Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

John P Bilezikian; Aliya A Khan; Shonni J Silverberg; Ghada El-Hajj Fuleihan; Claudio Marcocci; Salvatore Minisola; Nancy Perrier; Antonio Sitges-Serra; Rajesh V Thakker; Gordon Guyatt; Michael Mannstadt; John T Potts; Bart L Clarke; Maria Luisa Brandi; International Workshop on Primary Hyperparathyroidism

doi:10.1002/jbmr.4677

Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop

J Bone Miner Res. 2022 Nov;37(11):2293-2314. doi: 10.1002/jbmr.4677. Epub 2022 Oct 17.

Authors

Affiliations

¹ Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
² Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada.
³ Calcium Metabolism and Osteoporosis Program, WHO CC for Metabolic Bone Disorders, Division of Endocrinology, American University of Beirut, Beirut, Lebanon.
⁴ Department of Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
⁵ Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, 'Sapienza', Rome University, Rome, Italy.
⁶ Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁷ Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁸ Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Oxford, UK.
⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
¹⁰ Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA.
¹² Fondazione Italiana sulla Ricerca sulle Malattie dell'Osso (F.I.R.M.O. Foundation), Florence, Italy.

PMID: 36245251
DOI: 10.1002/jbmr.4677

Abstract

The last international guidelines on the evaluation and management of primary hyperparathyroidism (PHPT) were published in 2014. Research since that time has led to new insights into epidemiology, pathophysiology, diagnosis, measurements, genetics, outcomes, presentations, new imaging modalities, target and other organ systems, pregnancy, evaluation, and management. Advances in all these areas are demonstrated by the reference list in which the majority of listings were published after the last set of guidelines. It was thus, timely to convene an international group of over 50 experts to review these advances in our knowledge. Four Task Forces considered: 1. Epidemiology, Pathophysiology, and Genetics; 2. Classical and Nonclassical Features; 3. Surgical Aspects; and 4. Management. For Task Force 4 on the Management of PHPT, Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology addressed surgical management of asymptomatic PHPT and non-surgical medical management of PHPT. The findings of this systematic review that applied GRADE methods to randomized trials are published as part of this series. Task Force 4 also reviewed a much larger body of new knowledge from observations studies that did not specifically fit the criteria of GRADE methodology. The full reports of these 4 Task Forces immediately follow this summary statement. Distilling the essence of all deliberations of all Task Force reports and Methodological reviews, we offer, in this summary statement, evidence-based recommendations and guidelines for the evaluation and management of PHPT. Different from the conclusions of the last workshop, these deliberations have led to revisions of renal guidelines and more evidence for the other recommendations. The accompanying papers present an in-depth discussion of topics summarized in this report. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Keywords: ENDOCRINE PATHWAYS; PARATHYROID-RELATED DISORDERS; PTH/VIT D/FGF23.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Hyperparathyroidism, Primary* / complications
Hyperparathyroidism, Primary* / diagnosis
Hyperparathyroidism, Primary* / therapy