Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 May;406(3):571-585.
doi: 10.1007/s00423-021-02173-1. Epub 2021 Apr 21.

Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK)

T Weber  1 , C Dotzenrath  2 , H Dralle  3 , B Niederle  4 , P Riss  4 , K Holzer  5 , J Kußmann  6 , A Trupka  7 , T Negele  8 , R Kaderli  9 , E Karakas  10 , F Weber  3 , N Rayes  11 , A Zielke  12 , M Hermann  13 , C Wicke  14 , R Ladurner  15 , C Vorländer  16 , J Waldmann  17 , O Heizmann  18 , S Wächter  5 , S Schopf  19 , W Timmermann  20 , D K Bartsch  5 , R Schmidmaier  15 , M Luster  5 , K W Schmid  3 , M Ketteler  21 , C Dierks  22 , P Schabram  23 , T Steinmüller  24 , K Lorenz  22
Affiliations
Review

Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK)

T Weber et al. Langenbecks Arch Surg. 2021 May.

Abstract

Background and aims: The purpose of this review is to provide updated recommendations for the surgical management of primary (pHPT) and renal (rHPT) hyperparathyroidism, formulating a new guideline of the German Association of Endocrine Surgeons (CAEK).

Methods: Evidence-based recommendations for the diagnosis and therapy of pHPT and rHPT were assessed by a multidisciplinary panel using PubMed for a comprehensive literature search together with a structured consensus dialogue (S2k guideline of the Association of the German Scientific Medical Societies, AWMF).

Results: During the last 20 years, a variety of new preoperative localization procedures, such as sestamibi-SPECT, 4D-CT, and various PET/CT procedures, were established for pHPT. High-resolution imaging, together with intraoperative parathyroid hormone (IOPTH) measurement, enabled focused or minimally invasive surgery to become the most favored surgical technique. Patients with pHPT and nonlocalizing imaging have a higher risk of multiglandular disease. Surgical therapy provides very high cure rates, with a clear relation to the surgeon's experience in parathyroid procedures. Reoperative parathyroidectomy, children with pHPT or familial forms, and parathyroid carcinoma are addressed and require special surgical expertise. A multidisciplinary team of experienced nephrologists, transplant, and endocrine surgeons should assess the diagnosis and treatment of renal HPT.

Conclusion: Surgery is the only curative treatment for pHPT and should be considered for all patients with pHPT. For rHPT, a more selective approach is required, and parathyroidectomy is indicated only when conservative treatment options fail. In parathyroid carcinoma, the adequacy of local resection influences local disease control.

Keywords: Guideline; Hyperparathyroidism; Parathyroid carcinoma; Parathyroidectomy; Primary hyperparathyroidism; Renal hyperparathyroidism.

PubMed Disclaimer

References

    1. Nilsson IL (2019) Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties. J Intern Med 285:149–164 - PubMed
    1. Chirurgische Therapie des primären Hyperparathyreoidismus. Mitteilungen der Deutschen Gesellschaft für Chirurgie G86, Heft 04/1999
    1. Lundstam K, Heck A, Mollerup C, Godang K, Baranowski M, Pernow Y, Varhaug JE, Hessman O, Rosén T, Nordenström J, Jansson S, Hellström M, Bollerslev J, SIPH Study Group (2015) Effects of parathyroidectomy versus observation on the development of vertebral fractures in mild hyperparathyroidism. J Clin Endocrinol Metab 100:1359–1367 - PubMed
    1. Roman SA, Sosa JA, Pietrzak RH, Snyder PJ, Thomas DC, Udelsman R, Mayes L (2011) The effects of serum calcium and parathyroid hormone changes on psychological and cognitive function in patients undergoing parathyroidectomy for primary hyperparathyroidism. Ann Surg 253:131–137 - PubMed
    1. Espiritu RP, Kearns AE, Vickers KS, Grant C, Ryu E, Wermers RA (2011) Depression in primary hyperparathyroidism: prevalence and benefit of surgery. J Clin Endocrinol Metab 96:E1737–E1745 - PubMed

Substances

LinkOut - more resources