Curriculum standards
Knowledge guides
LG13: Scientific foundations of endocrinology
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.
For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.
Anatomy, histology, and physiology of the endocrine organs, such as:
- Adipose tissue
- Adrenal cortex
- Adrenal medulla
- Bone
- Female reproductive tract
- Hypothalamus
- Male reproductive tract
- Pancreas
- Parathyroid glands
- Pituitary gland
- Thymus gland
- Thyroid gland
Classes of hormones
- Structure, function, and biosynthesis of hormones:
- aminergic hormones
- peptide hormones
- steroid hormones
Mechanisms of hormone action
- Classes of nuclear hormone receptors
- Classes of peptide and aminergic hormone receptors
- Distinguish between autocrine, endocrine, and paracrine functions of hormones
- Principles of receptor signalling:
- G-protein coupled
- nuclear
- tyrosine kinase
Regulation of hormonal systems
- Key biosynthetic pathways of hormones:
- adrenal:
- adrenal androgens
- aldosterone / renin-angiotensin axis
- catecholamines
- cortisol / HPA axis
- calcium regulation and bone physiology:
- bone turnover markers
- calcitonin
- fibroblast growth factor 23 (FGF23)
- parathyroid hormone (PTH)
- parathyroid hormone-related protein (PTHrP)
- RANKL
- vitamin D biosynthesis pathway
- hypothalamus / anterior and posterior pituitary axes:
- ACTH, cortisol, CRH
- arginine vasopressin
- dopamine, prolactin
- FSH, gonadotropin-releasing hormone (GnRH), LH, oestrogen, progesterone, testosterone
- growth hormone (GH), GHRH, insulin-like growth factor 1 (IGF-1)
- oxytocin
- thyroid hormones, TRH, thyroid-stimulating hormone (TSH)
- lipid metabolism
- pancreatic and gastrointestinal hormones:
- gastric inhibitory polypeptides (GIPs) / glucagonlike peptide (GLP), ghrelin, peptide YY
- glucagon
- insulin
- somatostatin
- reproduction:
- activins, AMH, inhibins
- HPG axes (FSH, GnRH, LH, oestrogen, progesterone, testosterone)
- adrenal:
- Major stimuli and inhibitors of individual hormones
- Negative and positive feedback regulation of endocrine systems
Life stages
- Fetal endocrinology:
- development of endocrine organs
- growth and nutrition principles
- role of placental and maternal hormones
- Neonatology:
- endocrine function effects on birth size (either small or large for gestational age)
- endocrine organs in postnatal physiology:
- hypothalamic-pituitary-thyroid / adrenal / gonadal axis
- mini-puberty of infancy
- endocrine physiology:
- full-term neonates
- premature neonates
- Childhood:
- growth and development principles:
- normal variation
- growth and development principles:
- Adolescence:
- endocrine disease’s effects on:
- concerns and anxieties of parents / carers
- neurodevelopment
- physiology
- psychology
- social problems
- hormonal maturation and development:
- effects of chronic disease on normal endocrine development
- endocrine disease’s effects on:
- Transition to adult life:
- chronic endocrine disease assessment and management
- chronic endocrine disease burden and the role of:
- endocrine emergencies education
- psychosocial support
- male and female gonadal maturation principles
Pharmacology
- Mechanism of action of major drug classes
- Ongoing management with these therapies
- Principles of pharmacology:
- drug distribution, metabolism, and excretion
- drug interactions, precautions, and contraindications
- Safe dose adjustments
- Side effects, and how to manage them
- Up-to-date, evidence-based best practice and clinical judgement to individualised medication management plans
Principles of statistics and epidemiology
- Basic statistics:
- absolute and relative risk
- confidence intervals, null hypothesis and P-values
- likelihood ratios and odds ratios
- power calculations, type I and II errors
- sensitivity, specificity, and predictive values
- statistical tests – ANOVA, chi-square, linear versus logistic regression analysis, parametric versus nonparametric t-tests
- survival / ROC curves
- Clinical research studies:
- case reports
- cohort or registry studies
- ethical principles
- meta-analysis, scoping reviews, systematic reviews
- observational studies
- randomised control trials
- study types, and advantages and limitations
- Levels of evidence and classes of recommendations
- Population risk determination of endocrine disease development:
- biomarker development
- community / policy prevention measures
- principles of population screening
- risk scoring systems
Bone density and structure
- Densitometry investigations and limitations
- Quantitative bone ultrasound
- Quantitative CT assessment of bone density
Chemical pathology and laboratory testing of hormones
- Assay indications and limitations
- Assay interference – endogenous and exogenous paramete
- General laboratory processes for sample collection, storage, and processing
- Physiological influences on hormone assay results:
- age
- circadian rhythm
- exercise
- fasting
- menstrual cycle
- pregnancy
- Reference ranges and how they are derived, including indications for:
- age-matched
- gestational reference ranges
- sex-matched
- Sensitivity and specificity of testing choice
- Types of assays, such as:
- chemiluminescence
- colorimetric
- high performance liquid chromatography
- immunoassay
- mass spectrometry
Cytology and histopathology
- Adrenal cortical tumours
- Adrenal medulla tumours and paragangliomas
- Gonadal histology – assessment of tumour risk with DSD, hormone secreting gonadal tumours
- Other endocrine and neuroendocrine tumours, including malignancy
- Parathyroid
- Pituitary
- Thyroid nodule FNA interpretation
Dynamic endocrine testing
- Arginine stimulation test
- Assessment of disorders of glucose homeostasis
- Assessment of disorders of water homeostasis
- Assessment of glucocorticoid production
- Assessment of growth disorders
- Assessment of puberty disorders
- Clonidine stimulation test
- Clonidine suppression test
- Combined protocols – consider timing and order of tests
- Combined tests
- Fasting study
- Glucagon stimulation test
- GnRH stimulation test
- HCG stimulation test
- Mixed meal test
- Oral glucose tolerance test
- Oral glucose tolerance test for GH excess
- Overnight high dose dexamethasone test
- Overnight low dose dexamethasone test
- Short synacthen test
- Short synacthen test with adrenal androgens
- Stimulated copeptin
- Water deprivation test
Genetic testing
- For conditions where genetic testing is indicated, appropriate counselling and consent to be provided to patients prior to testing
- Role of microarrays, gene panels, targeted gene sequencing whole genome, and exome sequencing
Non-invasive tests and clinical assessment tools
- Diabetes management monitoring data:
- ambulatory blood pressure
- clinical risk assessment tools used with clinical judgment in the discussion of management with patients, such as monogenic diabetes calculator
- continuous glucose monitoring output data
- Ferriman–Gallwey scoring
- insulin dose calculator applications
- insulin pump upload data
- manual or digital blood glucose level diary
- Prader / external masculinisation score
- salivary testing
- Tanner staging
- urine testing
Nuclear medicine
- Diagnostic utility of nuclear isotopes in endocrine disease, such as:
- adrenal
- bone scans
- hyperinsulinism
- neuroendocrine tumours
- parathyroid
- thyroid
- Therapeutic utility of nuclear isotopes in endocrine disease management, including radionuclide ablation
Radiological investigations
- Awareness and applicability of scoring systems for risk, such as thyroid cancer TiRADS scoring
- Bone age
- CT scan, including role for monitoring
- Functional PET scanning
- MRI:
- adrenal
- hypothalamus
- pancreatic
- pituitary
- reproductive tract
- Skeletal survey for skeletal dysplasias
- Ultrasound assessment for parathyroid, puberty, and thyroid disorders
- Endocrine medical emergencies
- Evidence for best practice and its application, using clinical judgement, for individuals’ circumstances, in partnership with patients
- Incorporate environmentally sustainable practices in clinical care
- Multidisciplinary care and review
- Options for improving equitable access to comprehensive endocrine care for individuals, such as:
- multidisciplinary involvement
- resources appropriate to patients’ language and cultural needs
- use of telehealth and other digital health tools