European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

This European expert consensus statement provides recommendations for the diagnosis and management of primary hyperparathyroidism (PHPT), chronic hypoparathyroidism in adults (HypoPT), and parathyroid disorders in relation to pregnancy and lactation. Specified areas of interest and unmet needs identified by experts at the second ESE Educational Program of Parathyroid Disorders in 2019 were discussed during two virtual workshops in 2021 and subsequently developed by working groups with interest in the specified areas. PHPT is a common endocrine disease. However, its differential diagnosis of familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represents areas of uncertainty requiring clarifications. HypoPT is an orphan disease characterized by low calcium concentrations due to insufficient PTH secretion, most often secondary to neck surgery. Prevention and prediction of surgical injury to the parathyroid glands are essential to limit the disease-related burden. Long-term treatment modalities including the place for PTH replacement therapy and the optimal biochemical monitoring and imaging surveillance for complications to treatment in chronic HypoPT need to be refined. The physiological changes in calcium metabolism occurring during pregnancy and lactation modify the clinical presentation and management of parathyroid disorders in these periods of life. Modern interdisciplinary approaches to PHPT and HypoPT in pregnant and lactating women and their newborn children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed at a broader clinical audience and were developed with the focus on endocrinologists in training.

Related collections

Most cited references 185

Record: found
Abstract: found
Article: not found

The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism.

Miguel Herrera, Sally E. Carty, Robert Udelsman … (2016)

Primary hyperparathyroidism (pHPT) is a common clinical problem for which the only definitive management is surgery. Surgical management has evolved considerably during the last several decades.

0 comments Cited 262 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD).

(2009)

The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the management of chronic kidney disease-mineral and bone disorder (CKD-MBD) is intended to assist the practitioner caring for adults and children with CKD stages 3-5, on chronic dialysis therapy, or with a kidney transplant. The guideline contains recommendations on evaluation and treatment for abnormalities of CKD-MBD. This disease concept of CKD-MBD is based on a prior KDIGO consensus conference. Tests considered are those that relate to the detection and monitoring of laboratory, bone, and cardiovascular abnormalities. Treatments considered are interventions to treat hyperphosphatemia, hyperparathyroidism, and bone disease in patients with CKD stages 3-5D and 1-5T. The guideline development process followed an evidence based approach and treatment recommendations are based on systematic reviews of relevant treatment trials. Recommendations for testing used evidence based on diagnostic accuracy or risk prediction and linked it indirectly with how this would be expected to achieve better outcomes for patients through better detection, evaluation or treatment of disease. Critical appraisal of the quality of the evidence and the strength of recommendations followed the GRADE approach. An ungraded statement was provided when a question did not lend itself to systematic literature review. Limitations of the evidence, especially the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.

0 comments Cited 219 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop.

John P. Bilezikian, Maria Luisa Brandi, Richard Eastell … (2014)

Asymptomatic primary hyperparathyroidism (PHPT) is routinely encountered in clinical practices of endocrinology throughout the world. This report distills an update of current information about diagnostics, clinical features, and management of this disease into a set of revised guidelines.

0 comments Cited 210 times – based on 0 reviews      Review now

All references

Author and article information

Journal

Journal ID (nlm-ta): Eur J Endocrinol

Journal ID (iso-abbrev): Eur J Endocrinol

Journal ID (hwp): EJE

Title: European Journal of Endocrinology

Publisher: Bioscientifica Ltd (Bristol )

ISSN (Print): 0804-4643

ISSN (Electronic): 1479-683X

Publication date (Electronic): 03 December 2021

Publication date Collection: 01 February 2022

Volume: 186

Issue: 2

Pages: R33-R63

Affiliations

[1 ]Faculty of Medicine , University of Oslo, Oslo, Norway

[2 ]Section of Specialized Endocrinology , Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway

[3 ]Department of Endocrinology and Internal Medicine , Aarhus University Hospital, Aarhus, Denmark

[4 ]Schön-Klinik Hamburg , Department of Endocrine Surgery, Hamburg, Germany

[5 ]Division of Endocrinology , Department of Medicine, Leiden University Medical Center (LUMC), Leiden, the Netherlands

[6 ]Centro Hospitalar e Universitário de Coimbra , i3S – Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal

[7 ]Nuffield Department of Women’s and Reproductive Health , University of Oxford, Oxford, UK

[8 ]Department of Clinical and Experimental Medicine , University of Pisa, Pisa, Italy

[9 ]Institute of Endocrine and Metabolic Sciences , Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy

[10 ]Department of Endocrinology , Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden

[11 ]Endocrinology , Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

[12 ]The National Medical Research Centre for Endocrinology , Moscow, Russia

[13 ]Edinburgh Centre for Endocrinology & Diabetes , Royal Infirmary of Edinburgh, Edinburgh, UK

[14 ]Department of Endocrinology , Ghent University Hospital, Ghent, Belgium

[15 ]Division of Endocrinology and Diabetology , Medical University of Graz, Graz, Austria

[16 ]Thyroid Center , Luzerner Kantonsspital, Luzern, Switzerland

[17 ]Division of Rare Diseases , Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany

[18 ]Division of Endocrinology and Metabolism , Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

[19 ]Division of Endocrine Surgery , Department of General Surgery, Ege University Hospital, Izmir, Turkey

[20 ]Department of Internal Medicine and Medical Disciplines , Sapienza University of Rome, Rome, Italy

[21 ]Department of Digestive , Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France

[22 ]Assistance Publique-Hôpitaux de Paris (AP-HP) , Pitié-Salpêtrière Hospital, Nephrology Department, Boulevard de l’Hôpital, Paris, France

[23 ]Department of Endocrinology , University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

[24 ]Université de Paris Saclay , AP-HP, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Filière OSCAR, Service d’Endocrinologie et Diabète de l’Enfant, Hôpital Bicêtre Paris Saclay, Le Kremlin Bicêtre, France

[25 ]Department of Obstetrics and Gynecology , Medical University of Graz, Graz, Austria

[26 ]Reference Centre for Rare Bone , Calcium and Phosphate Disorders – University Hospital Ghent, Ghent, Belgium

[27 ]Center for Healthy Aging , Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany

[28 ]Endokrinologikum Göttingen , Georg-August-University Göttingen, Göttingen, Germany

[29 ]Université Paris-Saclay , Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares du Métabolisme du Calcium et du Phosphate, Le Kremlin-Bicêtre, France

Author notes

Correspondence should be addressed to J Bollerslev Email jens.bollerslev@ 123456medisin.uio.no

*(Details of the 2021 PARAT Working Group is presented in the Acknowledgements section)

Author information

Ansgar Heck http://orcid.org/0000-0002-3443-884X

Zhanna Belaya http://orcid.org/0000-0002-6674-6441

Salvatore Minisola http://orcid.org/0000-0001-6525-0439

Jean-Philippe Bertocchio http://orcid.org/0000-0002-4104-702X

Elizabeth M Winter http://orcid.org/0000-0002-0119-1588

Peter Kamenický http://orcid.org/0000-0002-1994-4226

Article

Publisher ID: EJE-21-1044

DOI: 10.1530/EJE-21-1044

PMC ID: 8789028

PubMed ID: 34863037

SO-VID: 000758bc-f84c-490d-a64e-e3994d958651

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

The flagship journal of the Society for Endocrinology. Learn more

European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

Read this article at

Abstract

Related collections

Bioscientifica Open Endocrinology

Most cited references 185

The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism.

KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD).

Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop.

Author and article information

Journal

Affiliations

Author notes

Author information

Article

History

Categories

Comments

Comment on this article

Similar content 119

Cited by 45

Most referenced authors 2,600