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

1. Diseases and syndromes treated in intermediate therapy services and clinical rooms
2. Acute bronchial asthma crisis and severe acute asthma

Adult respiratory failure

2. Acute myocardial infarction
3. Hypertensive crisis
4. Arrhythmias
5. Chest pain
6. Heart failure and acute pulmonary edema
7. Cerebrovascular disease
8. Cardiorespiratory arrest
9. Pulmonary thromboembolism and hypertensive pulmonary heart disease
10. Acute abdominal pain
11. Follow-up in the case of acute diarrhea
12. Follow-up in the case of anuria
13. Altered hydromineral balance
14. Meningoencephalitis
15. Acute febrile illness
16. Upper and lower gastrointestinal bleeding
17. Shock
18. Acute poisoning
19. Endocrine emergencies:

• Ketosis and diabetic ketoacidosis
• Lactic acidosis
• Nonketotic hyperosmolar coma
• Hypoglycemia
• Adrenal crisis
• Myxedema coma
• Thyroid crisis
• Acute hypocalcemia

20. Prevention and control of hospital-acquired diseases
21. Medical emergencies in pregnant women
22. 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

1. Basic principles in the endocrinology laboratory
2. Radioimmunoassay; hormones, proteins and steroids; ultra-microanalytical system
3. Fundamentals, indications, procedures and interpretation of baseline measurements or dynamic tests
4. Diagnostic procedures on: hypothalamus, pituitary gland, thyroid, parathyroid, pancreas and lipids, adrenal cortex, adrenal medulla, ovaries, testicles
5. Female reproduction, cytogenetics and immunology laboratories

III. Introductory clinical endocrinology, CH, embryology, anatomy, histology and physiology of the endocrine system:

1. 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

2. Neuroendocrinology

• Cortex-endocrine gland relationship
• Neurotransmitters
• Cortico-hypothalamus-pituitary relationship

3. Adeno and neurohypophysis

• Embryology
• Normal histology
• Anatomy
• Physiology
• Hypothalamic-pituitary relationships
• Peripheral actions of pituitary hormones and mechanisms of action

4. 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

5. 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

6. 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

7. Lipid metabolism

• Triglyceride metabolism: fat for energy
• Cholesterol metabolism
• Hyperlipidemia
• Atherosclerosis

8. 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
  1. 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

10. Ovaries

• Embryology
• Histology
• Anatomy
• Ovarian physiology
• Hypothalamic-pituitary-ovarian axis
• Oogenesis
• Peripheral actions of estrogen and progesterone
• Mechanism of action of ovarian hormones

11. Normal puberty
12. 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

 

13. 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
14. 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

15. 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

16. Skin and hormones

• Hormones, the epidermis and dermis
• Dermal vascularization and hormones
• Hormones, melanocytes and pigmentation

1. 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)
2. Study program
3. Acromegaly and gigantism
   • Concept
   • Etiology
   • Clinical picture
   • Differential diagnosis
   • Study program
4. Prolactinomas and hyperprolactinemia
   • Concept
   • Frequency
   • Clinical picture

Differential diagnosis

4. 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
5. Mild polyureic-polydipsic syndrome
   • Concept of VSDI, VRDI and potomania
   • Pathogenic classification
   • Clinical picture
   • Study program
6. 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
7. Tall stature syndrome
   • Concept
   • Causal classification
   • Etiological diagnosis
   • Differential diagnosis
   • Study program
8. 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
9. 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
10. Hypothyroidism
    • Concept
    • Causal classification
    • Clinical picture
    • Differential diagnosis
    • Study program
    • Hypothyroidism in children
11. 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
12. 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
13. Euthyroid goiter
    • Concept
    • Causal classification
    • Clinical diagnosis and etiology
    • Differential diagnosis
    • Complementary examinations
14. 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

15. Hypoparathyroidism

• Concept
• Etiological classification
  1. Causes with inadequate secretion of PTH
  2. Causes in which the secretion is normal but biologically ineffective
  3. Peripheral resistance to PTH (pseudohypoparathyroidism)
• Clinical picture
• Differential diagnosis
• Study program
• Other causes of hypocalcemia
• Pseudo-pseudohypoparathyroidism
• Rickets and osteomalacia
  1. Diabetes mellitus (DM)
• Definition
• Classification
• Conditions and associated syndromes
• Impaired glucose tolerance (IGT), previous and potential
• Pathophysiology
• Clinical picture

17. 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

18. Etiopathogenesis of type 2 DM
19. Diabetic ketoacidosis

• Concept of ketosis and ketoacidosis
• Triggers
• Clinical picture
• Complementary examinations
• Differential diagnosis
  1. Hyperosmolar coma and lactic acidosis
• Concept
• Clinical picture
• Triggers
• Differential diagnosis
• Complementary examinations

 

21. DM in children and adolescents

• Diagnosis
• Control criteria
• Acute complications
  1. Diabetes and pregnancy
• Gestational diabetes, concept and diagnosis
• Potential abnormality of glucose tolerance
• Most frequent congenital malformations in the child of a diabetic mother
  1. Ocular complications of DM Diagnosis
• Retina
• Iris
• Crystalline
• Conjunctiva
• Cornea
• Intraocular muscles
• Nerves

24. Diabetic nephropathy

• Concept
• Histological classification
• Clinical picture
• Differential diagnosis
• Complementary examinations

25. Diabetic neuropathy

• Concept
• Classification and diagnosis
• Complementary examinations

26. Skeletal and joint complications of DM

• Neuropathic arthropathy
• Diabetic osteopathy
• Osteopenia
• Articular syndromes of the hand

27. Vascular complications of DM

• Macroangiopathy
• Microangiopathy

28. Dermatology complications of DM

• Ochre dermatitis
• Diabetic dermopathy
• Necrobiosis lipoidica diabeticorum
• Diabetic bullae
• Granuloma annulare
  1. Diabetic foot
• Concept
• Etiopathogenesis
• Classification
• Clinical picture
• Complementary examinations

30. 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)
  1. Hypoglycemic syndrome
• Concept
• Causal classification
• Clinical picture
• Differential diagnosis
• Study program
  1. 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

33. Obesity
    • Concept
    • Diagnosis
    • Differential diagnosis
    • Classification
    • Complications
    • Study program
      34. Cushing’s disease
    • Concept
    • Causal classification
    • Clinical picture
    • Differential diagnosis
    • Study program
34. Adrenal insufficiency

• Concept
• Clinical picture and differential diagnosis
• Causal classification
• Study program
  1. Congenital adrenal hyperplasia (CAH)
• Concept
• Enzyme defects that produce congenital adrenal hyperplasia
• Clinical picture
• Differential diagnosis
• Study program

37. Primary hyperaldosteronism
    • Concept
    • Classification
    • Clinical picture
    • Differential diagnosis
    • Study program
38. Pheochromocytoma
    • Concept
    • Classification
    • Clinical picture
    • Differential diagnosis
    • Study program
      39. Amenorrhea
    • Concept of primary and secondary amenorrhea
    • Concept of oligomenorrhea
    • Causal classification
    • Etiological diagnosis
    • Study program
39. Female hypogonadism

• Causal classification
• Concept of primary and secondary hypogonadism
• Clinical picture
• Study program
  1. Abnormal uterine bleeding
• Concept
• Causal classification
• Etiological diagnosis
• Study program

42. Hirsutism

• Concept of hirsutism and hypertrichosis
• Assessment of the severity of hirsutism, quantitative index
• Causal classification
• Etiological diagnosis
• Study program
  1. Infertility (masculine and feminine)
• Concepts
• Causal classification
• Diagnosis
• Study program
  1. Masculine hypogonadism
• Causal classification
• Concept of primary and secondary, pre- and post-pubertal hypogonadism
• Clinical picture
• Study program

45. Empty scrotum syndrome

• Concept of cryptorchidism, retractile testicles, testicular ectopia and anorchia
• Clinical diagnosis
• Complementary examinations
  1. Pubertal delay
• Concept
• Clinical diagnosis and etiology
• Study program

47. Variations in pubertal development

• Premature pubarche or adrenarche
• Premature thelarche
• Premature menarche
• Virginal breast hypertrophy
• Small breasts
• Gynecomastia
• Menstrual disorders
  1. Early sexual development
• Concept of true early puberty and sexual precocity
• Etiological classification
• Clinical diagnosis and etiology
• Differential diagnosis
• Study program

49. Hypogenitalism

• Concept
• Classification
• Clinical diagnosis
• Study program
  1. 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

51. Gonadal tumors with endocrine function
    • Ovarian tumors
    • Testicular tumors
    • Classification
    • Diagnosis
      52. Systemic contraception
      53. Multiple endocrine adenomatosis (MEN)
      54. Endocrine hypertension
    • Renin-aldosterone axis in blood pressure control
    • Renin system description
    • Abnormalities of aldosterone and renin secretion
    • Electrolyte balance and hypertension diagnosis

 

1. Hypopituitarism

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

2. Acromegaly and gigantism

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

3. Prolactinomas and hyperprolactinemia

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

4. Other pituitary tumors
5. Mild polyuria-polydipsia syndrome

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

6. Therapeutic approach to tall stature syndrome
7. Therapeutic approach to short stature syndrome
8. Hyperthyroidism

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Treatment with medicine, surgery and I-131
• Secondary effects
• Most common complications
• Evolution
• Prognosis

9. Thyroiditis

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

10. Hypothyroidism:

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

11. 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

12. Euthyroid goiter

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

13. Hyperparathyroidism

• Objectives of comprehensive treatment
• Indications of surgical treatment
• Other forms of treatment
• Evolution
• Prognosis

14. Hypoparathyroidism

• Objectives of comprehensive treatment
• Dosages and routes of administration
• Other forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

15. 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

16. Diabetic ketoacidosis

• Objectives of comprehensive treatment
• Most common complications
• Evolution
• Prognosis

17. Hyperosmolar coma and lactic acidosis

• Objectives of comprehensive treatment
• Most common complications
• Evolution
• Prognosis

18. 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

19. Diabetes and pregnancy

• Objectives of comprehensive treatment
• Diets for pregnant women
• Insulin treatment schemes
• Secondary effects
• Most common complications
• Evolution
• Prognosis

20. Ocular complications of DM

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

21. Diabetic nephropathy

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

22. Diabetic neuropathy

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

23. Skeletal and joint complications of DM
24. Diabetic foot

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

25. 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)

26. Hypoglycemic syndrome

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

27. Hyperlipoproteinemia

• Objectives of comprehensive treatment
• Diets
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

28. Obesity

• Objectives of comprehensive treatment.
• Forms of treatment
• Most common complications
• Evolution
• Prognosis

29. Cushing’s disease

• Objectives of comprehensive treatment
• Forms of treatment
• Surgical criteria
• Pre-surgical preparation
• Evolution
• Prognosis

30. Adrenal insufficiency

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

31. Congenital adrenal hyperplasia (CAH)

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Most common complications
• Evolution
• Prognosis

32. Primary hyperaldosteronism

• Objectives of comprehensive treatment
• Forms of treatment
• Most common complications
• Evolution
• Prognosis

33. Pheochromocytoma

• Objectives of comprehensive treatment
• Forms of treatment
• Pre-surgical preparation
• Most common complications
• Evolution
• Prognosis

34. Treatment for types of Amenorrhea
35. Female hypogonadism

• Objectives of comprehensive treatment
• Forms of treatment

36. Treatment of abnormal uterine bleeding
37. Hirsutism

• Objectives of comprehensive treatment
• Forms of treatment
• Secondary effects
• Evolution
• Prognosis

38. Therapeutic approach to infertility treatment (masculine and feminine)
39. Masculine hypogonadism

• Objectives of comprehensive treatment
• Forms of treatment

40. Therapeutic approach to empty scrotum syndrome
41. Therapeutic approach to pubertal delay
42. Physical variations in pubertal development
43. Therapeutic approach to early sexual development
44. Therapeutic approach to hypogenitalism
45. Therapeutic approach to sexual differentiation abnormalities
46. Therapeutic approach to gonadal tumors with endocrine function
47. Systemic contraception

• Types of contraceptives
• Routes of administration
• Treatment schemes
• Secondary effects

48. Therapeutic approach to multiple endocrine adenomatosis (MEN)
49. Endocrine hypertension

• Objectives of comprehensive treatment
• Forms of treatment
• Evolution
• Prognosis