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01-05-2021 | Hyperparathyroidism | Systematic Reviews and Meta-analyses

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

Authors: T. Weber, C. Dotzenrath, H. Dralle, B. Niederle, P. Riss, K. Holzer, J. Kußmann, A. Trupka, T. Negele, R. Kaderli, E. Karakas, F. Weber, N. Rayes, A. Zielke, M. Hermann, C. Wicke, R. Ladurner, C. Vorländer, J. Waldmann, O. Heizmann, S. Wächter, S. Schopf, W. Timmermann, D. K. Bartsch, R. Schmidmaier, M. Luster, K. W. Schmid, M. Ketteler, C. Dierks, P. Schabram, T. Steinmüller, K. Lorenz

Published in: Langenbeck's Archives of Surgery | Issue 3/2021

Abstract

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.

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Title: Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK)
Authors: T. Weber
C. Dotzenrath
H. Dralle
B. Niederle
P. Riss
K. Holzer
J. Kußmann
A. Trupka
T. Negele
R. Kaderli
E. Karakas
F. Weber
N. Rayes
A. Zielke
M. Hermann
C. Wicke
R. Ladurner
C. Vorländer
J. Waldmann
O. Heizmann
S. Wächter
S. Schopf
W. Timmermann
D. K. Bartsch
R. Schmidmaier
M. Luster
K. W. Schmid
M. Ketteler
C. Dierks
P. Schabram
T. Steinmüller
K. Lorenz
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Hyperparathyroidism
Parathyroidectomy
Parathyroidectomy
Parathyroid Cancer
Published in: Langenbeck's Archives of Surgery / Issue 3/2021
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-021-02173-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Background and aims

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusion

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