Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi

Çağlar Alp; İrfan Karahan; Şenay Arıkan Durmaz

doi:10.18663/tjcl.334008

Review

A different view of normocalcemic hyperparathyroidism: The examination of cardiac problems

Year 2019, Volume: 10 Issue: 1, 104 - 109, 21.03.2019

Çağlar Alp İrfan Karahan Şenay Arıkan Durmaz

https://doi.org/10.18663/tjcl.334008

Abstract

While hyperparathyroidism is well
known among the clinicians, such side effects as renal complications and osteoporosis are closely monitored.
Besides various conducted studies have
found out several side effects such as hypertension, diastolic dysfunction,
endothelial dysfunction, heart valve calcification, arythmia, cardiac
hypertropy. Even some studies have pointed to increase in cardiac mortality is
correlated with hyperparathyroidizm. İn this review, it is intended to raise a
concern about cardiac complications occuring in primary hyperparathyroidism.

Keywords

hyperparathyroidism, cardiac effects, hypertension

References

1.Andersson P, Rydberg E, Willenheimer R. Primary hyperparathyroidism and heart disease--a review. Eur Heart J 2004; 25: 1776-87.
2. Kalla A, Krishnamoorthy P, Gopalakrishnan A, Garg J, Patel NC, Figueredo VM. Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample. Int J Cardiol 2017; 227: 335-37
3. Heath III, Hunter, Stephen F. Hodgson, Margaret A. Kennedy. "Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community." Nejm 1980; 302: 189-93.
4. Amanzadeh J, Reilly RF Jr. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol 2006; 2: 136-48.
5. Fardella C, Rodriguez-Portales JA. Intracellular calcium and blood pressure: comparison between primary hyperparathyroidism and essential hypertension. J Endocrinol Invest 1995; 18: 827-32.
6. Gennari C, Nami R, Gonnelli S. Hypertension and primary hyperparathyroidism: the role of adrenergic and renin-angiotensin-aldosterone systems. Miner Electrolyte Metab 1995; 21: 77-81.
7. Osto E, Fallo F, Pelizzo MR et al. Coronary microvascular dysfunction induced by primary hyperparathyroidism is restored after parathyroidectomy. Circulation 2012; 126: 1031-39.
8. Ozdemir D, Kalkan GY, Bayram NA et al. Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism. Endocrine 2014; 47: 609-17.
9. J.L. Anderson, R.C. Vanwoerkom, B.D. Horne, T.L. Bair, H.T. May, D.L. Lappé, J.B. Muhlestein, Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease: dependent or independent risk factors? Am. Heart J 2011; 162: 331-39.
10. D. Han, S. Trooskin, X. Wang, Prevalence of cardiovascular risk factors in male and female patients with primary hyperparathyroidism. J. Endocrinol. Invest 2012; 35: 548-52.
11. Stefenelli T, Abela C, Frank H et al. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab 1997; 82: 106-12.
12.Palmer M, Adami HO, Bergström R, Jakobsson S, Akerström G, Ljunghall S. Survival and renal function in untreated hypercalcaemia. Population-based cohort study with 14 years of follow-up. Lancet 1987; 1: 59-62.
13. Hagstrom M, Hellman EP, Larsson TE et al. Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation 2009; 119: 2765-71.
14. Buizert PJ, van Schoor NM, Simsek S et al. PTH: a new target in arteriosclerosis? J Clin Endocrinol Metab 2013; 98: 1583-90.
15. Soares AA et al. "Enhanced parathyroid hormone levels are associated with left ventricle hypertrophy in very elderly men and women." J Am Society Hypertens 2015; 9: 697-704.
16. Walker MD, Rundek T, Homma S et al. Effect of parathyroidectomy onsubclinical cardiovascular disease in mild primary hyperparathyroidism. Eur J Endocrinol 2012; 167: 277-85.
17. Johnstone LM, Jones CL, Grigg LE, Wilkinson JL, Walker RG, Powell HR. Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int 1996; 50: 998-1006.
18. Taylor EN, Curhan GC, Forman JP. Parathyroid hormone and the risk of incident hypertension. J Hypertens 2008; 26: 1390–94.
19. Schlüter KD, Weber M, Piper HM. Parathyroid hormone induces protein kinase C but not adenylate cyclase in adult cardiomyocytes and regulates cyclic AMP levels via protein kinase C-dependent phosphodiesterase activity. Biochem J 1995; 310: 439-44.
20. X. Liu, R. Xie, S. Liu, Rat parathyroid hormone 1-34 signals through the MEK/ERK pathway to induce cardiac hypertrophy. J Int Med Res 2008; 36: 942-50.
21. L. Brunaud, A. Germain, R. Zarnegar et al. Serum aldosterone is correlated positively to parathyroid hormone (PTH) levels in patients with primary hyperparathyroidism. Surgery 2009; 146: 1035-41.
22. Ogino K, Burkhoff D, Bilezikian JP. The hemodynamic basis for the cardiac effects of parathyroid hormone (PTH) and PTH-related protein. Endocrinology 1995; 136: 3024-30.
23. Pirro M, Manfredelli MR, Helou RS et al. Association of parathyroid hormone and 25-OH-vitamin D levels with arterial stiffness in postmenopausal women with vitamin D insufficiency. J Atheroscler Thromb 2012; 19: 924-31.
24.McMahon DJ, Carrelli A, Palmeri N et al. Parathyroidectomy upon left ventricular mass in primary hyperparathyroidism: A meta-analysis. J Clin Endocrinol Metab 2015; 100: 4399-407.
25. Nappi S, Saha H, Virtanen V et al. Left ventricular structure and function in primary hyperparathyroidism before and after parathyroidectomy. Cardiology 2000; 93: 229-33.
26. Barletta G, De Feo ML, Del Bene R et al. Cardiovascular effects of parathyroid hormone: a study in healthy subjects and normotensive patients with mild primary hyperparathyroidism. J Clin Endocrinol Metab 2000; 85: 1815-21.
27. S.A. Camacho, R. Brandes, V.M. Figueredo, M.V. Weiner, Ca2 + transient decline and myocardial relaxation are slowed during low flow ischemia in rat hearts. J Clin Invest 1994; 93: 951-57.
28. Sin HY. Prospective cohort study: Cinacalcet-mediated lowering of PTH level and cardiovascular disease mortality in younger Korean patients with stage 5 CKD at a Korean secondary hospital. J Clin Pharm Ther 2017; 5: 607-14
29. Nagashima M, Hashimoto K, Shinsato T et al. Marked improvement of left ventricular function after parathyroidectomy in a hemodialysis patient with secondary hyperparathyroidism and left ventricular dysfunction. Circ J 2003; 67: 269-72.
30. Nanasato M, Goto N, Isobe S et al. Restored cardiac conditions and left ventricular function after parathyroidectomy in a hemodialysis patient. Parathyroidectomy improves cardiac fatty acid metabolism assessed by 123I-BMIPP. Circ J 2009; 73: 1956-60.
31. Smogorzewski M, Perna AF, Borum PR, Massry SG. Fatty acid oxidation in the myocardium: Effects of parathyroid hormone and CRF. Kidney Int 1988; 34: 797-803.
32. Schiffl H, Lang SM. Hypertension Secondary to PHPT: Cause or Coincidence? Int J Endocrinol 2011; 2011: 974647.
33. Kizilgul M, Beketaev I, Dolapoglu A. Letter to the Editor: Could Low Phosphate Level Be the Reason for High Risk of Hypertension in Normocalcemic Primary Hyperparathyroidism? J Clin Endocrinol Metab 2015; 100: 39.
34. Tomaschitz A, Ritz E, Pieske B et al. Aldosterone and parathyroid hormone: a precarious couple for cardiovascular disease. Cardiovasc Res 2012; 94: 10-19.
35. Zia AA, Kamalov G, Newman KP et al. From aldosteronism to oxidative stress: the role of excessive intracellular calcium accumulation. Hypertens Res 2010; 33: 1091-101.
36. Bernini G, Moretti A, Lonzi S, Bendinelli C, Miccoli P, Salvetti A. Renin-angiotensin-aldosterone system in primary hyperparathyroidism before and after surgery. Metabolism 1999; 48: 298-300.
37. D. Fliser, E. Franek, P. Fode et al. Subacute infusion of physiological doses of parathyroid hormone raises blood pressure in humans. Nephrol Dial Transplant 1997; 12: 933-38.
38. B. Jespersen, A. Randlov, J. Abrahamsen et al.The altered pattern of reactivity may counteract raised blood pressure Am J Hypertens 1997; 10: 1356-67.
39. Rosenqvist M, Nordenström J, Andersson M, Edhag OK. Cardiac conduction in patients with hypercalcaemia due to primary hyperparathyroidism. Clin Endocrinol (Oxf) 1992; 37: 29-33.
40. Dokupilova A, Payer J. 24-hour outpatient ECG as a screening method in patients with primary hyperparathyroidism. Bratisl Lek Listy 2016; 117: 495-500.
41. C. Bosworth, M.C. Sachs, D. Duprez et al. Parathyroid hormone and arterial dysfunction in the multi-ethnic study of atherosclerosis. Clin. Endocrinol (Oxf) 2013; 79: 429-36.
42. Ekmekci A, Abaci N, Colak ON et al. Endothelial function and endothelial nitric oxide synthase intron 4a/b polymorphism in primary hyperparathyroidism. J Endocrinol Invest 2009; 32: 611-16.
43 Izumi G, Inai K, Shimada E, Nakanishi T. Vitamin D Kinetics and Parathyroid Gland Function in Patients with Congenital Heart Disease. Congenit Heart Dis 2016; 11: 700-706.
44. Y.C. Ku, M.E. Liu, C.S. Ku, T.Y. Liu, S.L. Lin, Relationship between vitamin D deficiency and cardiovascular disease. World J Cardiol 2013; 5: 337-46.
45. Wang L, Song Y, Manson JE et al. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 2012; 5: 819-29.
46. Loncar G, Bozic B, Cvetinovic N et al. Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure. J Endocrinol Invest 2017; 40: 297-304.
47. Suematsu Y et al. Effect of 1,25-dihydroxyvitamin D3 on induction of scavenger receptor and differentiation of 12-O-tetradecanoylphorbol-13-acetate-treated THP-1 human monocyte like cells.Journal of cellular physiology 1995; 165: 547-55.
48. Wilhelm SM, Wang TS, Ruan DT et al. The american association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016; 151: 959-68.

Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi

Year 2019, Volume: 10 Issue: 1, 104 - 109, 21.03.2019

Çağlar Alp İrfan Karahan Şenay Arıkan Durmaz

https://doi.org/10.18663/tjcl.334008

Abstract

Hiperparatiroidi klinisyenler
tarafından iyi bilinen bir hastalık olmakla birlikte öncelikle renal komplikasyonlar ve osteoporoz gibi yan etkiler yakın takip edilmektedir. Bununla birlikte
yapılan çeşitli çalışmalarda hiperparatiroidiye bağlı hipertansiyon, diastolik
disfonksiyon, endotel disfonksiyonu, kalp kapak kalsifkasyonu, aritmi, kardiyak
hipertrofi gibi yan etkiler belirtilmiştir. Hatta bazı çalışmalar kardiyak
mortalite artışıyla ilişkili bulunmuştur. Bu derlemede primer
hiperparatiroidide rastlanan kardiyak sorunlara dikkat çekmek amaçlanmıştır.

Keywords

Hiperparatiroidi, kardiyak etkiler, hipertansiyon

References

1.Andersson P, Rydberg E, Willenheimer R. Primary hyperparathyroidism and heart disease--a review. Eur Heart J 2004; 25: 1776-87.
2. Kalla A, Krishnamoorthy P, Gopalakrishnan A, Garg J, Patel NC, Figueredo VM. Primary hyperparathyroidism predicts hypertension: Results from the National Inpatient Sample. Int J Cardiol 2017; 227: 335-37
3. Heath III, Hunter, Stephen F. Hodgson, Margaret A. Kennedy. "Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community." Nejm 1980; 302: 189-93.
4. Amanzadeh J, Reilly RF Jr. Hypophosphatemia: an evidence-based approach to its clinical consequences and management. Nat Clin Pract Nephrol 2006; 2: 136-48.
5. Fardella C, Rodriguez-Portales JA. Intracellular calcium and blood pressure: comparison between primary hyperparathyroidism and essential hypertension. J Endocrinol Invest 1995; 18: 827-32.
6. Gennari C, Nami R, Gonnelli S. Hypertension and primary hyperparathyroidism: the role of adrenergic and renin-angiotensin-aldosterone systems. Miner Electrolyte Metab 1995; 21: 77-81.
7. Osto E, Fallo F, Pelizzo MR et al. Coronary microvascular dysfunction induced by primary hyperparathyroidism is restored after parathyroidectomy. Circulation 2012; 126: 1031-39.
8. Ozdemir D, Kalkan GY, Bayram NA et al. Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism. Endocrine 2014; 47: 609-17.
9. J.L. Anderson, R.C. Vanwoerkom, B.D. Horne, T.L. Bair, H.T. May, D.L. Lappé, J.B. Muhlestein, Parathyroid hormone, vitamin D, renal dysfunction, and cardiovascular disease: dependent or independent risk factors? Am. Heart J 2011; 162: 331-39.
10. D. Han, S. Trooskin, X. Wang, Prevalence of cardiovascular risk factors in male and female patients with primary hyperparathyroidism. J. Endocrinol. Invest 2012; 35: 548-52.
11. Stefenelli T, Abela C, Frank H et al. Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. J Clin Endocrinol Metab 1997; 82: 106-12.
12.Palmer M, Adami HO, Bergström R, Jakobsson S, Akerström G, Ljunghall S. Survival and renal function in untreated hypercalcaemia. Population-based cohort study with 14 years of follow-up. Lancet 1987; 1: 59-62.
13. Hagstrom M, Hellman EP, Larsson TE et al. Plasma parathyroid hormone and the risk of cardiovascular mortality in the community. Circulation 2009; 119: 2765-71.
14. Buizert PJ, van Schoor NM, Simsek S et al. PTH: a new target in arteriosclerosis? J Clin Endocrinol Metab 2013; 98: 1583-90.
15. Soares AA et al. "Enhanced parathyroid hormone levels are associated with left ventricle hypertrophy in very elderly men and women." J Am Society Hypertens 2015; 9: 697-704.
16. Walker MD, Rundek T, Homma S et al. Effect of parathyroidectomy onsubclinical cardiovascular disease in mild primary hyperparathyroidism. Eur J Endocrinol 2012; 167: 277-85.
17. Johnstone LM, Jones CL, Grigg LE, Wilkinson JL, Walker RG, Powell HR. Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int 1996; 50: 998-1006.
18. Taylor EN, Curhan GC, Forman JP. Parathyroid hormone and the risk of incident hypertension. J Hypertens 2008; 26: 1390–94.
19. Schlüter KD, Weber M, Piper HM. Parathyroid hormone induces protein kinase C but not adenylate cyclase in adult cardiomyocytes and regulates cyclic AMP levels via protein kinase C-dependent phosphodiesterase activity. Biochem J 1995; 310: 439-44.
20. X. Liu, R. Xie, S. Liu, Rat parathyroid hormone 1-34 signals through the MEK/ERK pathway to induce cardiac hypertrophy. J Int Med Res 2008; 36: 942-50.
21. L. Brunaud, A. Germain, R. Zarnegar et al. Serum aldosterone is correlated positively to parathyroid hormone (PTH) levels in patients with primary hyperparathyroidism. Surgery 2009; 146: 1035-41.
22. Ogino K, Burkhoff D, Bilezikian JP. The hemodynamic basis for the cardiac effects of parathyroid hormone (PTH) and PTH-related protein. Endocrinology 1995; 136: 3024-30.
23. Pirro M, Manfredelli MR, Helou RS et al. Association of parathyroid hormone and 25-OH-vitamin D levels with arterial stiffness in postmenopausal women with vitamin D insufficiency. J Atheroscler Thromb 2012; 19: 924-31.
24.McMahon DJ, Carrelli A, Palmeri N et al. Parathyroidectomy upon left ventricular mass in primary hyperparathyroidism: A meta-analysis. J Clin Endocrinol Metab 2015; 100: 4399-407.
25. Nappi S, Saha H, Virtanen V et al. Left ventricular structure and function in primary hyperparathyroidism before and after parathyroidectomy. Cardiology 2000; 93: 229-33.
26. Barletta G, De Feo ML, Del Bene R et al. Cardiovascular effects of parathyroid hormone: a study in healthy subjects and normotensive patients with mild primary hyperparathyroidism. J Clin Endocrinol Metab 2000; 85: 1815-21.
27. S.A. Camacho, R. Brandes, V.M. Figueredo, M.V. Weiner, Ca2 + transient decline and myocardial relaxation are slowed during low flow ischemia in rat hearts. J Clin Invest 1994; 93: 951-57.
28. Sin HY. Prospective cohort study: Cinacalcet-mediated lowering of PTH level and cardiovascular disease mortality in younger Korean patients with stage 5 CKD at a Korean secondary hospital. J Clin Pharm Ther 2017; 5: 607-14
29. Nagashima M, Hashimoto K, Shinsato T et al. Marked improvement of left ventricular function after parathyroidectomy in a hemodialysis patient with secondary hyperparathyroidism and left ventricular dysfunction. Circ J 2003; 67: 269-72.
30. Nanasato M, Goto N, Isobe S et al. Restored cardiac conditions and left ventricular function after parathyroidectomy in a hemodialysis patient. Parathyroidectomy improves cardiac fatty acid metabolism assessed by 123I-BMIPP. Circ J 2009; 73: 1956-60.
31. Smogorzewski M, Perna AF, Borum PR, Massry SG. Fatty acid oxidation in the myocardium: Effects of parathyroid hormone and CRF. Kidney Int 1988; 34: 797-803.
32. Schiffl H, Lang SM. Hypertension Secondary to PHPT: Cause or Coincidence? Int J Endocrinol 2011; 2011: 974647.
33. Kizilgul M, Beketaev I, Dolapoglu A. Letter to the Editor: Could Low Phosphate Level Be the Reason for High Risk of Hypertension in Normocalcemic Primary Hyperparathyroidism? J Clin Endocrinol Metab 2015; 100: 39.
34. Tomaschitz A, Ritz E, Pieske B et al. Aldosterone and parathyroid hormone: a precarious couple for cardiovascular disease. Cardiovasc Res 2012; 94: 10-19.
35. Zia AA, Kamalov G, Newman KP et al. From aldosteronism to oxidative stress: the role of excessive intracellular calcium accumulation. Hypertens Res 2010; 33: 1091-101.
36. Bernini G, Moretti A, Lonzi S, Bendinelli C, Miccoli P, Salvetti A. Renin-angiotensin-aldosterone system in primary hyperparathyroidism before and after surgery. Metabolism 1999; 48: 298-300.
37. D. Fliser, E. Franek, P. Fode et al. Subacute infusion of physiological doses of parathyroid hormone raises blood pressure in humans. Nephrol Dial Transplant 1997; 12: 933-38.
38. B. Jespersen, A. Randlov, J. Abrahamsen et al.The altered pattern of reactivity may counteract raised blood pressure Am J Hypertens 1997; 10: 1356-67.
39. Rosenqvist M, Nordenström J, Andersson M, Edhag OK. Cardiac conduction in patients with hypercalcaemia due to primary hyperparathyroidism. Clin Endocrinol (Oxf) 1992; 37: 29-33.
40. Dokupilova A, Payer J. 24-hour outpatient ECG as a screening method in patients with primary hyperparathyroidism. Bratisl Lek Listy 2016; 117: 495-500.
41. C. Bosworth, M.C. Sachs, D. Duprez et al. Parathyroid hormone and arterial dysfunction in the multi-ethnic study of atherosclerosis. Clin. Endocrinol (Oxf) 2013; 79: 429-36.
42. Ekmekci A, Abaci N, Colak ON et al. Endothelial function and endothelial nitric oxide synthase intron 4a/b polymorphism in primary hyperparathyroidism. J Endocrinol Invest 2009; 32: 611-16.
43 Izumi G, Inai K, Shimada E, Nakanishi T. Vitamin D Kinetics and Parathyroid Gland Function in Patients with Congenital Heart Disease. Congenit Heart Dis 2016; 11: 700-706.
44. Y.C. Ku, M.E. Liu, C.S. Ku, T.Y. Liu, S.L. Lin, Relationship between vitamin D deficiency and cardiovascular disease. World J Cardiol 2013; 5: 337-46.
45. Wang L, Song Y, Manson JE et al. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 2012; 5: 819-29.
46. Loncar G, Bozic B, Cvetinovic N et al. Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure. J Endocrinol Invest 2017; 40: 297-304.
47. Suematsu Y et al. Effect of 1,25-dihydroxyvitamin D3 on induction of scavenger receptor and differentiation of 12-O-tetradecanoylphorbol-13-acetate-treated THP-1 human monocyte like cells.Journal of cellular physiology 1995; 165: 547-55.
48. Wilhelm SM, Wang TS, Ruan DT et al. The american association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016; 151: 959-68.

There are 48 citations in total.

Details

Primary Language	Turkish
Subjects	Health Care Administration
Journal Section	Revıew Artıcle
Authors	Çağlar Alp This is me İrfan Karahan This is me Şenay Arıkan Durmaz
Publication Date	March 21, 2019
Published in Issue	Year 2019 Volume: 10 Issue: 1

Cite

APA	Alp, Ç., Karahan, İ., & Arıkan Durmaz, Ş. (2019). Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi. Turkish Journal of Clinics and Laboratory, 10(1), 104-109. https://doi.org/10.18663/tjcl.334008
AMA	Alp Ç, Karahan İ, Arıkan Durmaz Ş. Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi. TJCL. March 2019;10(1):104-109. doi:10.18663/tjcl.334008
Chicago	Alp, Çağlar, İrfan Karahan, and Şenay Arıkan Durmaz. “Normokalsemik Hiperparatiroidiye Farklı bakış: Kardiyak sorunların gözden geçirilmesi”. Turkish Journal of Clinics and Laboratory 10, no. 1 (March 2019): 104-9. https://doi.org/10.18663/tjcl.334008.
EndNote	Alp Ç, Karahan İ, Arıkan Durmaz Ş (March 1, 2019) Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi. Turkish Journal of Clinics and Laboratory 10 1 104–109.
IEEE	Ç. Alp, İ. Karahan, and Ş. Arıkan Durmaz, “Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi”, TJCL, vol. 10, no. 1, pp. 104–109, 2019, doi: 10.18663/tjcl.334008.
ISNAD	Alp, Çağlar et al. “Normokalsemik Hiperparatiroidiye Farklı bakış: Kardiyak sorunların gözden geçirilmesi”. Turkish Journal of Clinics and Laboratory 10/1 (March 2019), 104-109. https://doi.org/10.18663/tjcl.334008.
JAMA	Alp Ç, Karahan İ, Arıkan Durmaz Ş. Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi. TJCL. 2019;10:104–109.
MLA	Alp, Çağlar et al. “Normokalsemik Hiperparatiroidiye Farklı bakış: Kardiyak sorunların gözden geçirilmesi”. Turkish Journal of Clinics and Laboratory, vol. 10, no. 1, 2019, pp. 104-9, doi:10.18663/tjcl.334008.
Vancouver	Alp Ç, Karahan İ, Arıkan Durmaz Ş. Normokalsemik hiperparatiroidiye farklı bakış: Kardiyak sorunların gözden geçirilmesi. TJCL. 2019;10(1):104-9.

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