Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/28447
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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