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基于共识的甲状旁腺功能减退症诊断、治疗及监测建议:来自德语区国家(德国、奥地利、瑞士)的见解

Consensus-Based Recommendations for the Diagnosis, Treatment, and Monitoring of Hypoparathyroidism: Insights from the DACH Region.

作者信息

Tsourdi Elena, Amrein Karin, Meier Christian, Ketteler Markus, Kreissl Michael C, Mathew Annie, Vogelmann Tobias, Schubert Tino, Siggelkow Heide

机构信息

Department of Medicine III and Center for Healthy Aging, Technische Universität Dresden, Dresden, Germany.

Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

出版信息

Calcif Tissue Int. 2025 Aug 12;116(1):107. doi: 10.1007/s00223-025-01414-5.

Abstract

Hypoparathyroidism (HypoPT) is a rare endocrine disorder characterized by low parathyroid hormone (PTH) levels, hypocalcemia, hyperphosphatemia, reduced active vitamin D (1,25-OH2 vitamin D), and hypercalciuria. Due to its rarity, non-specialized physicians often lack experience managing HypoPT. To address this, expert consensus statements were developed for the DACH region (Germany, Austria, Switzerland), considering regional differences and high HypoPT incidence. These statements aim to enhance adherence to guideline recommendations and improve non-specialist knowledge. From December 2023 to April 2024, three rounds of a Delphi consensus survey were conducted with seven DACH-region clinical experts. Consensus was defined as agreement among at least 6 of 7 participants (85%). Experts agreed surgery accounts for 90% of chronic HypoPT cases. Common symptoms include paresthesia, muscle cramps, and fatigue. Albumin-adjusted serum calcium should be measured 12-24 h post-surgically, within 2 weeks, and every 3-6 months thereafter. Key treatment goals are maintaining albumin-adjusted serum calcium in the lower normal range, symptom control, and quality of life. Long-term objectives include avoiding hypo- and hypercalcemia phases and disease-related complications. Failure of calcium and active vitamin D therapy is defined by persistent symptoms, hospitalization, laboratory values outside of the normal range, or medication intolerance. Experts emphasized using HypoPT-specific, validated quality-of-life questionnaires. This consensus provides practical guidance for non-specialists in diagnosing, treating, and monitoring HypoPT, improving care in German-speaking regions.

摘要

甲状旁腺功能减退症(HypoPT)是一种罕见的内分泌疾病,其特征为甲状旁腺激素(PTH)水平低、低钙血症、高磷血症、活性维生素D(1,25 - 二羟维生素D)减少以及高钙尿症。由于其罕见性,非专科医生在管理HypoPT方面往往缺乏经验。为解决这一问题,针对德语区(德国、奥地利、瑞士)制定了专家共识声明,考虑到了地区差异和HypoPT的高发病率。这些声明旨在提高对指南建议的依从性并增进非专科医生的知识。2023年12月至2024年4月,对德语区的七位临床专家进行了三轮德尔菲共识调查。共识定义为7名参与者中至少6人达成一致(85%)。专家们一致认为手术导致了90%的慢性HypoPT病例。常见症状包括感觉异常、肌肉痉挛和疲劳。术后12 - 24小时、2周内以及此后每3 - 6个月应测量白蛋白校正后的血清钙。关键治疗目标是将白蛋白校正后的血清钙维持在正常范围下限、控制症状并提高生活质量。长期目标包括避免低钙血症和高钙血症阶段以及与疾病相关的并发症。钙和活性维生素D治疗失败的定义为持续存在症状、住院、实验室值超出正常范围或药物不耐受。专家们强调使用针对HypoPT的、经过验证的生活质量问卷。这一共识为非专科医生在诊断、治疗和监测HypoPT方面提供了实用指导,改善了德语区的医疗护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb8e/12343711/3b16ad63e3d1/223_2025_1414_Fig1_HTML.jpg

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