Requirements for Board Certification of the Division of Endocrine Surgery (DES)
Basic and Clinical Science Curriculum
Basic science curriculum
* Understanding of the development of the endocrine glands and a detailed knowledge of their anatomy including variations in position.
* Endocrine physiology as outlined below and pathogenesis of endocrine tumors.
* Possibilities and limitations of detection devices used clinically and in research including knowledge in molecular biology and assay methods Clinical science curriculum
* Understanding of the principles of endocrine investigation (including history, clinical examination and biochemical, radiological, isotopic, cytological and histological investigations and its limitations)* Knowledge in interpretation of cervical ultrasound findings
* Strategies for minimizing intervention and costs* Knowledge of actual controversies in indication and extent of endocrine procedures
Thyroid
1.1.Physiology and pathophysiologyrole of iodine in the normal function of the thyroid including pathways of iodine metabolism. Physiology of TSH and Thyrotropin releasing factor. Function of T3 and T4. Role of thyroglobulin in thyroid physiology. Thyroid hormone release. Principles underlying the functioning of the pituitary thyroid axis. Tests of thyroid function including the use of isotope uptake tests. Thyroid antibodies and their significance. An understanding of the physiological impact of Graves disease on normal bodily functions. Mechanisms of ophthalmic manifestations of Graves disease. Physiology of thyroid crisis. Effects of calcitonin.*
1.2. Embryology, pathology, cytology, classifications, geneticsembryological development of the thyroid gland; histology of benign thyroid disorders, classification of thyroid tumors, FNA, classification of FNA; limitations of FNA; TNM-Staging; genetics of hereditary thyroid malignancies (PTC, MTC) *
1.3. Clinical presentation and clinical workupsolitary thyroid nodule, goiter, hyperthyroidism (Plummer's disease, Graves' disease), thyroiditis (Hashimoto, De Quervain, Riedel), well differentiated thyroid cancer, MTC, UTC; thyroglossal cyst; ultrasound; radionuclide-imaging *
1.4. Perioperative managementpreoperative medical therapy of hyperthyroidism, thyroxine-replacement therapy, laryngoscopy *
1.5. Indications, operative techniques, management of complicationsalternative medical or radioisotope therapies, thyroidectomy, lymphadenectomy (central/lateral), techniques for preservation of the recurrent laryngeal nerve/external branch of the superior laryngeal nerve and parathyroid function, management of complications (recurrent nerve palsy, postoperative hypoparathyroidism, postoperative hemorrhage), retrosternal goiter, "minimally invasive" techniques and their controversies, operative strategies of recurrent disease
Parathyroids
2.1. Physiology and pathophysiologyunderstanding of the metabolism of calcium, magnesium and of phosphate. Activity of PTH on kidney, gut and bone. D Vitamins and its function. Measurement of PTH and an appreciation of the different terminal components. Functions of nephrogenic cyclic AMP in parathyroid physiology *
2.2 Embryology, anatomy, pathology, geneticsembryological development and migration of parathyroid glands; typical, atypical and ectopic localisations; Histopatholocial morphology of pHPT/sHPT, genetics of familial forms of pHPT *
2.3. Clinical presentation and clinical workupclinical presentation of pHPT/sHPT; lithium-induced HPT; bone mineral density; ultrasound; Sestamibi-scan
2.4. Perioperative managementmanagement of hypercalcemic crisis, management of preoperative vitamin D insufficiency; postoperative supplementation medication, workup of recurrent HPT *
2.5. Indications, operative techniques, management of complicationscontroversies and indication in asymptomatic pHPT; principles of IOPTH-monitoring and interpretations of its results, role of frozen section, bilateral neck exploration, focused parathyroidectomy; operative strategies in sHPT and familial-/lithium-induced HPT; management of parathyroid carcinoma, indication and management of recurrent HPT.
Adrenals
3.1. Physiology and pathophysiology Adrenal cortex: the biosynthesis of glucocorticoids. Physiology of glucocorticoids including their relevance to immunological mechanisms and would healing. Metabolism of cortisol and knowledge of those metabolites which are measured in clinical practice. Physiology of adrenal androgens and the effects of pathological overproduction. Biochemistry and precursors of aldosterone. Understanding of the renal angiotensin mechanisms. Action on aldosterone on distal tubule function. Aldosterone response to alterations in electrolyte levels. Adrenal medulla: metabolic pathways of adrenaline and noradrenaline production. Assessment of adrenal medullary activity. An understanding of the effects of excess catecholamines on cardiovascular and intestinal function and on carbohydrate metabolism.*
3.2. Pathology, classifications, geneticsclassification of adrenal tumors; histopathological morphology of hyperaldosteronism, hypercortisolism; classification of adrenocortical carcinoma; genetics of familial adrenal disease (MEN1, MEN2; VHL; SDHB; SDHB; NF1)*
3.3. Clinical presentation and clinical workupworkup and management of incidentalomas; knowledge of tests of adrenal cortical function and adrenal responsiveness (dexamethasone suppression / ACTH stimulation test); diagnostic imaging(CT/MRI); specific radionuclide imaging; adrenal venous sampling*
3.4. Perioperative managementpreoperative medical treatment (hyperaldosteronism, pheochromocytoma/paraganglioma); perioperative steroid management in patients with hypercortisolism,*
3.5.Indications, operative techniques, management for complicationssurgical approaches (conventional/endoscopic); concepts of subtotal adrenalectomy, bilateral adrenalectomy; adrenalectomy for metastasis, Addisonian crisis;
Pituitary
4.1. Physiology and pathophysiologystructure,cells of origin, the basic metabolism and function of anterior pituitary hormones with no feedback loops (growth hormone and prolactin) and those with feedback loops (LH, TSH and ACTH). Hypothalamic pituitary pathways and related releasing substances. Corticotrophin releasing factor and its relationship to ACTH. Physiology of ACTH and TSH including diurnal variation. ACTH changes in response to stress, illness and trauma.* 4.2. Clinical presentation and clinical workup Cushing's syndrome, hyperprolactinemia, acromegaly* 4.3. Therapy
Diffuse endocrine system of the gastro-entero-pancreatic tract
5.1. Physiology and pathophysiologyAppreciation of the physiology and pathophysiology of the secretion of serotonin, histamine, gastrin, insulin, glucagon, pancreatic polypeptide, VIP, secretin and somatostatin. The identification of cells of origin of gut hormones by immunocytochemistry. *
5.2. Embryology, pathogenesis, pathology, classifications, geneticsOrigin and particularities of the different endocrine cell-types of the gastro-entero-pancreatic tract; TNM-staging; WHO-classification; proliferation indexes; genetics of MEN1 *
5.3. Clinical presentation and clinical workupclinical presentation of histamine- and serotonin-induced carcinoid syndrome, carcinoid tumors of the gut, ECL-omas of the stomach, hypergastrinemia, hyperinsulinism; Crossectional imaging and specific radionuclide-imaging; *
5.4. Perioperative medical managementsomatostatin analogs; PPI; *
5.5. Indications, operative techniquesfor carcinoid tumors of the gut, for sporadic or MEN1-associated hypergastrinemia, for hyperinsulinism *
5.6. Palliative concepts in the management of neuroendocrine tumors. Biotherapy; chemotherapy, principals in the management of metastatic liver disease (surgery, radiofrequency ablation, chemoembolization), peptide receptor radionuclide therapy