I. Thyroid Gland Disorders
1. Identify iodine as necessary for the synthesis of thyroid hormones.
2. Identify TRH and TSH and describe their role in regulating thyroid
3. Identify thyroxine (T4) and triiodothyronine (T3) as the two major thyroid
4. Describe the difference between free vs. protein-bound thyroid hormone
5. Identify and describe the role of each of the following diagnostic tests in
evaluating thyroid disease.
T3 resin uptake
T3 RAI (total serum T3)
free thyroid index (FTI)
thyroid radioiodine uptake (RAI uptake)
fine needle aspiration and cytology
6. Identify autoimmune processess and treatment for hyperthyroidism as the
most common causes of hypothyroidism in the USA; identify iodine
deficiency as the most common cause worldwide.
7. Identify Hashimoto's thyroiditis as an autoimmune disease that often
results in hypothyroidism with goiter.
8. Define "cretinism." Identify the relationship between thyroid hormone
deficiency at birth and mental retardation.
9. Describe the typical signs and symptoms of hypothyroidism.
10. Describe the clinical picture of severe hypothyroidism with myxedema.
11. Describe basic principles of thyroid replacement therapy for
hypothyroidism (choice of drug, schedule for increasing dosages, cautions
in elderly or cardiac patients).
12. Identify Graves' disease as the most common cause of hyperthyroidism;
distinguish between Graves' disease and other forms of hyperthyroidism.
13. Identify or describe the classic signs and symptoms of hyperthyroidism;
identify infiltrative ophthalmopathy as specific for Graves' disease.
14. Briefly describe the pros and cons of treating hyperthyroidism with:
antithyroid drugs (e.g., propylthiouracil and methimazole),
15. Describe the syndrome of toxic multinodular goiter.
16. Describe the syndrome of subacute thyroiditis.
17. Describe the syndrome of thyroid storm.
18. Describe the workup for a patient with a solitary thyroid nodule.
19. Describe the difference between, and clinical significance of, "hot"
nodules versus "cold" nodules on radioisotope scanning.
II. Diabetes Mellitus
1. Know the laboratory criteria for the diagnosis of diabetes mellitus in
2. Describe the differences between type 1 and type 2 diabetes mellitus.
3. Recognize the typical symptoms of hyperglycemia which may cause the
patient to present to the primary care practitioner.
4. Briefly describe the role that each of the following plays in the causation
of diabetes mellitus:
5. Identify diabetic ketoacidosis (DKA) and nonketotic hyperglycemic-
hyperosmolar coma as the two major consequences of uncontrolled
6. Recognize the signs and symptoms of DKA.
7. Recognize the signs and symptoms of nonketotic hyperglycemic-
8. Describe the symptoms of hypoglycemia that may be caused by insulin or
9. List or recognize the major chronic complications of diabetes mellitus,
especially increased atherosclerosis (CAD, CVA, PVD), diabetic
retinopathy, nephropathy, neuropathy, and foot ulcers.
10. Describe the characteristic clinical findings of diabetic retinopathy.
11. Describe the role that each of the following plays in management of
weight reduction for obesity
self-monitoring of blood glucose
glycosylated hemoglobin assay (Hb A1c)
*Note: we will leave details of the insulins and oral agents to the Patient
Management course. You should at least have an idea of which insulins are
short-, intermediate-, or long-acting for this course.
12. Describe the management issues for each of the following special cases in
III. Endocrine Roundup:
A. Parathyroid Disorders
1. Describe the role of each of the following in calcium homeostasis.
parathyroid hormone (PTH)
2. Identify the problems caused in the body by hypercalcemia.
3. Identify hyperparathyroidism and malignancy as the two major causes of
4. Identify common causes of hypocalcemia.
5. Identify the problems caused in the body by hypocalcemia.
6. Describe the following signs associated with hypocalcemia.
B. Pituitary Gland Disorders
1. Describe the relationship between the hypothalamus and the anterior
2. Recognize each of the following as anterior pituitary hormones, and state
briefly what each of them does in the body.
adrenocorticotropic hormone (ACTH)
growth hormone (GH)
thyroid stimulating hormone (TSH)
follicle stimulating hormone (FSH)
ltteinizing hormone (LH)
3. Recognize bilateral temporal field loss (homonymous hemianopsia) as a
classic presenting sign in pituitary tumors.
4. Identify arginine vasopressin (AVP), also known as antidiuretic hormone
(ADH), as a hormone produced by the posterior pituitary gland.
5. Define "diabetes insipidus" and identify how it would be recognized.
6. Identify dwarfism, gigantism, and acromegaly as consequences of either
under- or over-secretion of growth hormone.
7. Recognize the association of galactorrhea and amenorrhea in women with
excessive prolactin secretion (hyperprolactinemia).
C. Adrenal Gland Disorders
1. Identify cortisol, aldosterone, and androgens as adrenal hormones.
2. Describe the negative feedback relationship of ACTH secretion and
3. Describe the clinical presentation of primary adrenal insufficiency
4. Describe the clinical presentation of adrenocortical hyperfunction
(Cushing's syndrome). Distinguish between Cushing's syndrome and
5. Identify primary hyperaldosteronism as a cause of secondary
hypertension; recognize the association with spontaneous hypokalemia.
6. Describe the clinical features of pheochromocytoma.
1. Identify risk factors for development of osteoporosis.
2. Describe the clinical findings of osteoporosis.
3. Describe prevention and treatment measures* for osteoporosis.
*Note: details of the pharmacologic treatment options will be tested in the
Patient Management course.