Tertiary hyperparathyroidism radiology. It accounts for the 'H' in the p.

Tertiary hyperparathyroidism radiology. Jul 22, 2025 · This article discusses the diagnosis, differential diagnosis, and evaluation of primary hyperparathyroidism, including key diagnostic criteria and considerations for accurate assessment. (a) Subperiosteal resorption (thick arrows), osteolysis of the distal phalangeal tufts (thin arrow), and extraskeletal calcification (asterisk). These findings are Calcification in the brain due to hyperparathyroidism Pepper & Salt, classical X-Ray appearance of hyperparathyroidism The gold standard of diagnosis is the PTH immunoassay. Apr 28, 2025 · Acro-osteolysis (plural: acro-osteolyses), also known as phalangeal osteolysis, refers to resorption of the distal phalanx. Imaging is particularly useful in the setting of primary hyperparathyroidism whereby accurate localization of a single parathyroid adenoma can facilitate minimally invasive parathyroidectomy. Procedure Appropriateness Category Relative Radiation Level US parathyroid Usually Appropriate O Sestamibi scan and pertechnetate thyroid scan Usually Appropriate CT neck without and with IV contrast Usually Appropriate ☢☢☢ Sestamibi dual-phase scan neck Usually Hyperparathyroidism, due to increased secretion of parathyroid hormones, may be primary, secondary or tertiary. When the diagnosis of hyperparathyroidism is certain and surgery is envisaged, imaging is useful for locating the hyperfunctioning gland or glands This 50 year old gentleman is known to have chronic renal failure, was admitted to our hospital for permcath insertion to undergo dialysis. Aug 22, 2009 · A-Z of Musculoskeletal and Trauma Radiology - June 2008Characteristics Parathormone excess may be primary, secondary or tertiary. The purpose of this In patients with tertiary hyperparathyroidism, preoperative imaging can aid in predicting which patients will have 1-2 gland disease. Apr 27, 2021 · Hyperparathyroidism, due to increased secretion of parathyroid hormones, may be primary, secondary or tertiary. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or Jun 26, 2023 · Abstract Parathyroid scintigraphy is an imaging technique that uses gamma-emitting radionuclide to locate hyperfunctioning parathyroid glands in patients with hyperparathyroidism. Apr 24, 2025 · The epidemiology of Brown’s tumors varies based on the underlying cause of HPT—primary, secondary, or tertiary. It can be primary, secondary, or tertiary. The terminal tuft is most commonly affected. This entity is commonly In pediatrics, multiphase CT protocols should be adjusted to optimize radiation dose. 4D-CT may be used for preoperative localization of hyper-functioning parathyroid glands in hyperparathyroidism. Additionally, advances in the understanding of primary hyperparathyroidism (PHPT This document summarizes the literature and provides imaging recommendations for hyperparathyroidism including primary hyperparathyroidism, recurrent or persistent primary hyperparathyroidism after parathyroid surgery, secondary hyperparathyroidism, and tertiary hyperparathyroidism. Advances in diagnostic techniques and early intervention Abstract Background The imaging techniques most commonly used in the diagnosis of hyperparathyroidisms are ultrasound and scintigraphy. 1% of the population and 90% of cases result from a single adenoma Feb 12, 2024 · Imaging techniques such as ultrasound, CT scan, and nuclear medicine scans may also be used to visualize the parathyroid glands and detect any abnormalities. Variant: 4 Adult or child. Primary Hyperparathyroidism (HPT) is most common, characteristically occurring in women (3:1) over 50. Abstract Purpose 99m Tc-labeled sestamibi scintigraphy combined with single-photon emission computed tomography (SPECT) has a high positive predictive value for localizing hyperfunctioning parathyroid lesions in primary hyperparathyroidism (pHPT) but relatively low sensitivity and specificity in secondary hyperparathyroidism (sHPT) and tertiary hyperparathyroidism (tHPT). 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 calcium, phosphate, and PTH levels. The role of imaging in hyper-parathyroidism is to guide minimally invasive sur-gical interventions for PHPT. It accounts for the 'H Figure 1|Radiographic and photographic images of hands of a patient with severe tertiary hyperparathyroidism. Jul 1, 2023 · Other forms of hyperparathyroidism consist in secondary (2° HPT) and tertiary hyperparathyroidism (3° HPT). It can be primary, secondary or tertiary. Accurate diagnosis of tertiary hyperparathyroidism enables healthcare providers to tailor a treatment plan that addresses the specific needs of the patient. Anatomically, these glands are located in the neck, para-lateral to the thyroid gland May 24, 2025 · Description Hyperparathyroidism is a clinical condition characterised by hypercalcemia resulting from an excessive secretion of parathyroid hormone (PTH). It accounts for the 'H' in the p Dec 14, 2021 · This feature, along with multiple lytic lesions on radiology, strongly favor brown tumor of hyperparathyroidism. Feb 1, 2025 · In over 80% of cases, primary hyperparathyroidism results from hypersecretion of PTH by a single parathyroid adenoma. Primary Hyperparathyroidism: Imaging to PathologyThe aim of this review is to describe the multimodal imaging (ultrasound, magnetic resonance, computed tomography, and nuclear medicine) of primary hyperparathyroidism and its correlation to the pathological findings. Surgery remains the first-line curative therapy in PHPT. Although, the role of these imaging modalities is better established in preoperative localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism, the same principles apply in secondary and tertiary hyperparathyroidism. Imaging is performed purely to localize parathyroid tumours and abnormal glands prior to surgery. It accounts for the 'H' in the p Feb 25, 2022 · National Institutes of Health (NIH) Clinical Center, Department of Radiology and Imaging Sciences, Bethesda, MD, United States The goal of parathyroid imaging is to identify all sources of excess parathyroid hormone secretion pre-operatively. Multi-glandular involvement, combining adenoma and/or hyperplasia in varying proportions, is also possible, although less frequent. Correlation with clinical history, radiological findings and serum PTH and calcium levels is recommended. Sestamibi scan offers Secondary and tertiary hyperparathyroidism (HPT) usually result from parathyroid gland hyperplasia that produces excess parathyroid hormone (PTH). Given recent advances in surgical techniques allowing more focused, minimally invasive procedures, presurgical identification of candidate operative tissue has become increasingly useful in avoidance of 4-gland exploration. Imaging is essential for preoperative localization, helping identify ectopic or multiglandular disease and facilitating Dec 28, 2011 · Secondary hyperparathyroidism shares many pathogenic, clinical, biochemical, radiological, and bone histological features of tertiary hyperparathyroidism, except that with the development of hypercalcemia the classification changes from secondary to tertiary hyperparathyroidism [4]. Primary HPT, often due to parathyroid adenomas, is the most common etiology in developed nations, while secondary HPT, associated with chronic kidney disease, predominates in areas with high rates of renal dysfunction (6). The most frequent Imaging methods, such as parathyroid gland ultrasound and scintigraphy with technetium (99mTc-sestamibi), will show hyperplastic parathyroid glands, but are not used for the diagnosis of tertiary hyperparathyroidism, as the diagnosis is established based on biochemical laboratory tests34. A single adenoma accounts for > 90% of all cases; carcinoma is rare (1%). Sep 1, 2022 · Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism. It is associated with a heterogeneous group of pathological entities, some of Sep 21, 2025 · Hyperparathyroidism is the increase in serum parathyroid hormone (PTH) production that may be of primary, secondary or tertiary causes. Aim Aim of the present research was to determine the usefulness of parathyroid scintigraphy and ultrasonography in patients diagnosed for hyperparathyroidism in Primary, Secondary and Tertiary Hyperparathyroidism Diagnostic and Therapeutic Updates, Springer, 2016 Reviewed by: Guido GASPARRI , Michele CAMANDONA , Nicola PALESTINI Case Discussion Hyperparathyroidism is the result of a solitary parathyroid adenoma in the vast majority of patients (~85%). Introduction The parathyroid gland is a group of glands located behind thyroid, usually four (1). May 14, 2023 · Primary hyperparathyroidism (PHPT) is a disorder character-ized by hypercalcemia and an elevated or inappropriately normal parathyroid hormone level. In patients with 3° HPT, total or subtotal parathyroidectomy is often performed. Apr 1, 2002 · The diagnosis of hyperparathyroidism is based on biochemical findings. In patients with 1-2 gland disease on congruent ultrasound and nuclear medicine imaging studies, the accuracy increases to 59%. It’s either an ultrasound or a nuclear scan. The compatibility of surgical findings with imaging findings and radiology reports in terms of exact anatomical quadrant localization of the parathyroid lesion, depth in the neck, and approximate size of the adenoma was deemed to indicate accurate localization (Figure 3). In younger patients with primary hyperparathyroidism, there is a higher prevalence of familial hyperparathyroidism including Oct 23, 2025 · Hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH), which leads to dysregulated calcium and phosphate metabolism. Most cases are caused by a single parathyroid adenoma, but multiple These findings are consistent with hyperparathyroidism which was confirmed. Knowing the differences helps doctors diagnose and treat these conditions right. In the last decades, imaging science has progressed a great deal. Jan 5, 2024 · Hyperparathyroidism is divided into 3 types: (1) primary hyperparathyroidism (PHPT), (2) secondary hyperparathyroidism (SHPT), and (3) tertiary hyperparathyroidism (THPT). 4D-CT is significantly more sensitive than Tc-99m sestamibi imaging and ultrasound for precise (quadrant) localization of hyper-functioning parathyroid glands. 1 PHPT is the most common type, originating from the overproduction of parathyroid hormone by a single (in 80% of cases) or multiple parathyroid glands. Most pediatric patients with sporadic primary hyperparathyroidism will be symptomatic, presenting with either end-organ damage or nonspecific symptoms. It is valuable for preoperative assessment before parathyroidectomy, which is a curative surgery in most cases of primary hyperparathyroidism and some cases of secondary hyperparathyroidism. May 20, 2025 · Hyperparathyroidism (HPT) is characterized by abnormally high parathyroid hormone (PTH) levels in the blood due to parathyroid gland overactivity. In younger patients with primary hyp … Tertiary hyperparathyroidism is characterized by increased parathyroid hormone (PTH) secretion that appears after prolonged secondary hyperparathyroidism, leading to the onset of hypercalcemia. There are many characteristic imaging features, predominantly involving the skeletal system. It accounts for the 'H' in the p We would like to show you a description here but the site won’t allow us. The condition can be primary, secondary, or tertiary based on the underlying cause. We retrospectively enrolled 35 consecutive patients who underwent dual-phase (at 10 minutes Editor's Note. Its manifestations include skeletal alterations, calcification of soft tissues, kidney stones, and functional alterations in other systems. Sep 17, 2020 · Primary hyperparathyroidism (PHPT) is a common endocrine abnormality, caused in most cases by a single parathyroid adenoma. This study aimed to establish an optimal protocol for 99mTc-sestamibi parathyroid imaging for lesion localization in patients with hyperparathyroidism (HPT). Feb 21, 2020 · Primary hyperparathyroidism is a systemic endocrine disease that has significant effects on bone remodeling through the action of parathyroid hormone on the musculoskeletal system. Women are affected approximately twice to three times as often as men. This document provides an overview of hyperparathyroidism and its imaging features. Primary hyperparathyroidism, defined as an independent focus of parathyroid hormone overproduction, has an estimated prevalence of 1:7000 in the United States. Jan 7, 2025 · US-guided microwave and radiofrequency ablation were effective and relatively safe for the treatment of secondary hyperparathyroidism in a multicenter prospective cohort of participants. HPT is further classified based on the underlying Tertiary hyperparathyroidism is typically characterized by marked parathyroid hyperplasia or parathyroid adenomas. Infrequently, hyperparathyroidism can be due to multiple adenomas. This document summarizes the literature and provides imaging recommendations for hyperparathyroidism including primary hyperparathyroidism, recurrent or persistent primary hyperparathyroidism after parathyroid surgery, secondary hyperparathyroidism, and tertiary hyperparathyroidism. It accounts for the 'H Mar 31, 2025 · Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone after longstanding secondary hyperparathyroidism, and results in hypercalcemia. It is characterized by high serum calcium and high or inappropriately normal parathyroid hormone. Hyperparathyroidism can be primary, secondary, or tertiary, and is caused by excessive levels of parathyroid hormone. When performed, they may reveal enlarged parathyroid glands and various bone lesions like those found in primary hyperparathyroidism. Classic features include bone pain, fractures, renal impairment, nephrolithiasis, and mental distur-bance. Tertiary hyperparathyroidism. Jun 1, 2012 · Although no published appropriateness criteria exist for parathyroid scintigraphy, parathyroid scintigraphy is specifically designed to localize parathyroid adenomas or parathyroid hyperplasia in patients with hyperparathyroidism that is determined on the basis of elevated parathyroid hormone levels in the setting of an elevated serum calcium X-ray is the preferred imaging for diagnosis of secondary hyperparathyroidism as majority of findings are radiological. The primary treatment goal for tertiary hyperparathyroidism is to Aug 12, 2025 · Hyperparathyroidism is a condition caused by excessive parathyroid hormone in the body. Feb 8, 2025 · To investigate the association between imaging findings and histopathological characteristics of parathyroid glands in patients with secondary hyperparathyroidism (SHPT). Notably, jaw alterations can be the first clinical sign of Jan 1, 2022 · Primary hyperparathyroidism is the most common cause of hypercalcemia in the outpatient setting. - RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. Find out how it works, its benefits, and what to expect. Aug 12, 2025 · Hyperparathyroidism is a condition caused by excessive parathyroid hormone in the body. It accounts for the 'H Hyperparathyroidism is the effect of excess parathyroid hormone (PTH) in the body. Apr 15, 2022 · Primary hyperparathyroidism is primarily a clinical and biochemical diagnosis, but imaging modalities such as US, parathyroid scintigraphy, and four-dimensional CT are essential for accurate locali Dec 21, 2024 · Hyperparathyroidism is the effect of excess parathyroid hormone in the body. Parathyroid hyperplasia, as seen in this patient, accounts for the remaining cases, with parathyroid carcinoma encountered in less than 1% of instances. Aug 1, 2008 · Hyperparathyroidism Hyperparathyroidism can be primary, secondary, or tertiary. It accounts for the 'H Imaging of the parathyroid glands: Imaging of parathyroid glands is not needed Extra-osseous calcification is more common in secondary hyperparathyroidism than in the primary form Treatment: medical management; vitamin D replacement, phosphate restriction or binding agents Tertiary hyperparathyroidism May 5, 2021 · Tertiary hyperparathyroidism (HPT III) occurs when an excess of parathyroid hormone (PTH) is secreted by parathyroid glands, usually after longstanding secondary hyperparathyroidism. The diagnostic algorithms vary, depending mainly on the population, and experience of physicians. It accounts for the 'H' in the p Jul 16, 2025 · Parathyroid adenomas are benign tumors of the parathyroid glands and are the most common cause of primary hyperparathyroidism. It typically occurs in patients with long-standing secondary hyperparathyroidism, often as a result of chronic kidney disease (CKD). Initial imaging. Dec 22, 2022 · 1. Dec 21, 2024 · Hyperparathyroidism is the effect of excess parathyroid hormone in the body. Initially his physician in charge requested thyroid ultrasound which showed hyperplastic parathyroid glands Mar 30, 2025 · Associated conditions multiple endocrine neoplasia (MEN) 1 and 2A (primary hyperparathyroidism) chronic renal disease (secondary and tertiary hyperparathyroidism) renal osteodystrophy (secondary or tertiary hyperparathyroidism) Epidemiology Demographics occurs in 0. 1 Medical therapy remains the mainstay of management in second-ary and tertiary hyperparathyroidism; therefore, the focus of this review is related to PHPT. Hyperparathyroidism Types: Primary, Secondary & Tertiary Hyperparathyroidism is when the parathyroid glands make too much parathyroid hormone (PTH). Primary hyperparathyroidism, recurrent or persistent after parathyroid surgery. The parathyroid glands are found to undergo Aug 12, 2025 · Hyperparathyroidism is a condition caused by excessive parathyroid hormone in the body. We report a case of a 41-year-old female patient presented with severe osteoporosis Primary hyperparathyroidism results most commonly from a parathyroid adenoma, a benign parathyroid tumor that causes high levels of parathyroid hormone production. A parathyroid scan is a painless imaging procedure that’s used to find the location of an overactive parathyroid gland. Accurate preoperative localization of the involved glands is Hyperparathyroidism can be primary, secondary or tertiary depending on its aetiology. The resultant bone resorption produces cortical thinning (subperiosteal resorption) and osteopenia Jul 17, 2025 · Terminology The WHO classification of endocrine and neuroendocrine tumors recommends that the term parathyroid hyperplasia be reserved for secondary and tertiary hyperparathyroidism (usually in the context of chronic renal disease) 8. There are three main types: primary, secondary, and tertiary. Hyperparathyroidism (HPT) is characterized by abnormal calcium and phosphorus metabolism caused by excessive secretion of parathyroid hormone (PTH). Imaging can also be useful to localize ectopic or supernumerary aChief, Head and Neck Radiology, University of Colorado Denver, Denver, Colorado. Depending on the background of PTH overproduction, hyperparathyroidism is divided into primary, secondary, and tertiary hyperparathyroidism. It accounts for the 'H' in the p Nov 28, 2022 · Hyperparathyroidism is the effect of excess parathyroid hormone in the body. Collectively, secondary and tertiary HPT comprise a minority of the patients diagnosed with HPT. Pathology Increased levels of the PTH lead to increased osteoclastic activity. Here we present a case of multiple parathyroid adenomas in a 23-year-old woman with tertiary hyperparathyroidism due to chronic kidney disease and describe the ultrasonography and computed tomography findings. The parathyroid glands are found to undergo hyperplastic or adenomatous changes and act autonomously with increased parathormone secretion not suppressed by feedback control. However, most cases of PHPT are now asymptomatic at diagnosis or associated with nonspecific neurocognitive changes. It accounts for the 'H' in the p Tertiary hyperparathyroidism is characterized by increased parathyroid hormone (PTH) secretion that appears after prolonged secondary hyperparathyroidism, leading to the onset of hypercalcemia. This hormone plays a key role in regulating Tertiary hyperparathyroidism (THPT) is uncommon and occurs in less than 8% of patients with secondary hyperparathyroidism after a successful kidney transplantation. We would like to show you a description here but the site won’t allow us. Parathyroid adenoma accounts for 80% of cases of primary hyperparathyroidism. In countries where routine biochemical screening is not common, symptomatic hyperparathyroidism predominates. Pathogenesis The parathyroid glands, located posterior to the thyroid gland, are responsible for producing PTH. Imaging of the parathyroid glands: Imaging of parathyroid glands is not needed Extra-osseous calcification is more common in secondary hyperparathyroidism than in the primary form Treatment: medical management; vitamin D replacement, phosphate restriction or binding agents Tertiary hyperparathyroidism Learn about the parathyroid scan, a nuclear medicine imaging test for diagnosing hyperparathyroidism and parathyroid adenomas. A variety of imaging approaches have been evaluated and Mar 27, 2021 · Background Tertiary hyperparathyroidism following kidney transplantation is most commonly characterized by 4-gland hyperplasia, but single and double adenomatous disease has been demonstrated in this population as well. Apr 3, 2025 · Hyperparathyroidism is characterized by continuous exposure to excessive endogenous PTH, causing increased bone turnover in favor of bone resorption. There are many characteristic imaging features predominantly involving the skeletal system. Aug 12, 2025 · Hyperparathyroidism is a condition caused by excessive parathyroid hormone in the body. It accounts for the ' Tertiary hyperparathyroidism is defined as a condition that develops after prolonged nutritionally secondary hyperparathyroidism, characterized by hypercalcemia resulting from a chronically stimulated hyperplastic parathyroid gland that may form an adenoma. . 1 - 3 In patients with secondary hyperparathyroidism due to chronic renal failure, THPT results from autonomous proliferation of the parathyroid glands and hypersecretion of Jan 8, 2025 · Imaging studies: Imaging studies are not required to make a diagnosis of tertiary hyperparathyroidism. Variant: 2 Adult or child. Jul 16, 2025 · Hyperparathyroidism is a condition caused by excessive parathyroid hormone in the body. Tertiary hyperparathyroidism develops as a result of prolonged secondary hyperparathyroidism and is characterized by excessive secretion of parathyroid hormone after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. The radiological manifestations of hyperparathyroidism are well described (Table 1) [5]. Imaging plays a vital role in presurgical localization of parathyroid adenomas. Abstract Tertiary hyperparathyroidism is a condition characterized by excessive production of parathyroid hormone (PTH) by the parathyroid glands, leading to increased calcium levels in the blood. Diagnosis is based on elevated calcium and parathyroid hormone levels and clinical In patients with secondary or tertiary hyperparathyroidism, usually appropriate imaging tests include US parathyroid, CT neck without and with contrast, and various types of sestamibi scans. Materials and methods We performed a Keywords: parathyroid scintigraphy, 99m Tc-MIBI, dual isotope, hemodialysis, secondary hyperparathyroidism, tertiary hyperparathyroidism, surgery Secondary hyperparathyroidism (sHPT) is a frequent major complication for patients with end-stage renal disease on long-term hemodialysis or peritoneal dialysis. As parathyroidectomy is not usually part of the management of patients with 2° HPT, parathyroid imaging is not routinely performed in these patients. Diagnosis is made based on evaluation of serum labs and clinical evaluation. It is unknown whether preoperative imaging can assist in identifying patients who may qualify for focused surgery for adenomatous disease. There are several Jun 19, 2025 · Tertiary hyperparathyroidism is neoplastic proliferation arising in hyperplasia and giving rise to autonomous secretion of parathyroid hormone (PTH) in the setting of prolonged secondary hyperparathyroidism; necrosis, fibrosis or hemorrhage in a dominant nodule should prompt evaluation for malignancy May 1, 2014 · Hyperparathyroidism may be primary (unregulated hyperproduction of PTH with no identified stimulus), secondary (overproduction of PTH secondary to chronic abnormal stimulus such as renal failure or vitamin D deficiency) or tertiary (usually describing secondary hyperparathyroidism persisting despite successful renal transplantation and Nov 1, 2021 · This document summarizes the literature and provides imaging recommendations for hyperparathyroidism including primary hyperparathyroidism, recurrent or persistent primary hyperparathyroidism after parathyroid surgery, secondary hyperparathyroidism, and tertiary hyperparathyroidism. [1] The parathyroid glands are involved in monitoring and regulating blood calcium levels and respond by either producing or ceasing to produce parathyroid hormone. This is mainly classified as primary, secondary, and tertiary hyperparathyroidism. Parathyroid hyperplasia usually occurs in multiple endocrine neoplasia syndromes Tertiary hyperparathyroidism is characterized by the autonomous hyperfunction of the parathyroid gland in long-term secondary hyperparathyroidism due to the loss of feedback from serum calcium levels (1, 2). Some authorities reserve the term for secondary hyperparathyroidism that persists after successful renal transplantat … Tertiary hyperparathyroidism is a condition involving the overproduction of the hormone, parathyroid hormone, produced by the parathyroid glands. Dual-phase imaging with Tc-99m sestamibi is Hyperparathyroidism is one of the most common endocrine disorders worldwide. Aug 1, 2024 · Since the 2020 RadioGraphics publication of "Parathyroid 4D CT: What the Surgeon Wants to Know" (1), an advantageous dual-energy parathyroid CT protocol has been developed (2), and evidence has emerged that enhances the ability to use parathyroid CT results to facilitate individualized operative planning (3, 4). Imaging studies: Imaging techniques like ultrasound, CT scan, MRI, and sestamibi scan can be used to locate abnormal parathyroid glands in tertiary hyperparathyroidism. Imaging findings include generalized osteopenia, subperiosteal bone resorption of the fingers and ribs, and brown tumors Dec 21, 2024 · Hyperparathyroidism is the effect of excess parathyroid hormone in the body. Ultrasound provides a safe and quick imaging modality free of ionizing radiation, but is operator dependent. Imaging Jun 17, 2025 · This article reviews the skeletal involvement in the most frequent parathyroid disorders, hyperparathyroidism and hypoparathyroidism, and rare familial disorders of primary hyperparathyroidism metabolism, as assessed by clinical, laboratory, and imaging parameters, and the effect of the available treatment strategies. Primary hyperparathyroidism is usually due to a parathyroid adenoma. bl8ne4 j4vgx1 uj4qo 1jgf 7l 9oq0 ghu5 nz2 mmasm vz