Curriculum standards

Anatomy, histology, and physiology of the endocrine organs, including

• Adipose tissue
• Adrenal cortex
• Adrenal medulla
• Bone
• Female reproductive tract
• Male reproductive tract
• Pancreas
• Parathyroid
• Pituitary
• Thyroid

Classes of hormones

• Structure, function, and biosynthesis of hormones:
  • aminergic hormones
  • peptide hormones
  • steroid hormones
  • thyroid hormones

Mechanisms of hormone action

• Classes of peptide and aminergic hormone receptors
• Classes of nuclear hormone receptors
• Distinguish between endocrine, paracrine, and autocrine functions of hormones
• Principles of receptor signalling:
  • G-protein coupled
  • nuclear
  • tyrosine kinase

Regulation of hormonal systems

• 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)
  • vitamin D biosynthesis pathway
• Hypothalamus/anterior and posterior pituitary axes:
  • anti-diuretic hormone
  • CRH, ACTH, cortisol
  • dopamine, prolactin
  • GHRH, GH, IGF-1
  • GnRH, FSH, LH, oestrogen, progesterone, testosterone
  • oxytocin
  • TRH, TSH, thyroid hormones
• Key biosynthetic pathways of hormones
• Lipid metabolism
• Major stimuli and inhibitors of individual hormones
• Negative and positive feedback regulation of endocrine systems
• Pancreatic and gastrointestinal hormones:
  • gastrin
  • glucagon
  • glucagon-like peptide (GLP)/gastric inhibitory polypeptides (GIPs) and peptide YY
  • insulin
  • somatostatin
• Reproduction:
  • AMH, inhibins and activins
  • HPG axes (GnRH, FSH, LH, oestrogen, progesterone, testosterone)

Principles of statistics and epidemiology

• Basic statistics:
  • absolute and relative risk
  • likelihood ratios and odds ratios
  • null hypothesis and P-values, confidence intervals
  • sensitivity, specificity, and predictive values
  • statistical tests – chi-square, t-tests, ANOVA, linear vs logistic regression analysis, parametric vs non-parametric
  • type I and II errors, power calculations
• Clinical research studies:
  • case reports
  • cohort or registry studies
  • ethical principles
  • observational studies
  • randomised control trials
  • study types, advantages and limitations:
  • systematic reviews and meta-analysis
• 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

Non-invasive tests and clinical assessment tools

• Ambulatory blood pressure
• Clinical risk calculators (used with clinical judgment in the discussion of management with patients), such as:
  • cardiovascular risk calculators
  • breast cancer risk calculators
  • Dutch lipid score
  • fracture risk calculators
  • MODY calculator
• Diabetes management monitoring data:
  • manual or digital BGL diary
  • continuous glucose monitoring output data
  • insulin pump upload data
• Ferriman-Gallwey scoring
• Salivary testing
• Semen analysis
• Tanner staging
• Urine testing

Chemical pathology and laboratory testing of hormones

• Assay indications and limitations
• Assay interference (endogenous and exogenous parameters)
• 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:
  • indications for age-matched, sex-matched, gestational reference ranges
• Sensitivity and specificity of testing choice
• Types of assays, such as:
  • antibody chemiluminescence
  • liquid chromatography
  • tandem mass spectrometry

Cytology and histopathology

• Adrenal cortical tumours
• Adrenal medullary tumours and paragangliomas
• Hormone-secreting gonadal tumours
• Other neuro-endocrine tumours
• Pancreatic neuro-endocrine tumours
• Parathyroid
• Pituitary
• Thyroid nodule FNA interpretation and scoring

Dynamic endocrine testing

• Adrenal vein sampling
• Calcium stimulation testing
• Clonidine suppression test
• Fludrocortisone suppression test
• Glucagon and arginine stimulation tests
• Insulin tolerance test
• Mixed meal test
• OGTT for glucose and growth hormone
• Overnight metyrapone test
• Saline suppression test
• Short synacthen test for cortisol and 17OHP
• Stimulated copeptin testing
• Water deprivation test
• Workup for suspected Cushing syndrome:
  • dexamethasone suppression tests
  • inferior petrosal sinus sampling

Radiological investigations

• CT scan:
  • adrenal
  • metastases from endocrine malignancies
  • ovary
  • pancreas
  • parathyroid
  • pituitary
  • thymus
  • thyroid
• MRI:
  • adrenal
  • hypothalamus
  • ovary
  • pancreas
  • pituitary
• PET scan
• Ultrasound:
  • endometrium
  • ovary
  • parathyroid
  • testis
  • thyroid

Nuclear medicine

• Diagnostic utility of nuclear isotopes in endocrine disease, including thyroid, parathyroid and bone investigations
• Therapeutic utility of nuclear isotopes in endocrine disease management, including radionuclide ablation

Bone density and structure

• Densitometry investigations and limitations
• Quantitative CT assessment of bone density

Genetic testing

• For conditions where genetic testing is indicated, appropriate counselling and consent is provided to the patient prior to testing