Goals & Objectives
I. Rationale: Pediatric Endocrinology represents the study of communication; between distant
glands and organs and from cell to cell. Complicated feedback loops are involved in intricate
regulation of virtually all body functions through the endocrine system. Thyroid disease,
diabetes, short stature and many other conditions can affect the quality of life of children; the
general pediatrician needs a working knowledge of pediatric endocrinology principles in order to
effectively function on a day-to-day basis. By mastering the principles involved in evaluating a
child with a potential endocrine condition and developing a sound knowledge base of
endocrinology, the pediatric resident will be prepared to perform well as a general pediatrician in
the community after graduation.
II. Goal: To acquire and demonstrate the fund of knowledge and practical skills necessary to
manage common and complex pediatric endocrine conditions in infants, children, and
III. Specific Objectives:
A. Medical Knowledge
1. GOAL : Normal Versus Abnormal (Endocrine). Demonstrate the ability to differentiate
between normal and pathological states related to endocrinology, with the following
a. Describe normal patterns of linear growth and weight gain, applying this to evaluation of
variations in growth patterns.
b. Describe physiologic events in puberty and Tanner staging, and differentiate normal from
early and delayed puberty.
c. Differentiate premature thelarche and adrenarche from true precocious puberty.
2. GOAL : Common Conditions Not Referred (Endocrine). Demonstrate the ability to
diagnose and manage endocrine conditions generally not requiring referral; with the
a. Describe the pathophysiology of, recognize, and manage these conditions:
i. Abnormal newborn thyroid screen (initial evaluation)
ii. Benign premature adrenarche
iii. Benign premature thelarche
iv. Delayed puberty due to chronic disease or anorexia nervosa
v. Exogenous obesity
vi. Familial short stature, constitutional delay of growth or puberty
vii. Gynecomastia in a pubertal male
viii. Infant of mother with gestational diabetes
ix. Transient hypocalcemia in a newborn
x. Transient hypoglycemia in a newborn
3. GOAL: Conditions Generally Referred (Endocrine). Demonstrate the ability to
recognize, initiate management of, and refer endocrine conditions which require referral;
with the following objectives:
a. Identify, provide initial management of, and refer appropriately these conditions:
i. Adrenal insufficiency
ii. Ambiguous genitalia, hypogonadism, and micropenis
iii. Central and nephrogenic diabetes insipidus and psychogenic polydipsia
iv. Congenital adrenal hyperplasia
v. Delayed or precocious puberty
vi. Diabetes mellitus (diabetic ketoacidosis (DKA), long-term management)
vii. Endocrine and genetic causes of obesity
viii. Genetic syndromes and familial inheritance patterns with endocrine abnormalities
x. Hypoglycemia in childhood and adolescence
xi. Metabolic bone disease including rickets and skeletal dysplasias
xii. Persistent abnormalities of calcium, phosphorus, or magnesium homeostasis
xiii. Polycystic ovaries and hyperandrogenism in girls
xiv. Short stature variants, with selection of possible hormonal treatment
xv. Tall stature and excessive growth syndromes
xvi. Thyroid dysfunction and goiters
xvii. Turner syndrome
xviii. Undescended testes
xix. Zinc deficiency
4. GOAL: Diabetes Mellitus. Demonstrate understanding of the diagnosis and management
of diabetes mellitus; with the following objectives:
a. Recognize the initial presentation, perform confirmatory lab tests, treat immediate life
threatening complications, and refer for education.
b. Order and accurately interpret laboratory tests for screening, confirmation of diagnosis,
routine monitoring (glucose and Hemoglobin A1C), and identification of complications.
c. Recognize and treat DKA using appropriate IV and PO fluids, insulin, and laboratory
d. Demonstrate understanding of the correct use of home glucose monitoring and
adjustment of insulin dosages.
e. Describe the use of insulin including initial dosages, adjustment of dosages based on
serum glucose records or illness, different preparations, and pharmacokinetics.
f. Describe the principles behind preventative, anticipatory care for children with diabetes
and their families; be aware of community resources available to the family and diabetic
team (camps, American Diabetes Association materials, etc); be aware of future trends
for primary prevention of childhood diabetes.
g. Monitor patients routinely and review implications of diabetes associated complications
(retinopathy, nephropathy, neuropathy).
h. Identify the specialist's role in long-term management.
i. Counsel patients on the role of diet and exercise.
5. GOAL: Prevention (Endocrine). Demonstrate understanding of the pediatrician's role in
preventing morbidity related to endocrine dysfunction in children; with the following
a. Counsel parents and children about changes expected in puberty and normal variations.
b. Recognize need for influenza vaccination in children with certain endocrine disorders
(hypoadrenalism, diabetes mellitus, hypopituitary, and Cushings Syndrome).
c. Counsel asthmatics on steroids about risks.
d. Discuss Vitamin D supplements in breast fed infants and select populations with low
vitamin D, calcium, or phosphorus intake.
B. Skills: Acquire and demonstrate the following skills required to adequately evaluate and
manage the common maladies in pediatric endocrinology.
1. Obtain a comprehensive pediatric endocrinology history to include a clear definition of the
chief complaint, a comprehensive history of present illness, a thorough past medical
history to include a prenatal, perinatal and neonatal history to include birth weight and
length, medical history, developmental history, surgical history, dietary history and current
medicines expressed as standard dose per Kg or per M2, system review to include
symptoms related to the CNS, thyroid and chronic systemic diseases, family history to
include age, heights, weights, age of puberty and any medical conditions within the family
and to specifically annotate any endocrine maladies; (diabetes, thyroid disease, short
stature, abnormal puberty, infertility, menstrual irregularity, etc), and to summarize
relevant previous evaluations.
2. Evaluate and interpret growth data available in the medical record.
3. Perform a thorough physical examination with emphasis on the endocrine system to
include but not limited to, accurate measurement of stature/length, assessment of body
proportions (upper segment/lower segment ratio, arm span/height) and plotting in the
appropriate place on the appropriate growth curve, palpation of the thyroid gland,
assessment of sexual maturity rating (Tanner Stage), and comprehensive physical
examination related to the chief complaint.
4. Develop a differential diagnosis and plan for laboratory and radiologic evaluation related
to the history and physical examination.
5. Interpret laboratory results in the context of the particular patient.
6. Develop an appropriate plan for follow-up.
B. Patient Care: Demonstrate a family-centered consistent, compassionate, effective, and age
appropriate approach toward the evaluation and management of inpatients and outpatients
referred to the pediatric endocrinology service through the above activities.
C. Interpersonal Skills and communication: Demonstrate effective communication skills with
families and patients referred to the pediatric endocrinology service. Demonstrated effective
communication skill during the interaction with nurses and other doctors involved with the
referred patient. Maintain comprehensive and concise written consultations and notes on the
endocrine patients seen for the service.
D. Practiced based learning and improvement: Demonstrate the ability to use the medical
literature to effectively and cogently evaluate pediatric endocrine conditions or symptoms
and modify management plans appropriately based on the information obtained from the
literature. Demonstrate receptiveness to feedback provided during the rotation with
appropriate modification of behavior to improve performance.
E. Professionalism: Demonstrate a commitment to patient care and learning by timeliness,
responsibility for patients seen on the service, and sensitivity to cultural diversity.
F. Systems based practice: Demonstrate understanding of cost issues related to pediatric
endocrinology lab tests, radiographic studies, and medications. Demonstrate understanding
of health care prevention and maintenance related to pediatric endocrinology
I. LEARNING ACTIVITIES
A. Supplement learning by regularly reading the Pediatric Endocrinology articles provided in the
binder loaned to the resident at the beginning of the rotation. This binder contains over 50
articles covering endocrine topics important to the general pediatrician. These topics include:
1. Puberty- advanced and delayed
2. Thyroid disorders
3. Adrenal disorders
4. Growth disorders
5. Diabetes Mellitus
6. Other metabolic syndromes
7. Pituitary disorders
A. Patient care experience:
1. Perform initial assessment and plan for consultations written on inpatients referred to
2. See outpatient endocrine clinic patients with Dr Newman and Dr McClellan, writing the
notes on each patient seen. On a usual week this consists of seven ½ day clinics seeing
A. Meet with Dr Newman and Dr McClellan several times a week for informal discussions and
lectures on endocrinology topics. The discussions will focus on learning, in increased depth,
about the patients seen on the service.
B. At the end of the rotation participate in an oral examination in which you demonstrate
competence in evaluation and management of a patient in two or more of the following
1. A 16 year old girl with an enlarged thyroid gland
2. A 5 year old male with secondary sexual characteristics
3. A newborn with genital abnormalities
4. A 6 year old female with short stature
5. A 5 day old male with an abnormal newborn thyroid screen
6. A 14 year old female with recurrent diabetic ketoacidosis
7. A 15 year old diabetic with recurrent hypoglycemia
8. A 1 year old male with excessive growth
9. A 17 year old female with amenorrhea
10. A 2 year old male with bowed legs
A. Throughout the rotation, residents will be evaluated on their ability to gather data, analyze
data, and generate differential diagnoses and management plans based upon their reading
and experience. Residents should be able to discuss their initial approach, differential
diagnosis, evaluation, and management plan for each case encountered during the rotation.
B. Mid-rotation evaluation feedback will be given. A written evaluation of the resident’s
performance during the rotation will be completed at the conclusion of the experience.
Discussion of performance and feedback will be given at the conclusion of the oral
V. SUPERVISING STAFF
COL Robert J. Newman, MD
LTC Donald R. McClellan, MD