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Objective: To summarize and analyze the diagnostic and therapeutic characteristics of asymptomatic primary hyperparathyroidism (aPHPT). Methods: A retrospective analysis was conducted on the clinical data of 103 patients with aPHPT admitted to the Chinese PLA General Hospital from January 2012 to September 2023. The clinical characteristics, treatment modes, and prognoses of the patients were analyzed. GraphPad Prism 8.0 software was used for statistical analysis. Results: Among the 103 cases, there were 37 males and 66 females, aged from 25 to 78 years, with an average age of (53.81±11.34) years. Ninety-eight cases (95.15%) visited due to abnormal findings during physical examination and 5 cases (4.85%) due to hypertension, diabetes or other diseases. All patients underwent minimally invasive parathyroidectomy with small incision, with 96 cases (93.20%) pathologically diagnosed as adenomas and 7 cases as hyperplasia (6.80%). Postoperative mean serum calcium, parathyroid hormone (PTH) and alkaline phosphatase (ALP) levels were respectively significantly lower than preoperative levels, while postoperative serum phosphorus level was significantly higher than preoperative level ( P <0.05). The mean lesion volume was (3.32±6.72)cm 3 (range 0.05-49.50 cm 3 ). Patients with different lesion volumes had significant differences in preoperative serum calcium, PTH and ALP levels. Lesion volume was positively correlated to preoperative serum calcium(ρ=0.36, P <0.01), PTH(ρ=0.50, P <0.01) and ALP(ρ=0.39, P <0.01). Among 103 patients, 94 cases were followed up (91.26%), 9 cases were lost (8.74%), and the mean follow-up period was (60.15±29.23) months. The followed-up patients were alive and had no recurrence of lesions or complications, and their blood calcium levels were normal. Conclusion: aPHPT can be preliminarily diagnosed through blood biochemistry and imaging examination, and minimally invasive surgery can offer good prognosis without serious complications.

To review the diagnosis and treatment of a case of hypercalcium crisis caused by primary hyperparathyroidism（PHPT） and prophylactic treatment of hungry bone syndrome. In a 32-year-old male with hypercalcemia, the main manifestations were loss of appetite, nausea, polyuria, polydipsia, fatigue, lethargy, etc. parathyroid hormone, serum calcium increased, thyroid function was normal, thyroid color ultrasound and MRI showed space-occupying behind the right thyroid, radionuclide examination showed abnormal imaging agent concentration in the right parathyroid area, there was a history of pathological fracture. Clinically diagnosed as hypercalcemia crisis secondary to PHPT., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

This case reported a case of multiple endocrine neoplasia type 1（MEN1）. The patient was admitted to hospital on January 17 2020 due to persistent ostealgia and the elevated calcium level in the last 2 years. Laboratory tests showed elevated parathyroid hormone（PTH） and serum calcium level, which were 2295 ng/L（normal, 10-69 ng/L） and 3.15 mmol/L（normal, 2.03-2.54 mmol/L）. Ultrasound of the neck found a solid nodule under the left inferior pole of thyroid, while 99mTc-MIBI SPECT/CT showed enhancement at the same place. Subsequently, cranial MRI found a tumor in sellar area, and abdominal MRI showed a tumor in left adrenal gland. Finally, the patient was diagnosed as MEN1., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

To investigate the effectiveness and safety of ultrasound-guided microwave ablation (MWA) in treatment of primary hyperparathyroidism (PHPT). A total of 12 PHPT patients with parathyroid adenoma were treated with MWA in Nanjing University of Chinese Medicine Affiliated Hospital of Integrated Traditional Chinese and Western Medicine from May 2019 to February 2021. The patients were followed up once every 3 months for 3-12 months. Levels of serum parathyroid hormone (PTH), calcium and phosphorus were detected before and 20 min, 4h and 1day after ablation, and during follow-up period. The volume and volume reduction rate of parathyroid lesion were compared before the treatment and at the end of follow-up. The technical and clinical success of MWA were assessed as well. At the end of follow-up, median serum PTH [66.60 (42.21,80.03) ng/L vs.169.90 (89.01,396.50) ng/L] and calcium [2.39 (2.32,2.49) mmol/L vs. 2.75 (2.57,2.96) mmol/L] levels in 12 patients decreased significantly (all P <0.05). A complete response in terms of PTH and calcium levels was achieved in 6 of the 12 patients, while 4 of the patients had slightly elevated PTH levels just above the upper limit of normal reference range, and 2 of the patients remained abnormal PTH and calcium levels. The clinical cure rate was 50%. The volumes of all lesion after ablation were significantly decreased ( P <0.05), with the technical success rate reaching 92.3%. No serious complications were observed. Ultrasound-guided MWA, thus, is safe and effective in the treatment of PHPT.

Objective: To provide more options for preoperative localization diagnosis in patients with primary hyperparathyroidism (PHPT), the diagnostic efficacy of parathyroid 4-dimensional computed tomography (4D-CT) in patients with PHPT was evaluated. Methods: This was a single-center retrospective study including 57 patients with surgical proved PHPT. All of the patients underwent 4D-CT, 99 Tc m -sestamibi parathyroid imaging (MIBI), and ultrasonography (US) preoperatively. The reference standard for correct localization was based on operation reports and pathology confirmation. The patients were grouped according to the preoperative serum calcium levels, tumor diameter, or ectopic lesions (yes/no), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of 4D-CT, MIBI and US, alone or in combination, were analyzed in total and each subgroup patients. Results: Fifty-seven patients (39 women, 18 men; mean age of 56.5 years) were evaluated, including four cases with multi-gland disease and thirteen cases with ectopic parathyroid lesions. In all the patients, similar diagnostic efficacy was found in 4D-CT (AUC: 0.943) and MIBI (AUC: 0.927), both of which were higher than that of US (AUC: 0.847) ( P = 0.01 for 4D-CT vs. US; P = 0.04 for MIBI vs. US). In a subset analysis for ectopic quadrants, the diagnostic efficacy of 4D-CT was significantly higher than that of MIBI ( P = 0.04) or US ( P = 0.01), with the sensitivity of 100%, 69.2%, and 61.5%, and AUC of 0.989, 0.846, and 0.808 for 4D-CT, MIBI and US, respectively. Conclusions: 4D-CT has similar diagnostic efficacy for preoperative localization to MIBI in patients with PHPT, and it is superior to MIBI and US in identifying the ectopic parathyroid gland. 4D-CT can be recommended as an alternative preoperative localization method, especially when parathyroid lesions could not be precisely located by US and MIBI.

Objective: To evaluate the diagnostic efficacy of technetium-99m methoxyisobutylisonitrile single photon emission/ computed tomography ( 99m Tc- MIBI SPECT/CT), 99m Tc- MIBI double- phase scintigraphy (DPS) DPS and ultrasound (US) in preoperative localization of hyperparathyroidism (HPT) and explore the factors affecting the diagnostic efficacy of 99m Tc-MIBI SPECT/CT., Methods: We retrospectively analyzed the data of 104 patients with HPT undergoing surgical resection between January, 2015 and July, 2019. Preoperative 99m Tc-MIBI imaging was performed in all the patients, and 82 patients also received US examination preoperatively. Semi-quantitative analysis was used to draw the region of interest and calculate the lesion/ ipsilateral deltoid muscle (T/NT) uptake ratio. The sensitivity and detection performance of 99m Tc-MIBI SPECT/CT, DPS and US in the diagnosis of HPT patients were compared, and the correlations of the T/NT ratios of parathyroid adenoma (PA) and parathyroid hyperplasia (PH) with the expression levels of COX-2 and Bcl-2 were analyzed., Results: The diagnostic sensitivity of 99m Tc- MIBI SPECT/CT, DPS and US for HPT was 95.19% (99/104), 91.3% (95/104) and 81.71% (67/82), respectively, demonstrating a significantly higher diagnostic sensitivity of 99m Tc-MIBI SPECT/CT than US ( χ 2 =9.59, P =0.008). For PH lesions, 99m Tc-MIBI SPECT/CT had the highest diagnostic sensitivity, followed by DPS and then by US ( P < 0.05), but their sensitivity did not differ significantly for PA ( P >0.05). The T/NT ratio in fatty hyperplastic glands was significantly lower than that in fat-free hyperplastic glands ( P =0.009). In PA, Bcl-2 expression was significantly lower in false negative lesions than in true positive lesions ( P =0.046), but Cox-2 expression did not show such a difference ( P >0.05). In PH lesions, the expressions of Bcl-2 and Cox- 2 did not differ significantly between false negative than true positive lesions ( P >0.05)., Conclusions: 99m Tc-MIBI SPECT/CT has a high sensitivity for HPT localization, and the T/NT ratio is positively correlated with the lesion volume. An increased expression of Bcl-2 in PA lesions and a decreased cell fat content in PH lesions can facilitate the detection of HPT glands by 99m Tc-MIBI SPECT/CT.

Objective: To summarize and analyze the clinical characteristics of primary hyperpara-thyroidism (PHPT) with normocalcemic parathormone elevation (NPE) after surgical treatment, so as to improve the therapeutic ability and standardized post-operative follow-up of PHPT patients., Methods: Nine patients who were diagnosed with PHPT in the Department of Endocrinology of China-Japan Friendship Hospital from August 2017 to November 2019 were selected as the subjects. They all developed NPE within 6 months after surgical treatment. The clinical features and outcomes were collected and analyzed retrospectively, in addition, the related literature was reviewed., Results: Clinical features: among the 9 patients, 6 were middle-aged and elderly females and 3 were male. The main clinical manifestations were bone pain, kidney stones, nausea and fatigue except for one case of asymptomatic PHPT. Pre-operative examination showed high serum calcium [(3.33±0.48) mmol/L], low serum phosphorus [0.76 (0.74, 0.78) mmol/L], high 24-hour urinary calcium [8.1(7.8, 12.0) mmol/24 h], obviously elevated intact PTH [(546.1±257.7) ng/L], vitamin D deficiency [25-hydroxyvitamin D 3 (21.0±5.7) nmol/L]. Serum levels of bone alkaline phosphatase [7 patients 41.3(38.6, 68.4) μg/L, 2 patients >90 μg/L] and N-terminal midcourse osteocalcin (>71.4 μg/L) were significantly elevated. The estimated glomerular filtration rate decreased in 2 patients. Imaging examination: 7 patients had osteoporosis. Renal calculi were found in 3 patients by renal ultrasound. Imaging examination of parathyroid glands found definite lesions in all the patients, including 2 cases of multiple lesions and 7 cases of single lesions., Treatment and Outcome: two patients underwent parathyroidectomy, while other patients were treated with microwave thermal ablation. PTH increased 1 month after therapy [(255.0±101.4) ng/L], and no recurrent lesions were found by parathyroid ultrasound. After combined treatment with cal-cium and vitamin D for six months, PTH decreased significantly and the level of serum calcium remained normal at anytime during the follow-up period., Conclusion: The occurrence of postoperative NPE may be related to the higher pre-operative PTH, vitamin D deficiency and lower creatinine clearance. However, NPE may not predict recurrent hyperthyroidism or incomplete parathyroidectomy. Adequate calcium and vitamin D supplementation after surgery seems to be beneficial for patients with NPE. Post-operative follow-up of PHPT patients should be standardized to prevent and treat post-operative NPE.

Objective: To study relative risk factors for temporarily inhibited parathyroid hormone (PTH) secretion after surgery of primary hyperparathyroidism (PHPT). Methods: Seventy-two cases with PHPT from October 2017 to March 2019 in Beijing Chaoyang Hospital were analyzed retrospectively, including 22 males and 50 females aged from 13 to 83 years old. They were reviewed and divided into a complete inhibition group (24 cases, PTH=0 pg/ml), an incomplete inhibition group (23 cases, 0

Objectives: The prevalence of asymptomatic primary hyperparathyroidism (PHPT) in China is lower than that in European and American countries and the study about the characteristics of asymptomatic PHPT was rare in China. This study aims to explore the characteristics of asymptomatic PHPT., Methods: Clinical data of 150 patients with PHPT confirmed by operation and pathological examination were retrospectively analyzed. The patients were assigned into a symptomatic PHPT group ( n =124) and an asymptomatic PHPT group ( n =26)., Results: The proportion of adenomas was higher than that of adenocarcinoma in the asymptomatic PHPT group. The proportion of the first diagnosis due to hypercalcemia found via biochemical examination in the asymptomatic PHPT group was higher than that in the symptomatic PHPT group (76.92% vs 25.81%, P <0.001). The duration was shorter in the asymptomatic PHPT patients than that in the symptomatic PHPT patients (median 12 months vs 24 months, P =0.004). The serum calcium, the albumin-corrected serum calcium, and parathyroid hormone (PTH) were lower in the asymptomatic PHPT patients than those in the symptomatic PHPT ( P =0.003, P =0.006, and P =0.042, respectively). The serum 1,25-dihydroxyvitamin D 3 was higher ( P <0.001), the diameter was shorter ( P =0.028), and the bone mineral densities (BMD) of L 2~4 and femoral neck were higher in the asymptomatic PHPT patients than those in the symptomatic PHPT patients (both P <0.001)., Conclusions: Only a minority of PHPT patients are asymptomatic. Compared with the symptomatic PHPT patients, the primary cause of diagnosis is hypercalcemia, the duration of diagnosis and the diameter of parathyroid gland are shorter, the levels of serum calcium, and PTH are lower, the proportion of adenomas, vitamin D, and the BMD of L 2-4 and femoral neck are higher, and the pathological type is benign in the asymptomatic PHPT patients.

Objective: To explore the safety and efficacy of airless endoscopic surgery in the treatment of parathyroid diseases. Methods: By retrospective comparison, clinical treatment of 26 patients with primary hyperparathyroidism admitted to the Department of Otolaryngology and Head and Neck Surgery of the Hospital, Sun Yat-sen University from January 2018 to January 2023 were collected. They were divided into traditional group（13 cases） and endoscopic group（13 cases） according to the surgical method. The traditional group underwent traditional open parathyroid surgery, and the endoscopic group underwent airless endoscopic surgery through the subclavian approach. The efficacy, postoperative incision pain, incidence of adverse events, and aesthetic effects of the two groups were evaluated. Results: A total of 26 patients were included, including 13 patients in the traditional group and 13 patients in the endoscopic group. There was no significant difference in the incidence of hypocalcemia and transient hypoparathyroidism on the first day after surgery between the two groups（ P >0.05）. No patients with incision pain（>3 points） or swallowing pain were found in both groups after the operation, and they were afraid or unwilling to cough and expel phlegm. There were no significant differences in the amount of blood loss, duration of operation, incidence of temporary recurrent laryngeal nerve palsy and transient hypocalcemia, and postoperative pain score between the two groups. The endoscopic group's scar evaluation score and aesthetic effect satisfaction score at 6 months after surgery were higher than those of the traditional group（ P <0.01）. Conclusion: Airless Endoscopic parathyroid surgery via the subclavian approach has good effectiveness and safety, which did not significantly increase the risk of surgery. It can safely remove the lesion and leave no surgical scar on the anterior neck, which has the advantage of a good cosmetic effect. It is a safe and feasible endoscopic parathyroid surgery and can be used as a new choice for patients undergoing parathyroid surgery., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

To explore the impact of gender on presentation of primary hyperparathyroidism (PHPT), clinical data of 150 histopathologically proven PHPT patients were collected and retrospectively analyzed. Most of the patients (72.0%) were parathyroid adenoma (PA), and 9.3% of them were parathyroid carcinoma (PC). In PA patients, albumin-corrected serum calcium levels (TASC) were lower in women than in men [ (2.84±0.28) mmol/L vs. (3.03±0.34) mmol/L, P= 0.006]. In all PHPT subjects, serum urea nitrogen, creatinine, uric acid levels were lower in women than in men. Bone pain was more frequent in women over 50 years old than in men (52.33% vs.29.17%, P= 0.045). The incidence of PC was higher in men than in women (20.59% vs. 6.03%, P= 0.010). In conclusion, there are gender differences in the clinical presentation of PHPT. TASC was high in men with PA compared to women with PA. Bone pain was more common in the woman patients over 50 years old, and PC was more common in men.

Objective: To discuss the diagnosis, preoperative imaging and surgical technique of patients who underwent reoperation for persistent hyperparathyroidism. Methods: A prospective database about primary hyperparathyroidism in Department of General Surgery, Peking Union Medical College Hospital was searched for the patients who underwent reoperation for persistent hyperparathyroidism from January 2009 to December 2016. The information about the initial operation, preoperative imaging study and result of reoperations were collected and reviewed. A total of 58 patients underwent reoperation for hyperparathyroidism. Eleven of these patients were referred to this institute for reoperation after missing single parathyroid lesion in the initial parathyroidectomy. Nine patients were female, and the mean patient age at reoperation was 54.9 years. Results: For this group, the accuracy of ultrasound neck scan and sestamibi scintigraphy was 10/11 in identifying diseased parathyroid gland before reoperation. Combined with enhanced CT and SPECT, all parathyroid lesions were localized before reoperations. With general anesthesia or cervical plexus block, all diseased parathyroid glands were removed in the reoperations. No signs of hyperparathyroidism appeared during follow-up. Conclusions: The initial surgery for primary hyperparathyroidism should be performed in experienced center to avoid reoperations. Combining preoperative localization and cervical exploration will help to increase the success rate of reoperation.

Background Normocalcemic primary hyperparathyroidism (NCPHPT), as a new phenotype of primary hyperparathyroidism (PHPT), has gained increasing attention. NCPHPT is easily misdiagnosed in clinical practice, and its risk factors need to be evaluated further. Objective To investigate the clinical features of NCPHPT and to explore its risk factors. Methods Patients diagnosed with PHPT (n=153) were retrospectively selected from Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2021, and divided into an experimental group (NCPHPT group) and a hypercalcemia PHPT group according to the corrected total serum calcium level. Meanwhile, individuals undergoing physical examination with normal parathyroid function were selected as the control group. The differences in clinical characteristics, glucose and bone metabolism, imaging and pathology results among the groups were compared. Multivariate Logistic regression analysis was used to analyze the risk factors of NCPHPT. Results The number of cases in NCPHPT, hypercalcemia PHPT and control groups was 36, 117 and 50, respectively. For biochemical indices, compared with healthy control group, the levels of alkaline phosphatase (AKP), uric acid (UA), and parathyroid hormone (PTH) were much higher in NCPHPT group, while serum phosphorus was much lower (P0.05). Multivariate Logistic regression analysis showed that urolithiasis〔OR=2.462, 95%CI (1.178, 3.552), P=0.011〕, decreased serum phosphorus〔OR=0.027, 95%CI (0.001, 0.711), P=0.031〕and increased AKP〔OR=2.809, 95%CI (1.422, 8.020), P=0.037〕were relevant factors for NCPHPT. Conclusion Patients with NCPHPT have many clinical symptoms such as elevated blood pressure, abnormal glucose metabolism, abnormal bone mineral density and urolithiasis. The presence of urolithiasis, hypophosphatemia and increased AKP indicates the possible existence of NCPHPT, which can be used for early Screening of NCPHPT to reduce the misdiagnosis rate.

Objective: To evaluated the results of surgical treatment for primary hyperparathyroidism coexistent with thyroid cancer., Methods: From March 2007 to May 2014, 27 patients suffered thyroid carcinoma coexistent with primary hyperparathyroidism with pathological and laboratory confirmation were studied retrospectively. In 8 of 27 cases thyroidectomy and parathyroidectomy were performed separately, with interval time of 3 to 26 months, and in the remaining cases both procedures were done simultaneously. During surgery quick PTH evaluation and calcium measure were routinely performed., Results: Postoperative temporary hypoparathyroidism was found in 26 of 27 cases, and postoperative permanent hypoparathyroidism developed in 4 cases that underwent separate operation. Limited movement of vocal cord was showed in 4 cases after parathyroidectomy, but it lasted no more than 2 months. No permanent paralysis of recurrent laryngeal nerve was found. No thyroid cancer or hyperparathyroidism was found with follows-up of 11 to 43 months., Conclusions: Thyroidectomy and parathyroidectomy performed separately have higher risk to develop hypoparathyroidism than they are done simultaneously. PTH and calcium should be evaluated in patients with thyroid carcinoma whenever available.

Objective: To explore the clinical features and genetic variants in two children with neonatal severe hyperparathyroidism (NSHPT)., Methods: Two children who were diagnosed with NSHPT at the Children's Hospital Affiliated to Xi'an Jiaotong University respectively in August 2019 and April 2022 were selected as the study subjects. Clinical data were collected, and both children were subjected to whole exome sequencing (WES). Candidate variants were verified by Sanger sequencing., Results: The main clinical features of the two children have included growth delay, hypotonia, hypercalcemia, hypophosphatemia, hyperparathyroid hormonemia, and renal calcium deposition. WES results showed that child 1 has harbored a homozygous c.1378&#95;1G>A splicing variant of the CASR gene, which was unreported previously, whilst child 2 has harbored a homozygous c.2038C>T missense variant of the CASR gene, which was known to be likely pathogenic. Sanger sequencing confirmed that the parents of both children were heterozygous carriers., Conclusion: The homozygous c.1378&#95;1G>A and c.2038C>T variants of the CASR gene probably underlay the NSHPT in the two children. Discovery of the c.1378&#95;1G>A variant has enriched the mutational spectrum of the CASR gene.

Objective: To discuss the clinical characteristics of primary hyperparathyroidism (PHPT) with kidney stones., Methods: The clinical data of 23 cases undergoing diagnostic evaluation and surgery for PHPT combined with kidney stones between January 2004 and February 2012 was retrospectively analyzed. The 23 cases had undergone preoperative parathyroid neck color ultrasound, CT or (99)mTc-methoxy isobutyl isonitrile ((99)mTc-MIBI) diagnosis. The surgical treatment included parathyroid disease and kidney stones. The intravenous calcium, phosphorus and serum intact parathyroid hormone (iPTH) levels, 24 hours urinary calcium concentrations were measured 3 days before and 7 days after surgery., Results: There were 8 male and 15 female patients. The stone diameter were (3.2 ± 0.7) cm (range 2.1-4.0 cm). All patients did both parathyroid surgery and kidney surgery. The statistical discrepancy of serum calcium (there were (3.31 ± 0.39) mmol/L before surgery and (2.12 ± 0.18) mmol/L at 7 days after surgery, t = 11.26), serum phosphorus ((0.70 ± 0.09) and (1.21 ± 0.21) mmol/L in before and after surgery respectively, t = 10.53), iPTH (there were (28.8 ± 10.0) pmol/L before surgery and (3.6 ± 2.6) pmol/L after surgery, t = 12.83) and 24-hours urine calcium (there were (7.2 ± 3.1) mmol/d before surgery and (3.6 ± 2.5) mmol/d after surgery, t = 8.81) before and after the operation was significant (all P < 0.01). PTH concentration with serum calcium concentration correlation coefficient was r = 0.59 (P < 0.01). Eighteen patients (78.3%) had solitary parathyroid adenomas, two patients (8.7%) had multiple parathyroid adenomas, and three patients (13.0%) had multiglandular hyperplasia confirmed at surgery and histology. During follow-up, 8 patients had stone recurrence and 3 patients were did operation again to deal with renal stone within 2 years. Among them, 7 cases were normal, 1 case of parathyroid adenomas recurrence and reoperation., Conclusions: The parathyroid operation may reduce the calculus recurrence remarkably. Early diagnosis and treatment of primary hyperparathyroidism is helpful to reduce the calculus recurrence and preserve the renal function.

Objective: To investigate the causes of misdiagnosis and the surgical treatment of primary hyperparathyroidism (PHPT)., Methods: The clinical data of 26 patients with PHPT from July 2008 to January 2013 in The Affiliated Hospital of Chengde Medical College and The Fourth Hospital of Hebei Medical University were retrospectively analyzed, including preoperative diagnosis and operative method. The level of serum calciumion and serum parathyroid hormone (PTH), Ultrasonography, CT, (99)mTc-methoxy isobutylis onitrile ((99)mTc-MIBI) were used in the diagnosis before operation. All patients accepted surgical treatment after the level of serum calciumion decreased to normal., Results: The level of PTH was examined 10 min after resection, which declined more than 50%. After pathological examination, 23 cases were diagnosed as parathyroid adenoma, 2 cases were parathyroid hyperplasia, and 1 case was parathyroid carcinoma. The level of serum calciumion and serum parathyroid hormone were returned to the normal level after operation. All patients recovered with no postoperative complication.Followed up lasted from 6 months to 5 years, no case recurred.Sixteen cases with symptoms experienced significant improvement in signs, including 10 cases with clinical symptoms completely disappeared., Conclusions: The test of serum calciumion and serum PTH, Ultrasonography, CT, (99)mTc-MIBI are helpful to reduce the misdiagnose rate of primary hyperparathyroidism before operation. The examination of serum parathyroid hormone in operation is helpful to reduce the operation range and time.

Objective: To analyze the X-ray, CT and MR imaging findings in skeletal disease with primary hyperparathyroidism (PHPT), so as to discuss the clinic feature and differential diagnosis., Methods: Thirty patients with PHPT were confirmed by surgery and pathological examination. In 15 patients the lesion were found in femur. There were 15 tibia, 12 fibula, and 14 iliac lesions. In three patients lesions were found in vertebrae. Three patients had lesions in humeri. In five patients lesions were found in rib. Twelve patients had lesions in phalanges. Thirty patients were studied preoperatively with radiographs, CT and MR imaging. The imaging findings were compared with the pathologic diagnosis and confirmed by double blind method., Results: Radiographs of the bone in 30 patients showed generalised osteopaenia. There were 20 (66.7%) cases with bone resorption, which include 12 (40.0%) cases with subperiosteal resorption, 11 (36.7%) cases with cortical bone resorption, and 10 (33.3%) cases with subchondral resorption. There were 19 (63.3%) cases with osteitis fibrosa cystica/brown tumor. There were 5 (16.7%) patients sustained a pathological fracture., Conclusion: X-ray, CT and MR imaging founding reflect the imaging and pathology features in skeletal disease of PHPT. The iliac lesions could been found in common, and usually eroding sacroiliac joint. Skeletal disease of PHPT should be differentiated from osteolytic metastatic tumor of bone, osteodysplasia fibrosa, giant cell tumor of bone and aneurysmal bone cysts.

Objective: To study the prevalence of hypercalcemia and primary hyperparathyroidism in middle-aged and elderly Chinese people who live in Beijing., Methods: This research was performed in a large elderly population group who came to our hospital for health checkup. The medical histories and relevant data of all the subjects were collected. Serum parathyroid hormone (PTH) concentration was determined in the 83 subjects whose blood calcium level was >or= 2.6 mmol/L. Meanwhile, another 83 of the subjects whose calcium level was < 2.6 mmol/L were chosen randomly as controls., Results: 2451 subjects underwent the investigation. 83 (3.39%) out of the total 2451 subjects were found to have calcium level >or= 2.6 mmol/L, and 5 of them had PTH > 65 ng/L but no causative factors for the elevation. These subjects were thought to have primary hyperparathyroidism and its prevalence was 0.204%., Conclusion: The prevalence of primary hyperparathyroidism was 0.204% in the investigated elderly subjects.

Objective: To evaluate the clinical characteristics and preoperative predictive factors in patients with parathyroid carcinoma. Methods: From January 2010 to December 2016, 150 patients with pathologically and biochemically confirmed primary hyperparathyroidism were enrolled in this study. The clinical data were reviewed to define 28 cases of parathyroid hyperplasia, 14 cases of parathyroid carcinoma (PC), and 108 cases of parathyroid adenoma (PA). The clinical characteristics between PC and PA group were compared and analyzed to explore predictive factors for PC. Results: Patients in PC group were significantly younger than those in PA group (47.9±13.9 vs 57.2±14.6 years, P =0.026). The diameter of tumor in PC group was larger than that in PA group (3.6±1.8 vs 2.2±1.4 cm, P =0.005). The levels of albumin-corrected serum calcium, parathyroid hormone (PTH), and alkaline phosphatase (AKP) were all higher in PC group than those in PA group (3.4±0.6 vs 2.9±0.3 mmol/l; 1 157.1 vs 201.6 pg/ml; 168 vs 97 IU/L; all P <0.05). PC correlated with age( r =-0.241, P =0.007), albumin-corrected serum calcium ( r =0.324, P <0.001), PTH levels ( r =0.301, P =0.001), serum AKP ( r =0.217, P =0.019) and tumor size( r =0.238, P =0.011). Receiver operator characteristic curve analysis showed that the optimum cut-off values as follows: albumin-corrected serum calcium 3.15 mmol/L, serum PTH concentration 1 011 pg/ml and tumor diameter 3.35 cm. These indicators can be helpful in the preoperative diagnosis of PC. Conclusions: Patients with PC were younger than the patients with PA. Albumin-corrected serum calcium, serum PTH concentration, and tumor diameter can be helpful in preoperative diagnosis of PC.

Objective: To explore the clinical, pathological characteristics and imaging manifestations of brown tumors caused by hyperparathyroidism, to improve the cognition of the disease., Methods: The clinical, pathological characteristics and imaging manifestations of 15 cases of pathologically confirmed brown tumors were retrospectively reviewed. To analyze the imaging and pathological correlations, in addition, between the primary and secondary hyperparathyroidism led to brown tumors differential diagnoses. Rseults: In the 15 cases, aged from 26 to 66 years with median age of 51 years, 7 cases were caused by primary hyperparathyroidism, 8 cases secondary to long-term hemodialysis. Of the 15 cases(total of 34 lesions), 11 cases were multi-part bone involved. 13 of 15 patients for osteoporosis and 2 cases were osteosclerosis.32 lesions had bone destruction, 26 lesions showed expansive bone destruction, 6 showed soluble bone destruction, 12 lesions had harden edge. 23 lesions in bone destruction had calcification or ossification internal. 13 cases with soft tissue mass, enhanced significantly can be found in 3 cases. 2 lesions occured in the skull, bone density increased and the plate edge blur. pathological findings fibrous tissue , rich in blood vessels, scattered hemosiderin deposition, osteoid tissue around it., Conclusion: Brown tumor has relatively specific clinical history and laboratory characteristics. The imaging features include harden edge, in bone destruction has calcification or ossification internal and with soft tissue mass some enhanced significantly. The secondary brown tumor more multi-part destruction and more vertebra were involved than the primary.We can find osteosclerosis in secondary brown tumor. Those characteristic features were important to help for the diagnosis of the brown tumor.

Objective: To explore the 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET-CT) manifestations and functions in patients with primary hyperparathyroidism (pHPT). 
, Method: The diagnosis of 1 case of double parathyroid adenomas secondary to pPTH was reported and the related literature was reviewed.
, Results: PET-CT showed two nodus shadow with slightly lower density compared with muscle, clear boundary and uniform density. Simultaneously, images also showed multiple enhanced FDG uptake of bone lesions in skeletal system. The maximum standard uptake values for ¹⁸F-FDG in the destructive bone lesions were more than 10. 
, Conclusion: ¹⁸F-FDG PET-CT is a well-established imaging technique for the diagnosis in pHPT. It not only can clearly visualize systemic lesions and accurately assess the extent of the disease, but also can accurately localize parathyroid adenoma. After resection of parathyroid adenoma, FDG PET-CT imaging can be useful to see the response to treatment and osteoblastic changes in brown tumor.

Concurrent thyroid carcinoma and parathyroid adenoma is rare, they can and do coexist. We present here a 63-year old man who had bilateral papillary thyroid carcinoma and a parathyroid adenoma in the right thyroid lobe. Thyroid cancer was confirmed surgically. After the operation, the patient was found hypercalcemie and hypophosphatemia along with an elevated parathyroid hormone (PTH), indicating primary hyperparathyroidism. Also, the parathyroid 99mTc-MIBI scan demonstrated parathyroid adenoma in the right lower pole of the thyroid. The abnormal parathyroid tissue was carried out, and then serum calcium and PTH levels decreased to normal ranges.

Objective: Through analyzing the 13 cases with primary hyperparathyroidism (PHPT) retrospectively, We detected the reasons of the misdiagnosis and the strategy of diagnosis and treatment for the disease., Method: Thirteen cases of clinical materials on PHPT were collected from 2002 to 2012. Initial symptom, laboratory examination and imaging findings were analyzed. Thirteen cases of patients with PHPT all were performed surgery. The period of postoperative follow up was from 3 to 24 months, averaged for 12.2 months., Result: Surgeries on 13 patients were successful, including 12 cases of parathyroid adenoma and 1 case of parathyroid hyperplasia. After the operation, blood calcium went back to normal, and the symptoms of bone and urinary tract were relieved., Conclusion: Initial symptoms of PHPT are predominantly manifested as bone and kidney types. Elevated PTH/blood calcium levels, B-ultrasound/CT and ECT localization are the important diagnosis basis of this disease. Surgical excision of the lesion parathyroid tissue is the most effective treatment.

Objective: to study the biochemistry of blood and feature of pathology of an animal model in rabbits with the early primary hyperparathyroidism(PHPT)., Methods: 60 rabbits were divided into six groups of 10 each and fed a control diet (Ca:P, 1:0.7) or a high-phosphate diet (Ca:P, 1:7) for 1-, 2- or 3-month intervals. Compared with the control animals, serum PTH levels, serum calcium levels and serum phosphorus levels were determined. The parathyroid and kidneys of all animals were performed by the histologic examination., Results: compared with the control animals, serum parathyroid hormone (PTH) levels were elevated at 1-, 2-, 3-month intervals in experimental group (t = -7.665, t = -16.033, t = 12.877 respective, P < 0.05), whereas serum calcium levels were decreased at all three time intervals (t = 6.184, t = 9.329, t = 13.842, respective, P < 0.05), but serum phosphorus levels did not change (t = 0.611, t = 1.041, t = 1.941, respective, P > 0.05). Parathyroid histopathologic studies demonstrated no change at 1 month whereas six of ten experimental animals showed mild hyperplasia at 2 months and nine of ten showed mild to moderate hyperplasia with gland enlargement at 3 months compared with control animals. Histopathologic examination of the kidneys showed no change at 1 month but focal parenchymal inflammation with calcium deposition at 2- and 3-month in the experimental groups., Conclusion: the high-phosphate diet successfully induced an animal model in rabbits with the early primary hyperparathyroidism, which has a better stability and reproducibility.

Objective: To investigate the diagnosis and surgical treatment of parathyroid carcinoma., Methods: The clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures., Results: Parathyroid carcinoma accounted for 8.9% (8/90) of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision: 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1 - 14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8% - 11.5% of patients with primary hyperparathyroidism., Conclusions: The diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc(99m)-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.

Objective: To discuss the diagnosis and management of asymptomatic primary hyperparathyroidism (PHPT)., Methods: Clinical data of 46 cases of primary hyperparathyroidism from January 1990 to December 2006 were retrospectively analyzed. There were 5 cases of asymptomatic PHPT. Three out of the 5 cases obtained the diagnosis by routine health examination and 1 case was misdiagnosed as thyroid tumor before surgery, but was conformed as parathyroid adenoma by intraoperative biopsy. Remaining 1 case was diagnosed because of weakness. The serum calcium and the parathyroid hormone (PTH) levels were elevated in 4 cases, while only 1 being normal range. Unilateral neck exploration was performed in all 5 cases., Results: There were no operational death, recurrent nerve injury or other complications. All patients had the same pathological diagnosis as parathyroid adenomas. Three cases showed gentle circumoral paresthesia after surgery with normal serum level of calcium, but the symptoms were relieved with oral use of calcium gluconate. Only 1 patient had tetany with the lowest level of serum calcemia at 1.96 mmol/L in 24 h postoperatively. The signs and symptoms were all relieved by intravenous use of calcium gluconate for 3 d after surgery. Remaining 1 case has normal level of serum calcemia after surgery. Time range of following-up for 4 cases was from 2 months to 2 years. The level of serum calcemia was normal for them. One lost following-up., Conclusions: Asymptomatic primary hyperparathyroidism could be diagnosed according to co-elevated serum calcemia and PTH without typical symptoms. Unilateral neck exploration was the best choice for the patients with accurate imaging localization. Conservative management including adequate hydration, dietary calcium intake and pharmacological approaches could be used for the patients who were unfit for surgery.

Objective: To evaluate the efficiency of (99)Tc(m)-sestamibi (MIBI) in the diagnosis of parathyroid diseases with primary hyperparathyroidism., Methods: One hundred and four cases with primary hyperparathyroidism underwent MIBI and parathyroidectomy between May 2010 to November 2013 were reviewed. With MIBI, single adenoma was found in 91 cases, two adenomas in 5 cases, carcinoma and hyperplasia in 3 cases respectively. Primary hyperparathyroidism was diagnosed based on the associated symptoms and signs in 93 patients, while it was indicated in 11 asymptomatic patients due to the presence of hypercalcemia in health examination. Parathroid hormone levels ranged from 98 to 2 800 ng/L, and serum calcium levels were between 2.56-4.23 mmol/L., Results: The sensitivity of MIBI for total diseased parntyroids was 84.0% (100/119), and that for parathyroid adenoma, parnthyroid carcinoma, atypical adenoma and primary parathyroid hyperplasia was 87.1% (88/101), 3/3, 2/2 and 7/13, respectively., Conclusions: MIBI is efficient in the diagnosis of parathyroid diseases with primary hyperparathyroidism. The size and cystic degeneration of parathroid disease are two common factors decreasing MIBI reliability, and thyroid nodule is additional source leading to false-positive results.

Objective: To highlight the characteristics of metastatic pulmonary calcification(MPC) of a patient with primary hyperparathyroidism., Methods: The clinical, radiological, pathological and (99)mTc-MDP bone scanning data of the patient with primary hyperparathyroidism were studied and relevant literature was reviewed., Results: This 56 year-old female patient presented with cough and shortness of breath. The chest CT scan showed multiple, bilateral infiltrates and calcification in the left lung and ventricular wall. Transbronchial lung biopsy was performed, and the pathological study showed that there was diffuse calcification in the alveoli and alveolar septa.(99)mTc-MDP bone-scanning showed pulmonary uptake mostly. The patient showed significant clinical and radiological improvement after surgical removal of the parathyroid gland., Conclusions: Patients of primary hyperparathyroidism with respiratory symptoms were easily misdiagnosed as primary pulmonary diseases.(99)mTc-MDP bone-scanning can be used to help differentiate MPC from other diseases with similar clinical and radiological findings, thus allowing prompt therapy.

Objective: To study the diagnosis and treatment of hyperparathyroidism., Method: 37 patients with primary hyperparathyroidism (PHPT) were confirmed pathologically. The course of the disease varied, the longest one being 14 years and the shortest one 3 months., Result: 35 patients had parathyroid adenoma, 1 hyperplasia of parathyroid, and 1 carcinoma of parathyroid. The main clinical manifestation was symmetrical pain of the supporting bones and joints, hypercalcemia, hypercalcinuria, hypophosphatemia, hyper-alkaline phosphatasemia, and increase of iPTH in peripheral blood. X-ray examination showed osteoporosis and decalcification, accompanied with multiple fracture occasionally, we injected (99m)Tc and MiBi into inferior thyroid artery as a demonstration for the diagnosis of tumor of parathyroid., Conclusion: The key procedure of the operation was to search for tumor of parathyroid. We used thymus-thyroid ligament as guide and injected methylene blue into the artery during operation to search thyroid.

Objective: To evaluate the effect of proliferation and apoptosis of parathyroid cell in rabbits with primary hyperparathyroidism (PHPT)., Methods: A total of 80 adult Chinese rabbits were randomly divided into two groups (n = 40 each). The control group was fed with a normal diet (Ca: P, 1:0.7) while the experimental group a high phosphate diet (Ca: P,1:7) for 3-, 4-, 5-, or 6-month intervals to establish the animal model of PHPT. The parathyroid was totally removed for pathological examination after all rabbits were sacrificed. The thyroparathyroid complex was removed en bloc, fixed in neutral formalin and prepared for histological examination. The number of parathyroid cell in PHPT was calculated. Proliferation was determined by immunohistochemistry of proliferation cell nuclear antigen (PCNA) while apoptosis assessed by in situ dUTP biotin nick-end labeling (TUNEL)., Results: The number of parathyroid cell was 1.61 times in PHPT than that in the normal control (673 +/- 151, 418 +/- 25, t = - 12.112, P < 0.01). Apoptotic index (AI) increased significantly more in PHPT than that in normal control (200.2 per thousand +/- 125.6 per thousand, 11.0 per thousand +/- 3.0 per thousand, t = -10.193, P < 0.01). The rate of PCNA positive-cell increased significantly more in PHPT than that in control (50.5 per thousand +/- 11.6 per thousand, 26.7 per thousand +/- 2.8 per thousand, t = -13.120, P < 0.05). So did Bcl-2 (460 per thousand +/- 190 per thousand, 67 per thousand +/- 4 per thousand, t = -14. 120, P < 0.05). There was a positive correlation between AI and PCNA (r = 0.861, P < 0.05). It was the same as between AI and Bcl-2 (r = 0.871, P < 0.05). The value of bone mineral density decreased significantly more in PHPT than that in normal control (152 +/- 34, 189 +/- 12, t = 9.236, P < 0.05)., Conclusion: PHPT may be mainly induced by an excessive proliferation of parathyroid cells and an acceleration of apoptotic process.

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