Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop
Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop
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DOI：
10.1210/jc.2014-1413
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发表时间：
2014-10-01
影响因子：
5.8
通讯作者：
Potts, John T., Jr.
中科院分区：
文献类型：
--
作者：
Bilezikian, John P.;Brandi, Maria Luisa;Potts, John T., Jr.
目的：无症状原发性甲状旁腺功能亢进（PHPT）是世界各地内分泌学临床实践中常见的疾病。本报告将有关该病的诊断、临床特征和管理的最新信息提炼成一套修订后的指南。参与者：代表国际群体的参与者，对无症状PHPT的各个方面感兴趣并具有专门知识，组成了四个讲习班小组，制定了要解决的关键问题。随后，他们于2013年9月19日至21日在意大利佛罗伦萨召开了为期3天的公开会议，会上就这些问题进行了一系列演讲和讨论。一个较小的小组委员会，即专家小组，随后举行了闭门会议，就如何处理公开论坛上公布的问题和数据达成基于证据的共识。证据：在会议之前，每个问题都通过相关的、广泛的文献检索来解决。研讨会小组和专家小组的所有报告和审议都是基于从文献检索中收集到的最新信息。共识过程：专家小组考虑了各个研讨会小组提供的所有证据，然后达成共识。结论：鉴于上届无症状PHPT管理国际研讨会的新发现，对管理指南进行了修订。修订后的指南包括：1)建议对骨骼和肾脏系统进行更广泛的评估；2)经进一步评估确定的骨骼和/或肾脏受累，成为手术指南的一部分；3)对那些不符合甲状旁腺手术指南的患者进行更具体的监测指南。这些指南可以帮助内分泌学家和外科医生照顾PHPT患者。提出了未来研究的蓝图，以促进对仍然不确定或有争议的问题的进一步调查。
Objective: Asymptomatic primary hyperparathyroidism (PHPT) is routinely encountered in clinical practices of endocrinology throughout the world. This report distills an update of current information about diagnostics, clinical features, and management of this disease into a set of revised guidelines.Participants: Participants, representing an international constituency, with interest and expertise in various facets of asymptomatic PHPT constituted four Workshop Panels that developed key questions to be addressed. They then convened in an open 3-day conference September 19-21, 2013, in Florence, Italy, when a series of presentations and discussions addressed these questions. A smaller subcommittee, the Expert Panel, then met in closed session to reach an evidence-based consensus on how to address the questions and data that were aired in the open forum.Evidence: Preceding the conference, each question was addressed by a relevant, extensive literature search. All presentations and deliberations of the Workshop Panels and the Expert Panel were based upon the latest information gleaned from this literature search.Consensus Process: The expert panel considered all the evidence provided by the individual Workshop Panels and then came to consensus.Conclusion: In view of new findings since the last International Workshop on the Management of Asymptomatic PHPT, guidelines for management have been revised. The revised guidelines include: 1) recommendations for more extensive evaluation of the skeletal and renal systems; 2) skeletal and/or renal involvement as determined by further evaluation to become part of the guidelines for surgery; and 3) more specific guidelines for monitoring those who do not meet guidelines for parathyroid surgery. These guidelines should help endocrinologists and surgeons caring for patients with PHPT. A blueprint for future research is proposed to foster additional investigation into issues that remain uncertain or controversial.