Key presentations and conditions
Basic Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Conditions
- Acute metabolic derangements
- adrenal insufficiency
- diabetic ketoacidosis
- electrolyte disorders
- hyperglycaemic hyperosmolar state
- hypertensive crisis
- hypo- and hypercalcaemia
- hypo- and hypernatraemia
- hypoglycaemia
- pituitary apoplexy
- thyroid storm
- Diabetes mellitus and its complications
- type 1
- type 2
- Glucocorticoid therapy complications
- Obesity and metabolic syndrome
- Osteoporosis and osteopenia
- Polycystic ovary syndrome
- Thyroid disease
- hypo- and hyperthyroidism
- thyroid nodules
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - 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
Less common or more complex presentations and conditions
Basic Trainees will understand these presentations and conditions. Basic Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Conditions
- Adrenal gland disorders:
- adrenal carcinoma
- adrenal incidentaloma
- adrenal insufficiency
- congenital adrenal hyperplasia
- Bone metabolism disorders:
- osteomalacia
- Paget disease
- vitamin D deficiency
- Diabetes insipidus:
- cranial
- nephrogenic
- Endocrine disorders in pregnancy:
- diabetes mellitus
- gestational
- pre-existing
- thyroid disease
- diabetes mellitus
- Gender dysphoria and management of transgender patients
- Gonadal system:
- amenorrhea, primary and secondary
- infertility
- male hypogonadism
- menopause
- Hypothalamic–pituitary axis disorders:
- acromegaly
- Cushing syndrome
- hypophysitis
- hypopituitarism
- prolactin excess - prolactinoma and stalk effect
- thyrotropinoma (TSH-oma)
- Multiple endocrine neoplasia
- Neuroendocrine tumours
- Parathyroid disease
- Pituitary disease
- Secondary hypertensive disorders:
- phaeochromocytoma
- primary hyperaldosteronism
- Thyroid disease, such as thyroid malignancy
For each presentation and condition, Basic Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a relevant clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients1 and their quality of life
Manage
- provide evidence-based management
For less common or more complex presentations and conditions the trainee must also seek expert opinions - 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
Epidemiology, pathophysiology and clinical sciences
Basic Trainees will describe the principles of the foundational sciences.
- Anatomy and physiology of the endocrine system
- Autoimmunity and genetics as they relate to hormone disease
- Inborn errors of metabolism (IEMs)
- Management of glucocorticoid therapy, including pharmacology and physiology
- Metabolic cycles such as Krebs cycle
- Nutrition in relation to conditions, such as diabetes mellitus, obesity, and osteoporosis
- Pharmacology of major drug classes used to treat diabetes, osteoporosis, and syndromes of hormonal excess or deficiency
- Processes of sexual differentiation, growth, development, puberty, reproduction, and ageing
- Secretion, transport, and feedback control of hormones
- Structure and function of adipose tissue, adrenals, bone, gonads, hypothalamus, parathyroids, pituitary, and thyroid
- Structure and function of hormones, hormone action, hormone receptors, and second messengers
Investigations, procedures and clinical assessment tools
Basic Trainees will know the indications for, and how to interpret the results of these investigations, procedures, and clinical assessments tools. Basic Trainees will know how to explain the investigation, procedure, or clinical assessment tool to patients, families, and carers.
Investigations
- Antibody testing for autoimmune endocrine disease:
- diabetes mellitus, type 1
- thyroid disease
- Carcinoid tumour marker tests:
- 5-hydroxyindoleacetic acid urine
- chromogranin A
- Diabetes-related investigations:
- acid-base investigations
- albumin-to-creatinine ratio test
- C-peptide test
- HbA1c
- Diagnostic tests for bone and mineral metabolism disorders (interpret results in the context of serum, urine calcium, and phosphate levels):
- 1:25 dihydroxy vitamin D
- 25-hydroxyvitamin D (calcitriol)
- bone turnover markers
- parathyroid hormone
- parathyroid hormone-related protein
- DXA bone scan
- Endocrine dynamic function tests:
- 72 hour fast
- ACTH stimulation test (short synacthen test)
- dexamethasone suppression tests
- insulin tolerance test
- salt suppression tests
- urinary free cortisol / salivary cortisol
- water deprivation test
- Fluid and electrolyte balance investigations
- Gastrointestinal hormone levels
- Imaging of endocrine organs (to assess function):
- parathyroid sestamibi
- technetium-labelled thyroid scan
- Imaging of endocrine organs (to assess structure):
- CT
- MRI
- ultrasound
- Investigations for phaeochromocytoma
- Markers of endocrine neoplasia
- Pituitary function testing
- Sex hormone levels
- Thyroid hormone levels
Clinical assessment tools
- Anthropometric assessment:
- body mass index (BMI)
- triceps skinfold
- waist-to-hip ratio (WHR)
- Growth charts
Important specific issues
Basic Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
- Diabetes mellitus management:
- cultural, linguistic, and religious influences on management, such as traditional foods, attitudes to weight, and fasting periods
- design of medication regimens appropriate to patients’ social support, coping skills, comorbidities, and life expectancy
- epidemiology and challenges of management in Māori and Aboriginal and Torres Strait Islander peoples
- multidisciplinary approach to management and the roles of diabetes educator, dietitian, podiatry, psychologist, and other allied health professionals
- practical and psychological aspects of blood glucose monitoring and insulin therapy, including needle phobia, safe use and disposal of sharps, hypoglycaemia, and driving or occupational issues
- psychosocial factors impacting the care of young adult patients with diabetes transitioning from paediatric care
- regular screening for complications
- targets for glycaemic control and other metabolic parameters
- Nutrition:
- investigations and lifestyle counselling for obese patients and the role of surgery (restrictive and malabsorptive procedures) in managing severe cases of obesity
- potential public health and personal health consequences, both physical and psychological, of the obesity epidemic
- principles of healthy nutrition and physical activity throughout the lifespan
- refeeding management in chronically undernourished patients and in the case of starvation
- Postoperative management of patients who have undergone:
- adrenal surgery
- pituitary surgery
- thyroid surgery
- References to patients in the remainder of this document may include their families or carers.