European Society of Endocrinology Clinical Guideline
NB - betreft richtlijn 2015
doi: 10.1530/EJE-15-0628
Eur J Endocrinol August 1, 2015 173 G1-G20
Treatment of chronic hypoparathyroidism in adults
1 Section of Specialized Endocrinology, Clinic of Medicine, Oslo University Hospital, Oslo, Norway
2 Faculty of Medicine,University of Oslo, Oslo, Norway
3 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
4 Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
5 Endocrine Research Unit, Department of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USA
6 Endocrine Surgery Unit, Hospital Universitari del Mar, Barcelona, Spain
7 Renal Division, Ghent University Hospital, Ghent, Belgium
8 Division of Endocrinology, Department of Medicine
9 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
10 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Abstract
Hypoparathyroidism (HypoPT) is a rare (orphan) endocrine disease with low calcium and inappropriately low (insufficient) circulating parathyroid hormone levels, most often in adults secondary to thyroid surgery.
Standard treatment is activated vitamin D analogues and calcium supplementation and not replacement of the lacking hormone, as in other hormonal deficiency states.
The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of chronic HypoPT in adults who do not have end-stage renal disease.
We intend to draft a practical guideline, focusing on operationalized recommendations deemed to be useful in the daily management of patients.
This guideline was developed and solely sponsored by The European Society of Endocrinology, supported by CBO (Dutch Institute for Health Care Improvement) and based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles as a methodological base.
The clinical question on which the systematic literature search was based and for which available evidence was synthesized was: what is the best treatment for adult patients with chronic HypoPT? This systematic search found 1100 articles, which was reduced to 312 based on title and abstract. The working group assessed these for eligibility in more detail, and 32 full-text articles were assessed. For the final recommendations, other literature was also taken into account. Little evidence is available on how best to treat HypoPT. Data on quality of life and the risk of complications have just started to emerge, and clinical trials on how to optimize therapy are essentially non-existent. Most studies are of limited sample size, hampering firm conclusions. No studies are available relating target calcium levels with clinically relevant endpoints. Hence it is not possible to formulate recommendations based on strict evidence.
This guideline is therefore mainly based on how patients are managed in clinical practice, as reported in small case series and based on the experiences of the authors.
Een van de figuren:
Monitoring and treatment of chronic hypoparathyroidism. *If dose of calcium or activated vitamin D is changed, re-evaluation of serum calcium levels is recommended after 1–2 weeks.
http://www.eje-online.org/content/173/2/G1/F1.large.jpg
© 2015 European Society of Endocrinology
Volledig richtlijn met alle tabellen/figuren:
http://www.eje-online.org/content/173/2 ... l.pdf+html
.