Normohormonal primary hyperparathyroidism: A systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#humans #calcium #parathyroid-hormone #hyperparathyroidism-primary #retrospective-studies

Normohormonal primary hyperparathyroidism: A systematic review and meta-analysis

Nabata et al., 2023 | Am J Surg | Meta Analysis

Citation

Nabata Kylie J, Wiseman Jacob J, Wiseman Sam M. Normohormonal primary hyperparathyroidism: A systematic review and meta-analysis. Am J Surg. 2023-Aug;226(2):186-196. doi:10.1016/j.amjsurg.2023.04.004

Abstract

OBJECTIVE: We aim to evaluate the body of evidence reporting on normohormonal primary hyperparathyroidism (NHpHPT) patients to help guide their diagnosis, characterization and treatment. BACKGROUND: Normohormonal primary hyperparathyroidism is a term used to describe patients with a normal PTH and elevated calcium levels. There is limited understanding regarding the presentation and appropriate management of these patients. METHODS: A systematic review was conducted: abstract and full-text screening were independently conducted by 2 investigators. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals were calculated. RESULTS: Twenty-two studies were identified. Patients with NHpHPT were more likely to present with lower PTH (p < 0.00001) and calcium (p < 0.00001) levels. Intraoperatively, the NHpHPT group was 1.8 times more likely to undergo bilateral neck exploration (BNE) and harbor multigland disease. The rates of surgical cure were 93% in the NHpHPT and 96% in the pHPT groups (p = 0.0003). CONCLUSION: Symptomatic patients with NHpHPT benefit from parathyroidectomy with prolonged intraoperative PTH monitoring, and a low threshold for conversion to BNE.

Key Findings

Twenty-two studies were identified. Patients with NHpHPT were more likely to present with lower PTH (p < 0.00001) and calcium (p < 0.00001) levels. Intraoperatively, the NHpHPT group was 1.8 times more likely to undergo bilateral neck exploration (BNE) and harbor multigland disease. The rates of surgical cure were 93% in the NHpHPT and 96% in the pHPT groups (p = 0.0003).

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population a normal pth and
Sample Size See abstract
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Calcium
  • Parathyroid Hormone
  • Hyperparathyroidism, Primary
  • Retrospective Studies
  • Parathyroidectomy

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Meta-Analysis, Systematic Review, Journal Article
  • Vertical: calcium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09