Primary hyperparathyroidism in adults—(Part I) assessment and medical management: Position statement of the endocrine society of Australia, the Australian & New Zealand endocrine surgeons, and the Australian & New Zealand bone and mineral society

作者：Frances Milat, Sabashini K. Ramchand, Madhuni Herath, Justin S. Gundara, Simon Harper, Stephen Farrell, Christian M. Girgis, Roderick Clifton‐Bligh, Hans G. Schneider, Sunita M C De Sousa, Anthony J. Gill, Jonathan W. Serpell, Kim Taubman, James Christie, Richard Carroll, Julie Ann Miller, Mathis Grossmann · 发表于：Clinical Endocrinology · 年份：2021 · DOI：10.1111/cen.14659 · 被引用次数：13 · 研究领域：Parathyroid Disorders and Treatments、Vitamin D Research Studies、Bone health and treatments

OBJECTIVE: To formulate clinical consensus recommendations on the presentation, assessment, and management of primary hyperparathyroidism (PHPT) in adults. METHODS: Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing nine key questions. RESULTS: PHPT is a biochemical diagnosis. Serum calcium should be measured in patients with suggestive symptoms, reduced bone mineral density or minimal trauma fractures, and in those with renal stones. Other indications are detailed in the manuscript. In patients with hypercalcaemia, intact parathyroid hormone, 25-hydroxy vitamin D, phosphate, and renal function should be measured. In established PHPT, assessment of bone mineral density, vertebral fractures, urinary tract calculi/nephrocalcinosis and quantification of urinary calcium excretion is warranted. Parathyroidectomy is the only definitive treatment and is warranted for all symptomatic patients and should be considered for asymptomatic patients without contraindications to surgery and with >10 years life expectancy. In patients who do not undergo surgery, we recommend annual evaluation for disease progression. Where the diagnosis is not clear or the risk-benefit ratio is not obvious, multidisciplinary discussion and formulation of a consensus management plan is appropriate. Genetic testing for familial hyperparathyroidism is recommended in select...