Endocrinology Rotation

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Regions: Endocrinology Elective
Rotation Director: John MacIndoe, M.D.
The Endocrinology rotation concentrates on basic endocrine principles and specific disease processes.  Residents will have an opportunity to see patients with diseases of the pancreas, thyroid, pituitary, adrenals, parathyroid and bone.  In addition, lipid disorders as they apply to endocrine disease, endocrine hypertension, polyglandular syndromes and multiple endocrine neoplasias will be covered.

Patients are seen four to five half-days per week in ambulatory Endocrine and Diabetes Clinics.  The remainder of each day is spent with inpatient consultations.  The rotation is set up so that residents see each patient independently and then patients are staffed with the attending endocrinologist.  All patients are seen and examined thoroughly by the attending.  The patients are then discussed with the residents.

The Faculty physician is responsible for overseeing care of all patients on this rotation.

Procedures include fine needle aspiration biopsies of the thyroid.  Didactic sessions are scheduled daily and are tailored to meet the objectives.  In addition, didactic sessions may be given to meet the needs to the individual resident.  A notebook containing recent papers and reviews in the literature has been assembled and is made available to each resident during the rotation.  A bibliography of this notebook is attached.

Residents are encouraged to attend the City Wide Endocrinology Conference, which is held weekly on Thursday afternoons at the University or the VA Medical Center.  Any special conferences regarding endocrinology or diabetes are brought to the attention of the resident as well.   Evidence-based medicine is incorporated into the rotation where appropriate.

There is no weekend or evening call associated with this rotation.  Questions about the rotation should be directed to John MacIndoe, M.D.

Endocrinology Lecture Series:
Didactic sessions will be provided to residents rotating through this rotation.  The following comprises the core lecture series.  It requires eight required lectures that will be given over the two week period.  This lecture series does not exclude the possibility of additional topics or didactic sessions based on the needs of the resident.  In addition, didactic sessions ma be formulated around specific patient care issues seen during the rotation.  The core lecture series was devised to compliment the endocrine rotation objectives for Internal Medicine residents.

The eight core lectures include:

1. Treatment of Type 2 Diabetes Mellitus
2. Type 1 Diabetes Mellitus and DKA
3. Thyroid Function Tests and Thyroid Nodules
4. Evaluation of a Goiter and the Differential Diagnosis of Hyperthyroidism and Hypothyroidism
5. Calcium Disorders and Osteoporosis, Including Estrogen Replacement Therapy
6. Diagnosis of Adrenal Disorders
7. The Anterior and Posterior Pituitary Hormones (with an emphasis on Hyperprolactinemia and Diabetes Insipidus)
8. Female Reproduction Including Amenorrhea, Hirsutism, PCO and CAH
    

Objectives:

• Understands all aspects of the management of diabetes mellitus
• Defines the pathophysiology of the different types of diabetes mellitus.
• Knows the criteria to establish a diagnosis of diabetes mellitus.
• Knows how to evaluate a patient with diabetes mellitus.
• Knows standards of care for managing patients with diabetes mellitus.
• Describes the different treatments available for the different types of diabetes mellitus.
• Describes the different chronic complications related to diabetes mellitus and their management.
• Defines the treatment for acute diabetic emergencies.
• Describes the treatment options of glycemic control that is used currently to guide therapy.
• Describes the role of diabetes education in the management of diabetes mellitus.
• Describes a diabetes diet and knows how to prescribe a diet for a patient with diabetes mellitus.

Understands disorders of the thyroid:

• Performs a competent thyroid examination.
• Understands thyroid function tests.
• Recognizes symptoms and signs of hyperthyroidism.
• Recognizes symptoms and signs of hypothyroidism.
• Knows the differential diagnosis for hyper-and hypothyroidism.
• Describes the treatments for patients with hyperthyroidism.
• Describes the treatments for patients with hypothyroidism.
• Describes the evaluation of a patient with a thyroid nodule.
• Knows how to monitor patients with thyroid disorders.

 Knowledge about calcium metabolism:

• Recognizes symptoms and signs of hypercalcemia.
• Recognizes symptoms and signs of hypocalcemia.
• Knows how to interpret PTH, phosphorus and albumin levels as they relate to calcium.
• Knows the differential diagnosis for calcium disorders.
• Defines the treatment for acute hypercalcemic crises.
• Defines the treatment for chronic hypo- and hypercalcemia.
• Defines prevention, diagnosis and treatment of osteoporosis.

 Knowledge of disorders of the adrenal gland:

• Recognizes symptoms and signs of chronic glucocorticoid deficiency.
• Recognizes symptoms and signs of chronic glucocorticoid excess.
• Knows the screening test to evaluate chronic adrenal insufficiency.
• Knows the screening test to evaluate for Cushing’s Syndrome.
• Distinguishes between primary and secondary adrenal insufficiency.
• Defines the treatment for acute adrenal insufficiency.

Knowledge of pituitary disorders:

• Recognizes symptoms and signs of anterior pituitary deficiencies.
• Recognizes symptoms and signs of proterior pituitary deficiencies.
• Recognizes symptoms and signs of a pituitary adenoma.
• Defines the treatment for diabetes insipidus.
• Describes hormone replacement for pituitary deficiencies.

Knowledge of basic reproductive endocrinology:

• Recognizes symptoms and signs of sex hormone deficiency in women.
• Recognizes symptoms and signs of sex hormone deficiency in men.
• Knows how to use sex steroid levels and gonadotropin levels in evaluating sex hormone deficiency states.
• Defines appropriate sex hormone replacement regimens.
• Recognizes the diagnosis and treatment of hirsutism.

Miscellaneous:

• Understands and recognizes MEN syndromes.
• Understands and recognizes polyglandular autoimmune syndromes and is able to differentiate them from MEN syndromes.
• Understands the causes of endocrine hypertension.
• Understands lipid disorders as they occur in endocrine disease.

Annotated Readings:
Will be provided to each resident.

Evaluation: All attending physicians are required to provide face to face evaluations with the residents at the end of each rotation, as well as provide evaluations on a web-based program called E*Value. 

The program encourages residents to be as autonomous in decision-making and patient care as prudent practice and self-assessment of abilities permits.  However, ALL PATIENTS are ultimately the responsibility of the supervising faculty physician.  In every patient care experience, including outpatient clinics, inpatient teams, and consultation, the resident is supervised by an attending physician.  That physician is available 24 hours per day, 7 days per week.  The name and contact information for the supervising physician will be provided to all residents at the beginning of every rotation.  There are no exceptions.