Endocrinology Specialization Training Program (For European Resident Physicians

YEAR RESIDENCY MONTHS WEEKS HOURS First Internal medicine Endocrinology service for adults 3* 8 13 35 60 hours per week** 60 hours per week Second General endocrinology Endocrinology and pregnancy Center for education and care of the diabetic patient Endocrinology laboratory 6 2 1 2 24 8 4 8 60 hours per week 60 hours per week 60 hours per week 60 hours per week Third General endocrinology Pediatric endocrinology service 8 3 32 12 60 hours per week 60 hours per week Diseases and syndromes treated in intermediate therapy services and clinical rooms Acute bronchial asthma crisis and severe acute asthma Adult respiratory failure Acute myocardial infarction Hypertensive crisis Arrhythmias Chest pain Heart failure and acute pulmonary edema Cerebrovascular disease Cardiorespiratory arrest Pulmonary thromboembolism and hypertensive pulmonary heart disease Acute abdominal pain Follow-up in the case of acute diarrhea Follow-up in the case of anuria Altered hydromineral balance Meningoencephalitis Acute febrile illness Upper and lower gastrointestinal bleeding Shock Acute poisoning Endocrine emergencies: Ketosis and diabetic ketoacidosis Lactic acidosis Nonketotic hyperosmolar coma Hypoglycemia Adrenal crisis Myxedema coma Thyroid crisis Acute hypocalcemia Prevention and control of hospital-acquired diseases Medical emergencies in pregnant women Ethical principles in the care of emergency patients and their families The following aspects are analyzed for each of the diseases studied: Concept, etiology, epidemiology, classification, clinical forms, pathophysiology, clinical manifestations, complementary tests, diagnosis, differential diagnosis, evolution, complications, sequelae, prognosis, comprehensive treatment (prophylactic, medical-surgical, acute and supportive), rehabilitation Basic principles in the endocrinology laboratory Radioimmunoassay; hormones, proteins and steroids; ultra-microanalytical system Fundamentals, indications, procedures and interpretation of baseline measurements or dynamic tests Diagnostic procedures on: hypothalamus, pituitary gland, thyroid, parathyroid, pancreas and lipids, adrenal cortex, adrenal medulla, ovaries, testicles Female reproduction, cytogenetics and immunology laboratories III. Introductory clinical endocrinology, CH, embryology, anatomy, histology and physiology of the endocrine system: General concepts of endocrinology Concept of endocrine regulation Feedforward Feedback. Positive and negative feedback Hormonal and humoral feedback Long, short and ultra-short loop feedback Hormonal biosynthesis patterns Definition of receptors and their cellular location General mechanisms of hormone action Neuroendocrinology Cortex-endocrine gland relationship Neurotransmitters Cortico-hypothalamus-pituitary relationship Adeno and neurohypophysis Embryology Normal histology Anatomy Physiology Hypothalamic-pituitary relationships Peripheral actions of pituitary hormones and mechanisms of action Thyroid Embryology Normal histology Anatomical relationships Iodine kinetics Hypothalamus-pituitary-thyroid regulation Thyroid autoregulation Thyroid hormone synthesis Peripheral actions of thyroid hormones and mechanism of their action Parathyroid Embryology Histology Anatomy Physiology Peripheral actions of PTH, calcitonin and vitamin D PTH synthesis and secretion Mineral metabolism (calcium, phosphorus and magnesium) Skeletal and mineral homeostasis Pancreas Embryology Histology Anatomy Hormone production Insulin and glucagon Insulin secretion Insulin mechanism of action Regulation of insulin synthesis Glucagon actions Other counterregulatory hormones and their action Fed and fasted glucose homeostasis Lipid metabolism Triglyceride metabolism: fat for energy Cholesterol metabolism Hyperlipidemia Atherosclerosis Adrenal cortex and medulla Embryology Histology Anatomy Steroidogenesis Hypothalamic-pituitary-adrenal axis Renin-angiotensin-aldosterone axis Circadian rhythm Peripheral actions of mineralocorticoids and glucocorticoids Hormonal mechanism of action of steroid hormones Biosynthesis of catecholamines Actions of catecholamines APUD system Testicles Embryology Histology Anatomy Testicular physiology Hypothalamic-pituitary-testicular axis Spermatogenesis Peripheral actions of testosterone and dihydrotestosterone Mechanism of action of androgens Importance of Sertoli cells Ovaries Embryology Histology Anatomy Ovarian physiology Hypothalamic-pituitary-ovarian axis Oogenesis Peripheral actions of estrogen and progesterone Mechanism of action of ovarian hormones Normal puberty Influence of the endocrine glands on development and growth Growth hormone Thyroid hormones Insulin Glucocorticoids Androgens Estrogen Progesterone Peptide growth factors Control of growth at the cellular level Prenatal growth Growth from birth to puberty Pubertal growth Bone age and physical maturity Development of specific organs and tissues Growth by hyperplasia and growth by hypertrophy Normal sexual differentiation Chromosomal sex and biological functions of the Y and X chromosomes H-Y antigen Differentiation of the gonads Differentiation of the internal genitals Differentiation of the external genitalia and urogenital sinus Sexual differentiation in the hypothalamus Psycho-sexual differentiation Genetics and endocrinology Mitosis and meiosis Normal human chromosomes Chromosomal aberrations Structural Numerical Interpretation Interpretation Chromosomal alterations of the most common endocrine diseases General principles of hereditary diseases Genetic action endocrine glands Immunology General concepts Concept of antigens Concept of antibodies Types of immunity (autoimmunity, humoral immunity and cellular immunity) Concept of HLA and its importance in pathology Autoimmunity and endocrine diseases Mechanisms involved in the production of autoimmune endocrinopathies Predisposing factors: environmental and genetic Autoimmune polyendocrine syndrome Nature of the immune response Immune-mediated tissue injury Influence of the endocrine system in the expression of allergic and immunological reactions Allergic and immunological reactions to hormones Skin and hormones Hormones, the epidermis and dermis Dermal vascularization and hormones Hormones, melanocytes and pigmentation Hypopituitarism Concept of panhypopituitarism and selective and partial hypopituitarism Causal classification Clinical picture Differential diagnosis (anorexia nervosa, primary hypothyroidism primary adrenal insufficiency, primary hypogonadism, anemias, hypoglycemic syndrome, cachexia from other causes, short stature from other causes) Study program Acromegaly and gigantism Concept Etiology Clinical picture Differential diagnosis Study program Prolactinomas and hyperprolactinemia Concept Frequency Clinical picture Differential diagnosis Other pituitary tumors Concept of pituitary tumor Concept of macro and micro adenoma Variants of tumor growth Classification according to hormonal secretion vs staining classification Clinical picture Other non-pituitary tumors (craniopharyngioma) Study program Mild polyureic-polydipsic syndrome Concept of VSDI, VRDI and potomania Pathogenic classification Clinical picture Study program Short stature Concept Causal classification Etiological diagnosis Differential diagnosis Study program Bone age determination, oral chromatin and skull radiology in the study of short stature syndrome Tall stature syndrome Concept Causal classification Etiological diagnosis Differential diagnosis Study program Hyperthyroidism Concept Classification Clinical picture varieties Differential diagnosis Etiopathogenesis of Graves-Basedow disease Clinical manifestations of Graves-Basedow disease Thyrotoxic crisis diagnosis and treatment Hyperthyroidism study program Thyroiditis Acute thyroiditis, etiology, diagnosis Subacute thyroiditis, etiology, diagnosis Hashimoto’s disease, etiology, diagnosis Chronic, mycotic and bacterial thyroiditis, etiology, diagnosis Riedel’s thyroiditis, etiology, diagnosis Hypothyroidism Concept Causal classification Clinical picture Differential diagnosis Study program Hypothyroidism in children Single thyroid nodule, nodular goiter, and thyroid cancer Concept Clinical diagnosis Pathological classification of the thyroid nodule Study program Clinical manifestation and survival of thyroid cancer Genetic alterations that affect the synthesis, transport and utilization of thyroid hormones Intrathyroidal enzyme abnormalities, diagnosis and treatment Uptake defect Organification defect Proteolysis defect Coupling defect Dehalogenation defect Extrathyroidal genetic alterations, diagnosis and treatment Changes in TBG serum concentration Peripheral resistance to thyroid hormones Euthyroid goiter Concept Causal classification Clinical diagnosis and etiology Differential diagnosis Complementary examinations Hyperparathyroidism Concepts of hypercalcemia and primary, secondary and tertiary hyperparathyroidism Etiology Clinical picture Differential diagnosis Study program Other causes of hypercalcemia Examinations that aid in the localization of a tumor Hypoparathyroidism Concept Etiological classification Causes with inadequate secretion of PTH Causes in which the secretion is normal but biologically ineffective Peripheral resistance to PTH (pseudohypoparathyroidism) Clinical picture Differential diagnosis Study program Other causes of hypocalcemia Pseudo-pseudohypoparathyroidism Rickets and osteomalacia Diabetes mellitus (DM) Definition Classification Conditions and associated syndromes Impaired glucose tolerance (IGT), previous and potential Pathophysiology Clinical picture Etiopathogenesis of type 1 DM Environmental factors Immunological factors Inherited genetic factors Role of the HLA system in the etiopathogenesis of type 1 DM Insulin gene polymorphism Etiopathogenesis of type 2 DM Diabetic ketoacidosis Concept of ketosis and ketoacidosis Triggers Clinical picture Complementary examinations Differential diagnosis Hyperosmolar coma and lactic acidosis Concept Clinical picture Triggers Differential diagnosis Complementary examinations DM in children and adolescents Diagnosis Control criteria Acute complications Diabetes and pregnancy Gestational diabetes, concept and diagnosis Potential abnormality of glucose tolerance Most frequent congenital malformations in the child of a diabetic mother Ocular complications of DM Diagnosis Retina Iris Crystalline Conjunctiva Cornea Intraocular muscles Nerves Diabetic nephropathy Concept Histological classification Clinical picture Differential diagnosis Complementary examinations Diabetic neuropathy Concept Classification and diagnosis Complementary examinations Skeletal and joint complications of DM Neuropathic arthropathy Diabetic osteopathy Osteopenia Articular syndromes of the hand Vascular complications of DM Macroangiopathy Microangiopathy Dermatology complications of DM Ochre dermatitis Diabetic dermopathy Necrobiosis lipoidica diabeticorum Diabetic bullae Granuloma annulare Diabetic foot Concept Etiopathogenesis Classification Clinical picture Complementary examinations Special situations in diabetic treatment Hypoglycemia Insulin lipodystrophy Insulin allergy Insulin resistance Other diabetic comas Infections Malignant otitis Acute hepatitis Hyperthyroidism Acute myocardial infarction (AMI) Hypoglycemic syndrome Concept Causal classification Clinical picture Differential diagnosis Study program Hyperlipoproteinemia Concepts of hyperlipidemia, hyperlipemia, α-lipoproteins, β-lipoproteins, pre beta lipoproteins, wide β-lipoprotein Mechanism of absorption and digestion of lipids Metabolism of lipoproteins Concept and types of apoproteins, function and properties Classification of hyperlipoproteinemia Diagnosis Obesity Concept Diagnosis Differential diagnosis Classification Complications Study program Cushing’s disease Concept Causal classification Clinical picture Differential diagnosis Study program Adrenal insufficiency Concept Clinical picture and differential diagnosis Causal classification Study program Congenital adrenal hyperplasia (CAH) Concept Enzyme defects that produce congenital adrenal hyperplasia Clinical picture Differential diagnosis Study program Primary hyperaldosteronism Concept Classification Clinical picture Differential diagnosis Study program Pheochromocytoma Concept Classification Clinical picture Differential diagnosis Study program Amenorrhea Concept of primary and secondary amenorrhea Concept of oligomenorrhea Causal classification Etiological diagnosis Study program Female hypogonadism Causal classification Concept of primary and secondary hypogonadism Clinical picture Study program Abnormal uterine bleeding Concept Causal classification Etiological diagnosis Study program Hirsutism Concept of hirsutism and hypertrichosis Assessment of the severity of hirsutism, quantitative index Causal classification Etiological diagnosis Study program Infertility (masculine and feminine) Concepts Causal classification Diagnosis Study program Masculine hypogonadism Causal classification Concept of primary and secondary, pre- and post-pubertal hypogonadism Clinical picture Study program Empty scrotum syndrome Concept of cryptorchidism, retractile testicles, testicular ectopia and anorchia Clinical diagnosis Complementary examinations Pubertal delay Concept Clinical diagnosis and etiology Study program Variations in pubertal development Premature pubarche or adrenarche Premature thelarche Premature menarche Virginal breast hypertrophy Small breasts Gynecomastia Menstrual disorders Early sexual development Concept of true early puberty and sexual precocity Etiological classification Clinical diagnosis and etiology Differential diagnosis Study program Hypogenitalism Concept Classification Clinical diagnosis Study program Abnormalities of sexual differentiation Concept Classification Concept of ambiguous genitalia Differential diagnosis of sexual differentiation abnormalities Gonadal dysgenesis: Turner, mixed and pure; diagnosis and treatment Klinefelter syndrome Diagnosis and treatment Masculine and feminine pseudo hermaphroditism, diagnosis Gonadal tumors with endocrine function Ovarian tumors Testicular tumors Classification Diagnosis Systemic contraception Multiple endocrine adenomatosis (MEN) Endocrine hypertension Renin-aldosterone axis in blood pressure control Renin system description Abnormalities of aldosterone and renin secretion Electrolyte balance and hypertension diagnosis Hypopituitarism Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Acromegaly and gigantism Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Prolactinomas and hyperprolactinemia Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Other pituitary tumors Mild polyuria-polydipsia syndrome Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Therapeutic approach to tall stature syndrome Therapeutic approach to short stature syndrome Hyperthyroidism Objectives of comprehensive treatment Dosages and routes of administration Treatment with medicine, surgery and I-131 Secondary effects Most common complications Evolution Prognosis Thyroiditis Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Hypothyroidism: Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Single thyroid nodule, nodular goiter, and thyroid cancer Objectives of comprehensive treatment Dosages and routes of administration Indications of surgical treatment Other forms of treatment Evolution Prognosis Euthyroid goiter Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Hyperparathyroidism Objectives of comprehensive treatment Indications of surgical treatment Other forms of treatment Evolution Prognosis Hypoparathyroidism Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Evolution Prognosis Diabetes mellitus (DM) and AGT Objectives of treatment Preventative treatment Diabetes education Diet Exercises Oral hypoglycemia, indications and contraindications, drugs used and mechanisms of action Metabolic control criteria Diabetic ketoacidosis Objectives of comprehensive treatment Most common complications Evolution Prognosis Hyperosmolar coma and lactic acidosis Objectives of comprehensive treatment Most common complications Evolution Prognosis DM in children and adolescents Objectives of comprehensive treatment Dosages and routes of administration Other forms of treatment Secondary effects Most common complications Metabolic control criteria Treatment for acute complications of DM Evolution Prognosis Diabetes and pregnancy Objectives of comprehensive treatment Diets for pregnant women Insulin treatment schemes Secondary effects Most common complications Evolution Prognosis Ocular complications of DM Objectives of comprehensive treatment Forms of treatment Secondary effects Most common complications Evolution Prognosis Diabetic nephropathy Objectives of comprehensive treatment Forms of treatment Secondary effects Most common complications Evolution Prognosis Diabetic neuropathy Objectives of comprehensive treatment Forms of treatment Secondary effects Most common complications Evolution Prognosis Skeletal and joint complications of DM Diabetic foot Objectives of comprehensive treatment Forms of treatment Secondary effects Most common complications Evolution Prognosis Special situations in diabetic treatment Hypoglycemia Insulin lipodystrophy Insulin allergy Insulin resistance Other diabetic comas Infections Malignant otitis Acute hepatitis Hyperthyroidism Acute myocardial infarction (AMI) Hypoglycemic syndrome Objectives of comprehensive treatment Forms of treatment Secondary effects Most common complications Evolution Prognosis Hyperlipoproteinemia Objectives of comprehensive treatment Diets Forms of treatment Secondary effects Most common complications Evolution Prognosis Obesity Objectives of comprehensive treatment. Forms of treatment Most common complications Evolution Prognosis Cushing’s disease Objectives of comprehensive treatment Forms of treatment Surgical criteria Pre-surgical preparation Evolution Prognosis Adrenal insufficiency Objectives of comprehensive treatment Forms of treatment Secondary effects Most common complications Evolution Prognosis Congenital adrenal hyperplasia (CAH) Objectives of comprehensive treatment Forms of treatment Secondary effects Most common complications Evolution Prognosis Primary hyperaldosteronism Objectives of comprehensive treatment Forms of treatment Most common complications Evolution Prognosis Pheochromocytoma Objectives of comprehensive treatment Forms of treatment Pre-surgical preparation Most common complications Evolution Prognosis Treatment for types of Amenorrhea Female hypogonadism Objectives of comprehensive treatment Forms of treatment Treatment of abnormal uterine bleeding Hirsutism Objectives of comprehensive treatment Forms of treatment Secondary effects Evolution Prognosis Therapeutic approach to infertility treatment (masculine and feminine) Masculine hypogonadism Objectives of comprehensive treatment Forms of treatment Therapeutic approach to empty scrotum syndrome Therapeutic approach to pubertal delay Physical variations in pubertal development Therapeutic approach to early sexual development Therapeutic approach to hypogenitalism Therapeutic approach to sexual differentiation abnormalities Therapeutic approach to gonadal tumors with endocrine function Systemic contraception Types of contraceptives Routes of administration Treatment schemes Secondary effects Therapeutic approach to multiple endocrine adenomatosis (MEN) Endocrine hypertension Objectives of comprehensive treatment Forms of treatment Evolution Prognosis