Presentations
- Diarrhoea
- Flushing/Sweating
- Hypoglycaemia
- Incidental findings or screening due to associated or familial disease
- Loss of consciousness
- Paroxysmal hypertension
- Rash
- Weight loss
Conditions
- Carcinoid tumours
- Germ cell secretory tumours
- MEN syndrome
- Pancreatic neuroendocrine tumours
- gastrinoma
- glucagonoma
- insulinoma
- VIPoma
- Paraganglioma/phaeochromocytoma
- Paraneoplastic humoral syndromes:
- ectopic Cushing syndrome
- hypercalcaemia
- SIADH
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Carney complex
- McCune–Albright syndrome
- Von Hippel–Lindau disease
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Clinical science
- Epidemiology, natural history, prognosis, and genetic predisposition of neuroendocrine disease
Diagnostic work up
- Thorough history, physical examination, and diagnostic work up of people suspected of presenting with neuroendocrine disease or with a predisposition to a neuroendocrine syndrome
- Limitations, indications and interpretation of biochemical assays, imaging, and genetic tests in the diagnostic work up and surveillance of neuroendocrine disorders
Investigations
- Dynamic and invasive endocrine testing:
- specific understanding of indications and contraindications:
- 72-hour fasting
- calcium stimulation testing
- clonidine suppression
- workup for suspected ectopic Cushing syndrome
- Imaging:
- indications for localisation and surveillance imaging for specific tumour syndromes
- limitations of imaging modalities for specific tumour syndromes:
- CT
- endoscopic ultrasound
- functional PET scan
- MRI
- ultrasound
- Laboratory biochemistry:
- interpretation of biochemical testing in the clinical context with consideration of limitations and interfering medications
- properties, principles, and indications for biochemical investigation:
- baseline testing
- dynamic testing
- specific understanding of the timing, patient preparation and assay platforms suited for hormone testing
- Referral for surgical management, including preventative if appropriate
Evidence-based practice
- Remain abreast of evidence for best practice and apply this using clinical judgement and individual circumstances in partnership with patients
- Seek multidisciplinary care/review from centres of neuroendocrine care expertise, such as:
- genetics
- nuclear medicine
- oncology
- radiotherapy services
- surgical service
General management considerations
- Impact of neuroendocrine tumour/cancer and/or genetic diagnoses on the patient, their partner and, where applicable, their family and carers
- Incorporate environmentally sustainable practices in clinical care
- Longitudinal and multidisciplinary care needs of people with neuroendocrine disease or cancer
- Options for improving equitable access to comprehensive care for individuals, such as:
- appropriate multicultural resources
- multidisciplinary involvement
- use of telehealth and other digital health tools
- Referral for pre-conception counselling, if applicable
- Screening and genetic counselling of patients with inherited endocrine disease and referral of their family members if appropriate and with informed consent
