Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

A. A. Khan; D. A. Hanley; R. Rizzoli; J. Bollerslev; J. E.M. Young; L. Rejnmark; R. Thakker; P. D’Amour; T. Paul; S. Van Uum; M. Zakaria Shrayyef; D. Goltzman; S. Kaiser; N. E. Cusano; R. Bouillon; L. Mosekilde; A. W. Kung; S. D. Rao; S. K. Bhadada; B. L. Clarke; J. Liu; Q. Duh; E. Michael Lewiecki; F. Bandeira; R. Eastell; C. Marcocci; S. J. Silverberg; R. Udelsman; K. Shawn Davison; J. T. Potts; M. L. Brandi; J. P. Bilezikian

doi:10.1007/s00198-016-3716-2

Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

A. A. Khan, D. A. Hanley, R. Rizzoli, J. Bollerslev, J. E.M. Young, L. Rejnmark, R. Thakker, P. D’Amour, T. Paul, S. Van Uum, M. Zakaria Shrayyef, D. Goltzman, S. Kaiser, N. E. Cusano, R. Bouillon, L. Mosekilde, A. W. Kung, S. D. Rao, S. K. Bhadada, B. L. ClarkeJ. Liu, Q. Duh, E. Michael Lewiecki, F. Bandeira, R. Eastell, C. Marcocci, S. J. Silverberg, R. Udelsman, K. Shawn Davison, J. T. Potts, M. L. Brandi, J. P. Bilezikian

Medicine

Research output: Contribution to journal › Review article › peer-review

380 Citations (Scopus)

Abstract

The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

Original language	English
Journal	Osteoporosis International
Volume	28
Issue number	1
DOIs	https://doi.org/10.1007/s00198-016-3716-2
Publication status	Published - Jan 1 2017

Bibliographical note

Funding Information:
AA Khan is on the advisory board for Amgen, Eli Lilly, and Merck; has research grants from NPS, Amgen, and Merck; and has received lecture fees from Amgen, Eli Lilly, Warner Chilcott, and Merck; D Hanley has received funding for grants from Amgen, Eli Lilly, Merck, and Novartis; has received funding for lectures from Amgen Eli Lilly and Novartis; and is on the membership board for Amgen, Eli Lilly, Merck, and Novartis; R Rizzoli received consultancy and lecture fees from Amgen, Eli Lilly, MSD, Danone, and Servier; L Rejnmark received consultancy and lecture fees from NPS Pharmaceuticals, Amgen, Eli Lilly, and Novo Nordic; RV Thakker is a chairman of Astra-Zeneca Stratified Medicine Panel and has received lecture and consultancy fees from Novartis, Eli Lilly, AstraZeneca, and Ipsen; S Kaiser has received consultancy fees from Amgen and Eli Lilly and has received lecture fees from Amgen, Eli Lilly, Merck, and NRS; L Mosekilde has received funds for the development of educational presentations; DS Rao is on the advisory board for Diasorin Inc., has received consultancy fees from NPS Pharmaceuticals, has received grants from NIAMS, and has received funding for lectures from Eli Lilly; M Lewiecki has received research grant support from Amgen, Merck, and Eli Lilly and has received consultancy fees from Amgen, Eli Lilly, Merck, Radius Health, AgNovos Healthcare, Theranova, and Alexion; R Eastell received grants, lecture fees, and travel expenses from Amgen, AstraZeneca, IDS, Eli Lilly, Merck, Novartis, Roche, Alexion, Otsuka, IBMS, and Warner Chilcott; KS Davison has received honorarium for lectures from Novartis, Merck, Amgen, and Eli Lilly; and ML Brandi has received consultancy fees and grant funding from Amgen, Eli Lilly, MSD, Novartis, Roche, and Servier.

Funding Information:
In this Canadian position paper, we update our previously published guidelines on PHPT with international consensus []. Canadian participation was invited at the Fourth International Workshop held in Florence Italy 2013. Canadian representatives met international colleagues in Florence and developed key questions addressing evaluation, imaging, diagnosis, and management of PHPT. Canadian representatives collaborated with international colleagues and formalized evidence-based recommendations to each of the key questions listed. A detailed section on parathyroid imaging was developed as this was highlighted as a need by Canadian endocrinologists. This position paper was supported and endorsed by Canadian Endocrine Update, McMaster University, and Western University. We summarize recent evidence and provide recommendations pertaining to the evaluation, diagnosis, presentation, and management of PHPT.

Publisher Copyright:
© 2016, The Author(s).

ASJC Scopus Subject Areas

Endocrinology, Diabetes and Metabolism

PubMed: MeSH publication types

Journal Article
Review
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00198-016-3716-2

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Khan, A. A., Hanley, D. A., Rizzoli, R., Bollerslev, J., Young, J. E. M., Rejnmark, L., Thakker, R., D’Amour, P., Paul, T., Van Uum, S., Shrayyef, M. Z., Goltzman, D., Kaiser, S., Cusano, N. E., Bouillon, R., Mosekilde, L., Kung, A. W., Rao, S. D., Bhadada, S. K., ... Bilezikian, J. P. (2017). Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporosis International, 28(1). https://doi.org/10.1007/s00198-016-3716-2

Khan, AA, Hanley, DA, Rizzoli, R, Bollerslev, J, Young, JEM, Rejnmark, L, Thakker, R, D’Amour, P, Paul, T, Van Uum, S, Shrayyef, MZ, Goltzman, D, Kaiser, S, Cusano, NE, Bouillon, R, Mosekilde, L, Kung, AW, Rao, SD, Bhadada, SK, Clarke, BL, Liu, J, Duh, Q, Lewiecki, EM, Bandeira, F, Eastell, R, Marcocci, C, Silverberg, SJ, Udelsman, R, Davison, KS, Potts, JT, Brandi, ML & Bilezikian, JP 2017, 'Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus', Osteoporosis International, vol. 28, no. 1. https://doi.org/10.1007/s00198-016-3716-2

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title = "Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus",

abstract = "The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of {"}Hyperparathyroidism. Primary{"} was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.",

author = "Khan, {A. A.} and Hanley, {D. A.} and R. Rizzoli and J. Bollerslev and Young, {J. E.M.} and L. Rejnmark and R. Thakker and P. D{\textquoteright}Amour and T. Paul and {Van Uum}, S. and Shrayyef, {M. Zakaria} and D. Goltzman and S. Kaiser and Cusano, {N. E.} and R. Bouillon and L. Mosekilde and Kung, {A. W.} and Rao, {S. D.} and Bhadada, {S. K.} and Clarke, {B. L.} and J. Liu and Q. Duh and Lewiecki, {E. Michael} and F. Bandeira and R. Eastell and C. Marcocci and Silverberg, {S. J.} and R. Udelsman and Davison, {K. Shawn} and Potts, {J. T.} and Brandi, {M. L.} and Bilezikian, {J. P.}",

note = "Funding Information: AA Khan is on the advisory board for Amgen, Eli Lilly, and Merck; has research grants from NPS, Amgen, and Merck; and has received lecture fees from Amgen, Eli Lilly, Warner Chilcott, and Merck; D Hanley has received funding for grants from Amgen, Eli Lilly, Merck, and Novartis; has received funding for lectures from Amgen Eli Lilly and Novartis; and is on the membership board for Amgen, Eli Lilly, Merck, and Novartis; R Rizzoli received consultancy and lecture fees from Amgen, Eli Lilly, MSD, Danone, and Servier; L Rejnmark received consultancy and lecture fees from NPS Pharmaceuticals, Amgen, Eli Lilly, and Novo Nordic; RV Thakker is a chairman of Astra-Zeneca Stratified Medicine Panel and has received lecture and consultancy fees from Novartis, Eli Lilly, AstraZeneca, and Ipsen; S Kaiser has received consultancy fees from Amgen and Eli Lilly and has received lecture fees from Amgen, Eli Lilly, Merck, and NRS; L Mosekilde has received funds for the development of educational presentations; DS Rao is on the advisory board for Diasorin Inc., has received consultancy fees from NPS Pharmaceuticals, has received grants from NIAMS, and has received funding for lectures from Eli Lilly; M Lewiecki has received research grant support from Amgen, Merck, and Eli Lilly and has received consultancy fees from Amgen, Eli Lilly, Merck, Radius Health, AgNovos Healthcare, Theranova, and Alexion; R Eastell received grants, lecture fees, and travel expenses from Amgen, AstraZeneca, IDS, Eli Lilly, Merck, Novartis, Roche, Alexion, Otsuka, IBMS, and Warner Chilcott; KS Davison has received honorarium for lectures from Novartis, Merck, Amgen, and Eli Lilly; and ML Brandi has received consultancy fees and grant funding from Amgen, Eli Lilly, MSD, Novartis, Roche, and Servier. Funding Information: In this Canadian position paper, we update our previously published guidelines on PHPT with international consensus []. Canadian participation was invited at the Fourth International Workshop held in Florence Italy 2013. Canadian representatives met international colleagues in Florence and developed key questions addressing evaluation, imaging, diagnosis, and management of PHPT. Canadian representatives collaborated with international colleagues and formalized evidence-based recommendations to each of the key questions listed. A detailed section on parathyroid imaging was developed as this was highlighted as a need by Canadian endocrinologists. This position paper was supported and endorsed by Canadian Endocrine Update, McMaster University, and Western University. We summarize recent evidence and provide recommendations pertaining to the evaluation, diagnosis, presentation, and management of PHPT. Publisher Copyright: {\textcopyright} 2016, The Author(s).",

year = "2017",

month = jan,

day = "1",

doi = "10.1007/s00198-016-3716-2",

language = "English",

volume = "28",

journal = "Osteoporosis International",

issn = "0937-941X",

publisher = "Springer London",

number = "1",

}

TY - JOUR

T1 - Primary hyperparathyroidism

T2 - review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

AU - Khan, A. A.

AU - Hanley, D. A.

AU - Rizzoli, R.

AU - Bollerslev, J.

AU - Young, J. E.M.

AU - Rejnmark, L.

AU - Thakker, R.

AU - D’Amour, P.

AU - Paul, T.

AU - Van Uum, S.

AU - Shrayyef, M. Zakaria

AU - Goltzman, D.

AU - Kaiser, S.

AU - Cusano, N. E.

AU - Bouillon, R.

AU - Mosekilde, L.

AU - Kung, A. W.

AU - Rao, S. D.

AU - Bhadada, S. K.

AU - Clarke, B. L.

AU - Liu, J.

AU - Duh, Q.

AU - Lewiecki, E. Michael

AU - Bandeira, F.

AU - Eastell, R.

AU - Marcocci, C.

AU - Silverberg, S. J.

AU - Udelsman, R.

AU - Davison, K. Shawn

AU - Potts, J. T.

AU - Brandi, M. L.

AU - Bilezikian, J. P.

N1 - Funding Information: AA Khan is on the advisory board for Amgen, Eli Lilly, and Merck; has research grants from NPS, Amgen, and Merck; and has received lecture fees from Amgen, Eli Lilly, Warner Chilcott, and Merck; D Hanley has received funding for grants from Amgen, Eli Lilly, Merck, and Novartis; has received funding for lectures from Amgen Eli Lilly and Novartis; and is on the membership board for Amgen, Eli Lilly, Merck, and Novartis; R Rizzoli received consultancy and lecture fees from Amgen, Eli Lilly, MSD, Danone, and Servier; L Rejnmark received consultancy and lecture fees from NPS Pharmaceuticals, Amgen, Eli Lilly, and Novo Nordic; RV Thakker is a chairman of Astra-Zeneca Stratified Medicine Panel and has received lecture and consultancy fees from Novartis, Eli Lilly, AstraZeneca, and Ipsen; S Kaiser has received consultancy fees from Amgen and Eli Lilly and has received lecture fees from Amgen, Eli Lilly, Merck, and NRS; L Mosekilde has received funds for the development of educational presentations; DS Rao is on the advisory board for Diasorin Inc., has received consultancy fees from NPS Pharmaceuticals, has received grants from NIAMS, and has received funding for lectures from Eli Lilly; M Lewiecki has received research grant support from Amgen, Merck, and Eli Lilly and has received consultancy fees from Amgen, Eli Lilly, Merck, Radius Health, AgNovos Healthcare, Theranova, and Alexion; R Eastell received grants, lecture fees, and travel expenses from Amgen, AstraZeneca, IDS, Eli Lilly, Merck, Novartis, Roche, Alexion, Otsuka, IBMS, and Warner Chilcott; KS Davison has received honorarium for lectures from Novartis, Merck, Amgen, and Eli Lilly; and ML Brandi has received consultancy fees and grant funding from Amgen, Eli Lilly, MSD, Novartis, Roche, and Servier. Funding Information: In this Canadian position paper, we update our previously published guidelines on PHPT with international consensus []. Canadian participation was invited at the Fourth International Workshop held in Florence Italy 2013. Canadian representatives met international colleagues in Florence and developed key questions addressing evaluation, imaging, diagnosis, and management of PHPT. Canadian representatives collaborated with international colleagues and formalized evidence-based recommendations to each of the key questions listed. A detailed section on parathyroid imaging was developed as this was highlighted as a need by Canadian endocrinologists. This position paper was supported and endorsed by Canadian Endocrine Update, McMaster University, and Western University. We summarize recent evidence and provide recommendations pertaining to the evaluation, diagnosis, presentation, and management of PHPT. Publisher Copyright: © 2016, The Author(s).

PY - 2017/1/1

Y1 - 2017/1/1

N2 - The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

AB - The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.

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JO - Osteoporosis International

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Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus

Abstract

Bibliographical note

ASJC Scopus Subject Areas

PubMed: MeSH publication types

UN SDGs

Access to Document

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