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Single-Gland Primary Hyperparathyroidism: Classic and Early Disease

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Medical and Surgical Treatment of Parathyroid Diseases

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Abstract

Primary hyperparathyroidism (PHPT) is an asymptomatic PTH-dependent hypercalcemia typically from a single gland adenoma, with variable risks for kidney stones and declining bone mass. Subtleties exist in diagnosing and differentiating PHPT from other forms of PTH-dependent hypercalcemia. Therapeutic intervention manages the short and long term complications including hypercalcemia, bone loss and fracture risks, renal function decline, and kidney stones. Careful attention to biochemical diagnosis followed by appropriate imaging establishes the diagnosis in most patients. Some studies now suggest a threshold for monitored patients where there is an increase in pathologic events raising the question should all correctly identified single-gland hyperparathyroidism patients undergo surgery at the time of diagnosis? Continued discussion and review of consensus guidelines provide a framework for care of these patients and framing future work to resolve these questions in what can be a slowly progressive but significantly detrimental disease.

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References

  1. Udelsman R, Akerstrom G, Biagini C, Duh QY, Miccloi P, Niederle B, et al. The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the fourth international workshop. J Clin Endocrinol Metab. 2014;99:3395–606. Clinical Review; Level 2; Grade A–B.

    Article  Google Scholar 

  2. Wermers RA, Khosla S, Atkinson EJ, Hodgson SF, O’Fallon WM, Melton LJ. The rise and fall of primary hyperparathyroidism: a population based study in Rochester, Minnesota, 1965-1992. Ann Intern Med. 1997;126:433–40. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  3. Yeh MW, Ituarte PH, Zhou HC, Zhao HY, Sun LH, Tao B, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab. 2013;98:1122–9. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lo CY, Cahan WF, Kung AW, Lam KY, Tam SC, Lam KS. Surgical treatment for primary hyperparathyroidism in Hong Kong: changes in clinical patterns over 3 decades. Arch Surg. 2004;139:77–82. Population/Observational Study; Level 3; Grade A–B.

    Article  PubMed  Google Scholar 

  5. Bilezikian JP, Ming X, Shi Y, Silverberg SJ. Primary hyperparathyroidism in women: a tale of two cities- New York and Beijing. Int J Fertil Womens Med. 2000;45:158–65. Population/Observational Study; Level 3; Grade A–B.

    CAS  PubMed  Google Scholar 

  6. Zhao L, Liu JM, He XY, Zhao HY, Sun LH, Tao B, et al. The changing clinical patterns of primary hyperparathyroidism in Chinese patients: data from 2000 to 2010 in a single clinical center. J Clin Endocrinol Metab. 2013;98:721–8. Population/Observational Study; Level 3; Grade A.

    Article  CAS  PubMed  Google Scholar 

  7. Bandera F, Griz L, Caldas G, Bandeira C, Freese E. From mild to severe primary hyperparathyroidism: the Brazilian experience. Arq Bras Endocrinol Metabol. 2006;50:657–63. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  8. Oliveira UE, Ohe MN, Santos RO, Cervantes O, Abrahão M, Lazaretti-Castro M, et al. Analysis of the diagnostic presentation profile, parathyroidectomy indication and bone mineral density follow up of Brazilian patients with primary hyperparathyroidism. Braz J Med Biol Res. 2007;40:519–26. Population/Observational Study; Level 3; Grade A–B.

    CAS  PubMed  Google Scholar 

  9. Spivacow FR, Martinez C, Polonsky A. Primary hyperparathyroidism: post operative long term evaluation [in Spanish]. Medicina (B Aires). 2010;70:408–14. Population/Observational Study; Level 3; Grade A–B.

    Google Scholar 

  10. De Lucia F, Minisola S, Romagnoli E, Pepe J, Cipriani C, Scillitani A, et al. Effect of gender and geographic location on expression of primary hyperparathyroidism. J Endocrinol Invest. 2013;36:123–6. Population/Observational Study; Level 3; Grade A–B.

    PubMed  Google Scholar 

  11. Bollerslev J, Jannson S, Mollerup CI, Nordenstrom J, Lundgren E, Torring O, et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective randomized clinical trial. J Clin Endocrinol Metab. 2007;92:1687–92. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  12. Silverberg SJ, Clarke BL, Peacock M, Bandeira F, Boutroy S, Cusano NE, et al. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the fourth international workshop. J Clin Endocrinol Metab. 2014;99:3580–94. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  13. Sorensen MD, Duh QY, Grogan RH, Tran TC, Stoller ML. Urinary parameters as predictors of primary hyperparathyroidism in patients with nephrolithiasis. J Urol. 2012;187:516–21. Population/Observational Study; Level 3; Grade A–B.

    Article  PubMed  Google Scholar 

  14. Turken SA, Cafferty M, Silverberg SL, de la Cruz L, Cimino C, Lange DL, et al. Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism. Am J Med. 1989;87:553–7. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  15. Walker MD, McMahon DJ, Inabnet WB, Lazar RM, Brown I, Vardy S, et al. Neuropsychological features in primary hyperparathyroidism: a prospective study. J Clin Endocrinol Metab. 2009;94:1951–8. Clinical Investigation; Level 2; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bollerslev J, Rosem T, Mollerup CL, Nordenstrom J, Baranowski M, Franco C, et al; Group SS. Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism. J Clin Endocrinol Metab. 2009;94:2251–61, Clinical Investigation; Level 1; Grade B.

    Google Scholar 

  17. Yu N, Lesse GP, Donman PT. What predicts adverse outcomes in untreated primary hyperparathyroidism? The Parathyroid Epidemiology and Audit Research Study (PEARS). Clin Endocrinol (Oxf). 2013;74:174–80. Population/Observational Study; Level 3; Grade A.

    Google Scholar 

  18. Farahnak P, Ring M, Caldahl K, Farnebo LO, Eriksson MJ, Nilsson IL. Cardiac function in mild primary hyperparathyroidism and the outcome after parathyroidectomy. Eur J Endocrinol. 2010;63:461–7. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  19. Persson A, Bollerslev J, Rosen T, Mollerup CL, Franco C, Isaksen GA, SIPH Study Group, et al. Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism. Clin Endocrinol (Oxf). 2011;74:174–80. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  20. Walker MD, Fleischer J, Rundek T, McMahon DJ, Homma S, Sacco R, et al. Carotid vascular abnormalities in primary hyperparathyroidism. J Clin Endocrinol Metab. 2009;94:3849–56. Clinical Investigation; Level 2; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Walker MD, Rundck T, Homma S, DiTullio M, Iwata S, Lee JA, et al. Effect of parathyroidectomy on subclinical cardiovascular disease in mild primary hyperparathyroidism. Eur J Endocrinol. 2012;167:277–85. Population/Observational Study; Level 3; Grade A–B.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Marcocci C, Brandt ML, Scillitani A, Corbetta S, Faggiano A, Gianotti L, et al. Italian society of endocrinology consensus statement: definition, evaluation and management of patients with mild primary hyperparathyroidism. J Endocrinol Invest. 2015;38:577–93. Clinical Review; Level 2; Grade B.

    Article  CAS  PubMed  Google Scholar 

  23. Wermers RA, Khosla S, Atkinson EJ, Grant CS, Hodgson SF, O’Fallon M, et al. Survival after the diagnosis of hyperparathyroidism: a population based study. Am J Med. 1998;104:115–22. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  24. Clifton-Bligh PB, Nery ML, Supramaniam R, Reeve TS, Delbridge L, Steil JN, et al. Mortality associated with primary hyperparathyroidism. Bone. 2015;74:121–4. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  25. Hedback G, Oden A. Increased risk of death from primary hyperparathyroidism – an update. Eur J Clin Invest. 1998;28:271–6. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  26. Norenstadt S, Ekborn A, Brandt L, Zedenius J, Nilsson I-L. Postoperative mortality in parathyroid surgery in Sweden during five decades: improved outcome despite older patients. Eur J Endocrinol. 2009;160:295–9. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  27. Kritchevsky SB, Tooze JA, Neiberg RH, Schwartz CG, Hausman DB, Johnson MA, et al. 25-hydroxy vitamin D, parathyroid hormone and mortality in black and white older adults: the health ABC study. J Clin Endocrinol Metab. 2012;97:4156–65. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Palmer M, Bergstrom R, Akerstrom G, Adams H-O, Jakobsson A, Liunghall S. Survival and renal function in untreated hypercalcemia: a population based cohort study with 14 years of follow up. Lancet. 1987;329:59–62. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  29. Rubin MR, Bilezikian JP, McMahon DJ, Jacobs T, Shane E, Siris E, et al. The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years. J Clin Endocrinol Metab. 2008;93:3462–70. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab. 2014;99:3561–9. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  31. Bilezikian JP, Khan AA, Potts Jr JT. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94:335–9. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Marcocci C, Bollerslev J, Khan AA, Shobeck DM. Medical management of primary hyperparathyroidism: proceedings of the fourth international workshop on the management of asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab. 2014;99:3607–18. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  33. Hinnie J, Bell E, McKillop E, Gallacher S. The prevalence of familial hypocalciuric hypercalcemia. Calcif Tissue Int. 2001;68:216–8. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  34. Nissen PH, Christensen SE, Heickendorff L, Brixen K, Mosekilde L. Molecular genetic analysis of the calcium sensing receptor gene in patients clinically suspected to have familial hypocalciuric hypercalcemia: phenotypic variation and mutation spectrum in a Danish population. J Clin Endocrinol Metab. 2007;92:4373–9. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  35. 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;99:3570–9. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  36. Cusano NE, Maalouf NM, Wang PY, Zhang C, Cremers SC, Haney EM, et al. Normocalcemic primary hyperparathyroidism and hypoparathyroidism in two community-based nonreferral populations. J Clin Endocrinol Metab. 2013;98:2734–41. Clinical Investigation; Level 3; Grade A.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. 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;92:3001–5. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  38. Parisien M, Cosman F, Mellish RWE, Schnitzer M, Nieves J, Silverberg SJ, et al. Bone structure in post-menopausal hyperparathyroid, osteoporotic and normal women. J Bone Miner Res. 1995;10:1393–9. Clinical Investigation; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  39. Steiniche T, Christiansen P, Vesterby A, et al. Primary hyperparathyroidism: bone structure, balance, and remodeling before and 3 years after surgical treatment. Bone. 2000;26:535–43. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  40. Wood K, Dhital S, Chen H, Sippel RS. What is the utility of distal forearm DXA in primary hyperparathyroidism? Oncologist. 2012;17:322–5. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Kenny AM, MacGillivary DC, Pilbeam CC, Crombie HD, Raisz LG. Fracture incidence in post-menopausal women with primary hyperparathyroidism. Surgery. 1995;118:109–14. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  42. Khosla S, Melton III LJ, Wermers RA, Corwson CS, O’Fallon WM, Riggs BL. Primary hyperparathyroidism and the risk of fracture: a population based study. J Bone Miner Res. 1999;14:1700–7. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  43. DeGeronimo S, Romoagnoli E, Diacinti D, D’Erasmo E, Minisola S. The risk of fractures in post-menopausal women with primary hyperparathyroidism. Eur J Endocrinol. 2006;155:415–20. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  Google Scholar 

  44. Vignali E, Viccica G, Diacinti D, Cetani F, Cianferotti L, Ambrogini E, et al. Morphometric vertebral fractures in postmenopausal women with primary hyperparathyroidism. J Clin Endocrinol Metab. 2009;94:2306–12. Clinical Investigation; Level 2; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Hernandez JL, Olmos JM, Pariente E, Nan D, Martínez J, Llorca J, et al. Influence of vitamin D status on vertebral fractures, bone mineral density, and bone turnover markers in normocalcemic postmenopausal women with high parathyroid hormone levels. J Clin Endocrinol Metab. 2013;98:1711–7. Clinical Investigation; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  46. Staruo-Linde J, Waldhauer E, Rolighed L, Mosekilde L, Vestergaard P. Renal stones and calcifications in patients with primary hyperparathyroidism: associations with biochemical variables. Eur J Endocrinol. 2012;166:1093–100. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  47. Cipriani C, Biamonte F, Costa AG, Zhang C, Biondi P, Diacinti D, et al. Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology. J Clin Endocrinol Metab. 2015;100:1309–15. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Ambrogini E, Catani F, Cianferotti L, Vignali E, Banti C, Vicinal G, et al. Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab. 2007;92:3114–31. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  49. Rao DS, Phillips ER, Divine GW, Talpos GB. Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab. 2004;89:5415–22. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  50. Silverberg SJ, Gartenberg F, Jacobs TP, Shane E, Siris E, Staron RB, et al. Increased bone mineral density after parathyroidectomy in primary hyperparathyroidism. J Clin Endocrinol Metab. 1995;80:729–34. Population/Observational Study; Level 3; Grade A–B.

    CAS  PubMed  Google Scholar 

  51. Silverberg SJ, Shane E, Jacobs TP, Siris E, Bilezikian JP. A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. N Engl J Med. 1999;341:1249–55. Population/Observational Study; Level 3; Grade A.

    Article  CAS  PubMed  Google Scholar 

  52. Nomura R, Sugimoto T, Tsukamoto T, Yamauchi M, Sowa H, Chen Q, et al. Marked and sustained increase in bone mineral density after parathyroidectomy in patients with primary hyperparathyroidism; a six year longitudinal study with or without parathyroidectomy in a Japanese population. Clin Endocrinol. 2004;60:335–42. Population/Observational Study; Level 3; Grade A–B.

    Article  Google Scholar 

  53. Lundstam K, Heck A, Mollerup C, Godang K, Baranowski M, Pernow Y, SIPH Study Group, et al. Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild primary hyperparathyroidism. J Clin Endocrinol Metab. 2015;100:1359–67. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  54. Roman SA, Sosa JA, Pietrzak RH, Snyder PJ, Thomas DC, Udelsman R, 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;253:131–7. Population/Observational Study; Level 3; Grade A–B.

    Article  PubMed  Google Scholar 

  55. Christensen SE, Nissen PH, Vestergaard P, Heickendorff L, Brixen K, Mosekilde L. Discriminative power of three indices of renal calcium excretion for the distinction between familial hypocalciuric hypercalcemia and primary hyperparathyroidism: a follow-up study on methods. Clin Endocrinol (Oxf). 2008;69:713–20. Clinical Investigation; Level 2; Grade A–B.

    Article  CAS  Google Scholar 

  56. Frank-Raue K, Leidig-Bruckner G, Haag C, Schulze E, Lorenz A, Schmitz-Winnenthal H, et al. Inactivating calcium-sensing receptor mutations in patients with primary hyperparathyroidism. Clin Endocrinol (Oxf). 2011;75:50–5. Clinical Investigation; Level 3; Grade A.

    Article  CAS  Google Scholar 

  57. Yamauchi M, Sugimoto T, Yamaguchi T, Yano S, Wang J, Bai M, et al. Familial hypocalciuric hypercalcemia caused by an R648stop mutation in the calcium-sensing receptor gene. J Bone Miner Res. 2002;17:2174–82. Basic Science; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  58. Van Husen R, Kim LT. Accuracy of surgeon performed ultrasound in parathyroid localization. World J Surg. 2004;28:1122–6. Clinical Investigation; Level 2; Grade A–B.

    Article  PubMed  Google Scholar 

  59. Blanchard C, Mathonnet M, Sebag F, Caillard C, Hamy A, Volteau C, et al. Surgery for ‘asymptomatic’ mild primary hyperparathyroidism improves some clinical symptoms postoperatively. Eur J Endocrinol. 2013;169:665–72. Population/Observational Study; Level 3; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  60. Cassibba S, Pellegrino M, Gianotti L, Baffoni C, Baralis E, Attanasio R, et al. Silent renal stones in primary hyperparathyroidism: prevalence and clinical features. Endocr Pract. 2014;20:1137–42. Population/Observational Study; Level 3; Grade A–B.

    Article  PubMed  Google Scholar 

  61. Grey A, Lucas J, Horne A, Gamble G, Davidson JS, Reid IR. Vitamin D repletion in patients with primary hyperparathyroidism and coexistent vitamin D insufficiency. J Clin Endocrinol Metab. 2005;90:2122–6. Clinical Investigation; Level 3; Grade A.

    Article  CAS  PubMed  Google Scholar 

  62. Locker FG, Silverberg SJ, Bilezikian JP. Optimal dietary calcium intake in primary hyperparathyroidism. Am J Med. 1997;102:543–50. Clinical Review; Level 2; Grade A–B.

    Article  CAS  PubMed  Google Scholar 

  63. Khan AA, Bilezikian JP, Kung AW, Ahmed MM, Dubois SJ, Ho AY, et al. Alendronate in primary hyperparathyroidism: a double-blind, randomized, placebo-controlled trial. J Clin Endocrinol Metab. 2004;89:3319–25. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

  64. Pasieka JL, Parsons LL. A prospective surgical outcome study assessing the impact of parathyroidectomy on symptoms in patients with secondary and tertiary hyperparathyroidism. Surgery. 2000;128:531–9. Clinical Investigation; Level 1; Grade B.

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Otolaryngology and Division of Endocrinology, Oregon Health and Science University, 3181 Sw Sam Jackson Park Rd, Portland, OR, 97239, USA

    Dana L. Madison M.D., Ph.D.

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  1. Dana L. Madison M.D., Ph.D.
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Correspondence to Dana L. Madison M.D., Ph.D. .

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Editors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Brendan C. Stack, Jr.

  2. Department of Geniatrics and Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Donald L. Bodenner

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Madison, D.L. (2017). Single-Gland Primary Hyperparathyroidism: Classic and Early Disease. In: Stack, Jr., B., Bodenner, D. (eds) Medical and Surgical Treatment of Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-26794-4_5

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