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Title: | 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. |
Austin Authors: | Miller, Julie A;Gundara, Justin;Harper, Simon;Herath, Madhuni;Ramchand, Sabashini K ;Farrell, Stephen G ;Serpell, Jonathan;Taubman, Kim;Christie, James;Girgis, Christian M;Schneider, Hans G;Clifton-Bligh, Roderick;Gill, Anthony J;De Sousa, Sunita M C;Carroll, Richard W;Milat, Frances;Grossmann, Mathis |
Affiliation: | Endocrinology Surgery Medicine (University of Melbourne) South Australian Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, South Australia Department of Surgery, University of Otago, Wellington, New Zealand Department of Endocrinology, St Vincent's Hospital, Fitzroy, Victoria, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia Department of Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia PRP Diagnostic Imaging, Sydney, New South Wales, Australia Clinical Biochemistry Unit, Alfred Pathology Service, Alfred Health, Melbourne, Victoria, Australia Kolling Institute, University of Sydney, Sydney, New South Wales, Australia Department of Endocrinology, Alfred Hospital, Melbourne, Victoria, Australia Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Clayton, Victoria, Australia Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia Department of Surgery, Redland Hospital, Metro South and Faculty of Medicine, University of Queensland, Saint Lucia, Queensland, Australia Department of Surgery, Logan Hospital, Metro South and School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia Department of Endocrinology, Monash Health, Clayton, Victoria, Australia Centre for Endocrinology & Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia Department of Medicine, Nursing & Health Sciences, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia Department of Surgery, Royal Children's Hospital, Parkville, Victoria, Australia Department of General Surgery, The Alfred Hospital, Melbourne, Victoria, Australia Department of Endocrine Surgery, Monash University, Victoria, Clayton, Australia Department of Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia Endocrine Surgical Centre, Epworth Hospital Network, Richmond, Victoria, Australia Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand Endocrine, Diabetes, and Research Centre, Wellington Regional Hospital, Wellington, New Zealand Department of Medical Imaging, St Vincent's Hospital, Fitzroy, Victoria, Australia Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia |
Issue Date: | 19-Dec-2021 |
Date: | 2021 |
Publication information: | Clinical Endocrinology 2021; |
Abstract: | To develop evidence-based recommendations to guide the surgical management and postoperative follow-up of adults with primary hyperparathyroidism. 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. 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. This position statement provides up-to-date guidance on evidence-based best practice surgical and postoperative management of adults with primary hyperparathyroidism. |
URI: | https://ahro.austin.org.au/austinjspui/handle/1/28447 |
DOI: | 10.1111/cen.14650 |
ORCID: | 0000-0002-1545-0368 0000-0001-8261-3457 0000-0002-6755-8469 0000-0002-0834-1948 |
Journal: | Clinical Endocrinology |
PubMed URL: | 34927274 |
PubMed URL: | https://pubmed.ncbi.nlm.nih.gov/34927274/ |
Type: | Journal Article |
Appears in Collections: | Journal articles |
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