Veidlapa Nr. M-3 (8)
Study Course Description

Endocrine Diseases I (Including Diabetes Mellitus Training)

Main Study Course Information

Course Code
REN_014
Branch of Science
Clinical medicine; Internal medicine
ECTS
46.00
Target Audience
Medicine
LQF
Level 8

Study Course Implementer

Course Supervisor

Residency Speciality

Speciality
Supervisor of Medical Speciality
Contacts

-

About Study Course

Objective

To provide medical residents with theoretical knowledge and practical skills in the diagnosis of endocrine diseases, differential diagnosis, recognition of various congenital and acquired endocrine syndromes, with particular focus on thyroid diseases and diabetes mellitus (including diabetes mellitus training).

Learning Outcomes

Knowledge

1.Completion of the study programme within the prescribed scope of the first year of studies: attendance of all study courses, attendance of 80% or more of theoretical activities, successful completion of the final examination. During training, the medical resident has worked in a specialised endocrinology department or consulting room, other specialised departments (during the study course) and consulting rooms, under the supervision of an endocrinologist who is qualified to train. The medical resident has regularly participated in resident seminars and lectures, prepares presentations at clinic morning sessions, has prepared at least 4 clinical cases each year (submitted to the head of the RSU Department of Internal Diseases) and has participated in the student training process. To understand in depth and analyse the role of hormones in normal development and ageing of the body, to understand the pathology of different endocrine glands, their diagnosis, treatment and prevention. Demonstrates an in-depth and expanded knowledge and understanding of medicine in general, but in endocrinology they meet the requirements of the relevant specialty and are at the forefront of the scientific and professional field, providing a basis for creative thinking in clinical practice and partly in research, and the ability to work in interdisciplinary contact. To recognise and describe different endocrine problems in humans. To define possible endocrine pathology, systematise diagnostic examinations and organise specific treatment.

Skills

1.To recognise and describe different endocrine problems in humans, to define possible endocrine pathology, systematise diagnostic examinations and organise specific treatment. To assess, identify and prevent potential risk factors for the development of various endocrine diseases; To be familiar with the pharmacokinetics and pharmacodynamics of endocrine agents, especially in insulin therapy; To work with glycemic self-monitoring devices and analyse the diabetes patient’s diary; To understand and interpret the results of various examinations (laboratory, radiological, morphological), to be familiar with and practically apply methods of conservative treatment and prevention of endocrine diseases; To know how to perform dynamic care of diabetes patients and training of patients (their relatives), to evaluate early diagnosis of various late complications and to learn techniques for their prevention; To critically evaluate specialised literature and base clinical decisions on evidence-based medicine.

Competences

1.Ability to independently apply acquired knowledge in solving medical problems, diagnosis, treatment, care and prevention of endocrine diseases. Ability to perform practical manipulations with skill. The medical resident has gained skills in working in a healthcare organisation as well as in education and research.

Assessment

Individual work

Title
% from total grade
Grade
1.

Individual work

-
-
The medical resident shall participate in the care of endocrine patients, acquiring knowledge and skills in specialised departments, diagnostic and training rooms and outpatient endocrinology practices. To participate in the planned seminars. To prepare clinical presentations for seminars. To get acquainted with the latest literature and prepare literature reviews. To understand the diagnostic and treatment features of endocrine diseases. Preparation for the examination test.

Examination

Title
% from total grade
Grade
1.

Examination

-
-
2.

Examination

-
-
An oral test that assesses the following: 1. successful completion of seminar test work, 2. the types and extent of intended manipulations have been learned, 3. independently implemented 1-week training course for type 1 and type 2 diabetes patients, 4. successful assessment of the medical resident’s clinical case analysis.

Study Course Theme Plan

FULL-TIME
Part 1
  1. Seminar

Modality
Location
On site
Specialized room

Topics

General principles of endocrinology. Hormone receptors and principles of action. Endocrinology of the brain, lungs, heart, blood cells, digestive system. Endocrinology and skin. ‘Atypical’ endocrine hormones and other biologically active substances (Prof. A. Lejnieks).
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Energy homeostasis, intermediary metabolism of carbohydrates, fats and proteins. Glycogen, gluconeogenesis, glycogenolysis, proteolysis, lipolysis. Glycation products: glycated haemoglobin, protein glycation end products (AGPs) (Prof. A.Lejnieks).
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Body fluid balance and electrolyte homeostasis. Body pH and its importance in electrolyte concentration changes. Osmolarity, osmolality. Oncotic pressure. Different environments and barriers of the body: extracellular, intracellular spaces. The importance of potassium, calcium, sodium, magnesium, zinc, chlorine, phosphorus and other electrolyte ions. (Prof. I. Konrāde).
  1. Seminar

Modality
Location
On site
Specialized room

Topics

The pancreas, its excretory and incretory activity. Food absorption sites and technology. Endocrine morphology and metabolic effects. Pancreatic enzymes and hormones. (Prof. A. Lejnieks)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Insulin as a protein hormone, its synthesis and its role in body homeostasis. Primary, secondary and tertiary structure of insulin. Active centres of the insulin molecule. Insulin as a hexamer. Insulin receptors. Glucose homeostasis. (Prof. A. Lejnieks)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Pathogenesis and classification of diabetes mellitus. Diagnosis and diagnostic criteria for diabetes mellitus. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Pathogenesis of type 2 diabetes and associated changes. Insulin resistance and its importance. HOMA index, its calculation. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Gestational diabetes. Diabetes mellitus in pregnant women. Diagnostic criteria for gestational diabetes. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Prediabetes (IFG, IGT): prevalence, diagnosis, clinic and possible treatment (exercise, diet, drug therapy). Association with cardiovascular disease. (Prof. A. Lejnieks)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Hypoglycaemia, its causes; changes in adults, changes in children. Functional hypoglycaemias. Insulinoma. (Prof. A. Lejnieks)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Diabetes mellitus and its acute complications - ketoacidosis coma, hyperosmolar coma, lactic acidosis coma: causes, clinic, diagnosis, treatment. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Carbohydrates and their role in the body. Fats and their role in the body. Proteins and their role in the body. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Neuroendocrine tumours: history, clinic, modern classification, diagnostic possibilities. Treatment technology and follow-up dynamic monitoring. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Effects of glycation end products on ageing of the body and various late complications of diabetes mellitus. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Diet and exercise of a diabetic patient. Self-control and its importance. Diaries of diabetic patients. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Lipid metabolism. Diabetic dyslipidaemia: free fatty acids, cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, lipoA and lipoB. Principles of treatment of dyslipidaemia: diet, drugs: statins, ezetimibe, fibrates (PPAR delta receptors), etc. (Prof. A. Lejnieks)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Principles of diet planning for diabetic patients. Glycaemic index. Bread units. Diabetes Plate Method. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Normal (physiological) insulin secretion by pancreatic beta cells. Glucose transporter proteins (GLUTs) in different tissues. The structure of the insulin molecule and its biological significance. Insulin as a drug (pharmacokinetics and pharmacodynamics). Fast- and long-acting insulin analogues. Principles of treatment of diabetes mellitus with insulin. Possible insulin therapy regimens. (Prof. A. Lejnieks)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Adipose tissue (adipocytes) as a biologically active organ: adiponectin, leptin. Endothelium and its function. Endothelial dysfunction. Adiposity. The body’s energy balance. Energy intake and consumption. The role of the pituitary gland in the development of adiposity. Principles of treatment. (Assoc. Prof. V. Mackēvičs)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Adaptation technology and implementation of different possible insulin regimens, demonstration of clinical examples. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Insulin pumps. Pancreas transplantation and pancreatic islet cell transplantation. Innovative treatments for diabetes mellitus: inhaled insulin, buccal insulin, oral insulin, vaccination, stem cell transplantation. (Prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Review of clinical trials on insulin analogues (rapid and long-acting) - literature review. (Prof. A. Lejnieks, prof. I. Konrāde)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Treatment of diabetes mellitus with oral antidiabetic medications: biguanides, sulfonylureas, glinides, glucose absorption inhibitors, thiazolidinediones, etc. (Prof. A. Lejnieks)
  1. Seminar

Modality
Location
On site
Specialized room

Topics

Incretins: GLP-1, DPP4i. Innovations in the treatment of type 2 diabetes. Modern treatment algorithm (literature review). Guidelines. (Prof. A. Lejnieks)
Total ECTS (Creditpoints):
46.00
Number of Residency Seminars:
24
Length (weeks):
34
Final Examination:
Residency exam (Theory and practice)

Bibliography

Required Reading

1.

Handbook of Inpatient Endocrinology, by Rajesh K. Garg (Editor), James V. Hennessey (Editor), & more, 2020

2.

Williams Textbook of Endocrinology, 14th Edition, 2019

3.

Goldman-Cecil Medicine, 2-Volume Set, 26th Edition, 2019

4.

Speroff’s Clinical Gynecologic Endocrinology and Infertility, 9th Edition, 2019

5.

Harrison’s principles of internal medicine. 20th Edition, 2018

6.

Harrison's Endocrinology, 4th Edition, 2017

7.

THE WASHINGTON MANUAL Endocrinology. Endocrinology subspecialty consult. 3rd Edition, 2013

8.

Greenspan Basic and Clinical Endocrinology. 5th Edition, Appleton & Lange 2011.

9.

Osteoporozes klīniskās vadlīnijas. Rīga, 2011.

10.

Andrology. Nieschlag, Eberhard; Behre, Hermann M.; Nieschlag, Susan (Eds.), 3rd Edition, 2010.

11.

Klīniskā medicīna. Profesora Aivara Lejnieka redakcija, 2010.

Additional Reading

1.

Gynecological Endocrinology, Journal

2.

Diabetes Care

3.

Diabetologie

4.

Endocrinology

5.

Journal of Clinical Endocrinology & Metabolism

6.

Latvijas Ārstu žurnāls

Other Information Sources

1.

Acromegaly. 2021

2.

Leslie DeGroot, MD - Endotext Founder 1928-2018, https://www.endotext.org/leslie-degroot-md-endotext-founder-1928-2018

3.

www.endotext.org

7.

UpToDate datubāze (pieejama tiešsaistē Rīgas Austrumu Klīniskajā Universitātes slimnīcā)