Primary hyperparathyroidism in adults—(Part II) surgical management and postoperative follow‐up: Position statement of the Endocrine Society of Australia, The Australian & New Zealand Endocrine Surgeons, and The Australian & New Zealand Bone and Mineral Society
Year: 2021
Type: article
Abstract: OBJECTIVE: To develop evidence-based recommendations to guide the surgical management and postoperative follow-up of adults with primary hyperparathyroidism. 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 eight key questions. RESULTS: Diagnostic imaging does not determine suitability for surgery but can guide the planning of surgery in suitable candidates. First-line imaging includes ultrasound and either parathyroid 4DCT or scintigraphy, depending on local availability and expertise. Minimally invasive parathyroidectomy is appropriate in most patients with concordant imaging. Bilateral neck exploration should be considered in those with discordant/negative imaging findings, multi-gland disease and genetic/familial risk factors. Parathyroid surgery, especially re-operative surgery, has better outcomes in the hands of higher volume surgeons. Neuromonitoring is generally not required for initial surgery but should be considered for re-operative surgery. Following parathyroidectomy, calcium and parathyroid hormone levels should be re-checked in the first 24 h and repeated early if there are risk factors for hypocalcaemia. Eucalcaemia at 6 months is consistent with surgical cure; parathyroid hormone levels do not need to be re-checked in the absence of other clinical indications. Longer-term surveillance of skeletal health is recommended. CONCLUSIONS: This position statement provides up-to-date guidance on evidence-based best practice surgical and postoperative management of adults with primary hyperparathyroidism.
Source: Clinical Endocrinology
DOI: 10.1111/cen.14650
Authors: Julie A. Miller, Justin Gundara, Simon Harper, Madhuni Herath, Sabashini K. Ramchand, Stephen Farrell, Jonathan Serpell, Kim Taubman, James Christie, Christian M. Girgis, Hans G. Schneider, Roderick Clifton‐Bligh, Anthony J. Gill, Sunita M. C. De Sousa, Richard W. Carroll, Frances Milat, Mathis Grossmann
Institutions: The Royal Melbourne Hospital, The University of Melbourne, Epworth Hospital, Griffith University, The University of Queensland, Logan Hospital, Wellington Hospital, University of Otago, Monash Medical Centre, Hudson Institute of Medical Research, Monash Health, Monash University, Austin Hospital, Austin Health, Royal Children's Hospital, St Vincent's Hospital Melbourne, St Vincent's Health, The Alfred Hospital, The University of Sydney, Royal North Shore Hospital, Westmead Hospital, Alfred Health, NSW Health Pathology, Royal Adelaide Hospital, The University of Adelaide
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funder: University of Otago
OpenAlex ID: W4200181799