Management of Primary Hyperparathyroidism

John P Bilezikian¹, Shonni J Silverberg¹, Francisco Bandeira², Filomena Cetani³, Manju Chandran⁴, Natalie E Cusano⁵, Peter R Ebeling⁶, Anna Maria Formenti⁷, Morten Frost⁸, Jessica Gosnell⁹, E Michael Lewiecki¹⁰, Frederick R Singer¹¹, Neil Gittoes¹², Aliya A Khan¹³, Claudio Marcocci¹⁴, Lars Rejnmark¹⁵, Zhikang Ye¹⁶, Gordon Guyatt¹⁶, John T Potts¹⁷

Affiliations

¹ Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
² Division of Endocrinology, University of Pernambuco Medical School Recife, Recife, Brazil.
³ Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
⁴ Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
⁵ Division of Endocrinology, Department of Medicine, Lenox Hill Hospital, New York, NY, USA.
⁶ Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
⁷ Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy.
⁸ Bone and Calcium Unit & Molecular Endocrinology Unit, Department of Endocrinology, Odense University Hospital, Odense, Denmark.
⁹ Department of Surgery, University of California, San Francisco, CA, USA.
¹⁰ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
¹¹ Endocrine/Bone Disease Program, Saint John's Cancer Institute, Santa Monica, CA, USA.
¹² Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital and University of Birmingham, Birmingham, UK.
¹³ Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada.
¹⁴ Department of Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
¹⁵ Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
¹⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
¹⁷ Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

PMID: 36054638
DOI: 10.1002/jbmr.4682

Free article

Management of Primary Hyperparathyroidism

John P Bilezikian et al. J Bone Miner Res. 2022 Nov.

Free article

. 2022 Nov;37(11):2391-2403.

doi: 10.1002/jbmr.4682. 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, University of Pernambuco Medical School Recife, Recife, Brazil.
³ Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
⁴ Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
⁵ Division of Endocrinology, Department of Medicine, Lenox Hill Hospital, New York, NY, USA.
⁶ Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
⁷ Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy.
⁸ Bone and Calcium Unit & Molecular Endocrinology Unit, Department of Endocrinology, Odense University Hospital, Odense, Denmark.
⁹ Department of Surgery, University of California, San Francisco, CA, USA.
¹⁰ New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
¹¹ Endocrine/Bone Disease Program, Saint John's Cancer Institute, Santa Monica, CA, USA.
¹² Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital and University of Birmingham, Birmingham, UK.
¹³ Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada.
¹⁴ Department of Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy.
¹⁵ Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
¹⁶ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
¹⁷ Endocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

PMID: 36054638
DOI: 10.1002/jbmr.4682

Abstract

Since the last international guidelines were published in 2014 on the evaluation and management of primary hyperparathyroidism (PHPT), new information has become available with regard to evaluation, diagnosis, epidemiology, genetics, classical and nonclassical manifestations, surgical and nonsurgical approaches, and natural history. To provide the most current summary of these developments, an international group, consisting of over 50 experts in these various aspects of PHPT, was convened. This paper provides the results of the task force that was assigned to review the information on the management of PHPT. For this task force on the management of PHPT, two questions were the subject of systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The full report addressing surgical and nonsurgical management of PHPT, utilizing the GRADE methodology, is published separately in this series. In this report, we summarize the results of that methodological review and expand them to encompass a much larger body of new knowledge that did not specifically fit the criteria of the GRADE methodology. Together, both the systematic and narrative reviews of the literature, summarized in this paper, give the most complete information available to date. A panel of experts then considered the last set of international guidelines in light of the newer data and assessed the need for their revision. This report provides the evidentiary background to the guidelines report. In that report, evidence from all task forces is synthesized into a summary statement and revised guidelines for the evaluation and management of PHPT. © 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: CELL/TISSUE SIGNALING-ENDOCRINE PATHWAYS; CLINICAL TRIALS; DISORDERS OF CALCIUM/PHOSPHATE METABOLISM; PARATHYROID-RELATED DISORDERS; PTH/VIT D/FGF23.

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References

REFERENCES

1. Bilezikian JP, Brandi ML, Eastell R, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab. 2014;99(10):3561-3569.
1. Ye Z, Silverberg SJ, Sreekanta A, et al. The efficacy and safety of medical and surgical therapy in patients with primary hyperparathyroidism: a systematic review and meta-analysis of randomized controlled trials. J Bone Miner Res. 2022;37(11):2351-2372.
1. Rao DS, Phillips ER, Divine GW, Talpos GB. Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism. J Clin Endocrinol Metab. 2004;89(11):5415-5422.
1. Ambrogini E, Cetani F, Cianferotti L, et al. Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective randomized clinical trial. J Clin Endocrinol Metab. 2007;92(8):3114-3121.
1. Bollerslev J, Jansson S, Mollerup CL, et al. Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial. J Clin Endocrinol Metab. 2007;92(5):1687-1692.

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Management of Primary Hyperparathyroidism

Affiliations

Management of Primary Hyperparathyroidism

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Abstract

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REFERENCES

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Research Materials