Management of Primary Hyperparathyroidism.

Area of Science:

• Endocrinology
• Metabolic Bone Diseases

Background:

• International guidelines for primary hyperparathyroidism (PHPT) were last updated in 2014.
• Significant new information has emerged regarding PHPT's evaluation, diagnosis, epidemiology, genetics, manifestations, and management.
• An international expert task force was convened to address these developments.

Purpose of the Study:

• To provide a current summary of developments in PHPT.
• To review and synthesize new knowledge on PHPT management.
• To provide the evidentiary background for revised international guidelines on PHPT.

Main Methods:

• Systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology for specific management questions.
• Narrative reviews encompassing a broader body of new knowledge beyond GRADE criteria.
• Expert panel assessment of existing guidelines in light of new data.

Main Results:

• A comprehensive review of recent literature on PHPT evaluation and management.
• Identification of new information on classical and nonclassical PHPT manifestations and natural history.
• Synthesis of evidence to inform revised clinical guidelines.

Conclusions:

• The report provides the most complete information available to date on PHPT.
• Expert consensus supports the need for revising the last set of international guidelines.
• Revised guidelines for PHPT evaluation and management are presented based on synthesized evidence.