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Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK)

  • Systematic Reviews and Meta-analyses
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Abstract

Background and aims

The purpose of this review is to provide updated recommendations for the surgical management of primary (pHPT) and renal (rHPT) hyperparathyroidism, formulating a new guideline of the German Association of Endocrine Surgeons (CAEK).

Methods

Evidence-based recommendations for the diagnosis and therapy of pHPT and rHPT were assessed by a multidisciplinary panel using PubMed for a comprehensive literature search together with a structured consensus dialogue (S2k guideline of the Association of the German Scientific Medical Societies, AWMF).

Results

During the last 20 years, a variety of new preoperative localization procedures, such as sestamibi-SPECT, 4D-CT, and various PET/CT procedures, were established for pHPT. High-resolution imaging, together with intraoperative parathyroid hormone (IOPTH) measurement, enabled focused or minimally invasive surgery to become the most favored surgical technique. Patients with pHPT and nonlocalizing imaging have a higher risk of multiglandular disease. Surgical therapy provides very high cure rates, with a clear relation to the surgeon’s experience in parathyroid procedures. Reoperative parathyroidectomy, children with pHPT or familial forms, and parathyroid carcinoma are addressed and require special surgical expertise. A multidisciplinary team of experienced nephrologists, transplant, and endocrine surgeons should assess the diagnosis and treatment of renal HPT.

Conclusion

Surgery is the only curative treatment for pHPT and should be considered for all patients with pHPT. For rHPT, a more selective approach is required, and parathyroidectomy is indicated only when conservative treatment options fail. In parathyroid carcinoma, the adequacy of local resection influences local disease control.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Katholisches Klinikum, An der Goldgrube 11, 55130, Mainz, Germany

    T. Weber

  2. HELIOS Universitätsklinikum, Wuppertal, Germany

    C. Dotzenrath

  3. Universitätsklinikum, Essen, Germany

    H. Dralle, F. Weber & K. W. Schmid

  4. Medizinische Universität , Wien, Austria

    B. Niederle & P. Riss

  5. Universitätsklinikum, Marburg, Germany

    K. Holzer, S. Wächter, D. K. Bartsch & M. Luster

  6. Schön-Klinik , Hamburg, Germany

    J. Kußmann

  7. Klinikum , Starnberg, Germany

    A. Trupka

  8. Krankenhaus Martha-Maria, München, Germany

    T. Negele

  9. Inselspital, Bern, Switzerland

    R. Kaderli

  10. Alexiander-Klinik, Krefeld, Germany

    E. Karakas

  11. Universitätsklinikum, Leipzig, Germany

    N. Rayes

  12. Diakonie-Klinikum, Stuttgart, Germany

    A. Zielke

  13. Krankenanstalt Rudolfstiftung, Wien, Austria

    M. Hermann

  14. Kantonsspital, Luzern, Switzerland

    C. Wicke

  15. LMU Klinikum Universität, München, Germany

    R. Ladurner & R. Schmidmaier

  16. Bürgerhospital, Frankfurt, Germany

    C. Vorländer

  17. MIVENDO Klinik, Hamburg, Germany

    J. Waldmann

  18. Diakonieklinikum, Rotenburg, Germany

    O. Heizmann

  19. Romed-Klinik, Bad Aibling, Germany

    S. Schopf

  20. Agaplesion Krankenhaus, Hagen, Germany

    W. Timmermann

  21. Robert-Bosch-Krankenhaus, Stuttgart, Germany

    M. Ketteler

  22. Universitätsklinikum, Halle, Germany

    C. Dierks & K. Lorenz

  23. Ratajczak & Partner, Freiburg, Germany

    P. Schabram

  24. DRK Kliniken, Berlin, Germany

    T. Steinmüller

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  1. T. Weber
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Contributions

T. Weber, C. Dotzenrath, and K. Lorenz coordinated the guidelines. All of the coordinators and coauthors were active in writing chapters, correcting drafts, voting for recommendations, and participating in the online consensus conference.

Corresponding author

Correspondence to T. Weber.

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Conflict of interest

Honoraria for speaking at symposia: Ketteler M, Schmidmaier R, Weber T, Wicke C, Zielke A. Position on advisory board or other types of management relationship: Ketteler M, Riss P, Schmidmaier R, Vorländer C, Weber T, Wicke C, Zielke A. All other authors declare no competing interests.

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Weber, T., Dotzenrath, C., Dralle, H. et al. Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons (CAEK). Langenbecks Arch Surg 406, 571–585 (2021). https://doi.org/10.1007/s00423-021-02173-1

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