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Guideline
. 2024;24(8):991-1006.
doi: 10.2174/0118715303260423231122111705.

Italian Guidelines for the Management of Sporadic Primary Hyperparathyroidism

Fabio Vescini  1 , Giorgio Borretta  2 , Iacopo Chiodini  3   4   4 , Marco Boniardi  5 , Marina Carotti  6 , Elena Castellano  2 , Cristiana Cipriani  7 , Cristina Eller-Vainicher  8 , Sandro Giannini  9 , Maurizio Iacobone  10 , Antonio Stefano Salcuni  1 , Federica Saponaro  11 , Stefano Spiezia  12 , Annibale Versari  13 , Guido Zavatta  14 , Zuzana Mitrova  15 , Rosella Saulle  15 , Simona Vecchi  15 , Debora Antonini  16 , Michele Basile  16 , Alexia Giovanazzi  17 , Agostino Paoletta  18 , Enrico Papini  19 , Agnese Persichetti  20 , Irene Samperi  21 , Alessandro Scoppola  22 , Roberto Novizio  23 , Pietro Giorgio Calò  24 , Filomena Cetani  25 , Luisella Cianferotti  26 , Sabrina Corbetta  27   28 , Maria Luisa De Rimini  29 , Alberto Falchetti  30 , Giovanni Iannetti  31 , Stefano Laureti  32 , Celestino Pio Lombardi  33 , Bruno Madeo  34 , Claudio Marcocci  25 , Sandro Mazzaferro  35 , Vittorio Miele  36 , Salvatore Minisola  37 , Andrea Palermo  38 , Jessica Pepe  7 , Alfredo Scillitani  39 , Laura Tonzar  1 , Franco Grimaldi  40 , Renato Cozzi  41 , Roberto Attanasio  42
Affiliations
Guideline

Italian Guidelines for the Management of Sporadic Primary Hyperparathyroidism

Fabio Vescini et al. Endocr Metab Immune Disord Drug Targets. 2024.

Abstract

Aim: This guideline (GL) is aimed at providing a clinical practice reference for the management of sporadic primary hyperparathyroidism (PHPT) in adults. PHPT management in pregnancy was not considered.

Methods: This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology (AME) and Società Italiana dell'Osteoporosi, del Metabolismo Minerale e delle Malattie dello Scheletro (SIOMMMS) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence. Those classified as "critical" were considered for the clinical practice recommendations.

Results: The present GL provides recommendations about the roles of pharmacological and surgical treatment for the clinical management of sporadic PHPT. Parathyroidectomy is recommended in comparison to surveillance or pharmacologic treatment in any adult (outside of pregnancy) or elderly subject diagnosed with sporadic PHPT who is symptomatic or meets any of the following criteria: • Serum calcium levels >1 mg/dL above the upper limit of normal range. • Urinary calcium levels >4 mg/kg/day. • Osteoporosis disclosed by DXA examination and/or any fragility fracture. • Renal function impairment (eGFR <60 mL/min). • Clinic or silent nephrolithiasis. • Age ≤50 years. Monitoring and treatment of any comorbidity or complication of PHPT at bone, kidney, or cardiovascular level are suggested for patients who do not meet the criteria for surgery or are not operated on for any reason. Sixteen indications for good clinical practice are provided in addition to the recommendations.

Conclusion: The present GL is directed to endocrinologists and surgeons - working in hospitals, territorial services or private practice - and to general practitioners and patients. The recommendations should also consider the patient's preferences and the available resources and expertise.

Keywords: Hyperparathyroidism; bisphosphonate; cinacalcet; parathyroidectomy; pharmacoeconomy.; sporadic; surgery; surveillance.

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Conflict of interest statement

Alberto Falchetti is the Editorial Advisory Board member of the journal Endocrine, Metabolic & Immune Disorders-Drug Targets.

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