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PARATHYROID DISEASE
THE ULTIMATE PHARMACY STUDY GUIDE & CLINICAL CHEAT SHEET
Reflecting NICE Guideline NG132 & Clinical Pharmacy Practice Notes
High-Yield Study Notes for Pharmacy Students
For personal use only. Commercial redistribution of this file as-is is prohibited.
, Parathyroid Disease | Pharmacy Revision Notes
Table of Contents
1. Parathyroid Anatomy, Histology & PTH Physiology .......................................................................................... 4
Anatomy & Histology of the Parathyroid Glands.............................................................................................. 4
PTH Physiology & Three-Organ Target Homeostasis ........................................................................................ 5
Vitamin D Metabolism & CKD Secondary HPT Pathophysiology ...................................................................... 6
2. Primary Hyperparathyroidism (PHPT) — Screening & Diagnosis (NICE NG132)............................................... 7
Epidemiology & Etiological Spectrum ............................................................................................................... 7
Primary Care Screening & NICE Diagnostic Pathway (NG132) ......................................................................... 7
Step 1: Primary Care — Albumin-Adjusted Serum Calcium Testing ............................................................. 7
Step 2: Primary Care — Measuring Parathyroid Hormone (PTH) ................................................................. 8
Step 3: Secondary Care Endocrine Work-Up ................................................................................................ 9
Clinical Features: 'Bones, Stones, Abdominal Groans, Psychic Moans' ............................................................ 9
3. PHPT Management Pathways — Surgical vs Non-Surgical (NICE NG132) ........................................................ 9
NICE NG132 Referral Criteria for Parathyroid Surgery ..................................................................................... 9
Preoperative Localization Imaging & Operative Choice ................................................................................. 10
Non-Surgical Pharmacotherapy & Pharmacy Practice.................................................................................... 11
1. Cinacalcet (Calcimimetic Pharmacology & Practice) .............................................................................. 11
2. Bisphosphonates in PHPT ....................................................................................................................... 11
NICE Table 1: Monitoring Schedule Summary ................................................................................................ 12
Management of PHPT in Pregnancy (NICE 1.7) .............................................................................................. 12
4. Secondary & Tertiary Hyperparathyroidism & CKD-MBD ............................................................................... 12
Secondary Hyperparathyroidism Pathophysiology ........................................................................................ 12
Tertiary Hyperparathyroidism Pathophysiology ............................................................................................. 13
CKD-Mineral and Bone Disorder (CKD-MBD).................................................................................................. 13
5. Hypoparathyroidism, Calcium Homeostasis & Emergency Management ...................................................... 14
Etiology & Neuromuscular Clinical Features................................................................................................... 14
Pharmacotherapy & Counselling for Hypoparathyroidism ............................................................................. 14
Emergency Management of Severe Hypercalcaemia ..................................................................................... 14
Multiple Endocrine Neoplasia (MEN) Syndromes .......................................................................................... 15
6. Pharmacy Practice, Pharmacology & Clinical Cheat Sheet ............................................................................. 15
High-Yield Drug Interactions & PK/PD Summary ............................................................................................ 15
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, Parathyroid Disease | Pharmacy Revision Notes
High-Yield Clinical Thresholds & Cheat Sheet ................................................................................................. 16
Page 3
PARATHYROID DISEASE
THE ULTIMATE PHARMACY STUDY GUIDE & CLINICAL CHEAT SHEET
Reflecting NICE Guideline NG132 & Clinical Pharmacy Practice Notes
High-Yield Study Notes for Pharmacy Students
For personal use only. Commercial redistribution of this file as-is is prohibited.
, Parathyroid Disease | Pharmacy Revision Notes
Table of Contents
1. Parathyroid Anatomy, Histology & PTH Physiology .......................................................................................... 4
Anatomy & Histology of the Parathyroid Glands.............................................................................................. 4
PTH Physiology & Three-Organ Target Homeostasis ........................................................................................ 5
Vitamin D Metabolism & CKD Secondary HPT Pathophysiology ...................................................................... 6
2. Primary Hyperparathyroidism (PHPT) — Screening & Diagnosis (NICE NG132)............................................... 7
Epidemiology & Etiological Spectrum ............................................................................................................... 7
Primary Care Screening & NICE Diagnostic Pathway (NG132) ......................................................................... 7
Step 1: Primary Care — Albumin-Adjusted Serum Calcium Testing ............................................................. 7
Step 2: Primary Care — Measuring Parathyroid Hormone (PTH) ................................................................. 8
Step 3: Secondary Care Endocrine Work-Up ................................................................................................ 9
Clinical Features: 'Bones, Stones, Abdominal Groans, Psychic Moans' ............................................................ 9
3. PHPT Management Pathways — Surgical vs Non-Surgical (NICE NG132) ........................................................ 9
NICE NG132 Referral Criteria for Parathyroid Surgery ..................................................................................... 9
Preoperative Localization Imaging & Operative Choice ................................................................................. 10
Non-Surgical Pharmacotherapy & Pharmacy Practice.................................................................................... 11
1. Cinacalcet (Calcimimetic Pharmacology & Practice) .............................................................................. 11
2. Bisphosphonates in PHPT ....................................................................................................................... 11
NICE Table 1: Monitoring Schedule Summary ................................................................................................ 12
Management of PHPT in Pregnancy (NICE 1.7) .............................................................................................. 12
4. Secondary & Tertiary Hyperparathyroidism & CKD-MBD ............................................................................... 12
Secondary Hyperparathyroidism Pathophysiology ........................................................................................ 12
Tertiary Hyperparathyroidism Pathophysiology ............................................................................................. 13
CKD-Mineral and Bone Disorder (CKD-MBD).................................................................................................. 13
5. Hypoparathyroidism, Calcium Homeostasis & Emergency Management ...................................................... 14
Etiology & Neuromuscular Clinical Features................................................................................................... 14
Pharmacotherapy & Counselling for Hypoparathyroidism ............................................................................. 14
Emergency Management of Severe Hypercalcaemia ..................................................................................... 14
Multiple Endocrine Neoplasia (MEN) Syndromes .......................................................................................... 15
6. Pharmacy Practice, Pharmacology & Clinical Cheat Sheet ............................................................................. 15
High-Yield Drug Interactions & PK/PD Summary ............................................................................................ 15
Page 2
, Parathyroid Disease | Pharmacy Revision Notes
High-Yield Clinical Thresholds & Cheat Sheet ................................................................................................. 16
Page 3
