Revised European Society of Endocrinology Clinical Practice Guideline: Treatment of Chronic Hypoparathyroidism in Adults

In the present European Society of Endocrinology (ESE) clinical guideline, we present recommendations for the diagnosis, management, and monitoring of chronic hypoparathyroidism (HypoPT) in adults. Management of HypoPT has changed since the first ESE clinical guideline was published in 2015, as has the knowledge on patient burden of the disease, and the understanding of associated morbidities. In line with the ESE policy, the 2015 guidelines were updated based on up-to-date scientific evidence. As HypoPT is an orphan disease, strong evidence for most outcomes is scarce and recommendations were based on careful synthesis of the literature and expert opinion. Postsurgical HypoPT should be defined as persisting more than 12 months following surgery; recovery could be expected even thereafter (clinical question I [Q I]). For Q II (optimal treatment of chronic HypoPT), relevant data regarding conventional treatment are lacking for clinically relevant endpoints and long-term effects. PTH replacement therapy reduces the pill burden of conventional therapy, improves various biochemical parameters, and potentially improves QoL. We cannot recommend a substantial role for parathyroid allotransplantation in the treatment of chronic HypoPT (Q III). In conclusion, we present recommendations for the diagnosis, management, and monitoring of chronic HypoPT in adults, to give health care providers practical clinical guidance on the management of this condition. The guideline can serve as a source for preparation of educational materials to empower patients and clinicians.