06.03 Endo/Metabolic

06.03 Endocrine / Metabolic [PDF link]: Acromegaly. Prolactinoma. Hyperparathyroidism. Hypoparathyroidism. Multiple endocrine neoplasia (MEN).

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More on acromegaly and prolactinoma

• No NICE guidelines.

• Reference guidelines for acromegaly

  • Katznelson L, Laws ER, Melmed S, Molitch ME, Murad MH, Utz A, et al. Acromegaly: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism 2014;99:3933–51. https://doi.org/10.1210/jc.2014-2700.

  • Giustina A, Barkan A, Beckers A, Biermasz N, Biller BMK, Boguszewski C, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. The Journal of Clinical Endocrinology & Metabolism 2020;105:e937–46. https://doi.org/10.1210/clinem/dgz096.

  • Fleseriu M, Biller BMK, Freda PU, Gadelha MR, Giustina A, Katznelson L, et al. A Pituitary Society update to acromegaly management guidelines. Pituitary 2021;24:1–13. https://doi.org/10.1007/s11102-020-01091-7.

• Reference guidelines for prolactinoma

  • Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:273–88. https://doi.org/10.1210/jc.2010-1692.

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More on hyperparathyroidism

• NICE guideline NG132 covers primary hyperPTH, published May 2019

• In primary care, measure corrected calcium (cCa) if

  • S/smx of hypercalcaemia (bones, stones, moans, groans)

  • Osteoporosis or fragility fracture

  • Renal stone

  • Incidental finding of raised cCa (>2.6)

• In primary care, measure PTH if

  • cCa ≥2.6 mmol/L on at least 2 occasions, or ≥2.5 mmol/L on at least 2 occasions and primary hyperPTH is suspected

  • Random PTH + cCa at the same time

• Frequency of monitoring is covered in 1.6

• No guidelines for secondary/tertiary hyper PTH.

More on hypoparathyroidism

• No NICE guidelines

• Other reference guidelines

  • Khan AA, Bilezikian JP, Brandi ML, Clarke BL, Gittoes NJ, Pasieka JL, et al. Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop n.d. https://doi.org/10.1002/jbmr.4691.

• Some bed time reading on pseudohypoparathyroidism (say it 5 times fast)

  • Linglart A, Levine MA, Jüppner H. Pseudohypoparathyroidism. Endocrinol Metab Clin North Am 2018;47:865–88. https://doi.org/10.1016/j.ecl.2018.07.011.