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Pathophysiology of Endocrinology, Diabetes and Metabolism

Spring 2005

New hormones and endocrine pathways have recently been discovered. These discoveries increased our understanding of normal human physiology and behavior which provides insights into the pathophysiology of various diseases. (Graphic courtesy of Dr. Pittas)

Highlights of this Course

In addition to covering the basics in the Concepts in Endocrine Pathophysiology lecture, the lectures in this course cover a wide range of subjects, from Pituitary Neoplasia to Diabetes and Obesity - Treatment to Goiter and Thyroid Nodular Disease. The course also contains Small Group Discussion sessions which consolidate the concepts and facts acquired during the lectures and pursues the ability to solve common clinical problems in Endocrinology and Metabolism with sample cases and solutions.

Course Description

The endocrine system has always had a certain mystique among scientists, clinicians and the general public. More recently, new hormones and complex endocrine pathways have been discovered that have increased our understanding of normal human physiology and behavior and provided insights into the pathophysiology of various diseases. As a result of these recent advances, the endocrine system has assumed a prominent role in our understanding and management of common medical conditions including diabetes, cardiovascular disease, obesity and aging.

This course provides a brief review of endocrine physiology. The course teaches the pathophysiology of each of the following endocrine areas through didactic lectures and small group discussions. It covers adrenal cortex, adrenal medulla (catecholamine excess), disorders of calcium metabolism (hypercalcemia and hypocalcemia), diabetes mellitus, obesity and the metabolic syndrome: pathogenesis, complications and management, obesity: pathogenesis, complications and management, thyroid disease, hypothalamic and pituitary disease, hypoglycemia, and congenital adrenal hyperplasia. The student wil learn the mechanism of action of the various medications used in the treatment of endocrine disorders as a way to emphsize physiology and pathophysiology. The concepts and facts learned during the lectures will be applied to solve clinical problems in the small group discussion sessions. The small group sessions prepare students to handle endocrine cases during their clinical years and prepare them for the USMLE exams as well.

Popular Content

    * Diabetes Mellitus: Diagnosis and Pathophysiology
    * Pituitary Neoplasia
    * Hyperthyroidism
    * Hypothyroidism
    * Goiter and Thyroid Cancer


  • To achieve an understanding of the pathophysiologic process by which hormonal secretion is abnormal.
  • To develop the ability to solve problems in clinical endocrinology and metabolism in a rational way based on the knowledge of normal endocrine physiology and endocrine pathology.
  • To understand the mechanism of action of various agents used in the diagnosis and treatment of endocrine disorders.
  • To develop the ability to analyze case histories of patients with clinical endocrine disorders.

1. Goals

  • To provide a brief review of endocrine physiology
  • To understand the pathophysiologic processes that underlie hormonal dysfunction and endocrine neoplasia
  • To develop the ability to solve clinical problems in endocrinology and metabolism in a rational way based on the knowledge of endocrine physiology and pathophysiology and the use of endocrine biochemical testing and imaging
  • To have fun while achieving the first three goals

2. Learning Objectives

  • To understand the pathophysiology of each of the following endocrine areas through didactic lectures and small group discussions:
    1. Adrenal Cortex
      • Adrenal Cortical Insufficiency
      • Adrenal Hyperplasia (Glucocorticoid and Mineralocorticoid Excess)
      • Adrenal Neoplasia (Adrenal Incidentaloma and Cortococarcinoma)
    2. Adrenal Medulla (Catecholamine Excess)
    3. Disorders of Calcium Metabolism (Hypercalcemia and Hypocalcemia)
    4. Diabetes mellitus, Obesity and the Metabolic Syndrome: Pathogenesis, Complications and Management
    5. Obesity: Pathogenesis, Complications and Management
    6. Thyroid Disease
      • Hypothyroidism
      • Hyperthyroidism
      • Thyroid Nodule, Goiter and Thyroid Cancer
    7. Hypothalamic and Pituitary Disease.
      • Pituitary Insufficiency
      • Pituitary Neoplasia
    8. Hypoglycemia
    9. Congenital Adrenal Hyperplasia
  • To understand the mechanism of action of the various medications used in the treatment of endocrine disorders as a way to emphasize physiology and pathophysiology, including:
    1. The use of synthetic hormones used as replacement therapy in endocrine deficiency
    2. The use of medications used to treat endocrine hyperfunction
    3. The use of oral hypoglycemic agents and insulin in treatment of diabetes
    4. The use of glucocorticoids in non-endocrine disease
  • The concepts and facts learned during the lectures will be applied to solve clinical problems in the small group discussion sessions. The two main goals of the small group sessions are: (1) to prepare students to handle endocrine cases during their clinical years, (2) prepare students for the USMLE (United Stated Medical Licensing ExaminationTM) exams. The cases will help consolidate the understanding of endocrine pathophysiology by focusing on common endocrine problems encountered in outpatient and inpatient practice. The following format is followed
    1. Formulating the clinical problem
    2. Establishing the diagnosis using hormone assay measurements and imaging modalities
    3. Discussing the pathophysiology
    4. Proposing an appropriate therapy for the disorder

3. Specific Information

Much of endocrine pathophysiology builds on the relevant physiology and biochemistry covered during first year; we strongly suggest reviewing these areas before attending lectures and small groups. A short review of physiology will be included in the lectures and lecture notes.

3.1. Syllabus

The syllabus contains all the material that is important to know for this course. Although the textbook and specific references for each lecture are shown for further reading, they are not required. The lecture notes are detailed. Material that is essential to know and will appear in the examination and in your boards is outlined in the "goals and objectives" section at the beginning of each lecture. Important material will appear in bold font in the lecture notes and will be emphasized in lectures and small groups, so it is advantageous that students attend both types of didactic sessions. The written syllabus has been shortened this year by about 5% compared to last year.

3.2. Lectures

Lectures often start with a review of physiology. We hope this will serve as a quick review of physiology in preparation for the boards. Lectures and small group discussion sessions start at assigned times and last for 45-50 minutes, allowing 5-10 minutes for questions/break.

3.3. Small Group Discussion Sessions

The objectives of these sessions are to consolidate the knowledge (concepts and facts) acquired during the lectures and to develop the ability to solve common clinical problems in Endocrinology and Metabolism by providing a forum for interactive discussion of clinical cases. A problem based approach is utilized in the small groups. There are four 2-hour long small group sessions (for a total of 8 hours or 33% of the total contact hours for pathophysiology).

NEW THIS YEAR - The Pathophysiology Small Groups are combined with the Pathology Labs and will run as Clinical Pathophys/Pathology Conferences. This will cut 6 hours of contact during the endocrine pathology/pathophysiology section and we hope it will make sessions more intellectually stimulating and gratifying.

Questions with multiple choice answers modeled after the USMLE examinations appear in the small groups. Although most of the questions are clinical in nature, the answers are based on correct knowledge of endocrine physiology and pathophysiology. A sincere effort should be made by the students to read the cases and think about the questions prior to each session. It is our observation that the students who do this get the most out of these sessions and do the best in the USMLE examination. During the small group sessions, material that was not covered in the lectures is often presented. This new material may appear in the final examination and the USMLE examination. It is therefore advantageous for students to attend the Small Group sessions.

The Small Groups are usually the closest contact between the faculty and students. Take advantage of this contact. Do not be an anonymous student. The Small Groups constitute an important part of your learning experience. The cases are meant to lead to open-ended discussion and the accompanying questions are intended to initiate the discussion. Students are expected to contribute to the discussion. The group leader should not monopolize the sessions. Group leaders are there to explain but also to probe and question as well. The answers to each discussion group session will be distributed at the end of each small group session. Student assignment to the small group discussion sessions is listed in the next pages.

3.4. Recommended Reference (Optional)

Basic and Clinical Endocrinology, edited by Frank Greenspan, Appleton-Lange Publishers, c. 2001. This is an excellent textbook but it is detailed and is not required for the course.

3.5. Faculty

The faculty is superb and highly dedicated. In 2004, the majority of lecturers received a student rating over 4. The lowest student rating for small group instructors was 4.20! Only lecturers and small group leaders who are truly dedicated to teaching and have received excellent ratings by the students have been invited back We are here to help you do your best.

3.6. Evaluation/Grading

The Pathophysiology Course has eight (8) sections. There is an exam at the end of each section (25 questions) that counts for 6.25% of the total grade. There will also be an exam that covers the entire course material (all 8 sections) given at the very end of the course that counts for 50% of the total grade. The final exam will have approximately 75 questions; about 10 questions will come from Endocrine.

3.7. Student Course Evaluation

This is a very important aspect of the course. It is up to you to make this course a better one based on constructive criticism. Please, fill out the standard TUSM questionnaire at the end of the course. Feel free to comment on any negative as well as any positive aspects of the course and try to give suggestions on how to improve the course. You are also encouraged to contact Dr. Pittas directly. We are taking your comments seriously and will use them to improve the course next year. In addition to students' comments, there are additional steps that are taken each year to evaluate and improve the course: Dr. Pittas meets individually with the majority of lectures to review the content of the lecture. Small group leaders meet at the conclusion of each small group to discuss the session. Dr. Pittas attends the majority of the lectures and works very closely with the director of the Endocrine Section of Systemic Pathology to coordinate the teaching experience of the Endocrine System.

At least in part, based on comments from your predecessors, the following changes have been made to the course in the last 3 years:

3.7.1. Integration with Pathology

  • The course material and schedule have become closely coordinated with Systemic Pathology.
  • In 2004, one of the small group sessions was done together with Pathology.
  • Starting in 2005, all small groups will be combined with the Pathology Labs. We believe this will enhance the educational experience while at the same time reducing overall contact hours.

3.7.2. Content

  • The schedule was changed so that class starts at an earlier time to accommodate independent study.
  • The allotted duration for lectures and breaks has been clarified.
  • In addition to the availability of tutors, the director has added office hours for students' questions.
  • The course material (and the exam) places less emphasis on treatment and more emphasis on concepts and basic material of endocrine pathophysiology.
  • Topics have been arranged in more logical fashion.
  • The lecture on Newborn Screening for Hypothyroidism has been incorporated in the Hypothyroidism lecture.
  • A new lecture on Obesity and the Science of Eating has been added.
  • The lecture on Growth Hormone Deficiency was incorporated in the Pituitary Insufficiency Lecture.
  • Overall lecture time has been reduced to 16 hours.
  • Small group sessions cover 8 hours.

3.7.3. Syllabus

  • The syllabus font has been increased to an easily readable size.
  • The same format and font is used in all of the lecture notes.
  • All lecture notes have been extensively updated both in content, organization and appearance.
  • All lecture notes have learning objectives.
  • The material required to learn the objectives can easily be found in the syllabus and it is emphasized in the lectures and small group sessions.
  • Important points are electronically highlighted.
  • Multiple original tables and figures have been added to the notes to better organize and clarify material.
  • The syllabus has undergone extensive and repeated spell check by software and by writers to eliminate spelling errors.
  • The entire material is placed on-line for easy access. It has been entered with XMetaL software which allows for a more dynamic presentation of the material.
  • References have been electronically linked to PubMed with PDF files accessible when available

3.7.4. Small Groups

  • The cases in the small group sessions have been thoroughly updated to be concise and focused.
  • The cases in the small group sessions include questions with multiple choice answers that have been modeled after the USMLE type of questions, in an effort to aid students with studying for the final examination and the boards.

3.7.5. Grading

  • The grading system for the Pathophysiology Course has been changed to allow equal weight among all sections. As a result, we hope for an equal (if not higher) level of interest in the Endocrinology section compared to other sections!

3.8. Tutoring

A tutor is available for any student who would like additional help with the material presented in the lectures, small groups and syllabus. Appointments can be made by contacting the tutor directly, either by phone or e-mail.

4. Schedule

4.1. Schedule of Activities, Spring 2005

Session Time Lecture
1 1 hour Concepts in Endocrine Pathophysiology
1 hour Adrenal Cortical Disease
1 hour Adrenal Medullary Disease
2 1 hour Hypercalcemia and Hypocalcemia
3 1 hour Obesity and the Science of Eating, Diabetes Mellitus & Obesity: Pathophysiology
1 hour Diabetes Mellitus - Pathophysiology
2 hours Small Group 1 - Combined Path/Pathophys Adrenal, Hypercalcemia
4 1 hour Goiter and Thyroid Nodular Disease
1 hour Thyroid Cancer
1 hour Diabetes Mellitus: Complications
1 hour Diabetes Mellitus & Obesity: Management
5 2 hours Small Group 2 - Combined Path/Pathophys Diabetes, Calcium
1 hour Hypothyroidism
1 hour Hyperthyroidism
6 1 hour Hypoglycemia
1 hour Pituitary Insufficiency
1 hour Pituitary Neoplasia
7 2 hours Small Group 3 - Combined Path/Pathophsy Thyroid
8 1 hour Congenital Adrenal Hyperplasia
2 hours Small Group 4 - Combined Path/Pathophys Hypothalamus, Pituitary, Hypoglycemia
9 1 hour Review (Optional)
10 1 hour Final examination

5. Readings

Basic and Clinical Endocrinology, edited by Frank Greenspan, Appleton-Lange Publishers, c. 2001. This is an excellent textbook but it is detailed and is not required for the course.

6. Final Thought

As a director, I have been extremely fortunate to work with superb and highly dedicated faculty. As you will see, the faculty is very enthusiastic about teaching in this course and we hope you find this section both stimulating and fun. All of us who are involved in this course make a special effort to prove that frequently in life, "the best is saved for last."

Session   Type Title  
1 Lecture Concepts in Endocrine Pathophysiology  
2 Lecture Adrenal Cortex  
3 Lecture Adrenal Medulla  
4 Lecture Hypercalcemia and Hypocalcemia  
5 Lecture Diabetes Mellitus Pathophysiology  
6 Lecture Small Group 1 - Combined Pathology/Pathophysiology Adrenal, Hypercalcemia  
7 Lecture Goiter and Thyroid Nodular Disease  
8 Lecture Thyroid Cancer  
9 Lecture Diabetes Mellitus Complications  
10 Lecture Diabetes Mellitus & Obesity: Management  
11 Lecture Small Group 2 - Combined Pathology/Pathophysiology Diabetes, Calcium  
12 Lecture Hypothyroidism  
13 Lecture Hyperthyroidism  
14 Lecture Hypoglycemia  
15 Lecture Pituitary Insufficiency  
16 Lecture Pituitary Neoplasia  
17 Lecture Small Group 3 - Combined Pathology/Pathophysiology Thyroid  
18 Lecture Congenital Adrenal Hyperplasia  
19 Lecture Small Group 4 - Combined Pathology/Pathophysiology Hypothalamus, Pituitary, Hypoglycemia  
20 Lecture Review  
21 Examination Exam   Tell A Friend