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__NOTOC__
== Heading==
{{Parathyroid disorders}}
{{CMG}}; {{AE}} {{Anmol}}, {{USAMA}}, {{SMP}}


{{SK}} Disorders of parathyroid gland; Parathyroid gland disorders.
===Subheading===


==Overview==
*Bullet<ref name="pmid26678235">{{cite journal |vauthors=Yeh TK, Yeh J |title=Chest Pain in Pediatrics |journal=Pediatr Ann |volume=44 |issue=12 |pages=e274–8 |date=December 2015 |pmid=26678235 |doi=10.3928/00904481-20151110-01 |url=}}</ref>
The [[parathyroid glands]] are small [[endocrine glands]] in the neck, usually located behind the [[thyroid|thyroid gland]], which produce [[parathyroid hormone]]. These glands were first discovered in the Indian Rhinoceros by Richard Owen in 1852. The sole function of the  [[parathyroid glands]] is to maintain the body's [[calcium]] level within a very narrow range, so that the nervous and muscular systems can function properly. When blood [[calcium]] levels drop below a certain point, calcium-sensing receptors in the [[parathyroid gland]] are activated to release hormone into the blood. [[Parathyroid hormone]] ([[PTH]], also known as [[parathormone]]) is a small protein that takes part in the control of [[calcium]] and [[phosphate]] [[homeostasis]], as well as bone physiology. [[Parathyroid hormone]] has effects antagonistic to those of [[calcitonin]]. It increases blood calcium levels by stimulating [[osteoclasts]] to break down [[bone]] and release [[calcium]]. It also increases [[gastrointestinal]] calcium absorption by activating [[vitamin D]], and promotes calcium uptake by the [[kidneys]]. Hyperparathyroidism is overactivity of the  [[parathyroid glands]] resulting in excess production of [[parathyroid hormone]] ([[PTH]]). Overactivity of one or more of the  [[parathyroid glands]] causes high calcium levels ([[hypercalcemia]]) and low levels of [[phosphorus]] in the blood. Hyperfunctioning of the  [[parathyroid glands]] could be due to [[adenoma]], [[hyperplasia]] or, rarely, [[carcinoma]] of the [[parathyroid glands]]. [[Hyperparathyroidism]] may present with symptoms of [[hypercalcemia]], such as painful bones, [[kidney stones]], [[abdominal pain]], psychic moans, and [[fatigue]]. An elevated concentration of [[Calcium|serum calcium]] with elevated [[parathyroid hormone]] level is diagnostic of [[Hyperparathyroidism|primary hyperparathyoidism]]. Surgical therapy is preferred over medical therapy in primary [[hyperparathyroidism]]. [[Hypoparathyroidism]] is a disorder characterized by [[hypocalcemia]] due to insufficient secretion of [[PTH]]. Most common cause for [[hypoparathyroidism]] is post-surgical including [[thyroidectomy]], [[parathyroidectomy]], and radical [[neck dissection]]. Second most common cause for [[hypoparathyroidism]] is [[autoimmune]] including [[polyglandular autoimmune syndrome type 1]] and isolated [[Hypoparathyroidism|autoimmune hypoparathyroidism]]. [[Hypoparathyroidism]] should be differentiated from other causes of [[hypocalcemia]]. Causes of [[hypocalcemia]] other than [[hypoparathyroidism]] include [[pseudohypoparathyroidism]], [[hypomagnesemia]], [[Vitamin D deficiency|hypovitaminosis D]], [[chronic kidney disease]], and relative [[hypocalcemia]] due to [[hypoalbuminemia]]. The hallmark of acute [[hypocalcemia]] due to [[hypoparathyroidism]] is [[tetany]]. A positive history of [[neck surgery]] and symptoms of [[hypocalcemia]] is suggestive of [[hypoparathyroidism]]. The most common symptoms of [[hypoparathyroidism]] include [[tetany]], [[paresthesia]], [[Carpopedal spasm|carpopedal spasms]], and circumoral [[numbness]]. Common symptoms of [[hypoparathyroidism]] include [[abdominal pain]], [[biliary colic]], [[fatigue]], [[muscle cramps]], [[Myoclonic jerk|myoclonic jerks]], new onset [[seizure]] due to [[hypocalcemia]] or worsening of [[Seizure|seizures]], and [[painful menstruation]]. Diagnosis of [[hypoparathyroidism]] is made by measurement of [[serum]] [[calcium]] (total and ionized), [[serum albumin]] (for correction), [[phosphate]], intact [[parathyroid hormone]] ([[PTH]]), and [[25-hydroxy vitamin D]] levels. Normal or inappropriately low serum intact [[parathyroid hormone]] ([[PTH]]) concentration in patients with subnormal [[serum albumin]] corrected total or ionized [[calcium]] concentration diagnostic of [[hypoparathyroidism]]. Pharmacologic medical therapies for [[hypoparathyroidism]] include [[Calcium supplement|calcium]] and [[Vitamin D3]] supplementation. Severe [[hypocalcemia]], a potentially life-threatening condition,  is treated as soon as possible with [[intravenous]] [[calcium]] (e.g. as [[calcium gluconate]]).
**SUbbllet


==Classification==
Parathyroid disorders may be classified as follows:<ref name="pmid21812031">{{cite journal |vauthors=Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, Jüppner H, D'Amour P, Fox J, Rejnmark L, Mosekilde L, Rubin MR, Dempster D, Gafni R, Collins MT, Sliney J, Sanders J |title=Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research |journal=J. Bone Miner. Res. |volume=26 |issue=10 |pages=2317–37 |year=2011 |pmid=21812031 |pmc=3405491 |doi=10.1002/jbmr.483 |url=}}</ref><ref name="pmid11117980">{{cite journal |vauthors=Marx SJ |title=Hyperparathyroid and hypoparathyroid disorders |journal=N. Engl. J. Med. |volume=343 |issue=25 |pages=1863–75 |year=2000 |pmid=11117980 |doi=10.1056/NEJM200012213432508 |url=}}</ref>
<br><br>
{{Family tree/start}}
{{Family tree | | | | | | | | | | | | | | B01 | | | |B01= Parathyroid disorders}}
{{Family tree | | | | | |,|-|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|-|.| }}
{{Family tree | | | | | D01 | | | | D02 | | | | D03 | | | | D04 | | | | D01= [[Hyperparathyroidism]] | D02= [[Familial hypocalciuric hypercalcemia]] | D03= [[Hypoparathyroidism]] | D04=Parathyroid hormone resistance diseases}}
{{Family tree | | | | | |!| | | | | | | | | | | |!| | | | | |!| }}
{{Family tree | |,|-|-|-|+|-|-|-|.| | | | | | | |!| | | | | |!| | | }}
{{Family tree | E01 | | E02 | | E03 | | | | | | |!| | | | | |!| | E01=Primary |E02=Secondary| E03=Tertiary }}
{{Family tree | | | | | | | | | | | | | | | | | |!| | | | | |!| }}
{{Family tree | | | | | | | | | | | | | | | | | |!| | | | | |!| }}
{{Family tree | | | | | | | | |,|-|-|-|v|-|-|-|v|^|-|-|.| | |!| }}
{{Family tree | | | | | | | E04 | | E05 | | E06 | | E07 | | |!| | E04=Post-surgical  |E05=Autoimmune |E06=Genetic defects associated |E07=Functional}}
{{Family tree | | | | | | | | | | | | | | | | | | | | | | | |!| | }}
{{Family tree | | | | | | | | | | | |,|-|-|-|-|-|v|-|-|-|-|-|^|.}}
{{Family tree | | | | | | | | | | | F01 | | | | F02 | | | | | F03| |F01=[[Pseudohypoparathyroidism]] |F02=[[Acrodysostosis]]|F03=Blomstrand chondrodysplasia}}
{{Family tree | | | | | | | | | | | |!| | | | | |!| | | | | | | | }}
{{Family tree | | | | | | | | |,|-|-|^|-|-|.| | |`|v|-|-|-|-|.| | | | }}
{{Family tree | | | | | | | | G01 | | | | G02 | | G03 | | | G04 | | | G01=[[Pseudohypoparathyroidism]] type 1|G02=[[Pseudohypoparathyroidism]] type 2|G03=[[Acrodysostosis]] type 1|G04=[[Acrodysostosis]] type 2}}
{{Family tree | | | | | | | | |!| | | | | | | | | | | | | | | }}
{{Family tree | | | |,|-|-|-|-|+|-|-|-|-|-|v|-|-|-|-|.| | | }}
{{Family tree | | | H01 | | | H02 | | | | H03 | | | H04 | | H01=Type 1A|H02=Type 1B|H03=Type 1C|H04=[[Pseudopseudohypoparathyroidism]]}}
{{Family tree/end}}
==Diagnosis==
The diagnosis of parathyroid disorders is mainly based on serum concentration of [[parathyroid hormone]], [[calcium]], and [[phosphate]].<ref name="pmid8964825">{{cite journal |vauthors=Silverberg SJ, Bilezikian JP |title=Evaluation and management of primary hyperparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=81 |issue=6 |pages=2036–40 |year=1996 |pmid=8964825 |doi=10.1210/jcem.81.6.8964825 |url=https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAfQwggHwBgkqhkiG9w0BBwagggHhMIIB3QIBADCCAdYGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMs2QB8t_zFXzSZJ4bAgEQgIIBp8fw3_iunlmFW1rMhoY9MDPeg_lHu7iYzuIrfwXHubghqdXOMvdWyttCOOgR3PHFZtE5IkmNB4hRahVQsPzHGwh5kiBmLGp9W8OQwFxrCIH0sBqjOxOiYc_yGAs0ybxF1mEh929-YxivBBC43EW1yFtSmwplSQfAWah7w6yxXbUhV8umq3pGQxqYDClp47IR7TyVeEneWZz85Z7MS80V4c-yZPG1ZPxQR-1kPk3rdji_8bAeXwJKRGScWzKPqSEQvXFWLV4sHwqgTrU53HSkURUJb8u-w4EOHMjtUATJPoGgFsZOcrf_xtPBZmcI_v5G3RO_cJDHueDwQNfRaGIO2ztcToFGmVpER4vGhqfrtr7mXHPNPyUUOa-_KWPE-qxDrUCG8kevm0tM8MButJkAmVdBxrIC4mSd8sAZb3KcfSKt9RUXFJpIiDoOut21ZFEGEU8O7vwjw4RhxridsegEUiCFWCxHftX9qUqELn90AJ2Fg1olxH9jI46KnEJPd7MNYReTvdeX5erBZmXjmP5oCT6vLYUbRLjXxyJQRl-d5N9O0vfTgZ5bbA}}</ref><ref name="pmid686009">{{cite journal |vauthors=Marx SJ, Spiegel AM, Brown EM, Koehler JO, Gardner DG, Brennan MF, Aurbach GD |title=Divalent cation metabolism. Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism |journal=Am. J. Med. |volume=6http://www.sciencedirect.com/science/article/pii/0002934378908148?via%3Dihub5 |issue=2 |pages=235–42 |year=1978 |pmid=686009 |doi=10.1016/0002-9343(78)90814-8 |url=}}</ref><ref name="pmid18650515">{{cite journal |vauthors=Shoback D |title=Clinical practice. Hypoparathyroidism |journal=N. Engl. J. Med. |volume=359 |issue=4 |pages=391–403 |year=2008 |pmid=18650515 |doi=10.1056/NEJMcp0803050 |url=}}</ref>
{|
! colspan="2" rowspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disorder}}
! colspan="4" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Laboratory findings}}
|-
| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Parathyroid hormone''' }}
| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Serum calcium'''}}
| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Serum phosphate'''}}
| style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Other findings'''}}
|-
! rowspan="3" style="background: #DCDCDC; text-align: center;" | Hyperparathyroidism
! style="background: #DCDCDC; text-align: center;" |Primary hyperparathyroidism
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''/Normal
| style="background: #F5F5F5; " |
*Normal/'''↑''' [[calcitriol]]
|-
! style="background: #DCDCDC; text-align: center;" |Secondary hyperparathyroidism
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''/Normal
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" | --
|-
! style="background: #DCDCDC; text-align: center;" |Tertiary hyperparathyroidism
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" | --
|-
! colspan="2" style="background: #DCDCDC; text-align: center;" |Familial hypocalciuric hypercalcemia
| style="background: #F5F5F5; text-align: center;" |Normal/'''↑'''
| style="background: #F5F5F5; text-align: center;" |Normal/'''↑'''
| style="background: #F5F5F5; text-align: center;" | --
| style="background: #F5F5F5;" |
* '''↓''' Urinary calcium/[[creatinine]] clearance ratio
|-
! colspan="2" style="background: #DCDCDC; text-align: center;" |Hypoparathyroidism
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; " |
*'''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
*Normal [[urinary]] [[cAMP]]
*Normal [[urinary]] [[phosphate]]
|-
! rowspan="5" style="background: #DCDCDC; text-align: center;" |Pseudohypoparathyroidism
! style="background: #DCDCDC; text-align: center;" | Type 1A
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; " |
*'''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
*'''↓''' [[Urinary]] [[cAMP]]
*'''↓''' [[Urinary System|Urinary]] [[phosphate]]
|-
! style="background: #DCDCDC; text-align: center;" | Type 1B
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; " |
*'''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
*'''↓''' [[Urinary]] [[cAMP]]
*'''↓''' [[Urinary System|Urinary]] [[phosphate]]
|-
! style="background: #DCDCDC; text-align: center;" | Type 1C
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; " |
*'''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
*'''↓''' [[Urinary]] [[cAMP]]
*'''↓''' [[Urinary System|Urinary]] [[phosphate]]
|-
! style="background: #DCDCDC; text-align: center;" | Pseudopseudohypoparathyroidism
| style="background: #F5F5F5; text-align: center;" |Normal
| style="background: #F5F5F5; text-align: center;" |Normal
| style="background: #F5F5F5; text-align: center;" |Normal
| style="background: #F5F5F5; text-align: center;" | --
|-
! style="background: #DCDCDC; text-align: center;" | Type 2
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5;" |
*'''↓''' [[1,25-dihydroxy vitamin D|1,25 Dihydroxy vitamin D]]
*Normal [[urinary]] [[cAMP]]
*'''↓''' [[Urinary]] [[phosphate]]
|-
! rowspan="2" style="background: #DCDCDC; text-align: center;" |Acrodysostosis
! style="background: #DCDCDC; text-align: center;" |Acrodysostosis type 1
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; " |
*Multiple hormone resistance
|-
! style="background: #DCDCDC; text-align: center;" |Acrodysostosis type 2
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; " |
*Multiple hormone resistance
|-
! colspan="2" style="background: #DCDCDC; text-align: center;" |Blomstrand chondrodysplasia
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; text-align: center;" |'''↓'''
| style="background: #F5F5F5; text-align: center;" |'''↑'''
| style="background: #F5F5F5; " |
* '''↓''' [[Urinary]] [[phosphate]]
* '''↑''' [[Urinary]] [[cAMP]]
|}
==Differentiating Parathyroid Disorders==
* The main presenting features of [[parathyroid]] disorders are related to [[calcium]] secretion. Accordingly, differentiating [[parathyroid]] disorders from other diseases is mainly dependent to changes in calcium level. Following algorithms are designed to differentiate diseases according to [[hypercalcemia]] and [[hypocalcemia]].<ref name="pmid21812031">{{cite journal |vauthors=Bilezikian JP, Khan A, Potts JT, Brandi ML, Clarke BL, Shoback D, Jüppner H, D'Amour P, Fox J, Rejnmark L, Mosekilde L, Rubin MR, Dempster D, Gafni R, Collins MT, Sliney J, Sanders J |title=Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research |journal=J. Bone Miner. Res. |volume=26 |issue=10 |pages=2317–37 |year=2011 |pmid=21812031 |pmc=3405491 |doi=10.1002/jbmr.483 |url=}}</ref><ref name="pmid8964825">{{cite journal |vauthors=Silverberg SJ, Bilezikian JP |title=Evaluation and management of primary hyperparathyroidism |journal=J. Clin. Endocrinol. Metab. |volume=81 |issue=6 |pages=2036–40 |year=1996 |pmid=8964825 |doi=10.1210/jcem.81.6.8964825 |url=https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAfQwggHwBgkqhkiG9w0BBwagggHhMIIB3QIBADCCAdYGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMs2QB8t_zFXzSZJ4bAgEQgIIBp8fw3_iunlmFW1rMhoY9MDPeg_lHu7iYzuIrfwXHubghqdXOMvdWyttCOOgR3PHFZtE5IkmNB4hRahVQsPzHGwh5kiBmLGp9W8OQwFxrCIH0sBqjOxOiYc_yGAs0ybxF1mEh929-YxivBBC43EW1yFtSmwplSQfAWah7w6yxXbUhV8umq3pGQxqYDClp47IR7TyVeEneWZz85Z7MS80V4c-yZPG1ZPxQR-1kPk3rdji_8bAeXwJKRGScWzKPqSEQvXFWLV4sHwqgTrU53HSkURUJb8u-w4EOHMjtUATJPoGgFsZOcrf_xtPBZmcI_v5G3RO_cJDHueDwQNfRaGIO2ztcToFGmVpER4vGhqfrtr7mXHPNPyUUOa-_KWPE-qxDrUCG8kevm0tM8MButJkAmVdBxrIC4mSd8sAZb3KcfSKt9RUXFJpIiDoOut21ZFEGEU8O7vwjw4RhxridsegEUiCFWCxHftX9qUqELn90AJ2Fg1olxH9jI46KnEJPd7MNYReTvdeX5erBZmXjmP5oCT6vLYUbRLjXxyJQRl-d5N9O0vfTgZ5bbA}}</ref><ref name="pmid686009">{{cite journal |vauthors=Marx SJ, Spiegel AM, Brown EM, Koehler JO, Gardner DG, Brennan MF, Aurbach GD |title=Divalent cation metabolism. Familial hypocalciuric hypercalcemia versus typical primary hyperparathyroidism |journal=Am. J. Med. |volume=6http://www.sciencedirect.com/science/article/pii/0002934378908148?via%3Dihub5 |issue=2 |pages=235–42 |year=1978 |pmid=686009 |doi=10.1016/0002-9343(78)90814-8 |url=}}</ref><ref name="pmid18650515">{{cite journal |vauthors=Shoback D |title=Clinical practice. Hypoparathyroidism |journal=N. Engl. J. Med. |volume=359 |issue=4 |pages=391–403 |year=2008 |pmid=18650515 |doi=10.1056/NEJMcp0803050 |url=}}</ref><ref name="pmid11134112">{{cite journal |vauthors=Yamamoto M, Akatsu T, Nagase T, Ogata E |title=Comparison of hypocalcemic hypercalciuria between patients with idiopathic hypoparathyroidism and those with gain-of-function mutations in the calcium-sensing receptor: is it possible to differentiate the two disorders? |journal=J. Clin. Endocrinol. Metab. |volume=85 |issue=12 |pages=4583–91 |year=2000 |pmid=11134112 |doi=10.1210/jcem.85.12.7035 |url=}}</ref><ref name="pmid7356229">{{cite journal |vauthors=Marx SJ, Stock JL, Attie MF, Downs RW, Gardner DG, Brown EM, Spiegel AM, Doppman JL, Brennan MF |title=Familial hypocalciuric hypercalcemia: recognition among patients referred after unsuccessful parathyroid exploration |journal=Ann. Intern. Med. |volume=92 |issue=3 |pages=351–6 |year=1980 |pmid=7356229 |doi= |url=}}</ref><ref name="pmid26713296">{{cite journal |vauthors=Mirrakhimov AE |title=Hypercalcemia of Malignancy: An Update on Pathogenesis and Management |journal=N Am J Med Sci |volume=7 |issue=11 |pages=483–93 |year=2015 |pmid=26713296 |pmc=4683803 |doi=10.4103/1947-2714.170600 |url=}}</ref><ref name="pmid1346019">{{cite journal |vauthors=Ratcliffe WA, Hutchesson AC, Bundred NJ, Ratcliffe JG |title=Role of assays for parathyroid-hormone-related protein in investigation of hypercalcaemia |journal=Lancet |volume=339 |issue=8786 |pages=164–7 |year=1992 |pmid=1346019 |doi=10.1016/0140-6736(92)90220-W |url=}}</ref><ref name="pmid7962324">{{cite journal |vauthors=Ikeda K, Ohno H, Hane M, Yokoi H, Okada M, Honma T, Yamada A, Tatsumi Y, Tanaka T, Saitoh T |title=Development of a sensitive two-site immunoradiometric assay for parathyroid hormone-related peptide: evidence for elevated levels in plasma from patients with adult T-cell leukemia/lymphoma and B-cell lymphoma |journal=J. 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==References==
==References==
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References

  1. ↑ Yeh TK, Yeh J (December 2015). "Chest Pain in Pediatrics". Pediatr Ann. 44 (12): e274–8. doi:10.3928/00904481-20151110-01. PMID 26678235.
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