Endocrinology and Diabetes

Module details

Title

Endocrinology and Diabetes

Type

Specialist

Module code

SLS126

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with the knowledge and understanding of the normal physiology and pathophysiology of the major endocrine organs in the body. They will appreciate the importance of clinical and biochemical parameters in diagnosing, assessing the response to treatment and monitoring patients with common endocrine disorders. In the work-based module they will be expected to apply this knowledge as they learn to perform endocrine assays using a range of methods and gain experience of the interpretation of hormone results in common endocrine conditions.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1,2,3	Competency Perform the analyses to laboratory standard operating procedures on patients with: pituitary tumours hypopituitarism growth hormone deficiency multiple endocrine neoplasia diabetes insipidus.	Action View
# 2	Learning outcome 1,2	Competency Perform the analyses to laboratory standard operating procedures on patients with: thyroid diseases thyroid cancers.	Action View
# 3	Learning outcome 1,2	Competency Perform the analyses to laboratory standard operating on patients with: male hypo- and hypergonadism female hypo- and hypergonadism infertility and/or patients undergoing fertility treatment pubertal disorders intersex disorders gonadal malignancies.	Action View
# 4	Learning outcome 1,2	Competency Perform the analyses to laboratory standard operating procedures on patients with: primary hypo- and hypercortisolism secondary hypo- and hypercortisolism hyperaldosteronism disorders of adrenal steroidogenesis adrenal androgen excess disorders of the adrenal medulla.	Action View
# 5	Learning outcome 1,2	Competency Perform the analyses to laboratory standard operating procedures on patients with: hypo- and hyperparathyroidism hypo- and hypervitaminosis D.	Action View
# 6	Learning outcome 2	Competency Perform the analyses to laboratory standard operating procedures on patients with: hyperinsulinaemia GI hormone-secreting tumours.	Action View
# 7	Learning outcome 2	Competency Perform the analyses to laboratory standard operating procedures on patients with endocrine causes of obesity.	Action View
# 8	Learning outcome 1,4	Competency Perform the analyses to laboratory standard operating procedures on patients with: newly diagnosed type 1 and type 2 diabetes stable diabetes on treatment acute diabetic complications chronic diabetic complications.	Action View
# 9	Learning outcome 1,2,3,4	Competency Identify cases that require urgent intervention and offer clinical advice on the follow-up and/or further management of the patient.	Action View
# 10	Learning outcome 5	Competency Interpret biochemical data in light of the clinical details.	Action View
# 11	Learning outcome 5	Competency Draft written reports on the results of investigations.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Undertake a a short synacthen test and Interpret and report results from	DOPS
Prepare a sample for macroprolactin analysis interpretation and reporting of a macroprolactin result	DOPS
Perform HbA1c Analysis	DOPS
Perform an immunoassay of a hormone.	DOPS
Perform a manual immunoassay with or without organic extraction of a hormone prior to analysis	DOPS
Perform a hormone assay by HPLC	DOPS
Perform an ELISA	DOPS
Perform a hormone assay by LCMS	DOPS
Select the tests and prepare a samples for the investigation of a couple with subfertility	DOPS
Prepare a sample for an investigation of an insulinoma	DOPS
Interpret an External Quality Assessment report for gonadotrophins	DOPS
Interpret and report results, from an abnormal glucose tolerance test	DOPS
Prepare a sample for the investigation of assay interference	DOPS
Explain the short synacthen test to a patient	OCE
Phone and discuss an abnormal thyroid function test with a healthcare professional	OCE
Explain the test procedure for a glucose tolerance test to a patient	OCE

Learning outcomes

1. Perform the range of laboratory techniques used in the workplace to investigate endocrine disorders and diabetes.
2. Undertake clinical and laboratory investigation and management of the following endocrine pathologies: pituitary, thyroid, gonadal and adrenal disorders; endocrine disorders of calcium metabolism and the gastrointestinal tract; and endocrine causes of obesity.
3. Perform clinical and laboratory investigation and analysis and management of diabetes mellitus.
4. Work in partnership with other clinical specialisms in the investigation of endocrine disorders and diabetes.
5. Interpret and report on clinical and laboratory investigations for endocrinology and diabetes in the correct clinical context.

Learning outcomes

1. Explain, compare and contrast the synthesis, secretion, metabolism and modes of action of hormones.
2. Describe the use of negative feedback systems and dynamic function tests to differentiate primary and secondary endocrine disorders.
3. Describe how to derive appropriate reference ranges and the importance of biological variation when interpreting hormone results.
4. Discuss and evaluate the clinical and laboratory investigation of a wide range of endocrine disorders.
5. Describe the design, operation and performance of the range of methods used in the measurement of hormones.
6. Explain and identify when interference can invalidate the validity of the result.
7. Explain the causes, classification and investigation of diabetes mellitus using the underpinning evidence base.
8. Describe the design, operation and performance of the range of laboratory and point-of-care methods used in the screening, diagnosis and monitoring of diabetes mellitus.
9. Describe the partnership of biochemical endocrinology to other clinical specialisms in the investigation of endocrine disorders and diabetes and patient care.

Indicative content

• Basic endocrinology, hormones and hormone action
• Methods used for measuring hormones in biological samples
• Biological variability and its impact on reference values in endocrinology
• Normal physiology and pathophysiology of:
  • pituitary gland (anterior and posterior)
  • thyroid gland
  • gonads (ovaries and testes)
  • adrenal glands
  • parathyroid glands
  • pancreas
  • adipose tissue
• Clinical and biochemical parameters for the diagnosis, treatment and monitoring of:
  • pituitary disorders
  • thyroid disorders
  • ovarian and testicular disorders
  • adrenal disorders
  • endocrine disorders of calcium metabolism
  • endocrine disorders of gastrointestinal function
  • endocrine causes of obesity
• Causes and classification of diabetes mellitus
• Clinical and biochemical parameters for the screening, diagnosis, treatment and monitoring of diabetes mellitus
• New developments in endocrinology

Activities

• Participate in multidisciplinary/clinical review meetings at which biochemical results of endocrine disorders are presented as part of the clinical record. Reflect on the case of one patient and follow through their investigation and treatment plan. Discuss your learning in terms of service delivery and benefits/outcomes for the patient.
• Attend ward rounds and clinics at which patients are being investigated for endocrine disease. Reflect on the process of investigation, the patient experience and the role of ward rounds and clinics in providing patient care. Identify key learning points for your future practice.
• Visit a GP centre/outreach clinic to reflect on its use of the biochemical service and the role of GPs, nurses and other staff in the diabetic patient pathway. Discuss and review possible improvements.
• Attend an Endocrine Investigation Unit to observe patients undergoing dynamic function tests. Review and discuss in terms of the procedure, the patient experience and care and your own future learning points.