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

Weber, T; Dotzenrath, C; Dralle, H; Niederle, B; Riss, P; Holzer, K; Kußmann, J; Trupka, A; Negele, T; Kaderli, R.; Karakas, E; Weber, F; Rayes, N; Zielke, A; Hermann, M; Wicke, C; Ladurner, R; Vorländer, C; Waldmann, J; Heizmann, O; ... (2021). Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK). Langenbeck's archives of surgery, 406(3), pp. 571-585. Springer 10.1007/s00423-021-02173-1

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Kaderli, Reto Martin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1435-2451

Publisher:

Springer

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

27 Dec 2021 09:06

Last Modified:

27 Dec 2021 09:06

Publisher DOI:

10.1007/s00423-021-02173-1

PubMed ID:

33880642

Uncontrolled Keywords:

Guideline Hyperparathyroidism Parathyroid carcinoma Parathyroidectomy Primary hyperparathyroidism Renal hyperparathyroidism

BORIS DOI:

10.48350/161933

URI:

https://boris.unibe.ch/id/eprint/161933

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