title: Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop.
abstract: OBJECTIVE
  Asymptomatic primary hyperparathyroidism (PHPT) is routinely encountered in clinical practices of endocrinology throughout the world. This report distills an update of current information about diagnostics, clinical features, and management of this disease into a set of revised guidelines.
  
  
  METHODS
  Participants, representing an international constituency, with interest and expertise in various facets of asymptomatic PHPT constituted four Workshop Panels that developed key questions to be addressed. They then convened in an open 3-day conference September 19-21, 2013, in Florence, Italy, when a series of presentations and discussions addressed these questions. A smaller subcommittee, the Expert Panel, then met in closed session to reach an evidence-based consensus on how to address the questions and data that were aired in the open forum.
  
  
  METHODS
  Preceding the conference, each question was addressed by a relevant, extensive literature search. All presentations and deliberations of the Workshop Panels and the Expert Panel were based upon the latest information gleaned from this literature search.
  
  
  METHODS
  The expert panel considered all the evidence provided by the individual Workshop Panels and then came to consensus.
  
  
  CONCLUSIONS
  In view of new findings since the last International Workshop on the Management of Asymptomatic PHPT, guidelines for management have been revised. The revised guidelines include: 1) recommendations for more extensive evaluation of the skeletal and renal systems; 2) skeletal and/or renal involvement as determined by further evaluation to become part of the guidelines for surgery; and 3) more specific guidelines for monitoring those who do not meet guidelines for parathyroid surgery. These guidelines should help endocrinologists and surgeons caring for patients with PHPT. A blueprint for future research is proposed to foster additional investigation into issues that remain uncertain or controversial.
authors.affiliation: Columbia University College of Physicians & Surgeons (J.P.B., S.J.S.), New York, New York 10032; University of Florence (M.L.B.), 50121 Florence, Italy; University of Sheffield (R.E.), Sheffield S5 7AU, United Kingdom; Yale University School of Medicine (R.U.), New Haven, Connecticut 06510; University of Pisa (C.M.), 56124 Pisa Italy; and Massachusetts General Hospital (J.T.P.), Boston, Massachusetts 02114.
authors.forename: John P
authors.initials: JP
authors.lastname: Bilezikian
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Brandi
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.forename: Shonni J
authors.initials: SJ
authors.lastname: Silverberg
authors.forename: Robert
authors.initials: R
authors.lastname: Udelsman
authors.forename: Claudio
authors.initials: C
authors.lastname: Marcocci
authors.forename: John T
authors.initials: JT
authors.lastname: Potts
mesh_terms: D058070:Asymptomatic Diseases / Q000628:therapy*; D004493:Education; D004704:Endocrinology / Q000592:standards*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000628:therapy*; D017410:Practice Guidelines as Topic