TRAINING SYLLABUS

• Hypothalamus and Pituitary
• Thyroid, Parathyroid and Bone
• Reproductive, Pregnancy and Paediatric Endocrinology
• Adrenal cortex and medulla
• Metabolism, Energy balance and Lipids
• Genetics, Oncology and neuroendocrine tumours
• Diabetes Mellitus
• 15 credits each

Generic Skills and Core Knowledge Learning Activity topics will include:

• Overview of Endocrinology
• How to read and appraise a paper
• Clinical History taking
• Physical examination
• Biostatistics for clinical sciences
• Hormone synthesis and release
• Mechanisms of hormone action
• Hormone measurement - a "how to" guide
• Diagnostic endocrinology
• Principles of endocrine imaging
• The patient journey; what you need to know
• Basics of molecular biology
• Gene regulation in endocrinology
• Nuclear receptors
• Evidence-based medicine in endocrinology
• Designing and interpreting clinical studies
• Referral system for endocrine patient
• Topic-based discussion boards

Hypothalamus and Pituitary Learning Activity topics will include:

• Structure and function of the hypothalamus and pituitary
• Physiology and pathology of the anterior pituitary
• Physiology and pathology of the posterior pituitary
• Pituitary Histopathology
• Bedside aspects of pituitary dysfunction
• Basal and dynamic testing
• Pituitary tumours
• Physiology and pathology of the GnRH axis
• The GH axis
• Cases and discussion

Hypothalamic and Pituitary Disorders

1. Pituitary Tumors
   • Cushing's Disease
   • Acromegaly
   • Prolactinoma
   • Non-functioning adenomas
2. Space-Occupying/ Infiltrative Dis
   • Cranipharyngloma
   • Hemochromatosis
   • Histiocytosis X
   • Sacroidosis
3. Hypopituitarism
   • Adrenal
   • Thyroid
   • Growth hormone
   • Gonadotropins
4. Water Balance
   • Diabetes insipidus
   • SIADH
5. Disease Specific Studies/ Procedures
   • GnRH stimulation
   • Insulin induced hypoglycemia
   • CRH stimulation
   • IPSS
   • Pituitary imaging MRI/CT
   • Dexamethasone suppression

Thyroid, Parathyroids and Bone Learning Activity topics will include:

• Thyroid anatomy
• Overview of thyroid physiology and pathology
• Thyroid testing
• Hyper and hypothyroidism
• Thyroid disease and pregnancy
• Thyroid imaging
• Graves ophthalmopathy
• Approach to the thyroid nodule
• Thyroid surgery
• Diagnosis and treatment of thyroid cancer
• Bone physiology
• Disorders of calcium metabolism
• Disorders of Vitamin D metabolism
• Osteoporosis / Metabolic bone disorders
• Hyperparathyroidism
• Management dilemmas in parathyroid disease
• Cases and discussion
• Physiology of Ca, Mg, Phosphate homeostasis
• Molecular biology, biochemistry & mechanism of action - calcitropic hormones

Reproductive, Pregnancy and Paediatric Endocrinology Learning Activity topics will include:

• Physiology of puberty
• Endocrinology of fertility and reproduction
• Endocrinology of normal pregnancy
• Endocrine disorders in pregnancy
• Evaluating the hypothalamo-pituitary-gonadal axis
• Menstrual disorders
• Hirsutism
• Polycystic ovarian syndrome
• Hormonal aspects of contraception
• Gynecomastia assessment and management
• Male gonadal failure
• Testosterone replacement
• Endocrinology in gender dysphoria
• Assessment and treatment of the infertile couple
• Turner syndrome
• Menopause and premature ovarian failure
• Normal growth and development
• Disorders of growth and development in childhood
• Cases and discussion

Adrenal Cortex and Medulla Learning Activity topics will include:

• Anatomy and Physiology of the adrenal cortex
• Glucocorticoid physiology
• The glucocorticoid receptor and Glucocorticoid resistance
• Investigating the adrenal axis
• Adrenal imaging
• Approaches to adrenal surgery
• Endocrine hypertension: investigations and management
• Conn's syndrome
• Cushing's syndrome: diagnosis, investigation, management
• Congenital adrenal hyperplasia
• Adrenal insufficiency
• Perioperative management of the adrenal patient
• Steroid therapy: uses and cautions
• The adrenal incidentaloma
• Adrenocortical carcinoma
• Phaeochromocytoma
• Paragangliomas
• Cases and discussion

Metabolism, Energy Balance and Lipids Learning Activity topics will include:

• Water and sodium homeostasis
• Disorders of potassium and magnesium balance
• Brief review of fuel metabolism
• Metabolism in starvation, feeding and exercise
• Effects of critical illness on metabolism
• Overview of lipid biology
• Genetic dyslipidaemias
• Secondary dislipidaemias
• Lipids and vascular risk
• Lipid-lowering therapies
• Health economics of obesity
• Regulation of appetite
• Fat as an endocrine organ
• Genetics of obesity
• Assessment and management of the obese patient
• Bariatric surgery
• Endocrine sequelae of eating disorders
• Cases and discussion

Genetics, Oncology and Neuroendocrine Tumours

This is an Elective Module that is suitable for students interested in clinical endocrinology and endocrine oncology.

The module will cover some of the basic sciences, research techniques and clinical sciences underpinning the understanding of the genetics and oncology as applicable to endocrinology. You will look at the pathophysiology, investigations and management of endocrine disorders associated with cancers, many of which are genetically-determined and increase your knowledge of the common and important conditions.

Learning Activity topics will include:
• Inherited endocrine syndromes
• Multiple Endocrine Neoplasia
• Von-Hippel Lindau disease
• Succinate dehydrogenase, phaeochromocytoma and paragangliomas
• Guidelines for screening and surveillance
• Inherited syndromes of hormone resistance
• Hormone physiology of the Gut and Pancreas
• Neuroendocrine tumours: features and histopathology
• Diagnosis and treatment of neuroendocrine tumours
• Imaging of neuroendocrine tumours
• Carcinoid
• Tumour markers
• Insulinoma: diagnosis, localisation and treatment
• Endocrine aspects of oncology
• Late effects of oncology therapy
• Cases and discussion

Clinical Chemistry
This is an Elective Module that is suitable for students interested in clinical chemistry and/ or laboratory aspects of clinical endocrinology. This module is. recommended for trainees in metabolic medicine and clinical biochemistry, although it may also interest some trainees in endocrinology and diabetes.
The module will cover some of the basic sciences, research techniques and clinical sciences underpinning the understanding of clinical chemistry.
Learning Activity topics will include:
• Laboratory techniques in clinical biochemistry and the indications for investigations, interpretation of results and limitations and pitfalls in lab techniques.
• Inborn errors of metabolism including carbohydrate and protein metabolism, lysosomal disorders and mucopolysaccharidoses.
• Pathophysiology and evaluation of abnormalities of hem biosynthesis, porphyrias, red cell enzyme defects and other aspects of hematological chemical pathology.
• Pathophysiology, evaluation and investigation of disorders of copper metabolism.
• Use of biochemical markers in diagnosis and monitoring of disease including enzymes and proteins.
• Use of therapeutic drug monitoring and analytical toxicology and diagnosis and management of patients with poisoning including alcohol.

Diabetes Mellitus Learning Activity topics will include:

• Diagnostic criteria / classification
• Diet and education in Diabetes mellitus
• Diabetes, pre-diabetes and insulin resistance
• Current trials and evidence for glycaemic control
• Oral hypoglycaemic agents
• Insulins, injection regimes and pumps
• New and emerging therapies
• Diabetic emergencies
• Diabetes and the eye
• Diabetes and the kidney
• Diabetic neuropathies
• Diabetic gastroenteropathies
• Macrovascular disease
• The foot in diabetes
• Diabetes in special circumstances
• Diabetes, exercise and sports
• Inpatient diabetes
• Diabetes in pregnancy, in childhood and adolescence HOT topics
• Cases and discussion

1. Research Methodology
2. Diabetic Foot Care Hands on
3. Diabetic Retinopathy
4. Insulin Technique (Hands On)
5. Communication /Counseling Skills

LOG BOOK
The learning experience of a trainee should be properly recorded in the log book which should provide information on:

• Cases and statistics of outpatient / inpatient which have been managed and followed through, with details on highlights and learning points of each case with related literature references.
• Procedures/ endocrine dynamic testing and statistics should demonstrate procedures observed / done with supervision and done independently.
• Educational activities
• Research Activities
• Publications
• Presentation at meetings
• Attendance of courses, seminars, workshops The log book records should demonstrate increasing exposure and experience of the trainee throughout the training period.

EVALUATION

1. Internal Evaluation
   There will be an internal evaluation after every six months.
2. Evaluation after First Year
   After completion of one year, there will be examination from the topics included in the 1st year of syllabus and those who pass will be able to appear in final examination. The examination will be consisting of:
   • Theory:
     Paper 1 SEQs (10) (100 Marks)
     Paper 2 BCQs (75) (100 Marks)
   • OSPE (200 Marks)
   • Long Case (200 Marks)
   • Short Cases (200 Marks) After passing theory, student can appear in three attempts whether availed or un-availed. The candidates will only be promoted in 2nd year course after passing first year.

• Exit Evaluation
  On satisfactory completion of of 2 year training, exit examination will be taken from the topics included in the 2nd year of syllabus. The trainee will be assessed by an invited Board of Examiners determined by the Examination Department, LUMHS. Exit evaluation will include:
  • Review of log book and Supervisor / Trainer assessment reports.
  • Theory:
    Paper 1 SEQs (10) (100 Marks)
    Paper 2 BCQs (75) (100 Marks)
  • OSPE (200 Marks)
  • Long Case (200 Marks)
  • Short Cases (200 Marks)
• Research Project Presentation/Thesis defence or two publications pertaining to subject during the training period. Examination will be conducted twice a year. After passing theory student can appear in three attempts whether availed or un-availed.

CERTIFICATION OF COMPLETION OF TRAINING
A Certificate of Completion of Subspecialty Training (M. Sc in Endocrinology and Diabetes) will be awarded to the trainee following completion of the required training period and Exit Evaluation.

Note: The University authorities reserve the right to make change/ amend the rules & regulations, or in any other aspect of admission process and conduct/ completion of the course as and when deemed necessary, without prior notice.