European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

Jens Bollerslev; Lars Rejnmark; Claudio Marcocci; Dolores M Shoback; Antonio Sitges-Serra; Wim van Biesen; Olaf M Dekkers; European Society of Endocrinology

doi:10.1530/EJE-15-0628

European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults

Eur J Endocrinol. 2015 Aug;173(2):G1-20. doi: 10.1530/EJE-15-0628.

Authors

Jens Bollerslev¹, Lars Rejnmark², Claudio Marcocci², Dolores M Shoback², Antonio Sitges-Serra², Wim van Biesen², Olaf M Dekkers³; European Society of Endocrinology

Affiliations

¹ Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark Jens.bollerslev@medisin.uio.no.
² Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark.
³ Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical

PMID: 26160136
DOI: 10.1530/EJE-15-0628

Abstract

Hypoparathyroidism (HypoPT) is a rare (orphan) endocrine disease with low calcium and inappropriately low (insufficient) circulating parathyroid hormone levels, most often in adults secondary to thyroid surgery. Standard treatment is activated vitamin D analogues and calcium supplementation and not replacement of the lacking hormone, as in other hormonal deficiency states. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of chronic HypoPT in adults who do not have end-stage renal disease. We intend to draft a practical guideline, focusing on operationalized recommendations deemed to be useful in the daily management of patients. This guideline was developed and solely sponsored by The European Society of Endocrinology, supported by CBO (Dutch Institute for Health Care Improvement) and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles as a methodological base. The clinical question on which the systematic literature search was based and for which available evidence was synthesized was: what is the best treatment for adult patients with chronic HypoPT? This systematic search found 1100 articles, which was reduced to 312 based on title and abstract. The working group assessed these for eligibility in more detail, and 32 full-text articles were assessed. For the final recommendations, other literature was also taken into account. Little evidence is available on how best to treat HypoPT. Data on quality of life and the risk of complications have just started to emerge, and clinical trials on how to optimize therapy are essentially non-existent. Most studies are of limited sample size, hampering firm conclusions. No studies are available relating target calcium levels with clinically relevant endpoints. Hence it is not possible to formulate recommendations based on strict evidence. This guideline is therefore mainly based on how patients are managed in clinical practice, as reported in small case series and based on the experiences of the authors.

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Chronic Disease
Endocrinology / methods
Endocrinology / standards*
Humans
Hypoparathyroidism / diagnosis
Hypoparathyroidism / therapy*
Practice Guidelines as Topic / standards*
Societies, Medical / standards*
Treatment Outcome