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      Management of Hypoparathyroidism: Summary Statement and Guidelines

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          Abstract

          Objective:

          Hypoparathyroidism is a rare disorder characterized by hypocalcemia and absent or deficient PTH. This report presents a summary of current information about epidemiology, presentation, diagnosis, clinical features, and management and proposes guidelines to help clinicians diagnose, evaluate, and manage this disorder.

          Participants:

          Participants in the First International Conference on the Management of Hypoparathyroidism represented a worldwide constituency with acknowledged interest and expertise in key basic, translational, and clinical aspects of hypoparathyroidism. Three Workshop Panels were constituted to address questions for presentation and discussion at the Conference held in Florence, Italy, May 7–9, 2015. At that time, a series of presentations were made, followed by in-depth discussions in an open forum. Each Workshop Panel also met in closed sessions to formulate the three evidence-based reports that accompany this summary statement. An Expert Panel then considered this information, developed summaries, guidelines, and a research agenda that constitutes this summary statement.

          Evidence:

          Preceding the conference, each Workshop Panel conducted an extensive literature search as noted in the individual manuscripts accompanying this report. All presentations were based upon the best peer-reviewed information taking into account the historical and current literature.

          Consensus Process:

          This report represents the Expert Panel's synthesis of the conference material placed in a context designed to be relevant to clinicians and those engaged in cutting-edge studies of hypoparathyroidism.

          Conclusions:

          This document not only provides a summary of our current knowledge but also places recent advances in its management into a context that should enhance future advances in our understanding of hypoparathyroidism.

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          Most cited references89

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          Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target-organ involvement, treatment, and challenges for future research.

          Recent advances in understanding the epidemiology, genetics, diagnosis, clinical presentations, skeletal involvement, and therapeutic approaches to hypoparathyroidism led to the First International Workshop on Hypoparathyroidism that was held in 2009. At this conference, a group of experts convened to discuss these issues with a view towards a future research agenda for this disease. This review, which focuses primarily on hypoparathyroidism in the adult, provides a comprehensive summary of the latest information on this disease. Copyright © 2011 American Society for Bone and Mineral Research.
            • Record: found
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            European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults.

            Hypoparathyroidism (HypoPT) is a rare (orphan) endocrine disease with low calcium and inappropriately low (insufficient) circulating parathyroid hormone levels, most often in adults secondary to thyroid surgery. Standard treatment is activated vitamin D analogues and calcium supplementation and not replacement of the lacking hormone, as in other hormonal deficiency states. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of chronic HypoPT in adults who do not have end-stage renal disease. We intend to draft a practical guideline, focusing on operationalized recommendations deemed to be useful in the daily management of patients. This guideline was developed and solely sponsored by The European Society of Endocrinology, supported by CBO (Dutch Institute for Health Care Improvement) and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles as a methodological base. The clinical question on which the systematic literature search was based and for which available evidence was synthesized was: what is the best treatment for adult patients with chronic HypoPT? This systematic search found 1100 articles, which was reduced to 312 based on title and abstract. The working group assessed these for eligibility in more detail, and 32 full-text articles were assessed. For the final recommendations, other literature was also taken into account. Little evidence is available on how best to treat HypoPT. Data on quality of life and the risk of complications have just started to emerge, and clinical trials on how to optimize therapy are essentially non-existent. Most studies are of limited sample size, hampering firm conclusions. No studies are available relating target calcium levels with clinically relevant endpoints. Hence it is not possible to formulate recommendations based on strict evidence. This guideline is therefore mainly based on how patients are managed in clinical practice, as reported in small case series and based on the experiences of the authors.
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              Executive summary of the 2013 International Society for Clinical Densitometry Position Development Conference on bone densitometry.

              The International Society for Clinical Densitometry (ISCD) convenes a Position Development Conference (PDC) every 2-3 yr to make recommendations for guidelines and standards in the field of musculoskeletal measurement and assessment. The recommendations pertain to clinically relevant issues regarding the acquisition, quality control, interpretation, and reporting of various aspects of musculoskeletal health metrics. Topics for consideration are developed by the ISCD Board of Directors and the Scientific Advisory Committee. For the 2013 PDC, body composition analysis was a central topic area for the first time and considered timely because of the scientific advances in measurement of fat and lean body mass by dual-energy X-ray absorptiometry (DXA). Indications for DXA and vertebral fracture assessment and use of reference data to calculate bone mineral density T-scores were also updated. Task Forces for each of these areas were assigned questions of relevance to a clinical audience and asked to conduct comprehensive literature reviews. Reports with proposed Position Statements were then presented to an international panel of experts. The Expert Panel included representatives of the International Osteoporosis Foundation, the American Society for Bone and Mineral Research, the National Osteoporosis Foundation, Osteoporosis Canada, and the North American Menopause Society. The PDC was held in Tampa, FL, contemporaneously with the Annual Meeting of the ISCD, March 21 through March 23, 2013. This report describes the methodology of the 2013 ISCD PDC and summarizes the results of the 2013 ISCD PDC for vertebral fracture assessment/DXA and National Health and Nutrition Survey (NHANES) Reference Database Task Forces. A separate article in this issue will summarize the results of the Body Composition Analysis Task Forces. Copyright © 2013. Published by Elsevier Inc.

                Author and article information

                Journal
                The Journal of Clinical Endocrinology & Metabolism
                The Endocrine Society
                0021-972X
                1945-7197
                June 01 2016
                June 01 2016
                : 101
                : 6
                : 2273-2283
                Affiliations
                [1 ]Department of Surgery and Translational Medicine (M.L.B.), University of Florence, 50121 Florence, Italy
                [2 ]Columbia University College of Physicians & Surgeons (J.P.B.), New York, New York 10032
                [3 ]Endocrine Research Unit (D.S.), San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, California 94121
                [4 ]Clinic and Laboratory of Experimental Endocrinology (R.B.), Gasthuisberg, KU Leuven, 3000 Leuven, Belgium
                [5 ]Mayo Clinic (B.C.), Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Minnesota 55905
                [6 ]Academic Endocrine Unit (R.V.T.), Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LJ, United Kingdom
                [7 ]McMaster University Calcium Disorders Clinic (A.A.K.), Hamilton, Canada L8S4L8
                [8 ]Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114
                Article
                10.1210/jc.2015-3907
                26943719
                01fc757c-4838-409c-a3af-b08ef35ed985
                © 2016
                History

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