types of hyperparathyroidism primary secondary tertiary surgery MBBS overview

hyperparathyroidism parathyroid gland anatomy diagram image primary secondary tertiary

osteitis fibrosa cystica brown tumor nephrolithiasis hyperparathyroidism bone changes image

node /home/daytona/skills/shared/scripts/fetch_images.js \ "https://www.hyperp…

node /home/daytona/skills/shared/scripts/fetch_images.js \ "https://pubs.rsna.…

mkdir -p /home/daytona/workspace/hyperparathyroidism-ppt

~/hyperparathyroidism-ppt/build.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── Fetch images ───────────────────────────────────────────────────────────
const imgUrls = [
  "https://www.hyperparathyroidmd.com/wp-content/uploads/2021/06/Parathyroid-Gland-Functuion-Figure-1.jpg", // 0 parathyroid anatomy/function
  "https://upload.wikimedia.org/wikipedia/commons/4/45/3D_Medical_Animation_still_shot_Hyperparathyroidism.jpg", // 1 3D hyperparathyroidism
  "https://upload.wikimedia.org/wikipedia/commons/e/e5/Osteitis_fibrosa_cystica_tibiae_X-ray.jpg", // 2 OFC xray
  "https://figures.semanticscholar.org/65a65c939a61ba7379abff1c3dc75a37415ce627/2-Table1-1.png", // 3 comparison table
  "https://media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs12020-017-1414-2/MediaObjects/12020_2017_1414_Fig4_HTML.gif", // 4 brown tumor
  "https://media.springernature.com/lw685/springer-static/image/art%3A10.1007%2Fs12020-017-1414-2/MediaObjects/12020_2017_1414_Fig8_HTML.gif", // 5 renal changes
];

const imgData = JSON.parse(
  execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imgUrls.map(u => `"${u}"`).join(" ")}`
  ).toString()
);

function img(idx) {
  const d = imgData[idx];
  if (d.error) return null;
  return d.base64;
}

// ─── Presentation setup ─────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Types of Hyperparathyroidism";
pres.author = "4th Year MBBS – Surgery Presentation";

// Colour palette
const DARK_BG   = "0D2340";  // deep navy
const ACCENT    = "1E88E5";  // vivid blue
const ACCENT2   = "29B6F6";  // lighter blue
const GOLD      = "FFB300";  // amber accent
const WHITE     = "FFFFFF";
const LIGHTGRAY = "ECF3FA";
const DARK_TEXT = "1A2D45";
const TEAL      = "00ACC1";
const GREEN     = "43A047";
const ORANGE    = "EF6C00";

// ─── Helper functions ────────────────────────────────────────────────────────
function addSlideTitle(slide, text, sub) {
  // top accent bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.1, fill: { color: ACCENT } });
  // title bg strip
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0.1, w: 10, h: 0.75, fill: { color: DARK_BG } });
  slide.addText(text, {
    x: 0.3, y: 0.1, w: 9.4, h: 0.75,
    fontSize: 22, bold: true, color: WHITE, valign: "middle", margin: 0
  });
  if (sub) {
    slide.addText(sub, {
      x: 0.3, y: 0.88, w: 9.4, h: 0.28,
      fontSize: 11, color: ACCENT, italic: true, margin: 0
    });
  }
}

function addBullets(slide, items, opts) {
  const base = { fontSize: 13, color: DARK_TEXT, bullet: { indent: 20 }, paraSpaceAfter: 4 };
  slide.addText(
    items.map((item, i) => ({
      text: item,
      options: { ...base, ...(typeof item === "object" ? item.options : {}), bullet: true, breakLine: i < items.length - 1 }
    })),
    { ...opts }
  );
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: DARK_BG };

  // decorative arcs
  sl.addShape(pres.ShapeType.ellipse, { x: 7.5, y: -1.5, w: 5, h: 5, fill: { color: ACCENT, transparency: 80 }, line: { type: "none" } });
  sl.addShape(pres.ShapeType.ellipse, { x: -1, y: 3,    w: 4, h: 4, fill: { color: ACCENT2, transparency: 85 }, line: { type: "none" } });

  // top line
  sl.addShape(pres.ShapeType.rect, { x: 1, y: 1.6, w: 0.08, h: 2.2, fill: { color: GOLD }, line: { type: "none" } });

  sl.addText("TYPES OF", { x: 1.3, y: 1.6, w: 8, h: 0.5, fontSize: 16, color: ACCENT2, bold: false, charSpacing: 6, margin: 0 });
  sl.addText("HYPERPARATHYROIDISM", { x: 1.3, y: 2.05, w: 8, h: 0.9, fontSize: 36, bold: true, color: WHITE, margin: 0 });
  sl.addText("Primary  |  Secondary  |  Tertiary", { x: 1.3, y: 2.95, w: 8, h: 0.4, fontSize: 16, color: GOLD, margin: 0 });
  sl.addShape(pres.ShapeType.rect, { x: 1.3, y: 3.45, w: 4, h: 0.04, fill: { color: ACCENT }, line: { type: "none" } });

  sl.addText("Surgery Class Presentation  |  4th Year MBBS", { x: 1.3, y: 3.6, w: 7, h: 0.3, fontSize: 11, color: ACCENT2, italic: true, margin: 0 });

  if (img(1)) {
    sl.addImage({ data: img(1), x: 6.6, y: 1.2, w: 3.1, h: 3.8, rounding: true });
  }
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW: What is Hyperparathyroidism?
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: LIGHTGRAY };
  addSlideTitle(sl, "What is Hyperparathyroidism?", "Parathyroid gland physiology overview");

  // image left
  if (img(0)) {
    sl.addImage({ data: img(0), x: 0.25, y: 1.2, w: 4.0, h: 3.9 });
  }

  // content right
  const bullets = [
    "4 tiny parathyroid glands sit behind the thyroid",
    "Secrete PTH (Parathyroid Hormone) — 84 amino acid polypeptide",
    "PTH normally raises serum Ca²⁺ and lowers phosphate",
    "Hyperparathyroidism = excess PTH secretion",
    "Subdivided into Primary, Secondary, and Tertiary types",
  ];
  addBullets(sl, bullets, { x: 4.5, y: 1.25, w: 5.2, h: 4.0 });

  // PTH actions box
  sl.addShape(pres.ShapeType.rect, { x: 4.5, y: 3.9, w: 5.2, h: 1.35, fill: { color: ACCENT, transparency: 85 }, line: { color: ACCENT, w: 1 } });
  sl.addText("PTH Actions", { x: 4.55, y: 3.92, w: 5.1, h: 0.28, fontSize: 11, bold: true, color: DARK_BG, margin: 0 });
  sl.addText([
    { text: "Bone: ", options: { bold: true } }, { text: "↑ osteoclast activity → Ca²⁺ release   " },
    { text: "Kidney: ", options: { bold: true } }, { text: "↑ Ca²⁺ reabsorption, ↑ 1,25(OH)₂D synthesis   " },
    { text: "Gut: ", options: { bold: true } }, { text: "↑ Ca²⁺ absorption via calcitriol" },
  ], { x: 4.55, y: 4.22, w: 5.1, h: 1.0, fontSize: 11, color: DARK_TEXT, margin: 0 });

  // bottom accent
  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: ACCENT }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – PRIMARY HYPERPARATHYROIDISM
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addSlideTitle(sl, "Primary Hyperparathyroidism", "Autonomous PTH over-secretion by the gland itself");

  // colored label
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.15, w: 1.8, h: 0.35, fill: { color: ACCENT }, line: { type: "none" } });
  sl.addText("PRIMARY HPT", { x: 0.25, y: 1.15, w: 1.8, h: 0.35, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });

  const col1 = [
    { text: "Aetiology", options: { bold: true, color: ACCENT, fontSize: 13 } },
    { text: "Adenoma (85%)  •  4-gland hyperplasia (14%)  •  Carcinoma (<1%)", options: { fontSize: 12, color: DARK_TEXT } },
    { text: "\nPathophysiology", options: { bold: true, color: ACCENT, fontSize: 13 } },
    { text: "Autonomous PTH secretion → hypercalcemia\nNegative feedback to Ca²⁺ is lost", options: { fontSize: 12, color: DARK_TEXT } },
    { text: "\nLabs", options: { bold: true, color: ACCENT, fontSize: 13 } },
    { text: "↑ PTH  |  ↑ Serum Ca²⁺  |  ↓ Phosphate\n↑ urinary Ca²⁺  |  ↑ Alk Phos (if bone involved)", options: { fontSize: 12, color: DARK_TEXT } },
    { text: "\nAssociations", options: { bold: true, color: ACCENT, fontSize: 13 } },
    { text: "MEN-1 (parathyroid + pituitary + pancreas)\nMEN-2A (parathyroid + MTC + phaeochromocytoma)", options: { fontSize: 12, color: DARK_TEXT } },
  ];

  sl.addText(col1, { x: 0.25, y: 1.6, w: 4.8, h: 4.0, margin: 4 });

  // right panel with clinical features
  sl.addShape(pres.ShapeType.rect, { x: 5.25, y: 1.15, w: 4.5, h: 4.45, fill: { color: "EBF5FF" }, line: { color: ACCENT, w: 1 } });
  sl.addText("Clinical Features – \"Bones, Stones, Groans, Psychic Moans\"", {
    x: 5.35, y: 1.2, w: 4.3, h: 0.45, fontSize: 11, bold: true, color: DARK_BG, margin: 0
  });

  const features = [
    "🦴 Bones: bone pain, pathological fractures, osteitis fibrosa cystica",
    "🪨 Stones: renal calculi (nephrolithiasis), nephrocalcinosis",
    "😣 Groans: N&V, constipation, peptic ulcer, pancreatitis",
    "🧠 Psychic: depression, confusion, fatigue, cognitive impairment",
    "Most cases now ASYMPTOMATIC — found on routine bloods",
  ];
  addBullets(sl, features, { x: 5.35, y: 1.65, w: 4.3, h: 3.8, fontSize: 11 });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: ACCENT }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – BONE CHANGES (with X-ray image)
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: LIGHTGRAY };
  addSlideTitle(sl, "Bone Changes in Primary HPT", "Osteitis Fibrosa Cystica – Skeletal Manifestations");

  if (img(2)) {
    sl.addImage({ data: img(2), x: 5.8, y: 1.2, w: 3.9, h: 4.1 });
    sl.addText("X-ray: OFC – subperiosteal resorption of tibiae", {
      x: 5.8, y: 5.3, w: 3.9, h: 0.25, fontSize: 9, color: DARK_TEXT, italic: true, align: "center", margin: 0
    });
  }

  const boneBullets = [
    "↑ PTH → ↑ RANKL on osteoblasts → ↑ osteoclast activation",
    "Subperiosteal resorption (classic on radial side of middle phalanx)",
    "Generalized osteoporosis: phalanges, vertebrae, proximal femur",
    "Dissecting osteitis – 'railroad track' appearance on histology",
    "Brown Tumors: reactive fibrovascular masses from microfractures + hemorrhage (hemosiderin = brown color)",
    "Cystic degeneration of brown tumors → OSTEITIS FIBROSA CYSTICA",
    "'Salt and pepper skull' – granular skull X-ray",
  ];
  addBullets(sl, boneBullets, { x: 0.25, y: 1.25, w: 5.3, h: 4.3, fontSize: 12 });

  // brown tumor callout
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 5.1, w: 5.2, h: 0.45, fill: { color: ORANGE, transparency: 80 }, line: { color: ORANGE, w: 1 } });
  sl.addText("Brown Tumors ≠ true neoplasms; resolve after parathyroidectomy", {
    x: 0.3, y: 5.1, w: 5.1, h: 0.45, fontSize: 11, bold: true, color: ORANGE, valign: "middle", margin: 0
  });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: ACCENT }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – SECONDARY HYPERPARATHYROIDISM
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addSlideTitle(sl, "Secondary Hyperparathyroidism", "Compensatory PTH rise due to chronic hypocalcemia");

  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.15, w: 2.1, h: 0.35, fill: { color: TEAL }, line: { type: "none" } });
  sl.addText("SECONDARY HPT", { x: 0.25, y: 1.15, w: 2.1, h: 0.35, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });

  // flow diagram
  const boxStyle = { fill: { color: "E3F2FD" }, line: { color: TEAL, w: 1.5 } };
  const arrowOpts = { color: TEAL, bold: true, align: "center", fontSize: 20 };

  const steps = [
    { text: "Chronic Renal Failure\n(CKD → ↓ 1,25(OH)₂D, hyperphosphatemia)", x: 0.3, y: 1.65, w: 3.5, h: 0.75 },
    { text: "Persistent Hypocalcemia", x: 0.3, y: 2.8, w: 3.5, h: 0.55 },
    { text: "Parathyroid Gland HYPERPLASIA\n(all 4 glands)", x: 0.3, y: 3.7, w: 3.5, h: 0.7 },
    { text: "↑ PTH (REACTIVE / compensatory)\nSerum Ca²⁺ low-normal", x: 0.3, y: 4.7, w: 3.5, h: 0.7 },
  ];

  steps.forEach(s => {
    sl.addShape(pres.ShapeType.rect, { x: s.x, y: s.y, w: s.w, h: s.h, ...boxStyle });
    sl.addText(s.text, { x: s.x + 0.05, y: s.y, w: s.w - 0.1, h: s.h, fontSize: 11, color: DARK_TEXT, valign: "middle", align: "center", margin: 3 });
  });

  // arrows
  [2.42, 3.37, 4.42].forEach(y => {
    sl.addText("↓", { x: 0.3, y, w: 3.5, h: 0.38, ...arrowOpts });
  });

  // right panel – causes
  sl.addShape(pres.ShapeType.rect, { x: 4.1, y: 1.15, w: 5.6, h: 4.45, fill: { color: "E0F7FA" }, line: { color: TEAL, w: 1 } });
  sl.addText("Common Causes", { x: 4.2, y: 1.2, w: 5.4, h: 0.35, fontSize: 13, bold: true, color: TEAL, margin: 0 });

  const causes = [
    "CKD / End-stage renal disease (most common)",
    "Vitamin D deficiency / malabsorption",
    "Osteomalacia / Rickets",
    "Malabsorption syndromes (Crohn's, coeliac)",
    "Hypomagnesemia",
  ];
  addBullets(sl, causes, { x: 4.2, y: 1.6, w: 5.3, h: 1.8, fontSize: 12 });

  sl.addText("Key Distinguishing Features", { x: 4.2, y: 3.5, w: 5.4, h: 0.35, fontSize: 13, bold: true, color: TEAL, margin: 0 });
  sl.addText([
    { text: "PTH: ", options: { bold: true } }, { text: "↑↑   " },
    { text: "Ca²⁺: ", options: { bold: true } }, { text: "Normal or ↓   " },
    { text: "PO₄: ", options: { bold: true } }, { text: "↑ (renal failure)" },
  ], { x: 4.2, y: 3.87, w: 5.3, h: 0.5, fontSize: 12, color: DARK_TEXT, margin: 0 });

  sl.addShape(pres.ShapeType.rect, { x: 4.2, y: 4.45, w: 5.3, h: 0.5, fill: { color: TEAL, transparency: 85 }, line: { color: TEAL, w: 1 } });
  sl.addText("Renal Osteodystrophy: osteomalacia + subperiosteal resorption + OFC", {
    x: 4.2, y: 4.45, w: 5.3, h: 0.5, fontSize: 11, color: DARK_TEXT, valign: "middle", margin: 4
  });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: TEAL }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – TERTIARY HYPERPARATHYROIDISM
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: LIGHTGRAY };
  addSlideTitle(sl, "Tertiary Hyperparathyroidism", "Autonomous PTH secretion after prolonged secondary HPT");

  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.15, w: 2.0, h: 0.35, fill: { color: ORANGE }, line: { type: "none" } });
  sl.addText("TERTIARY HPT", { x: 0.25, y: 1.15, w: 2.0, h: 0.35, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });

  // evolution diagram
  sl.addText("Evolution: Secondary → Tertiary HPT", { x: 0.25, y: 1.6, w: 9.5, h: 0.3, fontSize: 13, bold: true, color: DARK_BG, margin: 0 });

  const evo = [
    { label: "Secondary HPT\n(prolonged)", color: TEAL, x: 0.3 },
    { label: "Persistent\nstimulation", color: "888888", x: 2.5 },
    { label: "Autonomous\nadenoma forms", color: ORANGE, x: 4.7 },
    { label: "Tertiary HPT\n(autonomous)", color: "C62828", x: 6.9 },
  ];
  evo.forEach((e, i) => {
    sl.addShape(pres.ShapeType.rect, { x: e.x, y: 2.0, w: 2.0, h: 0.7, fill: { color: e.color }, line: { type: "none" } });
    sl.addText(e.label, { x: e.x, y: 2.0, w: 2.0, h: 0.7, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
    if (i < 3) sl.addText("→", { x: e.x + 1.98, y: 2.0, w: 0.52, h: 0.7, fontSize: 20, bold: true, color: DARK_BG, align: "center", valign: "middle", margin: 0 });
  });

  const col1 = [
    { text: "Pathophysiology", options: { bold: true, color: ORANGE, fontSize: 13 } },
    { text: "Prolonged stimulation of parathyroid glands (in secondary HPT) leads to monoclonal expansion and autonomous PTH secretion, even after correction of the underlying cause (e.g. renal transplant).", options: { fontSize: 12, color: DARK_TEXT } },
    { text: "\nTrigger / Context", options: { bold: true, color: ORANGE, fontSize: 13 } },
    { text: "Seen in long-standing CKD or post-renal transplant patients\nGland becomes independent of Ca²⁺ feedback", options: { fontSize: 12, color: DARK_TEXT } },
    { text: "\nLabs", options: { bold: true, color: ORANGE, fontSize: 13 } },
    { text: "↑↑ PTH   |   ↑ Ca²⁺ (hypercalcemia – like primary)\nLooks like primary HPT in a renal failure patient", options: { fontSize: 12, color: DARK_TEXT } },
  ];
  sl.addText(col1, { x: 0.25, y: 2.85, w: 4.8, h: 2.7, margin: 4 });

  // right box
  sl.addShape(pres.ShapeType.rect, { x: 5.2, y: 2.85, w: 4.5, h: 2.7, fill: { color: "FFF3E0" }, line: { color: ORANGE, w: 1 } });
  sl.addText("Treatment Insight", { x: 5.3, y: 2.9, w: 4.3, h: 0.35, fontSize: 13, bold: true, color: ORANGE, margin: 0 });
  const txBullets = [
    "Subtotal parathyroidectomy (3.5 glands removed)",
    "Total parathyroidectomy + autotransplant",
    "Occurs even after successful renal transplant",
    "Distinguish from primary HPT by history of CKD/dialysis",
  ];
  addBullets(sl, txBullets, { x: 5.3, y: 3.3, w: 4.3, h: 2.15, fontSize: 12 });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: ORANGE }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – COMPARISON TABLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addSlideTitle(sl, "Comparison at a Glance", "Primary  vs  Secondary  vs  Tertiary");

  const rows = [
    [
      { text: "Feature",        options: { bold: true, color: WHITE, fill: { color: DARK_BG } } },
      { text: "Primary",        options: { bold: true, color: WHITE, fill: { color: ACCENT  } } },
      { text: "Secondary",      options: { bold: true, color: WHITE, fill: { color: TEAL    } } },
      { text: "Tertiary",       options: { bold: true, color: WHITE, fill: { color: ORANGE  } } },
    ],
    ["Cause",               "Adenoma / Hyperplasia / Ca",      "CKD / Vit D def",          "Prolonged 2° HPT"],
    ["Feedback",            "Autonomous (lost feedback)",      "Reactive (appropriate)",   "Autonomous (like 1°)"],
    ["PTH",                 "↑",                               "↑↑",                       "↑↑"],
    ["Serum Ca²⁺",         "↑ (hypercalcemia)",               "Low / Normal",             "↑ (hypercalcemia)"],
    ["Phosphate",           "↓",                               "↑ (renal failure)",        "Variable"],
    ["Glands",              "Single adenoma (usually)",        "All 4 hyperplastic",       "1–2 autonomous glands"],
    ["Treatment",           "Parathyroidectomy (single gland)","Treat underlying cause\n± cinacalcet", "Subtotal PTX or total + autograft"],
  ];

  const colW = [2.1, 2.4, 2.4, 2.6];
  const colX = [0.25, 2.35, 4.75, 7.15];

  rows.forEach((row, r) => {
    row.forEach((cell, c) => {
      const isHeader = r === 0;
      const isFeatureCol = c === 0 && r > 0;
      const cellText = typeof cell === "object" ? cell.text : cell;
      const cellBg = isHeader
        ? (typeof cell === "object" ? cell.options.fill.color : DARK_BG)
        : isFeatureCol ? "F0F4F8" : (r % 2 === 0 ? WHITE : "F7FAFF");

      sl.addShape(pres.ShapeType.rect, {
        x: colX[c], y: 1.25 + r * 0.53, w: colW[c], h: 0.53,
        fill: { color: cellBg }, line: { color: "D0D8E4", w: 0.5 }
      });
      sl.addText(cellText, {
        x: colX[c] + 0.05, y: 1.25 + r * 0.53, w: colW[c] - 0.1, h: 0.53,
        fontSize: 10, color: isHeader ? WHITE : DARK_TEXT,
        bold: isHeader || isFeatureCol, valign: "middle", align: "center", margin: 2
      });
    });
  });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: ACCENT }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – DIAGNOSIS
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: LIGHTGRAY };
  addSlideTitle(sl, "Diagnosis of Hyperparathyroidism", "Clinical + Biochemical + Imaging approach");

  const diagBoxes = [
    { title: "History", color: ACCENT, items: ["Renal stones, fractures, abdominal pain", "Family history of MEN syndromes", "CKD / long-term dialysis", "Incidental hypercalcemia on bloods"] },
    { title: "Biochemistry", color: TEAL, items: ["↑ Serum PTH (intact PTH assay)", "Serum Ca²⁺ and albumin (corrected Ca)", "Serum phosphate, Mg²⁺, ALP", "24-hr urinary calcium", "Vit D (25-OH-D) levels"] },
    { title: "Imaging", color: ORANGE, items: ["USG neck – adenoma detection", "Sestamibi (Tc-99m) scan – gold standard localisation", "4D-CT / SPECT-CT", "DEXA scan for bone density"] },
  ];

  diagBoxes.forEach((b, i) => {
    const x = 0.25 + i * 3.2;
    sl.addShape(pres.ShapeType.rect, { x, y: 1.2, w: 3.0, h: 0.4, fill: { color: b.color }, line: { type: "none" } });
    sl.addText(b.title, { x, y: 1.2, w: 3.0, h: 0.4, fontSize: 13, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
    sl.addShape(pres.ShapeType.rect, { x, y: 1.6, w: 3.0, h: 3.95, fill: { color: WHITE }, line: { color: b.color, w: 1 } });
    addBullets(sl, b.items, { x: x + 0.05, y: 1.65, w: 2.9, h: 3.85, fontSize: 11 });
  });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: ACCENT }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – MANAGEMENT / SURGERY
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: WHITE };
  addSlideTitle(sl, "Management & Surgical Treatment", "When to operate and what to do");

  // medical
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 1.15, w: 4.5, h: 0.38, fill: { color: TEAL }, line: { type: "none" } });
  sl.addText("Medical Management (asymptomatic / temporising)", { x: 0.3, y: 1.15, w: 4.4, h: 0.38, fontSize: 11, bold: true, color: WHITE, valign: "middle", margin: 0 });
  const medItems = [
    "Hydration + loop diuretics (acute hypercalcaemia)",
    "Bisphosphonates – protect bone density",
    "Cinacalcet (calcimimetic) – for secondary HPT",
    "Vit D + phosphate binders (secondary HPT/CKD)",
    "Monitor Ca²⁺, renal function, bone density",
  ];
  addBullets(sl, medItems, { x: 0.3, y: 1.6, w: 4.4, h: 2.0, fontSize: 12 });

  // indications for surgery
  sl.addShape(pres.ShapeType.rect, { x: 0.25, y: 3.65, w: 4.5, h: 0.38, fill: { color: ACCENT }, line: { type: "none" } });
  sl.addText("Indications for Surgery (Primary HPT)", { x: 0.3, y: 3.65, w: 4.4, h: 0.38, fontSize: 11, bold: true, color: WHITE, valign: "middle", margin: 0 });
  const surgInd = [
    "Symptomatic HPT (stones, bones, groans)",
    "Serum Ca²⁺ > 1 mg/dL above normal",
    "Osteoporosis (T-score ≤ −2.5)",
    "eGFR < 60 mL/min",
    "Age < 50 years",
  ];
  addBullets(sl, surgInd, { x: 0.3, y: 4.1, w: 4.4, h: 1.45, fontSize: 12 });

  // surgical types
  sl.addShape(pres.ShapeType.rect, { x: 4.95, y: 1.15, w: 4.8, h: 4.45, fill: { color: "EBF5FF" }, line: { color: ACCENT, w: 1 } });
  sl.addText("Surgical Procedures", { x: 5.05, y: 1.2, w: 4.6, h: 0.38, fontSize: 13, bold: true, color: DARK_BG, margin: 0 });

  const surgProc = [
    { title: "Primary HPT", detail: "Focused minimally invasive parathyroidectomy (MIPTH) – excise single adenoma; bilateral neck exploration if multiglandular" },
    { title: "Secondary HPT", detail: "Subtotal parathyroidectomy (remove 3.5 glands) OR total parathyroidectomy with autotransplant to forearm" },
    { title: "Tertiary HPT", detail: "Subtotal or total parathyroidectomy + autotransplant; urgent in post-transplant hypercalcemia" },
    { title: "Intraoperative PTH (ioPTH)", detail: "Drop >50% from baseline = successful resection (Miami criterion)" },
  ];

  surgProc.forEach((p, i) => {
    sl.addShape(pres.ShapeType.rect, { x: 5.05, y: 1.65 + i * 0.95, w: 1.5, h: 0.82, fill: { color: ACCENT }, line: { type: "none" } });
    sl.addText(p.title, { x: 5.05, y: 1.65 + i * 0.95, w: 1.5, h: 0.82, fontSize: 10, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
    sl.addText(p.detail, { x: 6.6, y: 1.68 + i * 0.95, w: 3.05, h: 0.78, fontSize: 10, color: DARK_TEXT, valign: "middle", margin: 2 });
  });

  sl.addShape(pres.ShapeType.rect, { x: 0, y: 5.55, w: 10, h: 0.075, fill: { color: ACCENT }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – KEY TAKEAWAYS + SUMMARY
// ══════════════════════════════════════════════════════════════════════════════
{
  const sl = pres.addSlide();
  sl.background = { color: DARK_BG };

  sl.addShape(pres.ShapeType.ellipse, { x: 7.5, y: -1, w: 4.5, h: 4.5, fill: { color: ACCENT, transparency: 85 }, line: { type: "none" } });
  sl.addShape(pres.ShapeType.ellipse, { x: -1.5, y: 3.5, w: 4, h: 4, fill: { color: TEAL, transparency: 85 }, line: { type: "none" } });

  sl.addText("KEY TAKEAWAYS", { x: 0.4, y: 0.2, w: 9, h: 0.5, fontSize: 14, bold: true, color: GOLD, charSpacing: 6, margin: 0 });
  sl.addText("Types of Hyperparathyroidism", { x: 0.4, y: 0.68, w: 9, h: 0.55, fontSize: 26, bold: true, color: WHITE, margin: 0 });
  sl.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.25, w: 3.5, h: 0.05, fill: { color: GOLD }, line: { type: "none" } });

  const takeaways = [
    { label: "1°", color: ACCENT, text: "Autonomous PTH from adenoma → hypercalcemia. Definitive Rx = parathyroidectomy." },
    { label: "2°", color: TEAL,   text: "Reactive HPT to chronic hypocalcemia (usually CKD). Treat underlying cause ± surgery." },
    { label: "3°", color: ORANGE, text: "Autonomy develops after prolonged 2° HPT. Hypercalcemia despite correction of cause." },
    { label: "🦴", color: GOLD,   text: "Bones: OFC & brown tumors; 🪨 Stones: nephrolithiasis; 😣 Groans; 🧠 Psychic moans" },
    { label: "🔬", color: "A5D6A7", text: "Diagnosis: ↑ PTH + ↑ Ca²⁺ (1° & 3°); ↑ PTH + ↓/N Ca²⁺ (2°). Localise with sestamibi." },
  ];

  takeaways.forEach((t, i) => {
    sl.addShape(pres.ShapeType.rect, { x: 0.4, y: 1.45 + i * 0.75, w: 0.55, h: 0.6, fill: { color: t.color }, line: { type: "none" } });
    sl.addText(t.label, { x: 0.4, y: 1.45 + i * 0.75, w: 0.55, h: 0.6, fontSize: 14, bold: true, color: WHITE, align: "center", valign: "middle", margin: 0 });
    sl.addText(t.text, { x: 1.05, y: 1.48 + i * 0.75, w: 8.6, h: 0.6, fontSize: 12, color: WHITE, valign: "middle", margin: 0 });
  });

  sl.addText("Thank you — Any Questions?", { x: 0.4, y: 5.28, w: 9, h: 0.3, fontSize: 12, color: GOLD, italic: true, margin: 0 });
}

// ─── Write file ──────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/hyperparathyroidism-ppt/Hyperparathyroidism_Types.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/hyperparathyroidism-ppt && node build.js 2>&1

cd /home/daytona/workspace/hyperparathyroidism-ppt && \ node /home/daytona/skill…

~/hyperparathyroidism-ppt/build.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/hyperparathyroidism-ppt/build.js'

cd /home/daytona/workspace/hyperparathyroidism-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/hyperparathyroidism-ppt/Hyperparathyroidism_Types…