hypoparathyroidism AND management

2025 international guidelines management hypoparathyroidism calcium calcitriol PTH replacement

https://academic.oup.com/bjs/article/112/11/znaf247/8322132

anatomy diagram thyroid gland parathyroid glands location neck

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mkdir -p "/tmp/workspace/hypoparathyroidism-ppt/src" "/tmp/workspace/hypoparathyroidism-ppt/output" && python - <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE OUT='/tmp/workspace/hypoparathyroidism-ppt/output/Principles_of_Management_Hypoparathyroidism.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] NAVY=RGBColor(15,42,68); BLUE=RGBColor(25,104,156); TEAL=RGBColor(23,138,139); PALE=RGBColor(234,244,247); LIGHT=RGBColor(247,250,252); MID=RGBColor(91,111,126); DARK=RGBColor(32,45,55); WHITE=RGBColor(255,255,255); ORANGE=RGBColor(222,108,49); RED=RGBColor(185,61,61); GREEN=RGBColor(45,132,89); LINE=RGBColor(210,220,227) def rect(slide,x,y,w,h,color, radius=False, line=None): sh=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y), Inches(w),Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=color sh.line.color.rgb = color if line is None else line if radius: sh.adjustments[0]=0.08 return sh def text(slide,x,y,w,h,content,size=18,color=DARK,bold=False,align=PP_ALIGN.LEFT,font='Aptos',val=MSO_ANCHOR.TOP): tb=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True tf.margin_left=tf.margin_right=tf.margin_top=tf.margin_bottom=0; tf.vertical_anchor=val for i,line in enumerate(content.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align p.space_after=Pt(2) for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tb def title(slide, num, ttl, sub=''): rect(slide,0,0,13.333,0.38,NAVY) text(slide,0.62,0.55,11.6,0.48,ttl,28,NAVY,True) if sub:text(slide,0.64,1.05,11.5,0.28,sub,11,MID) text(slide,12.3,0.58,0.42,0.35,f'{num}/7',11,BLUE,True,PP_ALIGN.RIGHT) rect(slide,0.64,1.43,12.05,0.02,LINE) def footer(slide, cite): rect(slide,0.64,7.03,12.05,0.012,LINE) text(slide,0.66,7.10,11.65,0.2,cite,8,MID) text(slide,12.2,7.08,0.42,0.2,'Surgery',8,BLUE,True,PP_ALIGN.RIGHT) def card(slide,x,y,w,h,head,body,accent=TEAL,fs=15): rect(slide,x,y,w,h,WHITE,True,LINE) rect(slide,x,y,0.10,h,accent,True) text(slide,x+0.28,y+0.24,w-0.45,0.3,head,15,accent,True) text(slide,x+0.28,y+0.70,w-0.45,h-0.85,body,fs,DARK) def bullet(slide,x,y,w,label,desc,accent=TEAL): rect(slide,x,y,0.22,0.22,accent,True) text(slide,x+0.34,y-0.01,w-0.34,0.24,label,15,DARK,True) text(slide,x+0.34,y+0.30,w-0.34,0.44,desc,12,MID) # 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,0,13.333,0.20,TEAL) text(s,0.82,1.20,10.8,0.55,'Principles of Management',32,WHITE,True) text(s,0.82,1.86,10.8,0.55,'Hypoparathyroidism',34,RGBColor(138,220,217),True) text(s,0.84,2.68,8.6,0.55,'A practical surgical presentation: recognition, rescue, replacement, and surveillance',17,WHITE) # visual flow for x, lab, col in [(0.84,'Low PTH',TEAL),(3.35,'Low Ca²⁺',ORANGE),(5.86,'Symptoms',RED),(8.37,'Safe long-term control',GREEN)]: rect(s,x,4.25,2.06,0.7,col,True); text(s,x+0.08,4.46,1.9,0.25,lab,14,WHITE,True,PP_ALIGN.CENTER) for x in [2.93,5.44,7.95]: text(s,x,4.46,0.3,0.22,'→',18,WHITE,True,PP_ALIGN.CENTER) text(s,0.84,6.63,11.4,0.26,'For educational use. Acute symptomatic hypocalcaemia requires monitored urgent treatment.',10,RGBColor(198,215,225)) footer(s,'Core sources: Second International Workshop guidelines (2022); Fischer’s Mastery of Surgery, 8e, pp. 1143-44.') # 2 s=prs.slides.add_slide(blank); title(s,2,'1. Establish the diagnosis and urgency','Think low calcium + inappropriately low PTH, often after neck surgery') card(s,0.72,1.83,3.85,4.65,'Biochemical pattern','• Low albumin-adjusted or ionised calcium\n• Low or inappropriately normal intact PTH\n• Phosphate typically high\n• Check magnesium, creatinine/eGFR, 25-OH vitamin D, ECG\n\nPost-thyroidectomy is the common surgical setting.',TEAL,15) card(s,4.76,1.83,3.85,4.65,'Clinical severity','Mild\n• Perioral/acral paresthesia\n• Cramps, fatigue\n\nSevere / emergency\n• Tetany, seizure, laryngospasm\n• Arrhythmia or prolonged QT\n• Altered mental state',ORANGE,15) card(s,8.80,1.83,3.85,4.65,'Immediate principles','1. Stabilise ABCs and obtain ECG\n2. Measure ionised Ca if available\n3. Correct hypomagnesaemia\n4. Distinguish transient post-operative disease from chronic disease\n5. Identify reversible contributors',BLUE,15) footer(s,'Sources: Lippincott Illustrated Reviews: Biochemistry, 8e, p. 2237; Katzung, 16e, p. 620; 2022 International Workshop.') #3 s=prs.slides.add_slide(blank); title(s,3,'2. Treat acute symptomatic hypocalcaemia','Do not wait for complete work-up when there is tetany, seizure, laryngospasm, or ECG instability') card(s,0.72,1.82,4.0,4.75,'Resuscitation','• ABCs, cardiac monitoring, IV access\n• Give IV calcium gluconate slowly in a monitored setting for severe symptoms\n• Repeat / continuous infusion if symptoms recur, guided by ionised calcium\n• Treat seizures and secure airway if needed\n• Correct magnesium deficiency concurrently',RED,15) card(s,4.95,1.82,3.45,4.75,'Bridge to maintenance','Once stabilised:\n\n• Start oral elemental calcium\n• Add activated vitamin D (calcitriol or analogue)\n• Titrate using symptoms and serum calcium\n• Reduce IV calcium only after reliable oral therapy',ORANGE,15) card(s,8.62,1.82,4.02,4.75,'Avoid harm','• Extravasation risk: use secure IV access\n• Avoid over-correction and hypercalcaemia\n• Check renal function and phosphate\n• Reassess ECG, calcium, magnesium frequently\n\nDose and infusion rate must follow local protocol and patient factors.',TEAL,15) footer(s,'Sources: Harrison’s Principles of Internal Medicine, 22e, pp. 1236-41; Schwartz’s Principles of Surgery, 11e, p. 1707.') #4 s=prs.slides.add_slide(blank); title(s,4,'3. Conventional chronic therapy','Goal: relieve symptoms while keeping serum calcium in the low-normal or just-below-normal range') card(s,0.72,1.82,3.85,4.65,'Oral calcium','• Elemental calcium in divided doses\n• Take with meals if also controlling phosphate\n• Adjust for dietary intake, GI tolerance, and urinary calcium\n\nAvoid chasing a high-normal calcium concentration.',TEAL,15) card(s,4.76,1.82,3.85,4.65,'Activated vitamin D','• Calcitriol or active analogue is needed because PTH-dependent renal activation is impaired\n• Titrate gradually with calcium\n• Replete native vitamin D if deficient\n\nBalance benefit against hypercalciuria and hypercalcaemia.',ORANGE,15) card(s,8.80,1.82,3.85,4.65,'Adjuncts and diet','• Maintain magnesium in normal range\n• Dietary phosphate moderation if hyperphosphataemic\n• Thiazide plus low-sodium diet may reduce hypercalciuria\n• Individualise for CKD, malabsorption, pregnancy, or children',BLUE,15) footer(s,'Sources: 2022 International Workshop guideline; Katzung, 16e, p. 620; Lippincott Biochemistry, 8e, p. 2237.') #5 s=prs.slides.add_slide(blank); title(s,5,'4. Monitor for treatment-related complications','The therapeutic challenge is not simply correcting calcium: it is avoiding renal and mineral complications') # timeline text(s,0.80,1.75,2.1,0.25,'At baseline / titration',15,TEAL,True); text(s,4.15,1.75,2.1,0.25,'Stable treatment',15,BLUE,True); text(s,8.25,1.75,2.1,0.25,'If control is difficult',15,ORANGE,True) for x,c in [(0.78,TEAL),(4.12,BLUE),(8.22,ORANGE)]: rect(s,x,2.13,3.05,3.75,WHITE,True,LINE); rect(s,x,2.13,3.05,0.12,c,True) text(s,1.05,2.50,2.55,2.8,'• Serum calcium (ionised or adjusted)\n• Phosphate\n• Magnesium\n• Creatinine/eGFR\n• 25-OH vitamin D\n• 24-hour urine calcium\n• Renal imaging if indicated',14,DARK) text(s,4.40,2.50,2.55,2.8,'• Calcium, phosphate, magnesium, renal function at planned intervals\n• Review symptoms and adherence\n• 24-hour urine calcium periodically\n• Adjust after any dose change',14,DARK) text(s,8.50,2.50,2.55,2.8,'• Assess hypercalciuria, nephrolithiasis/nephrocalcinosis\n• Review calcium-phosphate product and renal decline\n• Consider PTH replacement referral',14,DARK) text(s,0.83,6.26,11.8,0.3,'Target biochemical control should be individualised. Persistent hypercalciuria or renal compromise warrants specialist review.',13,RED,True) footer(s,'Source: Evaluation and Management of Hypoparathyroidism, Second International Workshop, J Bone Miner Res. 2022;37:2568-2585.') #6 s=prs.slides.add_slide(blank); title(s,6,'5. When to consider PTH replacement therapy','Refer to endocrinology when conventional therapy is unsatisfactory or poorly tolerated') card(s,0.72,1.85,5.78,4.55,'Consider referral when any of the following persist despite optimised conventional therapy','• Symptomatic hypocalcaemia or poor quality of life\n• Hypercalciuria, renal stones/nephrocalcinosis, or declining renal function\n• Hyperphosphataemia or high calcium-phosphate burden\n• Requirement for high doses of calcium and active vitamin D\n• Malabsorption or inability to tolerate oral therapy',ORANGE,15) card(s,6.77,1.85,5.88,4.55,'What PTH replacement aims to do','• Replace the missing hormone physiology rather than solely supplementing calcium\n• May reduce reliance on calcium and activated vitamin D\n• Requires specialist selection, titration, and biochemical monitoring\n\nAvailability, approved products, and local pathways vary by country and over time.',TEAL,15) text(s,0.82,6.60,11.5,0.23,'Not a substitute for urgent IV calcium in acute symptomatic hypocalcaemia.',13,RED,True,PP_ALIGN.CENTER) footer(s,'Sources: 2022 International Workshop; Cardoso et al., Eur J Endocrinol. 2025;193:R65-R75. Review local regulatory status.') #7 s=prs.slides.add_slide(blank); title(s,7,'Surgical take-home algorithm','Prevent, detect early, treat promptly, and ensure safe follow-up after neck surgery') steps=[('1','Preserve','Identify and protect parathyroid vascular supply; if a gland is clearly nonviable or removed, confirm tissue and consider autotransplantation.'),('2','Screen','Educate patients about paresthesia/cramps. Check postoperative calcium as indicated and arrange early follow-up.'),('3','Rescue','Severe symptoms or ECG change: monitored IV calcium, correct magnesium, then establish oral calcium plus active vitamin D.'),('4','Sustain','Aim low-normal calcium, avoid hypercalciuria, and coordinate long-term endocrine surveillance.')] for i,(n,h,b) in enumerate(steps): y=1.73+i*1.19; rect(s,0.78,y,0.60,0.60,[TEAL,BLUE,ORANGE,GREEN][i],True); text(s,0.78,y+0.16,0.60,0.25,n,17,WHITE,True,PP_ALIGN.CENTER) text(s,1.62,y+0.01,1.25,0.25,h,16,NAVY,True); text(s,2.85,y+0.01,9.6,0.57,b,13,DARK) rect(s,0.78,6.55,11.85,0.30,PALE,True); text(s,0.96,6.60,11.45,0.17,'Key message: Treat the patient and the complications of treatment, not the calcium number alone.',12,NAVY,True,PP_ALIGN.CENTER) footer(s,'Sources: Fischer’s Mastery of Surgery, 8e, pp. 1076-77, 1143-44; Second International Workshop (2022).') prs.save(OUT) print(OUT) PY python - <<'PY' from pptx import Presentation p='/tmp/workspace/hypoparathyroidism-ppt/output/Principles_of_Management_Hypoparathyroidism.pptx' prs=Presentation(p) print('slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): texts=[sh.text for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] print(i, ' | '.join(texts[:3])) PY