Home  |  Library  |  PRIME  |  Newsroom  |  E-mail  |  Directions

Second-Year Medicine

Block 7: Endocrine & Reproductive Systems

Course objectives (first two sections of course policy document intended for students):

Course Goals and Subject Matter

Our primary goal in this course is to ensure that you finish with a well rounded, appropriately interdisciplinary understanding of the physiology and pathological basis and pharmacotherapy of Endocrinology. This will necessarily entail learning basic principles of several disciplines that had little or no exposure last year: pathology and pharmacology. In consideration of the large overlap in concepts and content of the fields, the teaching of the pathophysiology of endocrinology has been integrated that of renal particularly in the areas of diabetes, hypertension, aldosterone, water balance and calcium metabolism. The emphasis on pathophysiology of disease, mostly confined to CBL in Year 1, now becomes greater and more pervasive. We continually work to integrate the coverage of related disease processes by different disciplines including gross pathology, and to examine your learning using integrative questions.

Scope of the Course

Endocrinology

The focus is an integrative approach to endocrinology and hormonal regulation in health and disease.

Topic outline

  1. Neoplastic disorders — presented within each organ system.
  2. Basic principles of endocrinology
    1. Regulation of hormone synthesis and secretion
      1. General concepts of homeostasis — concepts of feedback, puberty, pulsatility, diurnal variation
    2. Hormone — Receptor Interaction
    3. Major classes of hormones
      1. Peptide Hormones
        1. Hypothalamic, Anterior Pituitary , Hormones, posterior pituitary hormones, pancreatic islet, hormones, calcium regulating hormones, other (epinephrine), HCG, IGF1, IGF2.
      2. Steroid Hormones — Adrenal, Gonadal, Thyroid
    4. Concepts of hormone excess of deficiency.
  3. Anterior Pituitary
    1. Hypothalamic Pituitary regulation
      1. TRH-TSH-Thyroid hormone
      2. Gonadal
      3. Adrenal
      4. Growth Hormone
      5. Prolactin
    2. Pituitary Tumors
      1. Functioning
      2. Non-functioning.
    3. Pituitary Failure.
    4. Vascular disorders- eg: pituitary apoplexy
  4. Posterior Pituitary
    1. Disorders of water balance
    2. Oxytocin
  5. Thyroid Disorders
    1. Review of structure, function, control mechanims and thyroid hormone transport
    2. Thyroid function testing
    3. Specific disorder: goiter, hyperthyroidism, Graves disease, Toxic multinodular goiter, toxic adenomas, thyroiditis, hypothyroidism, euthyropid sick syndrome,
    4. Treatment
  6. Parathyroid — integrated/reinforced with renal lectures
    1. Review of calcium, vitamin D homeostasis PTH PTHrP, Calcitonin
    2. Hypercalcemia and hypocalcemia, phosphate abnormalities
    3. Multiple endocrine neoplasia syndromes
  7. Metabolic Bone Disease
    1. Review of basic physiology and epidemiology
    2. Prinicples of Measurement
    3. Osteoporosis, Osteomalacia
  8. Obesity
    1. epidemiology
    2. Regulation of appetite, energy expenditure, regulation of weight, relationship to disease, metabolic syndrome,
    3. treatment
  9. Diabetes Mellitus (And other Pancreatic Islet disorders)-
    1. Multisystem disorder covered in 3 lectures and 1 CBL
    2. Psycho Social aspect covered in ECM
    3. Review of physiology
    4. Type 1 Diabetes
    5. Type 2 Diabetes
    6. Insulin resistance (liver and muscle) and insulin secretion
    7. Dyslipidemia
  10. Adrenal Disorders
    1. Review of basic biology
    2. Cushings Syndrome
      1. Pituitary
      2. Adrenal hyperfunction — adenoma and hyperplasia
      3. Ectopic ACTH
      4. Exogenous steroid use/abuse
    3. Pheochromocytoma
    4. Adrenal insufficiency — Addisons
    5. Congenital adrenal hyperplasia
    6. Review of gonadal differentiation, and disorders of intersex
    7. Review of androgen physiology and levels of feedback regulation and testing
    8. Disorders of pituitary, hypothalamus, gonads and enzymatic abnormalities (These are illustrated by Kallman’s and Klinefelter’s syndromes, testicular feminization and 5 alpha reductase deficiency as well as usual disorders of the pituitary as covered under “Pituitary”.
    9. Disorders of puberty
    10. Review of hypothalamic, pituitary ovarian regulation, menstrual cycle & testing
    11. Disorders of menstrual cycle — primary and secondary ammenorhea
    12. Disorders of androgen excess — etiology (ovarian and adrenal origin), clinical manifestations (hirsuitism)
    13. Menopause
  11. Systemic Disorder — hemochromocytosis
  12. Contraception
  13. Therapeutics — Taught as part of the specific organ system
    1. Mechanism of action of drugs
    2. Hormones and hormone analogues
    3. Stimulators of hormone synthesis (eg sulfonylureas)
    4. Potentiators of hormone actions (thiazolidinediones, metformin)
    5. Inhibitors of hormone effect
    6. Inhibitors of hormone production (propylthiouracils)
    7. Hormone antagonists (flutamide)
    8. Antiobesity agents
    9. Drugs to correct mineral defects (Calcium , phosphorus etc)
    10. Other modalities — surgery and radiation
    11. Iatrogenic effects on the endocrine system
    12. Adverse effects of drugs used in the treatment of endocrine disorders especially the elderly and newborn
    13. Psychosocial, environmental and cultural issues
      1. Effect on emotions
      2. Compliance with chronic complex treatment
      3. Complications (blindness with diabetes)
      4. Influence of disease on the person, family and society

Gynecological Pathology

Lectures and gross and histopathology of tumors and other abnormalities