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)

Author:

Bollerslev Jens12,Rejnmark Lars3,Zahn Alexandra4,Heck Ansgar12ORCID,Appelman-Dijkstra Natasha M5,Cardoso Luis6,Hannan Fadil M7,Cetani Filomena8,Sikjaer Tanja3,Formenti Anna Maria9,Björnsdottir Sigridur10,Schalin-Jäntti Camilla11,Belaya Zhanna12ORCID,Gibb Fraser13,Lapauw Bruno14,Amrein Karin15,Wicke Corinna16,Grasemann Corinna17,Krebs Michael18,Ryhänen Eeva11,Makay Özer19,Minisola Salvatore20ORCID,Gaujoux Sébastien21,Bertocchio Jean-Philippe22ORCID,Hassan-Smith Zaki23,Linglart Agnès24,Winter Elizabeth M5ORCID,Kollmann Martina25,Zmierczak Hans-Georg26,Tsourdi Elena27,Pilz Stefan15,Siggelkow Heide28,Gittoes Neil23,Marcocci Claudio8,Kamenický Peter29ORCID,_ _,Carola Zillikens,Morten Frost,Lars Rolighed,Antonio Sitges-Serra,Sabrina Corbetta,Brigitte Decallonne,Iuliana Gherlan,Laura Gianotti,Daniel Grigorie,Elif Hindié,Mairead Kiely,Kirsten Lindner,Polyzois Makras,Barbara Obermayer-Pietsch,Fastino R Perez-Lopez,Mikkel Pretorius,Federica Saponaro,Christian Trummer,Kyriakos Vamvakidis,Natia Vashakmadze,Maria P Yavropoulou

Affiliation:

1. 1Faculty of Medicine, University of Oslo, Oslo, Norway

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

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

4. 4Schön-Klinik Hamburg, Department of Endocrine Surgery, Hamburg, Germany

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

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

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

8. 8Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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

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

11. 11Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

12. 12The National Medical Research Centre for Endocrinology, Moscow, Russia

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

14. 14Department of Endocrinology, Ghent University Hospital, Ghent, Belgium

15. 15Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria

16. 16Thyroid Center, Luzerner Kantonsspital, Luzern, Switzerland

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

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

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

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

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

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

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

24. 24Université 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. 25Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria

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

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

28. 28Endokrinologikum Göttingen, Georg-August-University Göttingen, Göttingen, Germany

29. 29Université 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

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.

Publisher

Bioscientifica

Subject

Endocrinology,General Medicine,Endocrinology, Diabetes and Metabolism

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