European Society of Endocrinology Updates Guideline on Chronic Hypoparathyroidism Management

The ESE guideline reframes chronic hypoparathyroidism and favors earlier consideration of parathyroid hormone (PTH) replacement for adults with persistent disease—prompted by links between delayed recognition, ongoing complications, and unstable calcium control.

Chronic hypoparathyroidism is now defined as lasting 12 months or longer after neck surgery, reflecting higher rates of parathyroid recovery between six and 12 months. This shifts the diagnostic label of “chronic” to the 12‑month mark and alters timing for classification and follow‑up.

Management emphasis moves from routine calcium plus active vitamin D monotherapy toward earlier consideration of PTH replacement for patients with persistent symptoms, frequent biochemical instability, hypercalciuria, or progressive renal risk. Selection should focus on symptom burden, inability to maintain stable calcium on conventional therapy without complications, and individual renal risk profiles.

The guideline includes a clear transition algorithm for initiating recombinant PTH. It outlines concrete steps: candidate identification → planned tapering or adjustment of supplements → scheduled biochemical and urinary calcium monitoring checkpoints during and after transition, with stepwise dose and monitoring adjustments to reduce conversion risk.

Adoption integrates the 12‑month threshold and positions PTH replacement centrally for selected patients while explicitly noting evidence gaps in long‑term outcomes, optimal monitoring intervals, and complication surveillance. Priority research should target long‑term effectiveness, standardized monitoring schedules, and registries to guide service‑level implementation.