparathyroidism"
953:parathyroid carcinoma
924:
626:
618:
495:
410:ultimopharyngeal body
271:non-specific symptoms
236:, or other causes of
156:Monitoring, surgery,
4028:10.1210/jc.2012-4022
3791:10.7417/CT.2021.2322
3730:Kidney International
3679:Kidney International
3593:10.1056/NEJMcp032200
3119:hyperparathyroidism.
2851:10.1210/jc.2014-1414
2054:10.1210/jc.2015-3964
1738:10.2215/CJN.09750913
1612:: 1179551418785135.
1305:vitamin D deficiency
1255:, severe persistent
1221:vitamin D deficiency
1169:Creatinine clearance
1133:bone mineral density
1086:renal osteodystrophy
1058:vitamin D deficiency
878:Alkaline phosphatase
873:Alkaline phosphatase
809:milk alkali syndrome
771:without contrast or
545:to active vitamin D
414:parafollicular cells
400:. Specifically, the
370:Parathyroid adenomas
337:renal osteodystrophy
230:vitamin D deficiency
184:(PTH) levels in the
126:vitamin D deficiency
4493:Hyperparathyroidism
4315:Hyperparathyroidism
4284:Parathyroid disease
4181:Hyperparathyroidism
3743:10.1038/ki.2013.243
3410:10.1038/ki.2009.188
3274:Drug Benefit Trends
3234:10.1530/ERC-11-0140
2006:10.1530/EJE-08-0620
1784:Hyperparathyroidism
1337:parathyroid hormone
1129:fragility fractures
1078:1-alpha hydroxylase
1039:parathyroid hormone
945:parathyroid adenoma
926:Parathyroid adenoma
765:fragility fractures
742:and increase renal
539:1-alpha-hydroxylase
396:of the 3rd and 4th
322:rugger jersey spine
222:parathyroid adenoma
182:parathyroid hormone
178:Hyperparathyroidism
148:and high PTH levels
114:parathyroid adenoma
27:Hyperparathyroidism
4454:External resources
4292:Hypoparathyroidism
4195:2011-05-24 at the
3185:10.4158/EP11067.RA
3179:(Suppl 3): 18β27.
3173:Endocrine Practice
2952:10.4158/EP12158.OR
2940:Endocrine Practice
2168:10.4158/EP10308.RA
2156:Endocrine Practice
1944:(10116): 168β178.
1910:www.uclahealth.org
1809:Medical Hypotheses
1789:2011-05-24 at the
1209:hypoparathyroidism
1184:People age < 50
1070:pancreatic disease
1043:parathyroid glands
941:parathyroid glands
930:
629:
621:
513:. PTH acts on the
498:
455:vitamin D receptor
398:pharyngeal pouches
358:thiazide diuretics
292:, abdominal pain,
260:Signs and symptoms
226:parathyroid cancer
190:parathyroid glands
180:is an increase in
146:High blood calcium
118:parathyroid cancer
101:Primary, secondary
4502:
4501:
4362:
4361:
4214:(11): 1050β1059.
3838:10.1002/bjs.10554
3301:Endocrine Reviews
3150:978-0-7817-5317-3
2845:(10): 3570β3579.
2736:10.1002/jbmr.4665
2729:(11): 2315β2329.
2699:978-88-470-5758-6
2634:978-1-259-83763-0
2589:Stryer L (1995).
1869:10.1111/jdv.12187
1249:Parathyroidectomy
1237:phosphate binders
1233:Hyperphosphatemia
1202:parathyroidectomy
1198:systematic review
1117:Parathyroidectomy
726:levels and a low
712:
711:
581:hypovitaminosis D
453:binding with the
442:G-protein coupled
436:Regulation of PTH
238:low blood calcium
175:
174:
141:Diagnostic method
134:low blood calcium
21:Medical condition
4527:
4366:
4365:
4277:
4270:
4263:
4254:
4253:
4249:
4223:
4151:
4150:
4122:
4116:
4115:
4089:
4065:
4059:
4058:
4048:
4030:
4021:(3): 1122β1129.
4006:
4000:
3999:
3989:
3979:
3970:(12): CD006254.
3955:
3946:
3945:
3927:
3903:
3897:
3896:
3894:
3893:
3887:
3880:
3872:
3866:
3865:
3817:
3811:
3810:
3770:
3764:
3763:
3745:
3721:
3715:
3714:
3704:
3694:
3670:
3664:
3663:
3653:
3636:(10): CD010787.
3621:
3615:
3614:
3604:
3572:
3566:
3565:
3517:
3511:
3510:
3484:
3460:
3451:
3450:
3448:
3446:
3432:
3423:
3422:
3412:
3388:
3382:
3381:
3333:
3327:
3326:
3316:
3292:
3286:
3285:
3265:
3256:
3255:
3245:
3213:
3207:
3206:
3196:
3167:Marx SJ (2011).
3164:
3158:
3157:
3138:
3128:
3122:
3121:
3089:
3083:
3082:
3064:
3040:
3034:
3033:
2993:
2987:
2986:
2981:. Archived from
2970:
2964:
2963:
2935:
2929:
2928:
2919:(8): 1795β1802.
2904:
2898:
2897:
2895:
2894:
2880:
2871:
2870:
2830:
2824:
2823:
2813:
2781:
2775:
2774:
2756:
2738:
2714:
2708:
2707:
2683:
2670:
2669:
2667:
2666:
2652:
2639:
2638:
2620:
2605:
2604:
2586:
2577:
2576:
2536:
2519:
2518:
2508:
2476:
2465:
2464:
2454:
2414:
2403:
2402:
2362:
2356:
2355:
2323:
2314:
2313:
2312:
2311:
2288:
2277:
2276:
2274:
2273:
2259:
2253:
2252:
2250:
2249:
2235:
2229:
2228:
2218:
2186:
2180:
2179:
2147:
2141:
2140:
2130:
2090:
2084:
2083:
2073:
2048:(3): 1166β1173.
2033:
2027:
2026:
2008:
1984:
1978:
1977:
1929:
1920:
1919:
1917:
1916:
1902:
1896:
1895:
1888:
1882:
1881:
1871:
1847:
1841:
1840:
1800:
1794:
1781:
1775:
1774:
1766:
1760:
1759:
1749:
1717:
1706:
1705:
1681:
1675:
1674:
1646:
1640:
1639:
1629:
1597:
1586:
1585:
1565:
1559:
1558:
1538:
1521:
1520:
1518:
1516:
1497:
1458:
1457:
1432:(9684): 145β58.
1421:
1365:
1333:
1019:bipolar disorder
1000:pheochromocytoma
971:, respectively.
900:. Historically,
890:Nuclear medicine
885:Nuclear medicine
815:. Additionally,
793:multiple myeloma
781:nephrocalcinosis
773:renal ultrasound
755:to evaluate for
642:
641:
479:osteoprotegerina
308:(), vertigo and
36:
24:
23:
4535:
4534:
4530:
4529:
4528:
4526:
4525:
4524:
4505:
4504:
4503:
4498:
4497:
4449:
4448:
4377:
4363:
4358:
4354:Parathyroiditis
4342:
4309:
4286:
4281:
4221:10.1.1.322.5883
4197:Wayback Machine
4179:
4160:
4155:
4154:
4123:
4119:
4066:
4062:
4007:
4003:
3956:
3949:
3904:
3900:
3891:
3889:
3885:
3878:
3874:
3873:
3869:
3818:
3814:
3771:
3767:
3722:
3718:
3671:
3667:
3622:
3618:
3587:(17): 1746β51.
3573:
3569:
3518:
3514:
3461:
3454:
3444:
3442:
3434:
3433:
3426:
3389:
3385:
3342:Obesity Surgery
3334:
3330:
3293:
3289:
3266:
3259:
3214:
3210:
3165:
3161:
3151:
3129:
3125:
3090:
3086:
3041:
3037:
2994:
2990:
2971:
2967:
2936:
2932:
2905:
2901:
2892:
2890:
2882:
2881:
2874:
2831:
2827:
2782:
2778:
2715:
2711:
2700:
2684:
2673:
2664:
2662:
2654:
2653:
2642:
2635:
2621:
2608:
2601:
2587:
2580:
2537:
2522:
2477:
2468:
2415:
2406:
2363:
2359:
2324:
2317:
2309:
2307:
2289:
2280:
2271:
2269:
2261:
2260:
2256:
2247:
2245:
2237:
2236:
2232:
2187:
2183:
2148:
2144:
2091:
2087:
2034:
2030:
1985:
1981:
1930:
1923:
1914:
1912:
1904:
1903:
1899:
1890:
1889:
1885:
1848:
1844:
1801:
1797:
1791:Wayback Machine
1782:
1778:
1767:
1763:
1718:
1709:
1682:
1678:
1647:
1643:
1598:
1589:
1566:
1562:
1539:
1524:
1514:
1512:
1507:. August 2012.
1499:
1498:
1461:
1422:
1379:
1374:
1369:
1368:
1334:
1330:
1325:
1313:
1297:developed world
1293:
1273:
1246:
1217:
1131:, and improves
1121:nephrolithiasis
1114:
1106:
1094:
1045:in response to
1032:
951:, or rarely, a
935:results from a
919:
914:
887:
875:
862:
860:Serum phosphate
843:
830:
825:
805:hyperthyroidism
789:
777:nephrolithiasis
651:Vitamin D Level
613:
606:
598:
589:cholecalciferol
586:
574:
565:
519:collecting duct
438:
430:ionized calcium
426:
386:
345:
262:
120:
22:
17:
12:
11:
5:
4533:
4523:
4522:
4517:
4500:
4499:
4496:
4495:
4484:
4470:
4458:
4457:
4455:
4451:
4450:
4447:
4446:
4435:
4424:
4409:
4394:
4378:
4373:
4372:
4370:
4369:Classification
4360:
4359:
4357:
4356:
4350:
4348:
4344:
4343:
4341:
4340:
4335:
4330:
4325:
4319:
4317:
4311:
4310:
4308:
4307:
4302:
4296:
4294:
4288:
4287:
4280:
4279:
4272:
4265:
4257:
4251:
4250:
4203:
4187:
4159:
4158:External links
4156:
4153:
4152:
4117:
4080:(5): 574β581.
4060:
4001:
3947:
3898:
3867:
3832:(7): 804β813.
3812:
3785:(3): 241β246.
3765:
3736:(3): 622β623.
3716:
3665:
3616:
3567:
3532:(2): 163β168.
3512:
3475:(4): 271β278.
3452:
3424:
3383:
3348:(2): 220β224.
3328:
3307:(4): 477β501.
3287:
3257:
3228:(3): 389β407.
3208:
3159:
3149:
3123:
3104:(9): 1959β66.
3084:
3055:(1β2): 15β24.
3035:
3008:(2): 285β297.
2988:
2985:on 2011-07-16.
2965:
2930:
2899:
2872:
2825:
2796:(5): 609β619.
2776:
2709:
2698:
2671:
2660:www.mdedge.com
2640:
2633:
2606:
2599:
2578:
2551:(1): 349β372.
2520:
2466:
2429:(2): 216β224.
2404:
2377:(1): 239β297.
2357:
2338:(3): 117β121.
2315:
2278:
2254:
2230:
2201:(1): 102β108.
2181:
2142:
2105:(6): 793β800.
2085:
2028:
1999:(2): 317β323.
1979:
1921:
1897:
1883:
1842:
1795:
1776:
1761:
1732:(7): 1257β72.
1707:
1696:(2): 333β339.
1676:
1641:
1587:
1560:
1522:
1459:
1376:
1375:
1373:
1370:
1367:
1366:
1327:
1326:
1324:
1321:
1312:
1309:
1292:
1289:
1272:
1269:
1245:
1242:
1216:
1213:
1191:
1190:
1189:
1188:
1185:
1182:
1175:
1172:
1166:
1163:
1113:
1110:
1105:
1102:
1093:
1090:
1066:gastric bypass
1031:
1028:
1017:Patients with
918:
915:
913:
912:Classification
910:
886:
883:
874:
871:
861:
858:
857:
856:
853:
850:
842:
841:Calcium levels
839:
829:
826:
824:
821:
788:
785:
740:hyperchloremia
710:
709:
706:
703:
700:
697:
693:
692:
689:
686:
683:
680:
676:
675:
672:
669:
666:
663:
659:
658:
655:
652:
649:
646:
612:
609:
604:
596:
584:
572:
563:
487:hydroxyapatite
437:
434:
425:
422:
385:
382:
350:family history
348:do not have a
344:
341:
261:
258:
173:
172:
169:
165:
164:
154:
150:
149:
143:
137:
136:
107:
103:
102:
99:
95:
94:
91:
87:
86:
81:
75:
74:
67:
61:
60:
55:
49:
48:
38:
37:
29:
28:
20:
15:
9:
6:
4:
3:
2:
4532:
4521:
4518:
4516:
4513:
4512:
4510:
4494:
4490:
4489:
4485:
4483:
4480:
4476:
4475:
4471:
4469:
4465:
4464:
4460:
4459:
4456:
4452:
4445:
4441:
4440:
4436:
4434:
4430:
4429:
4425:
4423:
4419:
4418:
4414:
4410:
4408:
4404:
4403:
4399:
4395:
4393:
4389:
4388:
4384:
4380:
4379:
4376:
4371:
4367:
4355:
4352:
4351:
4349:
4345:
4339:
4336:
4334:
4331:
4329:
4326:
4324:
4321:
4320:
4318:
4316:
4312:
4306:
4303:
4301:
4298:
4297:
4295:
4293:
4289:
4285:
4278:
4273:
4271:
4266:
4264:
4259:
4258:
4255:
4247:
4243:
4239:
4235:
4231:
4227:
4222:
4217:
4213:
4209:
4204:
4202:
4198:
4194:
4191:
4188:
4186:
4182:
4177:
4173:
4172:
4167:
4162:
4161:
4148:
4144:
4140:
4136:
4132:
4128:
4121:
4113:
4109:
4105:
4101:
4097:
4093:
4088:
4083:
4079:
4075:
4071:
4064:
4056:
4052:
4047:
4042:
4038:
4034:
4029:
4024:
4020:
4016:
4012:
4005:
3997:
3993:
3988:
3983:
3978:
3973:
3969:
3965:
3961:
3954:
3952:
3943:
3939:
3935:
3931:
3926:
3921:
3918:(4): 1080β2.
3917:
3913:
3909:
3902:
3884:
3881:. Amgen Inc.
3877:
3871:
3863:
3859:
3855:
3851:
3847:
3843:
3839:
3835:
3831:
3827:
3823:
3816:
3808:
3804:
3800:
3796:
3792:
3788:
3784:
3780:
3776:
3769:
3761:
3757:
3753:
3749:
3744:
3739:
3735:
3731:
3727:
3720:
3712:
3708:
3703:
3698:
3693:
3688:
3684:
3680:
3676:
3669:
3661:
3657:
3652:
3647:
3643:
3639:
3635:
3631:
3627:
3620:
3612:
3608:
3603:
3598:
3594:
3590:
3586:
3582:
3578:
3571:
3563:
3559:
3555:
3551:
3547:
3543:
3539:
3535:
3531:
3527:
3523:
3516:
3508:
3504:
3500:
3496:
3492:
3488:
3483:
3478:
3474:
3470:
3466:
3459:
3457:
3441:
3437:
3431:
3429:
3420:
3416:
3411:
3406:
3402:
3398:
3394:
3387:
3379:
3375:
3371:
3367:
3363:
3359:
3355:
3351:
3347:
3343:
3339:
3332:
3324:
3320:
3315:
3310:
3306:
3302:
3298:
3291:
3283:
3279:
3275:
3271:
3264:
3262:
3253:
3249:
3244:
3239:
3235:
3231:
3227:
3223:
3219:
3212:
3204:
3200:
3195:
3190:
3186:
3182:
3178:
3174:
3170:
3163:
3156:
3152:
3146:
3142:
3137:
3136:
3127:
3120:
3115:
3111:
3107:
3103:
3099:
3095:
3088:
3080:
3076:
3072:
3068:
3063:
3058:
3054:
3051:(in German).
3050:
3046:
3039:
3031:
3027:
3023:
3019:
3015:
3011:
3007:
3003:
2999:
2992:
2984:
2980:
2976:
2969:
2961:
2957:
2953:
2949:
2945:
2941:
2934:
2926:
2922:
2918:
2914:
2910:
2903:
2889:
2885:
2879:
2877:
2868:
2864:
2860:
2856:
2852:
2848:
2844:
2840:
2836:
2829:
2821:
2817:
2812:
2807:
2803:
2799:
2795:
2791:
2787:
2780:
2772:
2768:
2764:
2760:
2755:
2750:
2746:
2742:
2737:
2732:
2728:
2724:
2720:
2713:
2705:
2701:
2695:
2691:
2690:
2682:
2680:
2678:
2676:
2661:
2657:
2651:
2649:
2647:
2645:
2636:
2630:
2626:
2619:
2617:
2615:
2613:
2611:
2602:
2600:0-7167-2009-4
2596:
2592:
2585:
2583:
2574:
2570:
2566:
2562:
2558:
2554:
2550:
2546:
2542:
2535:
2533:
2531:
2529:
2527:
2525:
2516:
2512:
2507:
2502:
2498:
2494:
2490:
2486:
2482:
2475:
2473:
2471:
2462:
2458:
2453:
2448:
2444:
2440:
2436:
2432:
2428:
2424:
2420:
2413:
2411:
2409:
2400:
2396:
2392:
2388:
2384:
2380:
2376:
2372:
2368:
2361:
2353:
2349:
2345:
2341:
2337:
2333:
2329:
2322:
2320:
2306:
2302:
2298:
2294:
2287:
2285:
2283:
2268:
2264:
2258:
2244:
2240:
2234:
2226:
2222:
2217:
2212:
2208:
2204:
2200:
2196:
2192:
2185:
2177:
2173:
2169:
2165:
2161:
2157:
2153:
2146:
2138:
2134:
2129:
2124:
2120:
2116:
2112:
2108:
2104:
2100:
2096:
2089:
2081:
2077:
2072:
2067:
2063:
2059:
2055:
2051:
2047:
2043:
2039:
2032:
2024:
2020:
2016:
2012:
2007:
2002:
1998:
1994:
1990:
1983:
1975:
1971:
1967:
1963:
1959:
1955:
1951:
1947:
1943:
1939:
1935:
1928:
1926:
1911:
1907:
1901:
1893:
1887:
1879:
1875:
1870:
1865:
1861:
1857:
1853:
1846:
1838:
1834:
1830:
1826:
1822:
1818:
1814:
1810:
1806:
1799:
1792:
1788:
1785:
1780:
1772:
1765:
1757:
1753:
1748:
1743:
1739:
1735:
1731:
1727:
1723:
1716:
1714:
1712:
1703:
1699:
1695:
1691:
1687:
1680:
1672:
1668:
1664:
1660:
1657:(1): 94β100.
1656:
1652:
1645:
1637:
1633:
1628:
1623:
1619:
1615:
1611:
1607:
1603:
1596:
1594:
1592:
1583:
1579:
1575:
1571:
1564:
1556:
1552:
1549:(4): 249β57.
1548:
1544:
1537:
1535:
1533:
1531:
1529:
1527:
1510:
1506:
1502:
1496:
1494:
1492:
1490:
1488:
1486:
1484:
1482:
1480:
1478:
1476:
1474:
1472:
1470:
1468:
1466:
1464:
1455:
1451:
1447:
1443:
1439:
1435:
1431:
1427:
1420:
1418:
1416:
1414:
1412:
1410:
1408:
1406:
1404:
1402:
1400:
1398:
1396:
1394:
1392:
1390:
1388:
1386:
1384:
1382:
1377:
1363:
1359:
1358:Kidney stones
1355:
1354:hypercalcuria
1351:
1350:hypercalcemia
1347:
1342:
1338:
1332:
1328:
1320:
1318:
1308:
1306:
1302:
1298:
1288:
1286:
1282:
1278:
1271:Calcimimetics
1268:
1266:
1262:
1261:calciphylaxis
1258:
1257:hypercalcemia
1254:
1250:
1241:
1238:
1234:
1230:
1226:
1222:
1212:
1210:
1205:
1203:
1199:
1196:
1186:
1183:
1180:
1176:
1173:
1170:
1167:
1164:
1161:
1157:
1156:
1154:
1153:
1152:
1150:
1146:
1142:
1138:
1134:
1130:
1126:
1122:
1118:
1109:
1101:
1098:
1089:
1087:
1081:
1079:
1075:
1071:
1067:
1063:
1059:
1055:
1052:
1048:
1044:
1041:(PTH) by the
1040:
1036:
1027:
1024:
1020:
1015:
1013:
1012:
1007:
1006:
1001:
997:
996:
991:
987:
986:
981:
977:
972:
970:
967:, as well as
966:
965:peptic ulcers
962:
961:kidney stones
958:
954:
950:
946:
942:
938:
937:hyperfunction
934:
927:
923:
909:
907:
903:
899:
895:
891:
882:
879:
870:
868:
854:
851:
848:
847:
846:
838:
836:
820:
818:
814:
810:
806:
802:
798:
797:breast cancer
795:, metastatic
794:
784:
782:
778:
774:
770:
766:
762:
758:
754:
750:
745:
741:
736:
734:
729:
725:
721:
717:
707:
704:
701:
698:
695:
694:
690:
687:
684:
681:
678:
677:
673:
670:
667:
664:
661:
660:
656:
653:
650:
647:
645:Serum calcium
644:
643:
640:
638:
634:
625:
617:
608:
602:
594:
590:
582:
578:
570:
566:
558:
556:
552:
551:transcellular
548:
544:
540:
535:
534:
530:
528:
524:
520:
516:
512:
508:
503:
502:
494:
490:
488:
484:
481:to allow for
480:
476:
472:
468:
463:
462:
458:
456:
452:
447:
443:
433:
431:
421:
419:
415:
411:
407:
403:
399:
395:
391:
381:
379:
378:malabsorption
375:
371:
367:
363:
359:
355:
351:
340:
338:
334:
330:
325:
323:
319:
318:racquet nails
315:
311:
307:
306:kidney stones
303:
299:
295:
291:
287:
283:
279:
274:
272:
268:
257:
255:
251:
247:
241:
239:
235:
231:
227:
223:
219:
214:
212:
208:
207:kidney stones
203:
199:
195:
191:
187:
183:
179:
170:
166:
163:
159:
155:
151:
147:
144:
142:
138:
135:
131:
127:
123:
119:
115:
111:
108:
104:
100:
96:
92:
88:
85:
82:
80:
79:Complications
76:
72:
71:kidney stones
68:
66:
62:
59:
58:Endocrinology
56:
54:
50:
47:
43:
39:
35:
30:
25:
19:
4486:
4472:
4461:
4437:
4426:
4411:
4396:
4381:
4314:
4211:
4207:
4169:
4130:
4126:
4120:
4077:
4073:
4063:
4018:
4014:
4004:
3967:
3963:
3915:
3911:
3901:
3890:. Retrieved
3870:
3829:
3825:
3815:
3782:
3778:
3768:
3733:
3729:
3719:
3685:(1): 26β36.
3682:
3678:
3668:
3633:
3629:
3619:
3584:
3580:
3570:
3529:
3525:
3515:
3472:
3468:
3443:. Retrieved
3439:
3400:
3396:
3386:
3345:
3341:
3331:
3304:
3300:
3290:
3277:
3273:
3225:
3221:
3211:
3176:
3172:
3162:
3154:
3134:
3126:
3117:
3101:
3097:
3087:
3052:
3048:
3038:
3005:
3001:
2991:
2983:the original
2978:
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