Module - Endocrinology and Diabetes (SLS126)

STP

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.

Work-based 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.

Work-based Competencies


Learning outcome Title Knowledge
1 1,2,3

Perform the analyses to laboratory standard operating procedures on patients with:

  • pituitary tumours
  • hypopituitarism
  • growth hormone deficiency
  • multiple endocrine neoplasia
  • diabetes insipidus.
  • The clinical symptoms, biochemistry and diagnosis of common pituitary disorders, including:
    • hyperprolactinaemia
    • acromegaly
    • Cushing’s disease.
  • The differential diagnosis of common pituitary endocrine disorders using dynamic function tests, including:
    • oral glucose tolerance tests
    • insulin/glucagon tolerance test
    • water deprivation test.
  • The role of imaging in the differential diagnosis of pituitary disorders.
2 1,2

Perform the analyses to laboratory standard operating procedures on patients with:

  • thyroid diseases
  • thyroid cancers.
  • The clinical symptoms and biochemistry of common thyroid disorders, including:
    • hypo- and hyperthyroidism
    • subclinical thyroid disease
    • thyroid carcinoma
    • medullary thyroid carcinoma.
  • The effect of the following clinical scenarios on the interpretation of thyroid function tests: neonates, pregnancy, non-thyroidal illness and thyroid hormone replacement monitoring.
3 1,2

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.
  • The clinical symptoms, biochemistry and diagnosis of common gonadal pathophysiologies, including:
    • erectile dysfunction
    • male subfertility
    • mnovulation/amenorrhoea
    • polycystic ovary syndrome (PCOS) and hirsutism
    • the menopause
    • gonadal hormone-secreting tumours
    • delayed and precocious puberty.
  • Differential diagnosis of common gonadal endocrine disorders using dynamic function tests, including:
    • gonadotrophin-releasing hormone (GnRH) test
    • human chorionic gonadotrophin (HCG) stimulation test.
  • The role of imaging in the differential diagnosis of gonadal disorders.
4 1,2

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.
  • The clinical symptoms, biochemistry, diagnosis and monitoring of replacement therapy in common adrenal disorders, including:
    • Cushing’s syndrome
    • Conn’s syndrome
    • Addison’s disease
    • congenital adrenal hyperplasia
    • adrenal androgen-secreting tumour
    • phaeochromocytoma and paraganglioma.
  • Differential diagnosis of common adrenal endocrine disorders using dynamic function tests, including:
    • short synacthen test
    • depot synacthen test
    • dexamethasone suppression test
    • corticotrophin-releasing hormone (CRH) test
    • adrenal vein sampling.
  • The role of imaging in the diagnosis of adrenal disorders.
5 1,2

Perform the analyses to laboratory standard operating procedures on patients with:

  • hypo- and hyperparathyroidism
  • hypo- and hypervitaminosis D.
  • The clinical symptoms, biochemistry and diagnosis of common endocrine disorders of calcium metabolism, including:
    • primary, secondary and tertiary parathyroid disease
    • vitamin D deficiency
    • chronic renal impairment
    • sarcoidosis.
  • The role of imaging in the diagnosis of parathyroid disorders.
6 2

Perform the analyses to laboratory standard operating procedures on patients with:

  • hyperinsulinaemia
  • GI hormone-secreting tumours.
  • The clinical symptoms, biochemistry and diagnosis of:
    • insulinoma
    • Zollinger–Ellinson syndrome
    • rare GI tract tumours
    • carcinoid tumours. 
  • The diagnosis of endocrine disorders of the GI tract using:
    • prolonged fast
    • markers of neuroendocrine tumours (e.g. chromogranins).
7 2

Perform the analyses to laboratory standard operating procedures on patients with endocrine causes of obesity.

  • The following causes of endocrine obesity, including how to exclude:
    • hypothyroidism
    • type 2 diabetes
    • Cushing’s syndrome
    • growth hormone deficiency.
8 1,4

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.
  • The clinical symptoms, biochemistry and diagnosis of diabetes mellitus:
    • primary and secondary diabetes
    • diabetic ketoacidosis
    • gestational diabetes.
  • Differential diagnosis and monitoring of diabetes using the following test(s):
    • fasting glucose test
    • oral glucose tolerance test
    • insulin and C-peptide
    • HbA1c
    • urinary albumin.
  •  The role of point-of-care (POC) glucose in the management of diabetes.
  • The governance issues of POCT testing for HbA1c and glucose.
9 1,2,3,4

Identify cases that require urgent intervention and offer clinical advice on the follow-up and/or further management of the patient.

  • Time-critical and grossly abnormal results requiring urgent clinical interventions for the disorders in this module.
  • The options for clinical interventions and their selection.
  • Responsibility for patient follow-up and further management.
10 5

Interpret biochemical data in light of the clinical details.

  • Correct use of data in relation to the full range of investigations specified within this module.
11 5

Draft written reports on the results of investigations.

  • Requirements of reports, including sources of information, appropriate use of patient records, reference materials and current national/international guidelines.

Work-based assessment


Complete 2 Case-Based Discussion(s)
Complete 2 of the following DOPS and/or OCEs
Type Title
DOPS 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
OCE 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