April 2008 THE COLLEGE OF PHYSICIANS OF SOUTH AFRICA

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FOR ADMISSION TO THE EXAMINATION FOR THE POST-SPECIALISATION

SUB-SPECIALTY CERTIFICATE IN

ENDOCRINOLOGY AND METABOLISM Cert Endocrinology and Metabolism(SA) 1.0

ELIGIBILITY TO TAKE THE EXAMINATION In order to be eligible to enter for this examination, the candidate:-

1.1

must comply with the requirements for registration as a medical practitioner, as prescribed by the Medical, Dental and Supplementary Health Services Act.

1.2

must be registered as a specialist Phy sician

2.0

ADMISSION TO THE EXAMINATION (to be read in conjunction with the Instructions) The following are the requirements for admission to the examination:

2.1

registration as a specialist Phy sician

2.2

certification of having completed at least eighteen months as a subspecialty trainee in accredited specialist department(s) / division(s) / unit(s) of Endocrinology and Metabolism, registered and approved by the Health Professions Council of South Africa.

2.3

submission of the prescribed logbook, filled in up to date, and certified by the head(s) of the department(s)/division(s)/unit(s) in which the candidate trained. The logbook must be evaluated every 6 months.

2.4

submission of research component (see Appendix B:2.1)

2.5

a written report/written reports from the head/s of the institution/s in which he or she trained. 3.0 ... /

Cert Endocrinology and Metabolism(SA) 3.0

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SYLLABUS AND TRAINING See Appendix A

4.0

FORMAT AND CONDUCT OF CONFERRING OF CERTIFICATE See Appendix B

5.0

RECOMMENDED READING See Appendix C

JOHANNESBURG April 2008

THE

EXAMINATION

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Cert Endocrinology and Metabolism(SA)

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APPENDIX A 1.0

SYLLABUS

1.1

Emergencies: Diabetes-related comas Thy rotoxic crisis and my xoedema coma Hy per- and hy pcalcemic crises Addisonian crisis Hy popituitary crisis Hy per- and hy ponatraemia Hy per- and hy pokalaemia

1.2

Diabetes Mellitus Diagnosis Aetio-pathogenesis ] Epidemiology ] Clinical manifestations ] Complications ] Including diabetes in children Therapy ] Intercurrent states (pregnancy , surgery ) Insulin resistance metabolic sy ndrome Rare genetic sy ndromes 1.2.1

Hypoglycaemia Insulinoma Other sy ndromes

1.2.2

Other pancreatic endocrine disorders (gastrinoma etc)

1.3

Lipid Disorders Hy pertrigly ceridaemia Hy percholesterolaemia Mixed dy slipidaemia Secondary dy slipidaemia Dy slipidaemia and atherosclerosis

1.4

Thyroid Disorders Graves’ disease Graves’ ophthalmopathy Multinodular goitre Toxic adenoma Toxicosis without hy perthy roidism Thy roiditis Primary thy roid neoplasms Thy ro- and trophoprivic hy pothy roidism Sub-clinical hy per-hy po-thy roidism Goitrous hy pothy roidism Iodine deficiency disorders Iodine-induced thy roid disease Thy roid hormone homeostasis in non thy roidal illness Euthy roid goitres Thy roid nodules

1.5…/

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1.5

Pituitary Disorders Prolactinoma Acromegaly Cushing’s disease Gly coprotein-secreting adenomas “Non-secretory ” adenomas Craniophary ngioma Other sellar masses Hy popituitarism Hy per- and Hy po- natraemic sy ndromes (including Diabetes Insipidus and SIADH, etc)

1.6

Adrenal Disorders Adrenal glucocorticoid and mineralocorticocoid hy pofunction Congenital adrenal hy perplasias Pharmacological use of glucocorticoids Phaeochromocy toma Adrenal “incidentaloma”

1.7

Parathyroid Disorders Hy per- and hy poparathy roidism

1.8

Metabolic Bone Disease Primary and secondary osteoporosis Rickets and osteomalacia Paget’s disease Abnormalities of vitamin D metabolism

1.9

Endocrine Hypertension Endocrine participation in essential hy pertension Renin-angiotensin hy pertension Mineralocorticoid-induced hy pertension Endocrine/metabolic sequelae of therapy

1.10

Growth and Pubertal Disorders Short stature Growth failure Tall stature Delay ed puberty Precocious puberty /pseudo-puberty Virilisation and feminisation Intersex

1.11

Ovarian Disorders Infertility PCOS/hirsutism Hormone replacement therapy Menopause

1.12

Testicular Disorders Infertility Hy pogonadism Androgen resistance Androgen replacement therapy Andropause (the aging male)

hy per-

and

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Cert Endocrinology and Metabolism(SA) 1.13

Nutritional Disorders Obesity Anorexia nervosa

1.14

Endocrine disorders in systemic diseases

1.15

Multi-endocrine Disorders MEN sy ndromes Poly glandular sy ndromes Disorders of vasodilator hormones “APUD” sy ndromes

1.16

Breast Disorders Galactorrhoea Gy naecomastia

1.17

Endocrine Oncology Endocrine responsive tumours (Ca breast, prostate) Para-neoplastic endocrine and metabolic manifestations Thy roid cancer

1.18

Renal Stones and Hypercalcaemia

1.19

Other Epidemiology of common endocrine & metabolic conditions Age-related changes in endocrine function Fertility control and complications Sexual dy sfunction Exercise phy siology Endocrine/Metabolic effects of drugs Receptor/second messenger abnormalities and hormone sy ndromes HIV infection and the endocrine sy stem

1.20

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resistance

Guidelines for training and education 1.20.1

This will include:

1.20.1.1 6 monthly assessment of competence by the Head of the Endocrinology & Metabolism Training Unit. 1.20.1.2 assessment of a logbook kept by the candidate recording the details of all patients seen 1.20.1.3 the details of research undertaken and manuscripts accepted or submitted for publication in the field of endocrinology & metabolism 1.20.1.4 exit examination under the auspices of the CMSA consisting of a written paper and an objective test

1.21…/

Cert Endocrinology and Metabolism(SA) 1.21

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Endocrinology & metabolism subspeciality training – academic programme A broad experience in general (internal) medicine is considered essential for the practise of endocrinology & metabolism 1.21.1

The management of out-patients:

1.21.1.1 attendance at specialist clinics will be obligatory . To ensure that out-patient training is implemented effectively an optimal number of new (n=1-2) and old (n=6-8) patients will be seen at each clinic under supervision and review. Sufficient patients with common and rarer endocrine and metabolic disorders must be seen to provide adequate personal experience 1.21.1.2 a logbook must be kept to record all out-patients for whom the doctor has assumed responsibility 1.22

The management of in-patients: 1.22.1

the management of in-patients must also be supervised and reviewed

1.22.2

a logbook must be kept to record all in-patients for whom the doctor has assumed responsibility . (Patients with very rare conditions, seen and discussed, should be added separately )

1.22.3

a logbook record of all dy namic tests performed by the trainee

1.23

Active participation at official ward rounds and organised academic activities such as journal club and research meetings and seminars will be mandatory

1.24

Contact with other departments relevant to endocrinology , such as Chemical Pathology , Histopathology , Radiology , Neurosurgery and Surgery (Endocrine) should be encouraged

1.25

A research protocol in the field of endocrinology and metabolism should be submitted within the first 6 months of appointment

1.26

Active participation at scientific meetings (local and international) will be encouraged

1.27

Rotation to other research centres (local and international) for a specific purpose and time period may be possible

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Cert Endocrinology and Metabolism(SA) 1.28

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Curriculum It is expected that completion of the curriculum will result in demonstrable competence at consultant level in the following areas: 1.28.1

Knowledge of Endocrine and Metabolic Disorders

1.28.1.1 This will require a thorough theoretical knowledge of the endocrine and metabolic diseases. It will include knowledge of the epidemiology , aetiology , pathogenesis, pathology , clinical features and management of these diseases 1.28.2

Clinical contact with the patient

1.28.2.1 This will require the trainee to be able to take a history and perform a clinical examination of a patient with an endocrine or metabolic disorder to include special details and methods outlined in the training record 1.28.3

Demonstrate experience of Endocrine disease through the age spectrum

and

Metabolic

1.28.3.1 It is envisaged that this experience could be obtained over the two y ears by contact with appropriate patients and by attendance at Paediatric Endocrinology clinics or specific courses 1.28.4

Endocrinological and Metabolic emergencies

1.28.4.1 Gain experience with the endocrinological and metabolic emergencies (Appendix A:1.1) 1.28.5

Selection of appropriate laboratory tests

1.28.5.1 This will require knowledge of the metabolic changes, and changes that accompany the endocrine or metabolic disease 1.28.6

Knowledge of the place of imaging techniques and untrasonography in the investigation of endocrine disease

1.28.6.1 This will require knowledge of the place of these investigations in the diagnosis, and in following the progression of disease 1.28.7

Understand the pharmacology of endocrine and metabolic diseases

drugs

used

in

the

1.28.7.1 This will require knowledge of the drugs used in the management of endocrine disorders as well as knowledge of endocrine hormone replacement therapy 1.28.8

Appreciate the role of patient education and management in endocrine and metabolic diseases

staff

1.28.8.1 This will require knowledge of the wide field of patient education required in the endocrine and metabolic disorders and the concept of the team approach to patient management 1.29

Special Skills 1.29.1

Performance and interpretation of dynamic endocrine tests

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1.29.1.1 The trainee will be required to demonstrate competence in performing dy namic tests of endocrine function and be able to interpret the results of these tests (Appendix B) 1.29.1.2 A logbook record of all dy namic tests performed by the trainee 1.29.2

Teaching experience

1.29.2.1 The trainee should be able to demonstrate the ability to teach medical and paramedical staff by experience and specific courses if necessary 1.29.3

Develop research experience

1.29.3.1 This will include training in the analy sis of data and an understanding of the principles and practise of clinical research. The trainee must complete a successful research project and eventually should be able to promote and supervise research in endocrinology and metabolism. Publication in a peer-reviewed journal or presentation of research project at a scientific meeting 1.30

Endocrine/Metabolic Laboratory Investigation 1.30.1

General Principles The radioimmuno-assay The radioreceptor-assay ELISA assay s Molecular endocrinology : DNA extraction, PCR amplification, SSCP, scanning, sequencing

1.30.2

Measurement of: Peptide hormones Steroid hormones Important substrates (glucose, lipids) Other (eg HbA1c)

1.30.3

Stimulatory Dynamic Tests Hy pothalamic-pituitary Pituitary ACTH HCG Glucose tolerance Glucagon

1.30.4

Suppression Dynamic Tests Hy pothalamic-pituitary T3/T4 Dexamethasone Sodium loading test for Primary Hy peraldosteronism

1.30.5

Other Dynamic Tests Water deprivation Prolonged fasting Posture / Captopril Priming “Glucose-clamp” Tests for insulin secretion/sensitivity JOHANNESBURG April 2008

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APPENDIX B 1.0

FORMAT OF THE EXAMINATION

1.1

T h e e x a mi n a t i o n w i l l b e i n w r i t t e n f o r ma t a n d w i l l c o n s i s t o f o n e w r i t t e n th e o r y p a p e r a n d o n e o b j e c tiv e te s t e x a min a tio n . T h e w r i t t e n t h e o r y p a p e r w i l l a d d r e s s t h e p r i n c i p le s a n d p r a c t i c e o f e n d o c r in o lo g y a n d me ta b o lis m, in c lu d in g a n a to my, n o r ma l p h ys io lo g y, p a th o p h ys io lo g y, b io c h e mis tr y, p h a r ma c o lo g y, mo le c u la r b io lo g y, c lin ic a l i n v e s t i g a t i o n , d i a g n o s i s a n d t r e a t me n t. T h e o b j e c t i v e t e s t w i l l i n c l u d e t h e in te r p r e ta tio n o f la b o r a to r y d a ta , d yn a mic te s ts , s h o r t c a s e - h is to r ie s a n d o th e r ma te r ia l a s p r o b le m- s o lv in g e x e r c is e s . A p p r o x ima t e l y o n e q u a r t e r o f b o th t h e w r i t t e n p a p e r a n d o b j e c t i v e t e s t w i l l b e d e v o te d to q u e s tio n s o f th e b a s ic s c ie n c e n a tu r e .

1.2

T h e r e w i l l b e n o c l i n i c a l o r o r a l e x a mi n a t i o n .

2.0

AWARDING OF CERTIFICATE

2.1

T h e c e r t i f i c a t e w i l l b e a w a r d e d t o t h o s e c a n d id a t e s w h o h a v e b o th s u c c e s s f u l l y c o mp l e t e d t h e e x a mi n a t i o n a n d f u l f i l l e d o n e o f t h e f o l l o w i n g criteria in relation to a research project: • • •

2.2

P r e s e n te d a n o r a l o r p o s te r p r e s e n ta tio n o f a n e n d o c r in o lo g ic a l n a tu r e a t a s c i e n t i f i c me e t i n g Published an endocrine paper (or have had such paper unconditionally accepted for publication) in a peer review journal Co mp le te d a Ma s te r s D e g r e e ( e g MMe d ) o n a n e n d o c r in o lo g ic a l to p ic

U p o n a w a r d o f th e Ce r tif ic a te , th e tr a in e e ma y a p p ly to th e H e a lth Professions Council of South Africa for subspeciality registration.

JOHANNESBURG April 2008

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APPENDIX C 1.0

RECOMMENDED READING

1.1

Books It is recommended that trainees should read a modern but relatively short and manageable textbook of Endocrinology in the first 3-6 months of training (eg. Greenspan and Baxter: Basic and Clinical Endocrinology ; Lavin: Manual of Endocrinology and Metabolism – updated every 2-3 y ears). Modern reference textbooks on Endocrinology , Metabolism and Diabetes should be readily available (eg. de Groot: Endocrinology ; Williams Textbook of Endocrinology ). For Paediatricians: eg. Bertrand, Rappoport, Sizonenko – Paediatric Endocrinology

1.2

Journals A range of general medical and endocrinology and diabetes journals are essential reading. Suggested journals include: • • • • • • •

Journal of Clinical Endocrinology and Metabolism Endocrine Reviews Clinical Endocrinology Diabetes Care Diabetic Medicine Diabetologia Journal of Paediatric Endocrinology

JOHANNESBURG April 2008