Endocrine Review

[edit] DM Pathophysiology

Understand how we regulate glucose under physiological circumstances
Discuss the physiology of Insulin Secretion
Describe the pathophysiologic alterations that contribute to hyperglycemia in Diabetes Mellitus
Categorize different types of Diabetes Mellitus
List the criteria for the diagnosis of Diabetes Mellitus

Outline the acute and chronic complications of diabetes.
Describe the approach to insulin therapy in type 1 and type 2 diabetes
Outline the acute complications of insulin deficiency/hyperglycemia.
Describe the spectrum of chronic complications of diabetes.
- Microvascular: Retinopathy, Nephropathy, and Neuropathy
- Macrovascular: Cardiovascular Disease
Describe the general approach to insulin therapy.

Understand the negative feedback relationship between the anterior pituitary hormones and their respective target glands, and the expected pituitary hormone responses to impaired flow in the hypophyseal portal system.
Know the visual field patterns that are typical for optic chiasmal compression, and understand the underlying mechanism for these patterns.
To the extent covered in these talks, know the signs and symptoms, differential diagnosis, expected hormonal abnormalities, and preferred diagnostic tests and treatments for growth hormone deficiency, acromegaly, hyperprolactinemia, pituitary microadenomas and macroadenomas, craniopharyngiomas, and diabetes insipidus.
Know the recommended screening tests for deficiency of each of the seven clinically important pituitary hormones, and the recommended screening tests for hypersecretion of growth hormone, prolactin, and ACTH (ACTH hyperfunction discussed primarily in the adrenal talk). Understand the rationale for endocrine stimulation and suppression tests, and recognize the circumstances in which either is indicated.
For a patient with deficiency of a pituitary hormone, know if hormonal replacement is clinically indicated, and if so, what agent or agents would typically be used?

Understand the negative feedback relationships between the adrenal and the pituitary, and between the adrenal and the renin-angiotensin system. Know which zone of the adrenal is primarily responsible for biosynthesis of glucocorticoids, mineralocorticoids and adrenal androgens. (Do not spend time learning the detailed biosynthetic pathways shown on several slides—they are included simply to illustrate the general relationships between the glucocorticoid, mineralocorticoid and androgen pathways.)
Know the signs and symptoms, differential diagnosis, expected hormonal abnormalities, and preferred diagnostic tests and treatments for the several forms of adrenal insufficiency, including Addison’s disease, pituitary ACTH deficiency, and hyporeninemic hypoaldosteronism.
To the extent covered in the talks, know the signs and symptoms, differential diagnosis, expected hormonal abnormalities, and diagnostic tests and treatments for the various forms of adrenal hyperfunction, including the 3 major types of Cushing’s syndrome, primary hyperaldosteronism, and pheochromocytoma. For Cushing’s syndrome, know which tests are indicated for distinguishing normal from abnormal (Cushing’s from non-Cushing’s) and which are indicated for identifying the specific etiology of Cushing’s in someone already identified as having Cushing’s.

List the causes of a diffuse goiter
List causes of a nodular goiter
Describe diagnostic evaluation of goiter/nodules
List reasons to biopsy a thyroid nodule
Describe changes to thyroid hormone economy during pregnancy
List recommendations for treating hypothyroidism during pregnancy
Recognize the symptoms of hypo- and hyperthyroidism
Describe the treatment of hypothyroidism
List the differential diagnosis of hyperthyroidism
Utilize a nuclear thyroid scan in differentiating the cause of hyperthyroidism
List treatment options for hyperthyroidism
Employ appropriate use of thyroid function tests
Accurately interpret thyroid function tests
Recognize pitfalls in the interpretation of thyroid function tests (TBG, pituitary disease, non steady-state)

Review the endogenous and exogenous pathways of lipid metabolism.
Review disorders of lipoprotein metabolism.
Understand the NCEP Guidelines for cholesterol screening and treatment of dyslipidemia. In a particular patient, be able to calculate LDL cholesterol, identify risk factors, determine LDL goal based on overall risk assessment, and develop a treatment algorithm. Understand recent data supporting the treatment of cholesterol to reduce risk of a cardiovascular outcome.
Overview of Metabolic Syndrome. Identify components of the metabolic syndrome and understand the requirements for making this diagnosis.
Understand management of triglycerides. Identify conditions and medications that can raise triglycerides levels.
Understand management of HDL cholesterol. Identify lifestyle factors and disease states that can lower HDL.
Broadly identify the effects of cholesterol lowering medications. Identify which classes are medications are used to raise and/or lower specific cholesterol subtypes.

Identify the key physiologic components which regulate serum calcium
Describe the mechanism by which Vitamin D deficiency lowers bone mineral density
Appreciate the incidence and importance of Vitamin D deficiency and importance of Vitamin D deficiency
Recognize the major causes of hypercalcemia with respect to clinical presentation, differential diagnosis, underlying pathophysiology, and basic management
List the indications for surgery in a patient with primary hyperparathyroidism

Understand the “life story” of bone with respect to young adult peak bone mass and lifelong bone remodeling in health and disease
Recognize the risk factors for low bone mass
Interpret a bone mineral density report
List T-scores from a bone mineral density report below which treatment is recommended
Describe the components of osteoporosis management
Understand the pathophysiology of osteomalacia and Paget’s disease of bone

Understand the normal physiology of the male hypothalamic-pituitary-gonadal axis
Understand the normal development of the male and female genitourinary system
Understand and identify selected disorders of sexual differentiation
Develop a differential diagnosis and diagnostic algorithm for male patients presenting with hypogonadism
Differentiate causes of primary and secondary hypogonadism
Appreciate the proper way to perform laboratory tests for the evaluation of male hypogonadism

Review the hormonal and uterine changes that characterize the normal female menstrual cycle
Understand the regulation of the female hypothalamic-pituitary-gonadal axis
Develop a differential diagnosis and diagnostic algorithm for patients presenting with amenorrhea
- History
- Physical exam
- Focused laboratory assessments