European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

Bollerslev, Jens; Rejnmark, Lars; Zahn, Alexandra; Heck, Ansgar; Appelman‐Dijkstra, Natasha M.; Cardoso, Luís; Hannan, Fadil; Cetani, Filomena; Sikjær, Tanja; Formenti, Anna Maria; Björnsdóttir, Sigríður; Schalin‐Jäntti, Camilla; Belaya, Zhanna; Gibb, Fraser; Lapauw, Bruno; Amrein, Karin; Wicke, Corinna; Grasemann, Corinna; Krebs, Michael; Ryhänen, Eeva; Makay, Özer; Minisola, Salvatore; Gaujoux, Sébastien; Bertocchio, Jean‐Philippe; Hassan‐Smith, Zaki; Linglart, Agnès; Winter, Elizabeth M.; Kollmann, Markus; Zmierczak, Hans‐Georg; Tsourdi, Elena; Pilz, Stefan; Siggelkow, Heide; Gittoes, Neil; Marcocci, Claudio; Kamenický, Peter

doi:10.1530/eje-21-1044

Cited by 92 publications

(138 citation statements)

References 186 publications

(242 reference statements)

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“…The recent EANM Guidelines [ 37 ] and the ESE Educational Program of Parathyroid Disorders (PARAT) [ 38 ] have discussed and recommended 18 F-Fluorocholine as an alternative first-line method whenever possible, especially in patients with negative or equivocal standard imaging findings, and our results supported this suggestion.…”

Section: Discussionsupporting

confidence: 80%

Preoperative Imaging with [18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

Dekorsy

Beyer

Spitzweg

et al. 2022

JCM

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Primary hyperparathyroidism (pHPT) is a common endocrine disorder due to hyperfunctioning parathyroid glands. To date, the only curing therapy is surgical removal of the dysfunctional gland, making correct detection and localization crucial in order to perform a minimally invasive parathyroidectomy. 18F-Fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) has shown promising results for the detection of pHPT, suggesting superiority over conventional imaging with ultrasounds or scintigraphy. A total of 33 patients with pHPT who had negative or equivocal findings in conventional imaging received 18F-FCH PET/CT preoperatively and were retrospectively included. A pathological hyperfunctional parathyroid gland was diagnosed in 24 cases (positive PET, 72.7%), 4 cases showed equivocal choline uptake (equivocal PET, 12.1%), and in 5 cases, no enhanced choline uptake was evident (negative PET, 15.2%). Twelve of the twenty-four detected adenoma patients underwent surgery, and in all cases, a pathological parathyroid adenoma was resected at the site detected by PET/CT. Two of the six patients without pathological choline uptake who received a parathyroidectomy revealed no evidence of parathyroid adenoma tissue in the histopathological evaluation. This retrospective study analyzes 18F-FCH PET/CT in a challenging patient cohort with pHPT and negative or equivocal conventional imaging results and supports the use of 18F-FCH for the diagnosis of hyperfunctional parathyroid tissue, especially in this patient setting, with a 100% true positive and true negative detection rate. Our study further demonstrates the importance of 18F-FCH PET/CT for successful surgical guidance.

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Section: Discussionsupporting

confidence: 80%

Preoperative Imaging with [18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

Dekorsy

Beyer

Spitzweg

et al. 2022

JCM

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“…They also recommend to confirm the chronicity by carefully tapering active treatment. 21 When utilizing our definition of hypoparathyroidism, lower postoperative serum calcium, parathyroid gland autotransplantation, and the occurrence of surgical complications were found to be independent risk factors for persistent hypoparathyroidism.…”

Section: Discussionmentioning

confidence: 85%

Persistent post-thyroidectomy hypoparathyroidism: A multicenter retrospective cohort study

et al. 2022

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Background and objective: The reported incidence of persistent hypoparathyroidism varies widely, and consensus on a definition is lacking. The objective was to evaluate the real-life incidence of persistent hypoparathyroidism by investigating a new pragmatic definition. Methods: This retrospective multicenter cohort study evaluated the effect of different definitions for persistent hypoparathyroidism on the incidence of hypoparathyroidism. In addition, risk factors for hypoparathyroidism were analyzed. Results: In total, 749 patients were included. Using the new pragmatic definition, we report an incidence of 7.9% of persistent hypoparathyroidism. When applying other commonly used definitions, incidence varied between 11.8% and 22.1%. Risk factors were parathyroid autotransplantation, presence of another surgical complication, and low postoperative serum calcium. Conclusions: Our data show that the incidence of persistent hypoparathyroidism in the literature may vary through the use of different definitions. This study indicates that a new pragmatic definition of persistent hypoparathyroidism has the potential to enable unbiased comparison between studies.

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“…Calcitriol (=1,25(OH)2D) and its analogues are used at much lower doses compared to vitamin D3, have a relatively high risk of hypercalcemia and a relatively narrow therapeutic window, and are not recommended for the treatment of common vitamin D deficiency [ 64 ]. Therefore, active vitamin D treatment is only indicated in certain diseases, such as chronic hypoparathyroidism, chronic kidney disease, or mineral and bone disorders (CKD-MBD) [ 64 , 86 ].…”

Section: Consensus Recommendationsmentioning

confidence: 99%

Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement

et al. 2022

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Vitamin D deficiency has a high worldwide prevalence, but actions to improve this public health problem are challenged by the heterogeneity of nutritional and clinical vitamin D guidelines, with respect to the diagnosis and treatment of vitamin D deficiency. We aimed to address this issue by providing respective recommendations for adults, developed by a European expert panel, using the Delphi method to reach consensus. Increasing the awareness of vitamin D deficiency and efforts to harmonize vitamin D guidelines should be pursued. We argue against a general screening for vitamin D deficiency but suggest 25-hydroxyvitamin D (25(OH)D) testing in certain risk groups. We recommend a vitamin D supplementation dose of 800 to 2000 international units (IU) per day for adults who want to ensure a sufficient vitamin D status. These doses are also recommended for the treatment of vitamin D deficiency, but higher vitamin D doses (e.g., 6000 IU per day) may be used for the first 4 to 12 weeks of treatment if a rapid correction of vitamin D deficiency is clinically indicated before continuing, with a maintenance dose of 800 to 2000 IU per day. Treatment success may be evaluated after at least 6 to 12 weeks in certain risk groups (e.g., patients with malabsorption syndromes) by measurement of serum 25(OH)D, with the aim to target concentrations of 30 to 50 ng/mL (75 to 125 nmol/L).

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European expert consensus on practical management of specific aspects of parathyroid disorders in adults and in pregnancy: recommendations of the ESE Educational Program of Parathyroid Disorders (PARAT 2021)

Cited by 92 publications

References 186 publications

Preoperative Imaging with [18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

Preoperative Imaging with [18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

Persistent post-thyroidectomy hypoparathyroidism: A multicenter retrospective cohort study

Clinical Practice in the Prevention, Diagnosis and Treatment of Vitamin D Deficiency: A Central and Eastern European Expert Consensus Statement

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