Presentations
- Abdominal pain
- Diarrhoea
- Dizziness
- Dysphagia
- Dyspnoea
- Early / Precocious puberty
- Excessive sweating
- Fatigue
- Frequent urination
- Growth failure
- Gynaecomastia
- Headache
- Heart palpitations
- High blood pressure
- Increased thirst
- Localised pain / swelling
- Nausea
- Short stature
- Skin rash
- Stomach ulcers
- Visual disturbance
- Vomiting
- Weight changes
Conditions
- Craniopharyngiomas
- Endocrine effects of cancer treatment (see ‘Important specific issues’)
- Endocrinopathies associated with primary oncological presentations:
- germinoma
- Langerhans cell histiocytosis
- optic gliomas and other suprasellar neoplasms
- sex cord stromal tumours
- testicular germ cell tumours
- Inherited tumour syndromes, including but not limited to:
- Beckwith–Wiedemann syndrome
- Carney complex
- DICER1 mutations
- Li Fraumeni syndrome
- Lynch syndrome
- multiple endocrine neoplasia:
- PTEN hamartoma syndrome
- SDH mutations
- Von Hippel-Lindau syndrome
- Other solid tumours:
- adrenocortical tumours
- phaeochromocytomas
- thyroid cancers
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
Conditions
- Neuroendocrine tumours:
- carcinoid
- gastrinomas
- insulinomas
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
- Effects of treatment of cancer on the neuroendocrine system
- Growth hormone-IGF-1 axis and the brain
- End-organ, hypothalamic, and pituitary physiology and feedback systems for adrenal, gonads, growth hormone, and thyroid
- Neuroendocrine control of appetite and satiety
- Neuroendocrinology and the reproductive axis
- Regulation of appetite and weight
- Thyroid axis and the brain
Pharmacological therapy
- Classes of chemotherapy drugs and their endocrine effects (basic understanding of)
- Gonadotropin-releasing hormone (GnRH) analogues
- Hormone replacement therapy, such as:
- desmopressin
- glucocorticoid replacement
- growth hormone replacement
- pubertal induction and maintenance therapy:
- oestrogen therapy – oral, transdermal
- testosterone therapy – gel, intramuscular
- use of gonadotrophin therapy
- thyroxine replacement
- Perioperative blockade for phaeochromocytomas:
- pharmacological therapy perioperatively:
- alpha and beta blockade
- calcium channel blockers
- Precision therapies and their endocrine effects (basic understanding of), including:
- dopamine receptor agonists
- prolactinomas
- somatostatin analogues
Investigations
- Hormone stimulation tests (order and interpret), including basal and dynamic testing of pituitary function
- Pituitary MRI
Procedures
- Options for fertility preservation, including procedures such as:
- oocyte harvest
- ovarian tissue cryopreservation
- semen analysis
- testicular aspiration
- testicular biopsy
Endocrine effects of cancer treatment
- Awareness of possible endocrinopathy associated with precision therapies, which remains in evolution:
- CAR-T – autoimmune thyroid disease
- monoclonal antibodies:
- adrenalitis
- autoimmune thyroid disease
- hypophysitis
- polyendocrinopathies
- type 1 diabetes
- small molecule kinase inhibitors – hypothyroidism
- Awareness of the interaction between other chemotherapy agents and endocrinopathies, such as:
- PEG-asparaginase-hyperglycaemia
- steroids:
- AVN
- fractures
- hyperglycaemia
- osteoporosis
- Complex late effects of cancer treatment
- Complications of alkylating chemotherapy, including:
- primary gonadal failure and effects, as per radiotherapy below
- Effects and complications of radiotherapy by region of exposure:
- cranial:
- central adrenal insufficiency
- central hypothyroidism
- central precocious puberty
- GH deficiency
- hypothalamic / pituitary axis dysfunction
- metabolic-like syndrome
- gonads:
- primary ovarian insufficiency, including:
- infertility / subfertility
- premature menopause
- pubertal delay / arrest
- testicular failure, including:
- infertility / subfertility
- post-pubertal testosterone deficiency
- pubertal delay / arrest
- thyroid:
- primary hypothyroidism
- thyroid nodules and carcinoma
- Endocrine complications of bone marrow transplant (note that complications of alkylating chemotherapy and total body irradiation also apply):
- autoimmune thyroid disease
- infertility / hypogonadism
- metabolic syndrome
- Endocrine complications of neurosurgery:
- pituitary (or nearby):
- central diabetes insipidus
- multiple pituitary hormone deficiencies (see LG16)
- Potential for multiple areas of endocrine end-organ damage, and how the interaction between comorbid endocrinopathies can impact management, such as:
- central precocious puberty with comorbid growth hormone deficiency
- mixed central and primary gonadal failure
- pubertal assessment in males after gonadotoxic therapies, and implications for clinical assessment and treatment
Inherited cancer syndromes
- Implications of genetic testing and the principles of clinical genomics
- Screening guidelines for inherited cancer syndromes, and interpret investigations
