Knowledge guides

LG 14: 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.

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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.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management and outcomes.

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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
  • Evidence for best practice and application of this, using clinical judgement for individual circumstances in partnership with patients
  • Endocrine medical emergencies, and knowledge of how to manage appropriately
  • Environmentally sustainable practices in clinical care
  • Improving equitable access to comprehensive endocrine care for individuals, including:
    • appropriate multicultural resources
    • multidisciplinary involvement
    • use of telehealth and other digital health tools
  • Seek multidisciplinary care/review wherever necessary