2026-2027 M3/M4 Course Syllabi

Internal Medicine
COURSE NUMBER:
07 11 01
TITLE:
ENDOCRINOLOGY/METABOLISM -IM -ICE
This elective provides broad exposure to the evaluation and management of patients with endocrine disorders. The students will see patients at the University of Cincinnati Medical Center, the Medical Arts Building and the VA Medical Center. Students will see ambulatory and hospitalized patients with various endocrine disorders, including diabetes mellitus, hyperlipidemia, metabolic bone disease, and disorders of pituitary, thyroid, parathyroid disorders, adrenals, gonads as well as sodium and calcium metabolism.
PREREQUISITES:
26931373 (INTERNAL MEDICINE CORE CLKSP)
expand all

GENERAL INFORMATION

COURSE YEAR:
M4
CREDIT HOURS:
8
CREDIT WEEKS:
4
DOMESTIC VISITING:
NO
INTERNATIONAL VISITING:
NO
GRADED:
Honors/High Pass/Pass/Fail
COURSE QUALIFICATIONS:
ICE
STATUS:
Full-Time   
OFFERED AS FULL-TIME AND PART-TIME: NO
ALLOWS OVERLAP: NO
COURSE LENGTH:
4 wks
DIRECTOR:
Abid Yaqub, MD
yaqubad@ucmail.uc.edu

ADMINISTRATIVE SUPPORT PERSON:
Gabriela Ionascu
ionascgi@ucmail.uc.edu
513-558-2592
MSB, 6055A
SITE(S):
UCMC - University of Cincinnati Medical Center
VAMC
MAX ENROLL:
2 
ROTATIONS:
Rotation Dates Max
1 04/06/2026 - 05/01/2026 2
2 05/04/2026 - 05/29/2026 2
3 06/01/2026 - 06/26/2026 2
4 06/29/2026 - 07/24/2026 2
5 07/27/2026 - 08/21/2026 2
6 08/24/2026 - 09/18/2026 2
7 09/21/2026 - 10/16/2026 2
8 10/19/2026 - 11/13/2026 2
9 11/16/2026 - 12/11/2026 0
10 12/14/2026 - 01/08/2027 0
11 01/11/2027 - 02/05/2027 2
12 02/08/2027 - 03/05/2027 2
13 03/08/2027 - 04/02/2027 2
14 04/05/2027 - 04/30/2027

NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)
PT Extended Electives will span the entire year, not just 4 weeks
WORKING HOURS:
8:00 am - 5:00 pm, Monday - Friday
REPORT 1ST DAY:
Will get email with directions prior to first day.

INSTRUCTION

LEARNING ACTIVITIES:
  • Case-Based Instruction/Learning
  • Clinical Experience - Inpatient
  • Conference
  • Demonstration (description, performance, or explanation of a process, illustrated by examples, observable action, specimens, etc)
  • Patient Presentation--Faculty
  • Patient Presentation--Learner
  • Self-Directed Learning (Learners take initiative for their own learning; diagnosing needs; formulating goals; identifying resources; implementing appropriate activities; and evaluating outcomes.)
  • Ward Rounds
 
In this course, we may cover complex health issues that often intersect with personal beliefs, societal debate, and evolving science. You will likely encounter information or perspectives that differ from your own. As physicians-in-training, your responsibility is to listen with curiosity, engage with evidence, and communicate respectfully—just as we do in patient care. Syllabi and course materials will be grounded in evidence-based medicine, scientific principles and reflect areas of ongoing scientific inquiry. In courses addressing policy, ethics, or societal issues, materials will be structured to promote evidence-based learning while transparently acknowledging where evidence is evolving or there are multiple viewpoints that may impact patient care.
LEARNING ENVIRONMENT POLICIES:
UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.

The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.
TEACHING:
50% Attending Physician
50% Fellow Physician
FEEDBACK:
ASSESSMENT:

ASSESSMENT METHODS:
Clinical Performance Rating/Checklist
Narrative Assessment
FINAL GRADE:
GRADE ASSIGNED BY: Course director

OBJECTIVES

Curricular Resources :
Textbooks:

-     Gardner DG, Shoback D, eds. Greenspan's Basic & Clinical Endocrinology. 10th ed. New York, NY: McGraw-Hill Education; 2018

-     Melmed S, Koenig R, Rosen C, Auchus R, Goldfine A, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Saunders; 2019

-     Jameson JL, De Groot LJ, de Kretser DM, Giudice LC, Grossman AB, Melmed S, Potts JT Jr, Weir GC, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2010.

-     Rosen CJ, Bouillon R, Compston JE, Rosen V, eds. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 8th ed. Washington, DC: Wiley-Blackwell; 2013.

-     Braverman LE, Cooper D, eds. Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text. 10th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2013.

-     Bilezikian JP, editor-in-chief. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. 9th ed. Washington, DC: Wiley-Blackwell; 2018.

-     Kopp P ed. Endotext. Endotext.org (A comprehensive online Endocrine Textbook)

Articles Reading List:

·         Thyroid:

-     McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine. 2012;42(2):252-265.

-     Taylor PN, Medici MM, Hubalewska-Dydejczyk A, Boelaert K. Hypothyroidism. Lancet. 2024 Oct 5;404(10460):1347-1364. doi: 10.1016/S0140-6736(24)01614-3. PMID: 39368843.

-     Biondi B, Cooper DS. Subclinical Hyperthyroidism. N Engl J Med. 2018 Jun 21;378(25):2411-2419.

-     Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421.

-     Burch HB, Perros P, Bednarczuk T, Cooper DS, Dolman PJ et al. Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022 Dec;32(12):1439-1470. doi: 10.1089/thy.2022.0251. Epub 2022 Dec 8. PMID: 36480280; PMCID: PMC9807259.

-     Burch H, Cooper D. Management of graves’ disease. A review. JAMA 2015; 314(23) 2544-2554.

-     Azizi F, Amouzegar A, Tohidi M, et al. Increased Remission Rates After Long-Term Methimazole Therapy in Patients with Graves' Disease: Results of a Randomized Clinical Trial. Thyroid 2019; 29(9); 1192-1200.

-     Azizi F, Takyar M, Madreseh E. Treatment of Toxic Multinodular Goiter: Comparison of Radioiodine and Long-Term Methimazole Treatment. Thyroid 2019; 29(5): 626-630.

-     Biondi B, Wartofsky L. Treatment with thyroid hormone. Endocr Rev. 2014;35(3):433-512.

-     Jonklaas J, Bianco AC, Bauer AJ, et al; American Thyroid Association Task Force on Thyroid Hormone Replacement. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24(12):1670-1751.

-     Peeters RP. Subclinical Hypothyroidism. N Engl J Med. 2017 Jun 29;376(26):2556-2565.

-     Ringel MD, Sosa JA, Baloch Z, Bischoff L, Bloom G et al. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985. doi: 10.1177/10507256251363120. PMID: 40844370

-     Nishino M, Nikiforova M. Update on molecular testing for cytologically indeterminate thyroid nodules. Arch Pathol Lab Med 2018; 142: 446-47.

-     Fugazzola L, Elisei R, Fuhrer D, et al. 2019 European Thyroid Association guidelines for the treatment and follow up of advanced radioiodine refractory thyroid cancer. Eur Thyroid J 2019; 8(5): 227-245.

-     Wells SA Jr, Asa SL, Dralle H, et al; American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25(6):567-610.

-     Fliers E, Bianco AC, Langouche L, Boelen A. Endocrine and metabolic considerations in critically ill patients. Thyroid function in crtically ill patients. Lancet Diabetes Endocrinol 2015; 3(10): 816-825.

-     Burch H. Drug effects on the thyroid. N Engl J Med 2019; 381 (8); 749-671.

-     Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389.

·         Diabetes Mellitus:

-     Standards of Medical Care in Diabetes—2025 American Diabetes Association. Diabetes Care 2025. Jan; 48 (Supplement 1): S1-264.

o   S27: Classification and Diagnosis of Diabetes

o   S128: Glycemic goals and hypoglycemia

o   S146: Diabetes technology

o   S181: Pharmacologic approaches to glycemic treatment

o   S207: Cardiovascular disease and risk management

o   S239: Chronic Kidney Disease and risk management

o   S252: Retinopathy, neuropathy, and foot care

o   S306: Management of diabetes in pregnancy

o   S321: Diabetes care in the hospital

-     Bionic Pancreas Research Group; Russell SJ, Beck RW, Damiano ER, El-Khatib FH, Ruedy KJ et al. A. Multicenter, Randomized Trial of a Bionic Pancreas in Type 1 Diabetes. N Engl J Med. 2022 Sep 29;387(13):1161-1172. doi: 10.1056/NEJMoa2205225. PMID: 36170500.

-     Brown SA, Forlenza GP, Bode BW, Pinsker JE, Levy CJ et al. Omnipod 5 Research Group. Multicenter Trial of a Tubeless, On-Body Automated Insulin Delivery System With Customizable Glycemic Targets in Pediatric and Adult Participants With Type 1 Diabetes. Diabetes Care. 2021 Jul;44(7):1630-1640. doi: 10.2337/dc21-0172. Epub 2021 Jun 7. PMID: 34099518; PMCID: PMC8323171.

-     Brown SA, Kovatchev BP, Raghinaru D, et al. Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. N Engl J Med. 2019:381:1707-1717.

-     Perioperative Hyperglycemia Management: An Update. Duggan EW, Carlson K, Umpierrez GE. Anesthesiology. 2017 Mar;126(3):547-560.

-     Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Furtado RHM, Bonaca MP, Mosenzon O, Kato ET, Cahn A, Bhatt DL, Leiter LA, McGuire DK, Wilding JPH, Sabatine MS. Comparison of the Effects of Glucagon-Like Peptide Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors for Prevention of Major Adverse Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus. Circulation. 2019 Apr 23;139(17):2022-2031.

-     SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Bonaca MP, Mosenzon O, Kato ET, Cahn A, Furtado RHM, Bhatt DL, Leiter LA, McGuire DK, Wilding JPH, Sabatine MS. Lancet. 2019 Jan 5;393(10166):31-39.

-     GRADE Study Research Group; Nathan DM, Lachin JM, Balasubramanyam A, Burch HB, Buse JB et al. Glycemia Reduction in Type 2 Diabetes - Glycemic Outcomes. N Engl J Med. 2022 Sep 22;387(12):1063-1074. doi: 10.1056/NEJMoa2200433. PMID: 36129996; PMCID: PMC9829320.

-     ACCORD Study Group: Effects of intensive glucose lowering in Type 2 Diabetes. N Engl J Med 2008; 358:2545-2559

-     ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560- 2572.

-     Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez-Gutiérrez R, González-González JG, Tamez-Peña AL. Steroid hyperglycemia: prevalence, early detection and therapeutic recommendations: a narrative review. World J Diabetes. 2015;6(8):1073-1781.

-     Balasubramanyam A, Nalini R, Hampe CS, Maldonado M. Syndromes of ketosis-prone diabetes. Endocr Rev. 2008;29(3):292-302.

-     Broome DT, Pantalone KM, Kashyap SR, Philipson LH. Approach to the Patient with MODY-Monogenic Diabetes. J Clin Endocrinol Metab. 2021 Jan 1;106(1):237-250. doi: 10.1210/clinem/dgaa710. PMID: 33034350; PMCID: PMC7765647.

-     Buzzetti R, Tuomi T, Mauricio D, Pietropaolo M, Zhou Z, Pozzilli P, Leslie RD. Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes. 2020 Oct;69(10):2037-2047. doi: 10.2337/dbi20-0017. Epub 2020 Aug 26. PMID: 32847960; PMCID: PMC7809717.



-     UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes [published correction appears in BMJ. 1999;318(7175):29]. BMJ. 1998;317(7160):703-713.

-     The DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986.

·         Bone and Mineral Metabolism:

-     Minisola S, Pepe J, Piemonte S, Cipriani C. The diagnosis and management of hypercalcaemia. BMJ. 2015 Jun 2;350:h2723

-     Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GE, Marcocci C, et al; International Workshop on Primary Hyperparathyroidism. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293-2314. doi: 10.1002/jbmr.4677. Epub 2022 Oct 17. PMID: 36245251.

-     Cristina EV, Alberto F. Management of familial hyperparathyroidism syndromes: MEN1, MEN2, MEN4, HPT-Jaw tumour, Familial isolated hyperparathyroidism, FHH, and neonatal severe hyperparathyroidism. Best Pract

-     Bollerslev J, Pretorius M, Heck A. Parathyroid hormone independent hypercalcemia in adults. Best Pract Res Clin Endocrinol Metab. 2018 Oct;32(5):621-638

-     Motlaghzadeh Y, Bilezikian JP, Sellmeyer DE. Rare Causes of Hypercalcemia: 2021 Update. J Clin Endocrinol Metab. 2021 Oct 21;106(11):3113-3128. doi: 10.1210/clinem/dgab504. PMID: 34240162.

-     Lee JY, Shoback DM. Familial hypocalciuric hypercalcemia and related disorders. Best Pract Res Clin Endocrinol Metab. 2018 Oct;32(5):609-61

-     Bilezikian JP. Hypoparathyroidism. J Clin Endocrinol Metab. 2020 Jun 1;105(6):1722–36. doi:10.1210/clinem/dgaa113. PMID: 32322899; PMCID: PMC7176479.

-     Pepe J, Colangelo L, Biamonte F, Sonato C, Danese VC, Cecchetti V, Occhiuto M, Piazzolla V, De Martino V, Ferrone F, Minisola S, Cipriani C. Diagnosis and management of hypocalcemia. Endocrine. 2020 Sep;69(3):485-495. doi: 10.1007/s12020-020-02324-2. Epub 2020 May 4. PMID: 32367335.

-     Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update. J Clin Endocrinol Metab. 2020 Mar 1;105(3)

-     Watts NB, Camacho PM, Lewiecki EM, Petak SM; AACE/ACE Postmenopausal Osteoporosis Guidelines Task Force. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract. 2021 Apr;27(4):379-380. doi: 10.1016/j.eprac.2021.02.001. Epub 2021 Feb 9. PMID: 33577971.

-     LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, Siris ES. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-2102. doi: 10.1007/s00198-021-05900-y. Epub 2022 Apr 28. Erratum in: Osteoporos Int. 2022 Jul 28;: PMID: 35478046; PMCID: PMC9546973.

-     Watts NB, Adler RA, Bilezikian JP, et al Endocrine Society. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(6):1802-1822. Buckley L, Humphrey MB. Glucocorticoid-Induced Osteoporosis. N Engl J Med. 2018 Dec 27;379(26):2547-2556

-     Kanis JA, Johnell O, Oden A, Johansson H, McCloskey EV. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19(4):385-39

-     Cosman F. Anabolic and antiresorptive therapy for osteoporosis: combination and sequential approaches. Curr Osteoporos Rep. 2014;12(4):385-395.

-     Lewiecki EM. Evaluating Patients for Secondary Causes of Osteoporosis. Curr Osteoporos Rep. 2022 Feb;20(1):1-12. doi: 10.1007/s11914-022-00717-y. Epub 2022 Jan 15. PMID: 35032004.

-     Khan AA, Morrison A, Hanley DA, et al; International Task Force on Osteonecrosis of the Jaw. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015;30(1):3-23

-     Mirza F, Canalis E. Management of endocrine disease: secondary osteoporosis: pathophysiology and management. Eur J Endocrinol. 2015;173(3):R131-R151

-     Bronson WH, Kaye ID, Egol KA. Atypical femur fractures: a review. Curr Osteoporos Rep. 2014;12(4):446-453

-     Bover J, et al. Osteoporosis, bone mineral density and CKD-MBD: treatment considerations. J Nephrol. 2017 Oct;30(5):677-687

-     Christov M, Jüppner H. Phosphate homeostasis disorders. Best Pract Res Clin Endocrinol Metab. 2018 Oct;32(5):685-706

-     Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 7, 1 July 2011, Pages 1911–1930

-     Minisola S, et al. Tumour-induced osteomalacia. Nat Rev Dis Primers. 2017 Jul 13;3:17044. doi: 10.1038/nrdp.2017.44.

-     Fukumoto S. FGF23-related hypophosphatemic rickets/osteomalacia: diagnosis and new treatment. J Mol Endocrinol. 2021 Feb;66(2):R57-R65. doi: 10.1530/JME-20-0089. PMID: 33295878.

-     Whyte MP. Hypophosphatasia: Enzyme Replacement Therapy Brings New Opportunities and New Challenges. J Bone Miner Res. 2017 Apr;32(4):667-675.

·         Pituitary Disease:

-     Freda PU, Beckers AM, Katznelson L, et al; Endocrine Society. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(4):894-904.

-     Melmed S, Casanueva FF, Hoffman AR, et al; Endocrine Society. Diagnosis and treatement of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273-288

-     Fleseriu M, Biller BMK, Freda PU, et al. A Pituitary Society update to acromegaly management guidelines. Pituitary. 2021;24:1-13.

-     Giustina A, Barkan A, Beckers A, et al. A Consensus on the Diagnosis and Treatment of Acromegaly Comorbidities: An Update. J Clin Endocrinol Metab. 2020;105(4):e937-e946.

-     Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML; Endocrine Society. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96(6):1587-1609

-     Silveira LF, Latronico AC. Approach to the patient with hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 2013;98(5):1781-1788

-     Fernández-Balsells MM, Murad MH, Barwise A, et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2011;96(4):905-912

-     Braun LT, et al. Whom should we screen for Cushing syndrome? The Endocrine Society practice guideline recommendations 2008 revisited. J Clin Endocrinol Metab. 2022; 107 (9): e3723-30.

-     Fleseriu M, Auchus R, Bancos I, et al. Consensus on diagnosis and management of Cushing’s Disease: a guideline update. 2021. Lancet Diabetes Endocrinol. 9(12): 847-875.

-     Nieman LK. Molecular derangements and diagnosis of ACTH dependent Cushing Syndrome. Endocrine Reviews 2022; 43(5): 852-877.

-     Varlamov E, Vila G, Fleseriu M. Perioperative management of a patient with Cushing Disease. J Endocrine Society 2022; 6(3): 1-13.

-     Fleseriu M, Hashim IA, Karavitaki N, Melmed S, Murad MH, Salvatori R, Samuels MH. Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016 Nov;101(11):3888-3921

-     Arima H, Cheetham T, Christ-Crain M, et al. Changing the name of diabetes insipidus: a position statement of the working group for renaming diabetes insipidus. J Clin Endocrinol Metab 2022; 108(1): 1-3.

-     Briet C, Salenave S, Bonneville JF, Laws E, Chanson P. Pituitary Apoplexy. Endocrine Reviews. 2015; 36(6): 622–645

-     Khan S, Salvatori R. The Perioperative and Postoperative Care for Pituitary Patients. Chapter in Transsphenoidal surgery, Complication Avoidance and Management Techniques. Laws E, et al. (2017).

-     Christ-Crain M, Refardt J, Winzeler. Approach to the patient: utility of the copeptin assay. J Clin Endocrinol Metab. 2022; 107(6): 1727-1738.

-     Martin-Grace J, Tomkins M, O’Reilly MW, et al. Approach to the patient: hyponatremia and the syndrome of inappropriate antidiuresis (SIAD). J Clin Endocrinol Metab 2022; 107(8): 2362-2376.

-     Peri A, Grohe C, Berardi R, et al. SIADH: differential diagnosis and clinical management. Endocrine 2017; 55(1): 311-319.

-     Ergin AB, Kennedy AL, Gupta MK, Hamrahian AH. The Cleveland Clinic Manual of Dynamic Endocrine Testing. New York, NY: Springer; 2015.

-     Chapman PR, Singhal A, Gaddamanugu S, Prattipati V. Neuroimaging of the Pituitary Gland: Practical Anatomy and Pathology. Radiol Clin North Am. 2020 Nov;58(6):1115-1133. doi: 10.1016/j.rcl.2020.07.009. Epub 2020 Sep 17. PMID: 33040852.

·         Adrenal Disorders:

-     Zavatta G, Di Dalmazi G. Recent Advances on Subclinical Hypercortisolism. Endocrinol Metab Clin North Am. 2018;47(2):375-383

-     Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015;3(3):216-226

-     He X, Findling JW, Auchus RJ. Glucocorticoid Withdrawal Syndrome following treatment of endogenous Cushing Syndrome. Pituitary. 2022 Jun;25(3):393-403.

-     Betterle C, Morlin L. Autoimmune Addison's disease. Endocr Dev. 2011; 20:161-172.

-     Grossman AB. Clinical Review#: the diagnosis and management of central hypoadrenalism. J Clin Endocrinol Metab. 2010;95(11):4855-4863

-     Quinkler M, Hahner S. What is the best long-term management strategy for patients with primary adrenal insufficiency? Clin Endocrinol (Oxf). 2012;76(1):21-25

-     Funder JW, Carey RM, Fardella C, et al; Endocrine Society. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266-3281.

-     Vaidya A, Carey RM. Evolution of the Primary Aldosteronism Syndrome: Updating the Approach.J Clin Endocrinol Metab. 2020 Dec 1;105(12):3771–83.

-     Halperin F, Dluhy RG. Glucocorticoid-remediable aldosteronism. Endocrinol Metab Clin North Am. 2011;40(2):333-341

-     Phyllis W. Speiser, Wiebke Arlt, Richard J. Auchus et al. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 103: 4043–4088, 2018

-     Claahsen HL, Speiser PW, Ahmed SF, et al. Congenital adrenal hyperplasia—current insights in pathophysiology, diagnostics, and management. Endocrine Reviews 2022; 43(1): 91-159

-     Vaidya A, Hamrahiyan A, Bancos I, Fleseriu M, Ghayee HK. The Evaluation of Incidentally Discovered Adrenal Masses. Endocrine Practice. 2019; 25(2):178-192

-     Nölting S, Bechmann N, Taieb D, at al. Personalized Management of Pheochromocytoma and Paraganglioma. Endocr Rev. 2022 Mar 9;43(2):199-239.

-     Neumann HPH, Young WF Jr, Eng C. Pheochromocytoma and Paraganglioma. N Engl J Med.2019 Aug 8;381(6):552-565.

-     Fagundes GFC, Almeida MQ. Perioperative Management of Pheochromocytomas and Sympathetic Paragangliomas. J Endocr Soc. 2022 Jan 14;6(2):bvac004.

-     Bancos I, Prete A. Approach to the Patient With Adrenal Incidentaloma. J Clin Endocrinol Metab.2021 Oct 21;106(11):3331-3353.

-     Kebebew E. . Adrenal incidentaloma. N Engl J Med. 2021; 384 (16); 1542-51.

·         Reproduction and Sexual Function:

Female:

-     Silveira LF, Latronico AC. Approach to the patient with hypogonadotropic hypogonadism. J Clin Endocrinol Metab. 2013;98(5):1781-1788.

-     Gordon CM, Kanaoka T, Nelson LM. Update on primary ovarian insufficiency in adolescents. Curr Opin Pediatr. 2015;27(4):511-519.

-     Torrealday S, Pal L. Premature menopause. Endocrinol Metab Clin North Am. 2015;44(3):543- 557.

-     Wierman ME. Hyperandrogenic Anovulation: Differential diagnosis and evaluation. Endocrinol Metab Clin North Am. 2021; 50 (1): 1-10.

-     Zaman A, Rothman MC. Postmenopausal hyperandrogenism. Endocrinol Metab Clin North Am. 2021; 50(1): 97-111.

-     Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103(6):e44-e50.

-     Gravholt CH, Viuff MH, Brun S, Stochholm K, Andersen NH. Turner syndrome: mechanisms and management. Nat Rev Endocrinol. 2019 Oct;15(10):601-614.

-     McCartney CR, Marshall JC. Clinical practice. Polycystic ovary syndrome. N Engl J Med. 2016;375(1):54-64. Article Teede HJ, et al.; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018 Aug;110(3):364-379.

-     Martin KA, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab. 2018;103(4):1-25.

-     Jha S, Turcu AF. Nonclassic congenital adrenal hyperplasia: What do endocrinologists need to know. Endocrinol Metab Clin North Am. 2021 50 (1): 151-165

-     Stuenkel CA, Davis SR, Gompel A, et al. Treatment of symptoms of the menopause: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(11):3975- 4011.

-     The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022 Jul 1;29(7):767-794

-     Torrealday S, Pal L. Premature menopause. Endocrinol Metab Clin North Am. 2015;44(3):543- 557. Article Santen RJ, Kagan R, Altomare CJ, Komm B, Mirkin S, Taylor HS. Current and evolving approaches to individualizing estrogen receptor-based therapy for menopausal women. J Clin Endocrinol Metab. 2014;99(3):733-747.

-     Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021 Jan 1;106(1):1-15.

Male:

-     Basaria S. Male hypogonadism. Lancet. 2014;383(9924):1250-1263.

-     Bhasin S, et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-1744.

-     Snyder PJ. The Benefits and Risks of Testosterone Treatment in Older Hypogonadal Men. Endocrinol Metab Clin North Am. 2022 Mar;51(1):149-156.

-     Snyder PJ, Bhasin S, Cunningham GR, et al. Lessons From the Testosterone Trials. Endocr Rev. 2018 Jun 1;39(3):369-386.

-     Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013 Jan 12;381(9861):153-65.

-     Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018 Sep;200(3):633-641.

-     Narula HS, Carlson HE. Gynaecomastia--pathophysiology, diagnosis and treatment. Nat Rev Endocrinol. 2014;10(11):684-698.

-     Kathrins M, Niederberger C. Diagnosis, and treatment of infertility-related male hormonal dysfunction. Nat Rev Urol. 2016;13(6):309-323.

Gender Incongruence:

-     Safer JD, Tangpricha V. Care of the Transgender Patient. Ann Intern Med. 2019;171(1):ITC1- ITC16.

-     Hembree WC, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017; 102(11): 3869-3903.
Knowledge/Skills:
GOALS AND OBJECTIVES:



1. During the elective, medical students will develop skills in the evaluation and management of hormonal problems including diseases of the following endocrine organs:

     Hypothalamus and pituitary

     Thyroid gland

     Adrenal cortex and medulla

     Pancreatic islets

     Ovaries and testes

     Parathyroid glands



2. Medical students will be expected to:

     -Identify the relationships of genetics and endocrine diseases.

     -Describe endocrine physiology and pathophysiology in systemic diseases and principles of hormone action.

     -Review immunological aspects of diabetes and other endocrinologic diseases.

     -Understand pathogenesis and epidemiology of diabetes mellitus.

     -Develop skills in the evaluation and management of type-1 and type-2 diabetes, including:



     Long term goals, counseling, education and monitoring

     Intensive insulin management in critical care and surgical patients

     Acute, life-threatening complications of hyper- and hypoglycemia

     Prevention and surveillance of microvascular, macrovascular and neuropathic complications

     Principles of patient directed diabetes education and dietary counseling



3. Medical students will learn and develop understanding of:

     Disorders of sodium and water homeostasis

     Disorders of bone and mineral metabolism with particular emphasis on the diagnosis and management of osteoporosis

     Parenteral nutrition support

     Nutritional disorders of obesity, anorexia nervosa, and bulimia

     Diagnosis and management of lipid and lipoprotein disorders

     Genetic screening and counseling for endocrine and metabolic disorders

     Learn about appropriate utilization and interpretation of clinical laboratory, radionuclide, and radiologic studies for the diagnosis and treatment of endocrine and      metabolic diseases.










Teaching Methods:

Medical Students will evaluate the patients by performing history and physical examination. For each interaction, the trainee will spend sufficient time with the patient to carry out an appropriate history and physical examination and then to interact with and be directly supervised by the endocrine fellows and faculty assigned to that activity. The learning experience surrounding patient interaction evolves from review of history, physical examination and laboratory results with the endocrine fellows and attending physicians, taking direction from the attending physician and being provided with references or other learning materials that can be used for self-instruction and subsequent review with the attending physician. The medical student will also learn, under supervision, how to interact not only with the patient and family, but also with other physicians and staff caring for the patient. In addition, attendings will review the consult and progress notes written by the students. They will provide constructive suggestions for presentation and communication of information in progress notes and consultations.



Disease Mix, Patient Characteristics and Types of Clinical Encounters:

Patients will have a variety of diseases that impact the endocrine system, diseases of other systems with coexisting endocrine disease, or manifestations of primary endocrine disease such as diabetes mellitus, thyroid or parathyroid. Patients will be adults of all ages, including the geriatric age group and both genders. The severity of illness will be much greater in the inpatient settings when compared to the ambulatory clinics. The patients seen are ethnically and racially mixed and representative of the population of southwestern Ohio.




Main Course Topics :
Disorders of the endocrine disorders, including:

Hypothalamus and pituitary (Pituitary tumors, hypopituitarism, Diabetes Insipidus)

Thyroid gland (Hypothyroidism, Hyperthyroidism, Thyroiditis, Thyroid nodules, Thyroid cancer, non-thyroidal illness)

Adrenal cortex and medulla ( Adrenal incidentaloma, Adrenal tumors, Congenital Adrenal Hyperplasia, Primary and secondary adrenal insufficiency, Pheochomocytoma, Paraganglioma, Primary Hyperaldosteronism, Cushing’s syndrome)

Pancreatic islets ( Diabetes Mellitus, Insulin and Glucagon)

Ovaries and testes (Hypogonadism, Ovarian failure, Polycystic Ovarian Syndrome, Hirsutism)

Bone and Parathyroid glands (Hypoparathyroidism, Primary hyperparathyroidism, Hypercalcemia, Hypocalcemia, Osteoporosis, Osteopenia).




Procedures:
  1. Become familiar with finger stick blood glucose testing, continuous glucose monitoring systems (CGMS) and insulin pump, insulin pens and other insulin delivery devices.  
  2. Participate in endocrine dynamic tests as the opportunity arises on their patients. These may include such tests as ACTH stimulation testing, Glucagon stimulation testing, metyrapore tests, dexamethasone suppression testing, oral glucose tolerance testing (OGTT) and 72 hour fast for hypoglycemia.
  3. Observe and/or participate in thyroid ultrasound exams and fine needle aspiration (FNA)biopsy of thyroid nodules.
  4. Understand the interpretation of bone density scans in evaluation and management of patients with disorders of bone metabolism.


Remediation Plan:
 N/A

SAMPLE WEEK

SCHEDULE NOTE:

Detailed Schedule & Conference information emailed prior to starting the elective.

ATTENDANCE AND ABSENCE POLICY

 

Session Attendance for M4 Students

  • Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
  • Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
  • AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
  • Excused Absences - The following will be considered excused absences:
    • Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
    • Personal illness, accident or a major catastrophic event
    • Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
  • Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
  • The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
  • The following items are explained in detail in the Medical Student Handbook:
    • Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work

See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.




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