Management of patients with hypoparathyroidism: a Delphi consensus analysis

PURPOSE: Chronic hypoparathyroidism is a rare endocrine disorder characterized by parathyroid hormone (PTH) deficiency and associated with substantial clinical and therapeutic challenges. Despite conventional therapy and the off-label use of teriparatide, important unmet needs persist regarding metabolic control, prevention of long-term complications, and health-related quality of life (HRQoL). Although recent international and national guidelines have updated recommendations on chronic hypoparathyroidism management, relevant uncertainties and heterogeneity remain in real-world practice, particularly concerning the identification of patients not adequately controlled with conventional therapy, the therapeutic positioning and timing of PTH replacement therapy, monitoring strategies, and the implementation of structured care pathways. This study aimed to assess the level of expert consensus on the current management of hypoparathyroidism in Italy and to identify key gaps and potential areas for therapeutic and organizational improvement. METHODS: A consensus survey was conducted using the Delphi method in two rounds. The Steering Committee defined 41 statements on the management of hypoparathyroidism, which were submitted to 20 expert clinicians via an online survey. Consensus was considered to have been reached with ≥ 70% of responses 4-5 (Likert scale 1-5). RESULTS: The completion rate was 100%. Consensus was reached for 39/41 statements (95.1%). Experts highlighted the limitations of conventional therapy and the off-label use of teriparatide, recognizing the impact of the disease on quality of life and the need for care pathways. The need for hormone replacement therapy was also emphasized, together with the importance of structured monitoring and multidisciplinary follow-up. CONCLUSION: Chronic hypoparathyroidism remains a clinically challenging condition with significant unmet needs. This Italian Delphi consensus complements recent international and national guidelines by providing expert-driven insights on real-world implementation, therapeutic positioning, monitoring, and care pathway development within the Italian healthcare context, supporting the need to introduce hormone replacement therapy and improve multidisciplinary management.