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.

Elizabeth M Winter, Michael Krebs, Eeva M Ryhänen, Ozer Makay, Salvatore Minisola, Sebastien Gaujoux, Jean-Philippe Bertocchio, Zaki K Hassan-Smith, Agnès Linglart, Corinna Grasemann, Martina Kollmann, Hans-Georg Zmierczak, Elena Tsourdi, Stefan Pilz, Heide Siggelkow, Neil J Gittoes, Claudio Marcocci, Peter Kamenicky, Anna Maria Formenti, Lars Rejnmark, Alexandra Zahn, Ansgar Heck, N M Appelman-Dijkstra, Luis Cardoso, Fadil M Hannan, Filomena Cetani, Tanja Sikjær, Jens Bollerslev, Sigridur Björnsdottir, Camilla Schalin-Jantti, Zhanna Belaya, Fraser Wilson Gibb, Bruno Lapauw, Karin Amrein, Corinna Wicke

Journal: European journal of endocrinology 2022;186(2):R33-R63

PMID: 34863037

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 (PARAT) 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 diagnosing to familial hypocalciuric hypercalcemia (FHH), the definition and clinical course of normocalcemic PHPT, and the optimal management of its recurrence after surgery represent 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 newborns children are proposed. The recommendations on clinical management presented here will serve as background for further educational material aimed for a broader clinical audience, and were developed with focus on endocrinologists in training.

Address: J Bollerslev, Section of Specialized Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Oslo, Norway.; L Rejnmark, Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, 8000, Denmark.; A Zahn, Department of Endocrine Surgery, Schön Klinik Hamburg-Eilbek, Hamburg, Germany.; A Heck, Section for Specialised Endocrinology, Department of Endocrinology, Medical Clinic, Oslo University Hospital, Rikshospitalet, Oslo, Norway.; N Appelman-Dijkstra, Department of Medicine; Division of Endocrinology, LUMC, Leiden, Netherlands.; L Cardoso, Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal.; F Hannan, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland.; F Cetani, Endocrinology and Metabolism, University of Pisa, Pisa, 56124, Italy.; T Sikjær, Department of Endocrinology and Internal Medicine, Aarhus Universitetshospital, Aarhus, Denmark.; A Formenti, Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, Milano, Italy.; S Björnsdottir, Department of Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.; C Schalin-Jantti, Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.; Z Belaya, neuroendocrinology and bone disease, The National Research Center for Endocrinology, Moscow, 117036, Russian Federation.; F Gibb, Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland.; B Lapauw, Endocrinology, Ghent University Hospital, Ghent, B-9000, Belgium.; K Amrein, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.; C Wicke, Thyroid Center, Luzerner Kantonsspital, Luzern, Switzerland.; C Grasemann, Department of Pediatrics, Ruhr University of Bochum Faculty of Medicine, Bochum, Germany.; M Krebs, Internal Medicine III, Div. Endocrinology, Medical University of Vienna, Vienna, 1090, Austria.; E Ryhänen, Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.; O Makay, general surgery, ege university, izmir, 35100, Turkey.; S Minisola, Department of Internal Medicine and Medical Disciplines, "Sapienza" University of Rome, Rome, 00161, Italy.; S Gaujoux, Digestive and Endocrine surgery, Hopital Cochin, Paris, France.; J Bertocchio, Nephrology department,, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Boulevard de l'Hôpital, 75013 Paris , France.; Z Hassan-Smith, Department of Endocrinology; University Hospitals Birmingham, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland.; A Linglart, Pediatric endocrinology, APHP, Bicêtre Paris-Sud Hospital, Le Kremlin Bicetre, 94270, France.; E Winter, Department of Medicine; Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands.; M Kollmann, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.; H Zmierczak, Reference centre for rare bone, calcium and phosphate disorders, Ghent Universitary Hospital, Ghent, Belgium.; E Tsourdi, Division of Endocrinology, Diabetes, and Bone Diseases, Dresden Technical University Medical Center , Dresden, 01307, Germany.; S Pilz, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.; H Siggelkow, Endokrinologikum Göttingen, Georg-August-University Göttingen, Gottingen, Germany.; N Gittoes, Department of Endocrinology; University Hospitals Birmingham , University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland.; C Marcocci, Clinical and Experimental Medicine, University of Pisa, Pisa, 56124, Italy.; P Kamenicky, Centre de Référence des Maladies Rares de l'Hypophyse, Le Kremlin-Bicêtre, Île-de-France, France.
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