During this one-month hospital rotation, you will attend general endocrine clinic, diabetes clinic and a didactic each week and will be exposed to a number of common endocrine problems and will learn to recognize them and know the initial workup of such disorders. Faculty will provide direct supervision as you gain experience in clinical consults.
You will be taught to increase your knowledge in the following areas:
- Classification of hormones and mechanism of hormone action
- Understanding of normal growth and sexual maturation during infancy, childhood and adolescence
- Knowledge of genetic short stature and constitutional growth delay
- Ability to elicit an endocrine history and perform a physical examination including anthropometric measurements and the Tanner rating for sexual maturation
- Etiology, clinical manifestations, diagnosis, treatment and prognosis of thyroid disorders including:
- congenital hypothyroidism
- acquired hypothyroidism
- evaluation of a goiter
- hyperthyroidism including Grave’s Disease
- Etiology, clinical manifestations, diagnosis and treatment of growth disorders
- endocrine causes of short stature, hypopituitarism, hypothyroidism, hypercortisolism
- psychosocial dwarfism
- chromosomal abnormalities: Turner’s Syndrome, Klinefelter Syndrome
- bone dysplasias
- congenital syndromes — Noonan’s Syndrome, Prader-Willi
- chronic disorders — inflammatory bowel disease, cystic fibrosis
- Disorders of calcium and phosphorus metabolism
- hyper and hypoparathyroidism
- rickets
- Disorders of sexual differentiation and maturation
- ambiguous genitalia
- undervirilized male
- virilized female — congenital adrenal hyperplasia
- true hermaphrodite
- early sexual maturation
- premature thelarche
- premature adrenarche
- complete isosexual precocity
- late sexual maturation — hyper and hypogonadotrapic hypogonadism
- others — Klinefelter’s Syndrome, micropenis, cryptorchidism, gynecomastia
- Disorders of the adrenal cortex:
- congenital virilizing adrenal hyperplasia
- Addison’s Disease
- Cushing’s Syndrome
- Miscellaneous:
- diabetes insipidus, hypoglycemia, craniapharyngioma
- hirsutism
- opportunity for experience in the Endocrine Laboratory is available by prior arrangement with the endocrine faculty
You also will receive significant training in diabetes and you will be taught to:
- understand the criteria for diagnosing Type 1, Type 2 and atypical diabetes mellitus
- know the causes of secondary diabetes like cystic fibrosis, Cushing’s Syndrome and genetic disorders like Prader-Willi
- understand the relevance of impaired glucose tolerance and stress hyperglycemia
- begin therapy in a newly diagnosed insulin dependent diabetic patient using insulin, meal planning, and self-glucose monitoring and understand the different approaches in meal planning in diabetes
- know the varieties of insulin or insulin analogue in terms of priorities and duration of action
- understand alternate insulin regimens that are considered more intensive management; e.g., insulin pump therapy and multiple daily injections
- know how to recognize and treat hypoglycemia
- understand the current concept of etiology of diabetes and the natural progression of depletion of islet cell secretory activity over time
- know how to manage a patient with diabetes pre-op and post-op
- understand the use of the glycosylated hemoglobin test
- be able to diagnose and treat diabetic ketoacidosis and be aware of the complications of treatment including hypokalemia and cerebral edema
- recognize the psychosocial factors that influence to diabetes management and be able to adjust insulin doses (inpatient and outpatient) and also be familiar with management of diabetes in the face of illness that alters the usual food intake and/or insulin requirements as well as knowing the role of exercise in diabetes
- understand transient diabetes of the newborn
- be familiar with the research into the etiology of Type 1 diabetes including autoimmunity, genetics, and viruses; know the relevant information about HL-A typing; understand the immunologic abnormalities that accompany this form of diabetes
- understand and be able to diagnose the long-term complications of insulin dependent diabetes including nephropathy, retinopathy, neuropathy, limited joint mobility, and cardiovascular disease
- understand the applications of whole pancreas transplants, islet cell transplantation, and the artificial pancreas
- understand basic principles of Continuous Subcutaneous Insulin Infusion
- know the results of the Diabetes Control and Complications Trial and its implications in diabetes management
- know what the Diabetes Prevention Trial is, and its implications in screening of individuals at high risk for developing diabetes
Specialty Conferences: Didactic sessions occur weekly and include two to three lectures given by the endocrine attendings and fellows.
Diabetes Camp: Offered this year to the resident on the Endocrine-Diabetes rotation.
You will see three to four patients per day for a total of about 120 patients.