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Eur J Endocrinol. 2019 Jun 1. pii: EJE-19-0316.R1. doi: 10.1530/EJE-19-0316. [Epub ahead of print]

MANAGEMENT OF ENDOCRINE DISEASE: Unmet therapeutic, educational and scientific needs in parathyroid disorders.

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J Bollerslev, Section of Specialized Endocrinology, Oslo University Hospital, Oslo, 0027, Norway.
C Schalin-Jantti, Division of Endocrinology, Department of Medicine, Helsinki University Hospital, Helsinki, FI-00290 , Finland.
L Rejnmark, Depatment of endocrinology and internal medicine, Aarhus Universitetshospital, Aarhus, Denmark.
H Siggelkow, Gastroenterology and Endocrinology, University of Goettingen, Göttingen, 37075, Germany.
H Morreau, Pathology, Leiden University Medical Center, Leiden, Netherlands.
R Thakker, Nuffield Department of Clinical Medicine, University of Oxford, Academic Endocrine Unit, Oxford, OX3 7LJ, United Kingdom of Great Britain and Northern Ireland.
A Sitges-Serra, Departament de Cirurgia, Hospital del Mar, Barcelona, 08018, Spain.
F Cetani, Endocrinology and Metabolism, University of Pisa, Pisa, 56124, Italy.
C Marcocci, Clinical and Experimental Medicine, University of Pisa, Pisa, 56124, Italy.


PARAT, a new European Society of Endocrinology program, aims to identify unmet scientific and educational needs of parathyroid disorders, such as primary hyperparathyroidism (PHPT), including parathyroid cancer (PC), and hypoparathyroidism (HypoPT). The discussions and consensus statements from the first PARAT workshop (September 2018) are reviewed. PHPT has a high prevalence in Western communities, PHPT has a high prevalence in Western communities, yet evidence is sparse concerning the natural history and whether morbidity and long-term outcomes are related to hypercalcemia or plasma PTH concentrations, or both. Cardiovascular mortality and prevalence of low energy fractures are increased, whereas Quality of Life is decreased, although their reversibility by treatment of PHPT has not been convincingly demonstrated. PC is a rare cause of PHPT, with an increasing incidence, and international collaborative studies are required to advance knowledge of the genetic mechanisms, biomarkers for disease activity, and optimal treatments. For example, ~20% of PCs demonstrate high mutational burden, and identifying targetable DNA variations, gene amplifications and gene fusions may facilitate personalized care, such as different forms of immunotherapy or targeted therapy. HypoPT, a designated orphan disease, is associated with a high risk of symptoms and complications. Most cases are secondary to neck surgery. However, there is a need to better understand the relation between disease biomarkers and intellectual function, and to establish the role of PTH in target tissues, as these may facilitate the appropriate use of PTH substitution therapy. Management of parathyroid disorders is challenging, and PARAT has highlighted the need for international transdisciplinary scientific and educational studies in advancing in this field.

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