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Endocrine, nutritional and metabolic conditions

About

What is covered

This interactive flowchart covers the guidance that NICE has produced on endocrine, nutritional and metabolic conditions.
For more information, including evidence from NICE-accredited sources, visit NICE Evidence Search.

Updates

Updates to this interactive flowchart

1 August 2017 Asfotase alfa for treating paediatric-onset hypophosphatasia (NICE highly specialised technologies guidance 6) added to hypophosphatasia in metabolic conditions.
28 June 2017 Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease (NICE technology appraisal guidance 449) added to neuroendocrine tumours in endocrine conditions and Eliglustat for treating type 1 Gaucher disease (NICE highly specialised technologies guidance 5) added to Gaucher disease in metabolic conditions.
21 February 2017 Migalastat for treating Fabry disease (NICE highly specialised technologies guidance 4) added to Fabry disease in metabolic conditions.
21 June 2016 Ultrasound-guided percutaneous radiofrequency ablation for benign thyroid nodules (NICE interventional procedures guidance 562) added to thyroid conditions.
15 December 2015 Elosulfase alfa for treating mucopolysaccharidosis type IVa (NICE highly specialised technologies guidance 2) added to metabolic conditions.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on endocrine, nutritional and metabolic conditions in an interactive flowchart

What is covered

This interactive flowchart covers the guidance that NICE has produced on endocrine, nutritional and metabolic conditions.
For more information, including evidence from NICE-accredited sources, visit NICE Evidence Search.

Updates

Updates to this interactive flowchart

1 August 2017 Asfotase alfa for treating paediatric-onset hypophosphatasia (NICE highly specialised technologies guidance 6) added to hypophosphatasia in metabolic conditions.
28 June 2017 Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease (NICE technology appraisal guidance 449) added to neuroendocrine tumours in endocrine conditions and Eliglustat for treating type 1 Gaucher disease (NICE highly specialised technologies guidance 5) added to Gaucher disease in metabolic conditions.
21 February 2017 Migalastat for treating Fabry disease (NICE highly specialised technologies guidance 4) added to Fabry disease in metabolic conditions.
21 June 2016 Ultrasound-guided percutaneous radiofrequency ablation for benign thyroid nodules (NICE interventional procedures guidance 562) added to thyroid conditions.
15 December 2015 Elosulfase alfa for treating mucopolysaccharidosis type IVa (NICE highly specialised technologies guidance 2) added to metabolic conditions.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Minimally invasive video-assisted parathyroidectomy (2014) NICE interventional procedures guidance 501
Minimally invasive video-assisted thyroidectomy (2014) NICE interventional procedures guidance 499
Intraoperative nerve monitoring during thyroid surgery (2008) NICE interventional procedures guidance 255
Thoracoscopic excision of mediastinal parathyroid tumours (2007) NICE interventional procedures guidance 247
Retrobulbar irradiation for thyroid eye disease (2005) NICE interventional procedures guidance 148
Endoscopic transsphenoidal pituitary adenoma resection (2003) NICE interventional procedures guidance 32
Asfotase alfa for treating paediatric-onset hypophosphatasia (2017) NICE highly specialised technologies guidance 6
Eliglustat for treating type 1 Gaucher disease (2017) NICE highly specialised technologies guidance 5
Migalastat for treating Fabry disease (2017) NICE highly specialised technologies guidance 4
Elosulfase alfa for treating mucopolysaccharidosis type IVa (2015) NICE highly specialised technologies guidance 2

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Why we made the recommendations on everolimus and sunitinib

NETs can affect the pancreas, gastrointestinal tissue and lungs and are difficult to diagnose and treat. They can significantly affect emotional health and often mean that people are unable to work. There is particularly high unmet need for people with NETs that affect the lungs.
Clinical trial evidence shows that everolimus and sunitinib are effective for treating pancreatic NETs compared with current treatment (best supportive care). Everolimus is effective for treating gastrointestinal and lung NETs compared with current treatment (best supportive care).
For treating pancreatic NETs, everolimus and sunitinib were recommended because they met NICE's end-of-life criteria. The cost effectiveness estimates varied, from below £20,000 up to £30,000 per quality-adjusted life year (QALY) gained.
For treating gastrointestinal NETs, everolimus did not meet the end-of-life criteria but was recommended because it is cost effective, at below £20,000 per QALY gained.
For treating lung NETs, everolimus did not meet the end-of-life criteria. The cost-effectiveness estimates for everolimus varied, from below £20,000 up to £30,000 per QALY gained. It was recommended because of the cost-effectiveness estimates and the limited treatment options available for people with lung NETs.
NICE's end-of-life criteria are that life expectancy for people with the condition should be less than 24 months and that treatment should extend life by more than 3 months.
For more information see the committee discussion in the NICE technology appraisal on everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease.

Glossary

neuroendocrine tumour

Paths in this pathway

Pathway created: December 2014 Last updated: October 2017

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