欧洲内分泌学会临床指南：成人慢性甲状旁腺功能减退症的治疗。
European Society of Endocrinology Clinical Guideline: Treatment of chronic hypoparathyroidism in adults.
机构信息
Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark
Section of Specialized EndocrinologyClinic of Medicine, Oslo University Hospital, Oslo, NorwayFaculty of MedicineUniversity of Oslo, Oslo, NorwayDepartment of Endocrinology and Internal MedicineAarhus University Hospital, Aarhus, DenmarkDepartment of Clinical and Experimental MedicineUniversity of Pisa, Pisa, ItalyEndocrine Research UnitDepartment of Veterans Affairs, San Francisco VA Medical Center, University of California, San Francisco, California, USAEndocrine Surgery UnitHospital Universitari del Mar, Barcelona, SpainRenal DivisionGhent University Hospital, Ghent, BelgiumDivision of EndocrinologyDepartment of MedicineDepartment of Clinical EpidemiologyLeiden University Medical Center, Leiden, The NetherlandsDepartment of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark.
出版信息
Eur J Endocrinol. 2015 Aug;173(2):G1-20. doi: 10.1530/EJE-15-0628.
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.
甲状旁腺功能减退症（HypoPT）是一种罕见的（孤儿）内分泌疾病，其特征为血钙水平降低和循环甲状旁腺激素水平异常降低（不足），最常见于甲状腺手术后的成年人。标准治疗方法是使用活性维生素 D 类似物和钙补充剂，而不是替代缺乏的激素，这与其他激素缺乏状态不同。本指南的目的是为临床医生提供有关成人慢性 HypoPT 治疗和监测的指导，这些患者没有终末期肾病。我们打算制定一份实用的指南，重点关注在患者日常管理中被认为有用的可操作建议。本指南由欧洲内分泌学会制定和独家赞助，由 CBO（荷兰卫生保健改进研究所）支持，并基于推荐评估、制定和评估（GRADE）原则作为方法论基础。系统文献检索所依据的临床问题以及综合可用证据的问题是：慢性 HypoPT 成年患者的最佳治疗方法是什么？这项系统搜索发现了 1100 篇文章，根据标题和摘要将其减少到 312 篇。工作组更详细地评估了这些文章的合格性，并评估了 32 篇全文文章。对于最终建议，还考虑了其他文献。关于如何最好地治疗 HypoPT 的证据很少。关于生活质量和并发症风险的数据才刚刚开始出现，关于如何优化治疗的临床试验实际上是不存在的。大多数研究的样本量有限，难以得出确定的结论。没有研究涉及目标钙水平与临床相关终点之间的关系。因此，不可能基于严格的证据制定建议。因此，本指南主要基于在小型病例系列中报告的以及作者经验的临床实践中如何管理患者。
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