Advances in the Clinical Management of Parathyroid Disorders: Report from the 2024 Workshop by the ESE Educational Program on Parathyroid Disorders.

Abstract

The present report from the ESE Educational Program on Parathyroid Disorders (PARAT Program) presents recent developments and novelties in the clinical care of parathyroid disorders in a question-and-answer format, based on a satellite workshop held in relation to the European Congress of Endocrinology in Stockholm, May 2024. The workshop focused on clinical aspects of three main themes: primary hyperparathyroidism (PHPT), chronic hypoparathyroidism (HypoPT) in adults, and parathyroid disorders in pregnancy, with an emphasis on advances since the 2022 PARAT consensus report. The first section focuses on the long-term complications - including fractures, renal impairment, mental health, and quality of life - in patients with asymptomatic or mild forms of PHPT and on treatment strategies for syndromic PHPT (multiple endocrine neoplasia 1-4). In the latter, we explore appropriate surgical and non-surgical approaches, imaging techniques for gland localization, and preservation strategies in cases of multiglandular involvement. The second section addresses transient and partial forms of HypoPT in comparison to chronic and complete parathyroid hormone deficiency. It highlights the potential skeletal consequences of chronic HypoPT, the underlying etiologies, and discusses treatment modifications in light of the evolving therapeutic landscape. The final section, dedicated to the specific considerations of parathyroid disorders during pregnancy and lactation, focuses on pregnancy planning in patients with hereditary syndromic forms of PHPT, the differentiation between parathyroid-related and unrelated causes of hypercalcemia, and the associated risks for both mother and fetus. Additionally, it addresses the practical aspects of managing pregnant women with HypoPT, aiming to provide practical guidance for clinicians. Clinical vignettes featuring 3 cases illustrate common clinical situations.