FELLOWSHIP IN Endocrinology, Diabetes and Metabolism

Module 1: Endocrinology - Basic and Systems Physiology of Endocrine Systems

• Embryology, anatomy and zonation of endocrine glands
• Hormone biosynthesis, secretion, metabolism and clearance
• Hormone receptors, signal transduction, feedback mechanisms
• Interaction of endocrine systems with cardiovascular, renal, musculoskeletal, neurologic systems
• Endocrine physiology in special states: puberty, pregnancy, ageing
• Genetics of endocrine regulation, endocrine-gene interactions
• Endocrine laboratory and imaging fundamentals (hormone assays, dynamic testing)
• Normal vs pathologic endocrine homeostasis

Module 2: Pituitary & Hypothalamic Disorders

• Hypothalamic-pituitary axis anatomy & physiology
• Hypopituitarism, pan-hypopituitarism, isolated hormone deficiencies
• Pituitary adenomas (prolactinoma, GH-secreting, ACTH-secreting)
• Craniopharyngioma, Rathke’s cleft cyst, non-functioning tumours
• Disorders of growth hormone: acromegaly, GH deficiency
• Disorders of ACTH/cortisol: Cushing’s disease, adrenal suppression
• Pituitary apoplexy, empty sella, hypogonadism
• Surgical, medical and radiological management; long-term follow-up

Module 3: Thyroid & Parathyroid Disease

• Thyroid gland development, physiology, iodine metabolism
• Thyroid dysfunction: hyperthyroidism, hypothyroidism, subclinical states
• Thyroid nodules, thyroid cancer, differentiated and medullary thyroid carcinoma
• Fine needle aspiration, thyroid ultrasound, nuclear medicine applications
• Parathyroid physiology: PTH, calcium-phosphate-vitamin D axis
• Primary hyperparathyroidism, hypoparathyroidism, familial forms
• Bone and mineral metabolism: osteoporosis, Paget’s disease, renal osteodystrophy
• Skeletal imaging (DEXA), bone turnover markers, management of metabolic bone disease

Module 4: Adrenal, Gonadal & Reproductive Endocrinology

• Thyroid gland development, physiology, iodine metabolism
• Thyroid dysfunction: hyperthyroidism, hypothyroidism, subclinical states
• Thyroid nodules, thyroid cancer, differentiated and medullary thyroid carcinoma
• Fine needle aspiration, thyroid ultrasound, nuclear medicine applications
• Parathyroid physiology: PTH, calcium-phosphate-vitamin D axis
• Primary hyperparathyroidism, hypoparathyroidism, familial forms
• Bone and mineral metabolism: osteoporosis, Paget’s disease, renal osteodystrophy
• Skeletal imaging (DEXA), bone turnover markers, management of metabolic bone disease

Module 5: Neuroendocrinology & Endocrine

• Neuroendocrine axes: hypothalamic hormones, peptide regulation, feedback loops
• Neuroendocrine tumours: pituitary, adrenal medulla, pancreatic NETs
• Endocrine manifestations of systemic malignancy (paraneoplastic syndromes)
• Thyroid-cancer management including surgery, radio-iodine, molecular markers
• MEN (multiple endocrine neoplasia) syndromes, genetic screening and counselling
• Endocrine-surgical collaboration: timing, risks, follow-up
• Long-term surveillance of endocrine cancers
• Translational research in endocrine tumour biology

Module 6: Clinical Skills, Diagnostics & Procedures in Endocrinology

• Endocrine history and physical examination (thyroid, adrenal, gonadal, bone)
• Interpretation of endocrine biochemical tests (hormones, metabolites, dynamic testing)
• Imaging modalities: US, CT/MR, PET, nuclear scanning in endocrine disease
• Fine needle aspiration (thyroid, parathyroid) and cytopathology basics
• Bone density measurement, bone histomorphometry, interpretation of skeletal imaging
• Endocrine outpatient vs inpatient care dynamics; consultative model
• Multidisciplinary care (endocrine surgery, nuclear medicine, nephrology, oncology)

Module 7: Diabetes - Pathophysiology & Classification of Diabetes

• Glucose metabolism, insulin secretion and action, insulin resistance
• Classification: Type 1, Type 2, LADA, MODY, Gestational diabetes
• Genetic, environmental and epigenetic contributors
• Beta-cell failure, incretin effect
• Glucagon axis, hepatic glucose output
• Monogenic and syndromic forms of diabetes
• Diabetes in special populations (pediatrics, pregnancy, elderly)
• Pre-diabetes, metabolic syndrome and progression to diabetes
• Emerging biomarkers, pathophysiologic research

Module 8: Clinical Management of Type 1 & Type 2 Diabetes

• Lifestyle interventions: diet, exercise, weight management
• Pharmacotherapy: insulin, oral agents, GLP-1, SGLT2, DPP4 inhibitors
• Insulin pump therapy, continuous glucose monitoring (CGM), hybrid closed loop systems
• How to individualise therapy: comorbidities, complications, cost-effectiveness
• Management of acute metabolic emergencies: diabetic ketoacidosis (DKA), hyperosmolar state
• Inpatient vs outpatient protocols, transitions of care
• Diabetes in renal disease, cardiovascular disease, hepatic disease
• Use of technology, telemedicine, digital health in diabetes care

Module 9: Diabetes Complications & Comorbidities

• Microvascular complications: retinopathy, nephropathy, neuropathy
• Macrovascular complications: coronary artery disease, stroke, peripheral vascular disease
• Foot care, ulcers, amputations – multidisciplinary approach
• Diabetic kidney disease: staging, management, transplantation issues
• Autonomic neuropathy, erectile dysfunction, gastroparesis
• Diabetes and cognition, dementia risk, psychosocial aspects
• Patient-centred care: self-management, education, behavioural health, screening guidelines, prevention strategies

Module 10: Special Situations in Diabetes

• Gestational diabetes: screening, management, postpartum follow-up
• Diabetes in children and adolescents: puberty, growth, transition to adult care
• Diabetes in the elderly: frailty, polypharmacy, hypoglycemia risk
• Diabetes in pregnancy, lactation, peripartum period
• Secondary diabetes: pancreatic disease, endocrine causes (Cushing’s, acromegaly), medication-induced
• Inpatient diabetes management: peri-operative, ICU, steroid-induced hyperglycaemia
• Technology integration: artificial pancreas, telehealth, apps
• Nutrition therapy, bariatric surgery and diabetes remission

Module 11: Metabolic and Lifestyle Medicine in Diabetes

• Nutrition and dietary strategies: low-carb, Mediterranean, plant-based, culturally sensitive care
• Physical activity, exercise prescription, behavioural change strategies
• Obesity management: pathophysiology, pharmacotherapy, surgical options
• Weight-loss interventions: lifestyle, pharmacologic, bariatric surgery
• Diabetes prevention programmes, community outreach, public health aspects
• Sleep disorders, circadian rhythm and diabetes risk
• Social determinants of health, health equity, cultural competence
• Digital tools and remote monitoring in lifestyle medicine

Module 12: Research, Quality Improvement & Systems-Based Diabetes Care

• Design and conduct of diabetes clinical trials, translational studies
• Quality improvement initiatives in diabetes care: metrics, registries, benchmarking
• Health systems: interdisciplinary care models, chronic disease management, cost-effectiveness
• Guidelines development, evidence-based practice, guideline adherence
• Patient-reported outcomes, patient engagement, shared decision-making
• Big data, artificial intelligence, predictive analytics in diabetes
• Ethics, health policy, reimbursement in diabetes care

Module 13: Metabolism - Metabolic Physiology & Molecular Basis

• Energy metabolism: ATP production, mitochondrial function, oxidative phosphorylation
• Lipid metabolism: lipoproteins, fatty acid oxidation, storage, transport
• Amino acid and protein metabolism, urea cycle, gluconeogenesis
• Carbohydrate metabolism: glycolysis, gluconeogenesis, glycogen metabolism
• Hormonal regulation of metabolism: insulin, glucagon, catecholamines, thyroid hormone
• Cellular metabolism: signalling pathways (AMPK, mTOR, SIRT), mitochondrial biogenesis, metabolomics, systems biology and emerging research in metabolism
• Nutrient sensing, microbiome-metabolism interplay

Module 14: Dyslipidaemia, Obesity & Metabolic Syndrome

• Pathophysiology of obesity, adipose tissue biology, adipokines
• Metabolic syndrome: criteria, epidemiology, pathogenesis
• Dyslipidaemia: classification, work-up, secondary causes
• Lipid modifying therapies, novel agents (PCSK9 inhibitors, ANGPTL3)
• Non-alcoholic fatty liver disease (NAFLD) / non-alcoholic steatohepatitis (NASH)
• Ectopic fat, lipotoxicity, metabolic complications of obesity
• Weight management strategies, bariatric metabolic surgery, endoscopic therapies
• Public health aspects of obesity and metabolic disorders

Module 15: Bone, Mineral & Connective Tissue Metabolism

• Bone biology: osteoblasts, osteoclasts, osteocytes, bone remodelling
• Mineral homeostasis: calcium, phosphate, magnesium, vitamin D metabolism
• Disorders: osteoporosis, rickets/osteomalacia, Paget’s disease, osteogenesis imperfecta
• Renal bone disease, secondary/tertiary hyperparathyroidism
• Bone imaging, densitometry, bone turnover markers
• Connective tissue metabolism, matrix biology, skeletal muscle-bone interplay
• Therapeutics: anti-resorptives, anabolics, novel bone agents
• Metabolic bone disease in endocrine and non-endocrine settings

Module 16: Nutritional, Exercise & Lifestyle Metabolism

• Nutrient absorption and metabolism: macro- and micro-nutrients
• Role of nutrition in metabolic health: vitamins, minerals, trace elements
• Exercise physiology, metabolic adaptations to training, sedentary behaviour
• Thermogenesis, brown and beige adipose tissue, metabolism in cold, diet-induced thermogenesis
• Interplay of nutrition, exercise, metabolism in disease prevention
• Gut-metabolism axis: microbiome, short-chain fatty acids, bile acids
• Nutrigenomics, personalised nutrition, metabolic phenotyping

Module 17: Metabolic Disorders and Rare Diseases

• Inborn errors of metabolism: glycogen storage, mitochondrial disorders, fatty acid oxidation defects
• Lipodystrophy, metabolic myopathies, storage diseases (e.g., Gaucher, Fabry)
• Endocrine-metabolic overlaps: thyroid/adrenal/pituitary impacts on metabolism
• Hypoglycaemia unexplained, hyperinsulinaemic states, insulinoma
• Hypercalcaemia, hypophosphataemia, rare mineral metabolic disorders
• Metabolic consequences of cancer therapy, HIV treatment, transplantation
• Genetic testing, metabolic screening, enzyme replacement therapies

Module 18: Research, Innovation & Systems Metabolism

• Translational metabolic research: bench-to-bedside, animal models, human phenotyping
• Omics in metabolism: genomics, proteomics, metabolomics, lipidomics
• Big data analytics, machine learning in metabolic disease prediction
• Systems biology and network modelling of metabolic pathways