EUROPOS SĄJUNGA
Europos Socialinis Fondas
Program of Medicine Studies
ENDOCRINOLOGY
MODULE
Forth Year
8 /9th Semester
th
Faculty of Medicine
Lithuanian University of Health Sciences
Contents
1. General information ................................................................................................... 4
2. General content of the module ................................................................................... 5
3. Aim and objectives of the module ............................................................................. 6
4. Tutorials ..................................................................................................................... 7
4.1. Case 1. Diabetic foot syndrome and its treatment (E / Surg) ............................. 7
Learning objectives and contents ......................................................................... 8
4.2. Case 2. A nodule in the neck (E / Surg) ............................................................. 9
Learning objectives and content ......................................................................... 11
4.3. Case 3. Feeling unwell is not without cause (Adrenal / pituitary diseases) (E /
Surg) ........................................................................................................................ 11
Aim ..................................................................................................................... 12
4.4. Case 4. Obese patient (E / Surg) ...................................................................... 13
Aim ..................................................................................................................... 14
5. Lectures .................................................................................................................... 15
5.1. Laboratory diagnostics of endocrine disease (2 hrs) ........................................ 15
In charge – assistant R.Steponavičiūtė ................................................................... 15
5.2. Neuroendocrine regulation of carbohydrate metabolism, body weight and
energy and its disorders and the molecular bases of complications (2 hrs) ............ 16
5.3. Neuroendocrine system and its role in the self-regulatory principles (2 hrs) 16
5.4. Diagnosis and treatment of diabetes mellitus and it’s complications (2 hrs) ... 16
5.5. Acute and late complications of diabetes mellitus (2 hrs) ............................... 17
5.6. Diabetes Mellitus in Children (2 hrs) .............................................................. 17
5.7. Radionuclides in diagnosing endocrine diseases. Treatment with radionuclides
(2 hrs) ...................................................................................................................... 18
5.8. Thyroid diseases (2 hrs) ................................................................................... 18
5.9. Thyroid cancer, thyroid and parathyroid surgery (2 hrs) ................................. 19
5.10. Endocrine Surgery (2 hrs) .............................................................................. 19
5.11. Adrenal disorders (2 val.) ............................................................................... 19
5.12. Perinatal endocrinology (2 hrs) ..................................................................... 20
5.13. Breast diseases (2 hrs) .................................................................................... 20
5.14. Obesity Surgery (2 hrs) .................................................................................. 21
6. Practicals .................................................................................................................. 21
6.1. Diabetes: diagnosis, prevention (2 hrs) ............................................................ 21
6.3. Acute diabetic complications and their treatment (2 hrs) ................................ 22
6.4. Chronic diabetic complications and their treatment (2 hrs) ............................. 22
6.5. Thyroid diseases: ethiopathogenesis, diagnostics. Thyroiditis. (2 hrs.) ........... 22
6.6. Grave’s disease: clinical maniphestation, diagnosis and treatment (3 hrs) ...... 23
6.7. Nodular goiter: diagnosis, treatment (2 hrs) .................................................... 23
6.8.Parathyroid diseases, metabolic bone diseases (3 hrs) .................................. 24
6.9. Cushing’s disease and syndrome (3 hrs) .......................................................... 24
6.10. Acute and chronic adrenal insufficiency (2 hrs) ............................................ 25
6.11. Endocrine causes of hypertension (2 hrs) ...................................................... 25
6.12. Functioning pituitary tumors (2 val.) ............................................................. 25
6.13. Hypopituitarism (2 hrs) .................................................................................. 25
6.14. Endocrine obesity (2 hrs) ............................................................................... 26
6.15. Acute conditions in pediatric endocrinology (3 hrs) ...................................... 26
6.16. Disorders of growth and puberty. The most common endocrine disease in
children (3 hrs) ........................................................................................................ 27
6.17. Thyroid disorders in children (2 hrs) ............................................................. 27
6.18. Surgical diabetic problems (2 hrs) ................................................................ 27
6.19. Regional anatomy of neck and neck incisions (2 hrs) .................................... 28
6.20. Thyroid and parathyroid surgery (2 hrs) ........................................................ 28
6.21. Adrenal and pancreatic endocrine surgery (3 hrs) ......................................... 28
6.22. Surgical Treatment of Obesity (2 hrs) ............................................................ 29
6.23. Breast cancer and benign diseases (2 hrs) ...................................................... 29
7. Seminars................................................................................................................... 32
8.1. Endocrinology .................................................................................................. 33
8.2. Diabetology ...................................................................................................... 34
8.3. Pediatric endocrinology ................................................................................... 35
8.4. Endocrine surgery and mamology ................................................................... 35
9. Supplement .............................................................................................................. 37
9.1. Procedures of study in module ......................................................................... 37
Work in wards ......................................................................................................... 37
Attendance .............................................................................................................. 37
Evaluation ............................................................................................................... 37
9.2. The final evaluation.......................................................................................... 37
1. General information
Supervisor of the module:: dr. Dalia Kozlovienė, Endocrinology Clinic
(d.kozloviene@gmail.com)
Coordinator of Module: Lecturer Zilvinas Dambrauskas, Surgery Clinic
(zilvinas.dambrauskas @ gmail.com)
Departments and auditoria hours:
Radiology Clinic
(2 auditoria hours)
Endocrinology Clinic
(77 auditoria hours)
Surgery Clinic
(21 auditoria hours)
Department of Biochemistry
(2 auditoria hours)
Clinics in Laboratory Medicine (2 auditoria hours)
Subjects, and responsible persons:
Endocrinology (prof. Rasa Verkauskienė, 8 37 326816)
Applied anatomy and operating surgery, endocrine and breast surgery
(assoc. prof. V.Krasauskas)
Clinical Radiology (Gintaras Kuprionis, PhD, 8 37 326206)
Clinical biochemistry (assoc. prof. A. Mongirdienė, 8 37 361139)
Clinical laboratory diagnostics (assist. R. Steponavičiūtė)
2. General content of the module
By analyzing the problems of this module the students gain new knowledge and apply
it to the following domains:

Feedback principles in diagnostics of endocrine diseases,

Regulation of carbohydrate metabolism

Mechanisms of development of diabetes and its

Classification and diagnosis of diabetes mellitus

Clinical peculiarities and diagnostic tests for type 1 diabetes mellitus

Clinical peculiarities and diagnostic tests for type 2 diabetes mellitus

Prevention of diabetes complications

classification, diagnosis, prevention and treatment principles of diabetic
retinopathy

Clinical stages of diabetic nephropathy, diagnosis, prevention and treatment
principles

Diagnosis, classification, prevention and treatment principles of diabetic
neuropathy

Classification, diagnosis, prevention and treatment principles of diabetic foot

Classification of insulin preparations, principles of treatment with insulin in
type 1 and type 2 diabetes mellitus

Diagnosis, prevention and treatment principles of diabetic ketoacidosis

Symptoms and causes of hypoglycemia in diabetes, diagnostics, prevention
and principles of treatment

Treatment of diabetes mellitus with oral antidiabetic medicine

Principles of the combined treatment with insulin and oral medicines

Reasons of thyrotoxicosis

Clinics, treatment principles of diffusive toxic goiter (Grave's disease)

Classification, clinical manifestation and treatment principles of thyroiditis

Causes, clinical manifestation and treatment principles of hypothyroidism

Clinical manifestation and treatment principles of endocrine ophthalmopathy

Clinical manifestation, diagnostic tests, treatment principles, the reasons for
the crisis, the principles of the treatment, prevention of suprarenal
insufficiency

Clinical manifestation, diagnostic tests and treatment principles of
phaeochromocytoma

Clinical manifestation, diagnostic tests and treatment principles of AKTH
dependent and AKTH independent Cushing’s syndrome (hypercorticism)

Etiology and pathogenesis, clinical manifestation, diagnostic tests and
treatment principles of acromegaly

Etiology and pathogenesis, clinical manifestation, diagnostic tests and
treatment principles of hyperprolactinemia

Etiology and pathogenesis, clinical manifestation, diagnostic tests and
treatment principles of hypopituitarism



Clinical manifestation, diagnostic tests and treatment principles of
hypoparathyroidism
Clinical manifestation, diagnostic tests and treatment principles of
hyperparathyroidism
Etiology and pathogenesis, clinical manifestation, diagnostic tests and
treatment principles of metabolic bone diseases, osteoporosis

Neuroendocrine body energy regulation and body weight

Obesity: causes, relationship to other diseases, treatment principles
3. Aim and objectives of the module
The student after have studied this module should know how to define, analyze,
explain and relate phenomena to the cases analyzed in the module. Attaining this aim,
students must gain knowledge about the structure, function and disorders in
pathological conditions, mechanisms and principles of their examination and
treatment:

Structure, function and the mechanisms of disorders of endocrine organs
(pancreas, thyroid, parathyroid, adrenals and pituitary)

Examination of patients with endocrine diseases, principles of treatment and
long-term monitoring

Epidemiology, the most important etiologic and pathogenesis mechanisms,
clinical manifestation, diagnostics, treatment and prevention principles of most
common endocrine diseases (listed in the table of contents)
4. Tutorials
4.1. Case 1. Diabetic foot syndrome and its treatment (E / Surg)
In charge - lecturer E. Danytė and V. Kymantas
Mr. G.K. (age - 64 years) presents to the doctor for a progressive phlegmona and
thirst. The wound on the right foot appeared 2 weeks before; there was no pain, so he
only put the bandage. One day he spent driving. After taking off the shoe, he noticed
that the foot was red and swollen. Also he had a fever up to 38oC. Patient turned to
the surgeon, who recommended the amputation of foot. Patient did not agree with
amputation. Since the glycaemia was found 17.2 mmol/l, he was referred to
endocrinologist. He had intermittent thirst for few years. He was complaining with
impaired vision. The increased arterial blood pressure was found, but until now no
antihypertensive medicine was prescribed. He had a stroke in 1999. His father had
type 2 diabetes. 2 years ago he had the ulcer in toe of right foot, painless, which
healed easily. For 4 days he uses antibiotics.
Physical examination:
height 170 cm, weight 95 kg. Temperature 38.5oC. No arrhythmia was found, the
heart rate 90 / min, BP 160/90 mmHg. Vesicular breathing, no rales. Abdomen soft,
painless. Liver not increased. Symptom of Jordan right (-), left (-). Pulse a.dorsalis
pedia palpable in both feet. The vibration is completely not sensed, the needle prick
and temperature sensation on both sides negative. On the right foot, I metatarsal at the
bottom surface the ulcer is present. The foot is swollen, hot, red above the ankle.
Laboratory tests: The HbA1c-12, 2 %., glycaemia 17.9 mmol/l. WBC 14.0 x 10 / 9 l,
RBC 4.42 x 10/12 l, Hb 135 g/l, PLT 290 x 10 / 9 l. CRP 156 mg/l, K 4.5 mmol/l, Na
136 mmol/l, urea 4.1 mmol/l, Chol 2.5 mmol/l, HDHCh 0.57 mmol/l, LDLCh 1.51
mmol/l, TG 0.71 mmol/l.
In microbiologicy from the wound grew very large group of beta-haemolytic
streptococci, sensitive to penicillin.
In foot X-ray no bone destruction was reported
What is the main problem, with which presents the patient?
What are the patient's problems (list all)?
In which the items of anamnesis and examination you will pay more attention?
What kind of examinations or laboratory tests do you need?
What treatment is needed and what specialties of physicians should be involved?
What type of diabetes a patient suffers from, why?
Why patient's foot is painless, in spite the ulcer?
What are the complications of diabetes do you suspect in this patient?
What is your examination plan, and what results can you expect?
How to treat major problems with which the patient presents?
What kind of treatment do you plan for other complications?
Patient education, control of diabetes and foot care?
What is examination of the patient with the diabetic foot syndrome?
Indications for surgical treatment and its principles?
Concept of the problem: The patient, who did not know that he is diabetic, has come
with the explicit chronic diabetes complications, which are not diagnosed until now.
In this situation, the diabetes epidemiology, classification, diagnosis, acute and
chronic complications, clinical, diagnostics and prevention, treatment of diabetes and
its complications are important.
Clinical signs:
• "dumb" process of diabetes, causing no discomfort
• Foot anesthesia, painless foot ulceration
• indices of hyperglycemia.
Aim:
Acquire knowledge, practical skills and abilities in diagnostic criteria of diabetes
and its acute and chronic complications, the most important etiologic and
pathogenetic mechanisms, the clinical manifestation, diagnosis and principles of
treatment and the assessment of risk factors.
Learning objectives and contents
To complete an analysis of this problem the students must know:

Assess the diabetes risk factors, diagnosis of diabetes, constructing the plan of
examination, assessing the results of tests, designating the initial treatment

Diagnose the acute and chronic diabetes complications, to know the most
important mechanisms of their development, know the clinical manifestation,
diagnosis and principles of the treatment and evaluate their risk factors

Know basics of patient education, foot care and criteria of diabetes control.
Patient examination for diabetic foot syndrome. Indications for surgical
treatment and its principles
4.2. Case 2. A nodule in the neck (E / Surg)
In charge - lecturer D. Kozlovienė / assoc. prof. V. Krasauskas
Description
A 50-year-old man presents with enlargement of left anterior neck. He has noted
increased appetite over past month with no weight gain, and more frequent bowel
movements over the same period. Physical examination
He is 178 cm tall and weighs 75 kg. The heart rate is 82 and the blood pressure is
110/76. There is an ocular stare with a slight lid lag. The thyroid gland is asymmetric
to palpation, increased III, soft and painless in palpation. There is a 3 x 2.5 cm firm
nodule in left lobe of the thyroid
What is the preliminary diagnosis according to the patient's history and physical
examination?
What items of history and physical examination seem most important?
What thyroid diseases you’ll include in differential diagnosis?
What changes in the eyes are found in thyroid diseases?
What kind of laboratory, hormone, radionuclide and invasive tests should be
performed the patient to confirm the diagnosis?
How to treat main diseases with which the patient present?
What are the possible complications of treatment and how they are treated?
What diagnostic tests are used to diagnose thyroid disorders?
What diagnostic tests are used to define thyroid nodules?
How to distinguish the thyroid and parathyroid nodules?
What are diagnostic tests are used to determine the localization of nodules, especially
in atypical cases?
What is the use of the X-ray with contrast in esophagus?
What is the use of the thyroid scan for therapists and surgeons?
What are methods of examination of thyroid nodules?
What can be pathohystological structure of thyroid nodule?
How the tactics of treatment depend on pathohystological structure of thyroid
nodule?
Define the diseases of Plummer, Graves?
When should one suspect malignisation of thyroid nodule?
What are the histological forms of thyroid cancer?
What kind of thyroid surgery is performed to treat thyroid cancer?
Does the extent of depend on histological findings in case of thyroid cancer?
How is fine needle aspiration of a thyroid nodule performed?
What is importance of cytology groups in choosing the treatment tactics?
How to differenciate thyrotoxic goiter and toxic adenoma?
What is characteristic for the scan of toxic adenoma?
What are the indications for surgical treatment of nodular goiter?
What kind of operations is performed in case of mononodular and plurinodular
goiter?
What is the treatment tactics of toxic goiter?
What is the treatment tactics of mononodular toxic goiter (toxic adenoma)?
How and why a thyrotropin stimulating test is performed?
What is localization of ectopic nodules of thyroid?
What is localization of goiter aberratio nodules?
In what combinations the multiple endocrine neoplasia may manifest?
Concept of the problem: The diagnosis of thyroid diseases, differential diagnosis,
treatment methods.
Clinical signs: increased metabolism, diffuse enlargement of in thyroid in left lobe,
exopthtalmus (ophthalmopathy), tachycardia
Aim
Learn clinical manifestation, diagnosis, differential diagnosis and treatment
principles, radical treatment and possible complications of treatment of thyroid
diseases.
Learning objectives and content
To complete an analysis of this problem the students must know:

To evaluate thyroid function in accordance with the clinical data, an objective
examination of the patient, consisting of examination plan, assess the results
of examination, to designate the treatment

Assess the thyroid nodular changes, create a plan of examination, assess the
results of examination, designate the initial treatment

Assess the indications for surgical treatment of nodular thyroid: clinical
manifestation, radiological examination and changes in cytology, possible
complications, possibility of recurrence of goiter, depending on thyroid
pathology, the former operations and applied post-operative treatment
4.3. Case 3. Feeling unwell is not without cause (Adrenal / pituitary
diseases) (E / Surg)
In charge - lecturer L. Daugintytė-Petrušienė
Description
History: A 27-year-old woman presents with depression, insomnia, increased facial
fullness and recent increase in facial hair. She had also had an episode of depression
and acute psychosis following uncomplicated delivery of normal baby boy 9 months
previously. Her menses have been irregular since their resumption after the birth (she
is not breast-feeding).
Height 165 cm. Weight 80 kg. The heart rate was 90 beats per minute and the blood
pressure was 146/110. Her face was puffy with an increase in facial hair and ruddy
complexion. There was no truncal obesity, peripheral wasting, or striae.
Serum electrolytes, white cell count, and hemoglobin and hematocrit were all within
normal limits.
What is the main problem, with which presents the patient?
What kind of examination, laboratory tests do you need?
What is the preliminary diagnosis depending on the patient's history and an objective
examination?
Which items in the history and research objective examination are most important?
What is differential diagnosis in the adrenal and pituitary diseases?
What kind of laboratory, hormone, radionuclide and invasive tests should be
performed to confirm the diagnosis?
How to treat main disease with which the patient presents?
What are the possible complications of the treatment and their treatment?
What results based on the research plan can you expect?
Concept of the problem: ACTH-dependent Cushing syndrome: differential
diagnosis, the explanation of the diagnostic tests, treatment, possible complications of
treatment and their treatment.
Clinical signs: facial roundness, hirsutism, dysmenorrhea, hypertension, obesity, and
depression.
Aim
Learn clinical manifestations of adrenal hyperfunction, possible causes, diagnosis,
treatment principles, use of diagnostic tests to differentiate primary and secondary
adrenal cortical hyperfunction. Learn clinical manifestations of phaeochromocytoma
clinic, diagnosis, treatment principles. Learn adrenal hypofunction clinical
manifestations, possible causes, diagnosis, treatment principles.
Learning objectives and contents
To complete an analysis of this problem the students must know:

clinical manifestations, possible causes, diagnosis, treatment principles of
adrenal hyperfunction. Use of diagnostic tests to differentiate primary and
secondary adrenal cortical hyperfunction.

definition,
clinical
types,
diagnosis,
treatment
principles
of
phaeochromocytoma

clinical manifestation, examination, evaluate the results of examination of
adrenal hypofunction. Use of diagnostic tests to differentiate the primary and
secondary adrenal hypofunction. Iinterpretation of results of diagnostic tests,
initial treatment, treatment of adrenal cortical insufficiency crisis, know its
causes, prevention principles

clinical manifestation of the pituitary hyperfunction and hypofunction, causes,
diagnosis and treatment principles
4.4. Case 4. Obese patient (E / Surg)
Assoc. prof. E. Varanauskienė / prof. A. Maleckas
Description
48-year-old man presents with the increasing body weight, shortness of breath during
moderate physical exertion, feet edema on the second half of the day, knee pain, low
back pain, did irregular thirst, more frequent urination, headaches in occipital area. He
always had a good appetite, the higher childhood body weight. Both parents' also had
increased body weight; the mother suffers from Type 2 diabetes, treated with oral
medication.
Objectively: Height 186 cm, weight 145 kg, BMI 41.9 kg / m², waist 134 cm. Fat
distributed evenly, more in central part of body, white striae in abdomen, accantosis
nigricans in neck. Heart rate 96 /min. Blood pressure 180/110 mm Hg st. Vesicular
breathing, the lower parts of sparse wet rales, edema in legs, the liver due to obesity
not palpable.
What is the preliminary diagnosis according to patient's history and objective
findings?
Which items of the history and examination you find most important?
What diseases do you think of?
What tests should be performed to confirm the diagnosis?
How to treat main diseases with which the patient presents?
What are the possible complications of treatment and how to treat them?
What are the negative consequences for health caused by obesity
What functions of the human body are affected by various factors released by
adipocytes and how?
What etiology, pathogenesis, clinical, laboratory, hormonal tests are used to
determine causes of obesity?
What endocrine disorders can lead to obesity?
What are the diagnostic methods applied to diagnose endocrine diseases?
How is obesity associated with increased risk of cardiovascular diseases?
What is relationship of obesity and hypertension?
What syndromes is an integral part of obesity?
What is the relationship between obesity and diabetes?
What treatment methods can be applied?
What groups of medicines are used in the treatment of obesity?
When a patient should be recommended the surgical treatment of obesity?
What defines the selecting the type of operation (restriction, malabsorbtion, etc..)
With are obesity-related problem in surgeries and anesthesia?
Concept of the problem: The morbid overweight and obesity is a growing problem
in modern society, causing many social and medical problems, because obese people
often have a number of accompanying somatic diseases (CD Type 2, hypertension,
dyslipidaemia, joint disease, blood clotting disorders, etc..), As also suffer from
psychological and mental disorders, as well as violations of social adaptation and
integration.
Clinical signs: central type of obesity, body mass index, anthropometric data,
acantosis nigricans, arterial hypertension, tachycardia, moist rales in the lower lung,
edema in legs, the most common accompanying diseases (CD Type 2, hypertension,
dyslipidaemia, joint diseases , etc..), diagnosis and correction of risk factors, weight
control.
Aim
Learn to assess the possible causes and consequences of obesity, obesity prevention
options, treatment of obesity and its complications, problem of morbid obesity,
metabolic syndrome and related diseases, as well as principles of conservative and
surgical treatment of obesity and accompanying diseases.
Learning objectives and contents
To complete an analysis of this problem the students must know:

How to assess body mass index and body structure

Evaluate potential obesity-related diseases and risk factors

Discuss main methods of conservative treatment of obesity and weightcontrol, their effectiveness

Discuss main surgical treatments for obesity (restriction, malabsorbtion
,combined operations), indication, and operating the treatment and possibly
the most common surgical anesthetic problems
Students must be familiar with these topics:
• Physiological (normal) distribution of fat;
• Types of adipocytes and their differences;
• Adipocytes, endocrine glands, their secretion and their importance for normal
functioning of the body;
• Causes and classification of obesity;
• Insulin resistance syndrome (metabolic syndrome) - the historical data,
epidemiology, etiology, pathogenesis, clinical features;
• Relationship of insulin resistance and obesity;
• obesity and diabetes mellitus - epidemiology, etiology and pathogenesis, clinical
features;
• Renin-aldosterone system – as the classical endocrine system;
• The importance of obesity to heart disease risks;
• Research for diagnosis of obesity and its consequences;
• Possibilities of obesity prevention;
• Principles of non-medicamental treatment of obesity;
• Pharmaceutical treatment of obesity;
• Surgical treatment of obesity.
5. Lectures
5.1. Laboratory diagnostics of endocrine disease (2 hrs)
Clinic of Laboratory Medicine
In charge – assistant R.Steponavičiūtė
Description.
Laboratory diagnosis of diabetes. Laboratory diagnosis of thyroid diseases,
parathyroid diseases, Laboratory diagnosis of adrenal diseases. Laboratory diagnosis
of hypothalamus and pituitary diseases, Pre-analytical and analytical factors affecting
laboratory test results. Interpretation of the test results.
5.2. Neuroendocrine regulation of carbohydrate metabolism, body
weight and energy and its disorders and the molecular bases of
complications (2 hrs)
Department of Biochemistry
In charge – assoc. prof.A. Mongirdienė
Description
Carbohydrate metabolism regulation in human body. The main hormones involved in
carbohydrate metabolism: insulin, glucagon, adrenaline. Their effects on carbohydrate
metabolism molecular basis. The laboratory assessment of hormone activity. Diabetes
complications: the molecular mechanisms of their development and correction of
biochemical aspects. Regulation of body weight: adipokines, CNS peptides,
neuromediators and others. Possibilities of correction of non-endocrine obesity.
5.3. Neuroendocrine system and its role in the self-regulatory
principles (2 hrs)
Endocrinology Clinic
In charge – assoc. prof. B. Žilaitienė
Description.
Hypothalamus - pituitary - target organ interactions. Primary, secondary, tertiary
disorders. Tropical part of the frontal pituitary hormones. Understanding of
hypofunction and hyperfunction. Feedback regulation principles in diagnosis of
endocrine diseases. Diagnostic tests.
5.4. Diagnosis and treatment of diabetes mellitus and it’s
complications (2 hrs)
Endocrinology Clinic
In charge – lecturer J. Butnorienė
Description
Diabetes definition, epidemiology. Types of diabetes mellitus. Mechanisms of
development of chronic hyperglycemia in the body. Diagnosis of diabetes mellitus:
clinical manifestations, diagnostic tests. Glucose tolerance test, its interpretation.
Screening for diabetes and its prevention. Role of diet and physical activity in the
treatment of diabetes. Treatment of diabetes mellitus with oral and injectable into the
abdominal subcutaneous tissue medications, the pharmaceutical groups of glycaemia
reducing medicaments, their mode of action and interaction. Insulin preparations:
classification, principles of insulin therapy in patients with type 1 and 2 diabetes.
Principles of combined treatment with insulin and oral agents..
5.5. Acute and late complications of diabetes mellitus (2 hrs)
Endocrinology Clinic
In charge – assoc. prof. R. Šulcaitė
Description
Acute complications of diabetes. Causes, diagnosis, treatment and prevention of
diabetic ketoacidosis. Hypoglycemia: causes, diagnosis, treatment and prevention.
Chronic microvascular complications of diabetes - retinopathy, nephropathy,
neuropathy: diagnosis, treatment, prevention. Macrovascular chronic complications of
diabetes - cardiovascular, peripheral vascular: diagnosis, treatment and prevention.
Diabetic foot syndrome: classification, diagnosis, treatment and prevention.
5.6. Diabetes Mellitus in Children (2 hrs)
Endocrinology Clinic
In charge – R. Dobrovolskienė, PhD
Description.
Classification and diagnostics of diabetes in childhood. Glucose tolerance test and
other diagnostic procedures. Clinics of type 1 diabetes in children. Types of insulins.
Insulin therapy regime for diabetic children. Insulin pump therapy - CSII. Self-control
of blood glucose. Importance of the diet, physical activity and psychosocial factors.
Acute and long term complications of diabetes. Diagnosis, prevention and treatment
of diabetic ketoacidosis. Causes, symptoms, prevention and treatment of
hypoglycaemia. Rare types of children diabetes. Type 2 diabetes in children.
Monogenic diabetes. Genetic syndromes associated with diabetes.
5.7. Radionuclides in diagnosing endocrine diseases. Treatment with
radionuclides (2 hrs)
Radiology Clinic
In charge – lecturer G.Kuprionis
Description
Devices used for diagnosis: radiometer, gamma camera, SPECT, SPECT / CT, PET.
Imaging principles. Radiopharmpreparations used in the diagnosis of endocrine
diseases: 131I, 123I, 99mTc, 201Tl, 99mTc-MIBI, 131I/123I-MIBG, somatostatin
analogues, 18F-FDG. Clinical indications for nuclear medical examination. Nuclear
medicine examination in diagnostics of thyroid, parathyroid, adrenal and other
neuroendocrine diseases. Diagnostic tests protocols. The importance of nuclear
medicine in diagnostics and treatment of endocrine diseases. Endocrine diseases
treated with liquid radipharmpreperations. Radiopharmpreparations used in the
treatment of endocrine diseases: 131I, 131I-MIBG, 177Lu-Dota, Dota-90Y, 111InDothan. Other methods of radiological examination (ultrasound, X-ray examination,
computer tomography, nuclear magnetic resonance)
in diagnostics of endocrine
diseases)
5.8. Thyroid diseases (2 hrs)
Endocrinology Clinic
In charge – lecturers L. Daugintytė-Petrušienė, D. Kozlovienė
Description
Thyroid hormones, mechanism of action, effect on the body. Hormonal changes in
thyroid disorders. Thyroid tests. Nodular goiter. Causes of thyroid hyperfunction
(thyrotoksicosis). Clinical manifestation, diagnosis and principles of treatment of
diffuse toxic goitre (Grave's disease). Endocrine ophthalmopathy. Causes, clinical
manifestation and treatment of thyroid hypofunction (hypothyrosis). Classification,
diagnostics and principles of treatment of thyroiditis.
5.9. Thyroid cancer, thyroid and parathyroid surgery (2 hrs)
Surgical Endocrinology Clinic
In charge – assoc.prof. V. Krasauskas
Description
Thyroid tumor histological classification (WHO 1988). Survival after operation for
thyroid cancer, depending on the form. The increased risk of developing thyroid
cancer. Fine (0,6-0,9 mm in diameter) needle aspiration biopsy of the nodule.
Topography in the thyroid. Thyroid blood flow and lymphatic system, tumor
metastases. Thyroid surgery. Postoperative complications: bleeding, voice cords
paresis. Parathyroid gland topography, the number of glands and localization options.
Methods used to determine the location of adenoma. Adenoma detection: value, the
choice of the volume of surgery. Calcium and ionized calcium variation in dynamics
of post-operative period. Post-operative hypocalcaemia symptoms, risks, surgical
treatment, in order to avoid transient hypocalcaemia.
5.10. Endocrine Surgery (2 hrs)
Surgical Endocrinology Clinic
In charge – assoc. prof. V. Krasauskas
Description
Indications for surgical treatment of diffuse goiter. Indications for surgical treatment
of nodal goiter. Toxic adenoma or toxic goiter? Thyroid surgery. Post-operative
complications. Hyperparathyroidism. Parathyroid surgery. Adrenal cortical tumors.
The adrenal core tumors. Adrenal surgery. Selection of method of operation.
5.11. Adrenal disorders (2 val.)
Endocrinology Clinic
In charge – lecturer N. Jakubonienė
Description
Adrenal hormones. Hormones of the cortex and the core of adrenal gland. Adrenal
disorders. Causes of mineralcorticoid excess: primary hyperaldosteronism, apparent
mineralcorticoid excess, pseudoaldosteronism caused by kidney tubular transportation
disturbance, hypoaldosteronism. Chronic adrenal insufficiency. Acute adrenal
isufficiency. Cushing’s disease and syndrome. Pheochromocytoma. Glucocorticoids,
mineralcorticoids in treatment. Adrenal tumors (incidentaliomas).
5.12. Perinatal endocrinology (2 hrs)
Endocrinology Clinic
In charge – prof. Rasa Verkauskienė
Description
Thyroid diseases in pregnancy and fetal thyroid function. Congenital hypothyroidism:
etiology, clinical presentation, diagnosis, newborn screening. Congenital adrenal
hyperplasia: etiology, clinical presentation, diagnosis, principles of treatment, prenatal
diagnosis and treatment options. Basics of disorders of sexual differentiation (DSD).
Neonatal hypoglycemia: differential diagnosis. Congenital hypopituitarism.
5.13. Breast diseases (2 hrs)
Surgical Endocrinology Clinic
In charge – prof. A. Boguševičius
Description
Benign breast diseases, etiology, pathogenesis and clinic. The most common benign
breast disorders and their treatment. Breast cancer epidemiology, etiology,
pathogenesis, clinical picture, diagnosis and treatment of the principles of: surgical,
radiation, chemotherapy and hormonal therapy
5.14. Obesity Surgery (2 hrs)
Description
Surgical Endocrinology Clinic
In charge – assoc. prof. A. Maleckas
Obesity and related problems of surgery (surgical and anesthetic problems, wound
complications, thromboembolic complications, etc.). Surgical treatment of obesity.
Diagnosis, indications, operation, patient care before and after surgery and patient
education. Characterization of surgical methods. Restriction operations (vertical
gastroplastics, adjustable ring). Malabsorbtion and combined operations (FILE-lapse
ileum, stomach detour, detour biliopankreatic). Cosmetic surgery (abdominoplastika,
"liposorbtion" operation).
6. Practicals
6.1. Diabetes: diagnosis, prevention (2 hrs)
Endocrinology Clinic
Description
Regulation of carbohydrate metabolism. Diabetes classification and diagnosis.
Glucose tolerance test. Type 1 diabetes clinical manifestation, diagnostic tests. Type 2
diabetes clinical manifestation, diagnostic tests. Prevention of diabetes complications
(diabetes control criteria).
6.2. Treatment of diabetes (3 hrs)
Endocrinology Clinic
Description
Classification of insulin preparations, principles of insulintherapy to treat type 1 and
type 2 diabetes. Treatment of diabetes with oral medications, principles of drug
action. Principles of combined treatment with insulin and oral drugs. Treatment
selection, indications, contra-indications.
6.3. Acute diabetic complications and their treatment (2 hrs)
Endocrinology Clinic
Description
Acute complications of diabetes. Diabetic ketoacidosis diagnosis, prevention and
treatment principles, hypoglycemia in the treatment of diabetes: symptoms and
causes, diagnosis, prevention and treatment principles.
6.4. Chronic diabetic complications and their treatment (2 hrs)
Endocrinology Clinic
Description
Chronic complications of diabetes. Microangiopathies and macroangiopathies.
Frequency, clinical manifestation, diagnosis, classification, treatment. Diabetic
retinopathy: classification, diagnosis, prevention and treatment principles. Stages of
diabetic nephropathy, diagnosis, prevention and treatment principles. Diabetic
neuropathy classification, diagnosis, prevention and treatment principles. Diabetic
foot classification, diagnosis, prevention and treatment principles.
6.5. Thyroid diseases: ethiopathogenesis, diagnostics. Thyroiditis. (2
hrs.)
Endocrinology Clinic
Description
Causes, pathogenesis, prevention of thyroid diseases. Examination of the patient if
thyroid diseases is suspected or diagnosed: interview, anamnesis (begining, course of
the disease, previous treatment, diseases in relatives, smoking history, previous
infections, etc.), inspection (consiousness, constitution, posture, tremor, face features,
xantelasmas, skin and mucosas, subcutaneous tissues, speech and movement speed,
swelling, redness of the soft tissues of the eye, freedom of movement, simetricity,
Symptoms of Grefe, Mebius, Stelvag), palpation (palpation of thyroid in standing and
suppine position, determination of localisation, size, consistency, tendernee, nodules;
thyroid size according to WHO). Palpation of periferic lymph nodes, pulse
determination, auscultation of the thyroid gland). Thyroid tests: laboratory, radiology,
invasive tests, their evaluation and selection of management strategy.
6.6. Grave’s disease: clinical maniphestation, diagnosis and
treatment (3 hrs)
Endocrinology Clinic
Description
Aprašas. General physical examination of the patient (tenderness in the neck,
palpitations, nervousness, indolence, swelling, somnolence, fatigue, increased
sweating, muscle weakness, intolerance of cold or heat, tremor, shortness of breath,
choking, eye pain, double vision), anamnesis (begining, course of the disease,
previous treatment, diseases in relatives, smoking history, previous infections, etc.),
inspection (consiousness, constitution, posture, tremor, face features, xantelasmas,
skin and mucosas, subcutaneous tissues, speech and movement speed, swelling,
redness of the soft tissues of the eye, freedom of movement, simetricity, Symptoms of
Grefe, Mebius, Stelvag), palpation (palpation of thyroid in standing and suppine
position, determination of localisation, size, consistency, tendernee, nodules; thyroid
size according to WHO). Palpation of periferic lymphnodes,determination of their
features. Evaluation of the skin, pulse and heart beat. Auscultation (thyroid
auscultation, heart ausctultation, SBP/DBP). Evaluation of other systems according to
the demand. Systemic review of symptoms of thyrotoxicosis, hypothyroidism,
euthyrosis. Validation of test plan. Differential diagnosis of thyroid diseases.
Interpretation of test results (thyroid ultrasound, TTH, FT4, FT3, anti TPO, anti TTH,
anti Tg, full blood count, ESR, thyroid scintigraphy, citomorphological thyroid
analysis). Treatment: strategy of the management of Grave’s disease. Indications and
contraindications for thyrostatic drugs. Doses. Patient observation plan. Indications
for radioiodine therapy, surgery. Principles of management of endocrine
ophthalmopathy. Principles of treatment of thyroiditis. Principles of treatment of
hypothyrosis.
6.7. Nodular goiter: diagnosis, treatment (2 hrs)
Endocrinology Clinic
Description. Examination of the patient if thyroid diseases is suspected or diagnosed:
interview, anamnesis (begining, course of the disease, previous treatment, diseases in
relatives, smoking history, previous infections, etc.), inspection (consiousness,
constitution, posture, tremor, face features, xantelasmas, skin and mucosas,
subcutaneous tissues, speech and movement speed, swelling, redness of the soft
tissues of the eye, freedom of movement, simetricity, Symptoms of Grefe, Mebius,
Stelvag), palpation (palpation of thyroid in standing and suppine position,
determination of localisation, size, consistency, tendernee, nodules; thyroid size
according to WHO). Palpation of periferic lymph nodes, pulse determination,
auscultation of the thyroid gland). Thyroid tests: laboratory, radiology, invasive tests,
their evaluation (sugn of malignancy in ultrasound, indications for fine needle
aspiration
of
thyroid
nodule),
needle
aspiration
of
thyroid
nodules
for
citomorphological and hystological evaluation, and selection of management strategy.
6.8.Parathyroid diseases, metabolic bone diseases (3 hrs)
Endocrinology Clinic
Description
Calcium anf phosphorus metabolism and its endocrine regulation. Hyper and
hypocalcemia: clinical manifestation, causes, diagnostics, treatment. Elements of bone
strength, remodelation of bone tissue, possibilities of its determination. Metabolic
bone diseases. Osteoporosis. Osteomalacia. Practical skills: examination of the patient
with osteoporosis and fractures; Chvostek’s, Trousseou tests, requirements of
evaluation of calcium and phosphorus metabolism, osteodensitometry in diagnosis
and further evaluation of osteoporosis; markers of bone metabolism, radiological tests
of parathyroid glands.
6.9. Cushing’s disease and syndrome (3 hrs)
Endocrinology Clinic
Description
Classification and pathophysiology of Cushing’s syndrome. Examination of the
patient when Cushing’s syndrome is suspected: anamnesis, inspection, clinical
symptoms and signs. Relation between clinical symptoms and mechanism of hormone
action. Laboratory diagnostics of Cushing’s syndrome: hormone analysis and
dynamic tests. Visual methods in diagnostics of the causes of Cushing’s syndrome.
Principles of the treatment of Cushing’s syndrome. Basics of diagnostics and
treatment of Cushing’s syndrome.
6.10. Acute and chronic adrenal insufficiency (2 hrs)
Endocrinology Clinic
Description
Adrenal steroid hormones and steroidogenesis. Action of corticosteroids. Etiology,
pathophysiology, clinical manifestation, laboratory diagnostics, hormone analysis and
dynamic tests of primary and secondary adrenal insufficiency. Long term replacement
therapy. Acute adrenal insufficiency: diagnostics, principles of treatment.
6.11. Endocrine causes of hypertension (2 hrs)
Endocrinology Clinic
Description
Adrenal
core
and
catecholamines:
synthesis,
secretion,
metabolism.
Pheochromocytoma and paraganglioma: clinical symptoms, diagnostis, principles of
teatment. Genetic and syndromal forms of pheochromocytoma (paraganglioma):
multiple endocrine neoplasia. Diagnostics, principles of teatment. Renineangiotensin–aldosterone system. Synthesis, methabolism, action of mineralcorticoids.
Primary aldosteronism: clinical manifestation, diagnostics, principles of teatment.
6.12. Functioning pituitary tumors (2 val.)
Endocrinology Clinic
Description
General description of hormones. Hormone synthesis and release. Hormonal
mechanisms of action. Function of hypothalamus and hypophysis system: hormones
of the front part of hypophysis, the intermediate part and posterior part of hypophysis.
Neuroendocrine system. Pituitary adenoma, secreting prolactin, growth hormone,
AKTH: clinical manifestation, diagnosis, and treatment.
6.13. Hypopituitarism (2 hrs)
Endocrinology Clinic
Description
Causes of hypopituitarism. Neuroendocrine system. Hormone synthesis and release.
Functional hypothalamic and pituitary system: hormones of anterior pituitary,
hormones of the intermediate part of pituitary gland, hormones of the posterior
pituitary.
Pathogenesis
of
hypopituitarism.
Partial
hypopituitarism
and
panhypopituitarism. Hypopituitarism: diagnosis and principles of treatment. Chronic
and acute hypopituitarism. Practical skills: understanding what clinical situations
should be considered in adult hypopituitarism. Clinical examination of the patient on
suspicion of hypopituitarism: a targeted collection of history and physical
examination, assessment of symptoms of hormone deficiency. Relation of clinical
symptoms
and
hormone
action
mechanism.
Laboratory
diagnostics
of
hypopituitarism: hormone analysis and dynamic tests. Visual methods in diagnostics
of the causes of hypopituitarism. Principles of treatment of hypopituitarism. Basic
knowledge about the diagnosis and treatment of acute hypopituitarism.
6.14. Endocrine obesity (2 hrs)
Endocrinology Clinic
Description
Changes in the endocrine system in obesity: infertility, metabolic syndrome,
hiperkorticizmas. Case of other risk factors, diagnosis and procedures. Endocrine
causes of obesity. Conservative treatment.
6.15. Acute conditions in pediatric endocrinology (3 hrs)
Endocrinology Clinic
Description
Neonatal hypoglycemia. Physiology of perinatal glucose homeostasis. Hypoglycemia
in infants and children. Definition, clinical manifestation, classification, diagnosis and
treatment of hypoglycemia. Diagnosis, prevention and treatment of diabetic
ketoacidosis. Hypoglycemia in patients with diabetes: causes, diagnosis, prevention
and treatment. Thyrotoxic crisis: diagnosis, treatment and prevention. Acute adrenal
insufficiency: diagnosis, prevention and treatments. Acute hypocalcaemia: diagnosis,
prevention and treatment. Acute hyponatremia: diagnosis, prevention and treatment.
6.16. Disorders of growth and puberty. The most common endocrine
disease in children (3 hrs)
Endocrinology Clinic
Description
Postnatal growth: infant, childhood and pubertal components. Height, weight gain and
body mass index (BMI) curves in girls and boys. Evaluation of growth velocity.
Importance of assessment of bone age. Calculation of predicted adult height. Familial
and constitutional short or tall stature. Hypopituitarism, growth hormone deficiency.
Turner syndrome: etiology, diagnosis and treatment. Normal sexual maturation in
children: thelarche, gonadarche and pubarche, the pubertal growth spurt. Precocious
puberty and delayed puberty: etiology, diagnosis and treatment. Hypogonadism in
children and adolescents: causes, diagnosis and treatment. Pubertal gynecomastia.
Menstrual disorders.
6.17. Thyroid disorders in children (2 hrs)
Endocrinology Clinic
Description
Thyroid function and thyroid diseases in children. Acquired hypothyroidism: etiology,
clinical presentation, diagnosis and treatment. Subclinical hypothyroidism in children.
Hyperthyroidism: etiology, clinical presentation, diagnosis and treatment. Diagnosis
of thyroid nodules by ultrasound and biopsy. Thyroid cancer in children: etiology,
clinical presentation, diagnosis and treatment.
6.18. Surgical diabetic problems (2 hrs)
Surgical Endocrinology Clinic
Description
Surgical complications of diabetes. Diabetic foot: neuropathy, angiopathy, ischemia
and the infection. Classification of diabetic foot wounds. Examination of the patient:
clinical and instrumental tests. Conservative and surgical treatment of diabetic foot.
Post-operative patient care and rehabilitation. Diabetic foot prevention
6.19. Regional anatomy of neck and neck incisions (2 hrs)
Surgical Endocrinology Clinic
Description
The neck line, areas, triangles. Neck and back of the neck. Neck areas: the outer,
inner, and the head rotating muscles. Neck organs (throat, esophagus, throat, thyroid,
parathyroid gland). Neck vascular trunk (carotid artery, internal, external, frontal vein,
vertebral artery, venous angles), nerve structures (n.vagus in the throat, plexus and
their branches, the neck sympathetic ganglion), lymph nodes (superficial and deep)
and lymphatic topography. Cervical fascia and the origin of its diversity. Fascia
positioning, intrafascial connections and enclosed spaces, the clinical significance.
Abscess spreading ways. Neck incisions. Purulent cervical opening. Staircase
incisions (skin and muscle incisions do not coincide). Sewing techniques, sewing
material, the needle.
6.20. Thyroid and parathyroid surgery (2 hrs)
Surgical Endocrinology Clinic
Description
The patient's position on the operating table. Operative incisions of neck to reach the
neck organs (thyroid, parathyroid gland, cervical lymph nodes, trachea, esophagus,
etc..), Opening of neck abscess. Anatomical landmarks, sections justification due to
topographoanatomic and cosmetic point of view. Collar-shaped (Kocher's) cross
section, its location, requirements, operating machinery. Thyroid surgery. Principles
of thyroid operations. Operations and post-operative complications. Bleeding and
paralysis of vocal cords. Clinical manifestation, treatment, surgical treatment tactics.
Repeated thyroid surgery. Parathyroid surgery.
6.21. Adrenal and pancreatic endocrine surgery (3 hrs)
Surgical Endocrinology Clinic
Description
Topographic anatomy of retroperitoneum, adrenal blood flow, autonomic venous
system. Adrenal cortical diseases - syndrome Conn’s, syndrome Cushing,
adrenogenital syndrome, adrenal cancer, incidentaloma. Pheaochromocytoma:
preparation for surgery and characteristics of operation. Indications for surgical
treatment. Methods of surgery. Pancreatic anatomy, endocrine function. Clinical
manifestation, laboratory diagnostics, instrumental diagnostic methods of insulinoma.
Indications for endocrine pancreatic tumors operations. Pancreatic endocrine tumor
surgery, their technical features, potential complications. Treatment and observation
after the removal of pancreatic endocrine tumors.
6.22. Surgical Treatment of Obesity (2 hrs)
Surgical Endocrinology Clinic
Description
Obesity and related problems of surgery (surgical and anesthetics problems, wound
complications, thromboembolic complications, etc.). Surgical treatment of obesity.
Diagnosis, indications, operations, patient care and patient education before and after
surgery. Characteristics of surgical methods. Restriction operations (vertical
gastroplastics, adjustable ring). Malabsorbtion and combined operations (FILE-lapse
ileum, stomach detour, biliopankreatic detour). Cosmetic surgery (abdominoplastics,
"lipoabsorbtion" operation). Discussion of clinical situations, key issues in
ambulatory consultation. Working in the operating room (various obesity operations:
observation and discussion).
6.23. Breast cancer and benign diseases (2 hrs)
Surgical Clinic
Description
The most common benign breast disorders: diagnosis and treatment. Breast cancer
epidemiology, etiology, pathogenesis, clinical picture, diagnosis and treatment of the
principles of: surgical, radiation, chemotherapy and hormonal therapy. Monitoring of
patients after completion of treatment.
Main literature:
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 Basevičius A., Lukoševičius S., Kiudelis J., Dobrovolskienė L. Ir kt.
Radiologijos pagridai. Kaunas, KMU leidykla, 2005.
 Brėdikis J., Girdžius P., Rinkevičius S. ir kt. Topografinė anatomija ir
operacinė chirurgija. V., Mokslo ir enciklopedijų leidykla, 1995.
Brimas G. Chirurginis nutukimo gydymas. Mokslinė monografija. ISBN 9955497-84-X 2005. Vilnius.
 Clark O.H., Duh Q-Y. Textbook of Endocrine Surgery. W.B. Saunders
Company, Philadelphia, 1997.
 EANM Procedure Guidelines.
http://www.eanm.org/scientific_info/guidelines/guidelines_intro.php?navId=5
 Harrison’s Principles of Internal Medicine. Ed. K.Hauser, B.Longo,
F.Jameson. 2005.
 Henry M. M., Thompson J. N. Clinical Surgery. Elsevier Saunders, London
2005.

Kučinskienė Z. Klinikinės biochemijos ir laboratorinės diagnostikos
pagrindai. Vilniaus universiteto leidykla, 2008.

Morris P.J., Malt R.A. Oxford textbook of surgery, 2005.

Norkus A., Baliutavičienė D., Danytė E. Žalinkevičius R. Cukrinio
diabeto diagnostika ir mitybos principai. Kaunas 2007.

Nucleaar Medicine Resources Manual. http://wwwpub.iaea.org/MTCD/publications/PDF/Pub1198_web.pdf

Pavilionis S., Burneckis E., Gavelis V. ir kt. Žmogaus anatomija. V.,
“Mokslas”, 1984.

Šulcaitė R. 2 tipo cukrinis diabetas. Kaunas. 2002.
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Tietz Clinical Quide to Laboratory Tests, fourth edition by Alan Wu.
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Turner H.E., Wass J.A.H. Oxford handbook of endocrinology and
diabetes. 2002..

http://www.british-thyroidassociation.org/news/Docs/Thyroid_cancer_guidelines_2007.pdf

http://www.cadre-diabetes.org/

http://www.desg.org/component/option,com_docman/task,cat_view/gi
d,46/dir,ASC/order,name/Itemid,61/limit,5/limitstart,0/

http://www.obesityonline.org/slides/slide01.cfm?tk=2
 http://www.thyroidtoday.com/
 www.kmu.lt/endokrinologija/

Wallach J. Handbook of Interpretation of Diagnostic tests. Lippincott
Williams & Wilkins, USA 1998.
 Zaleckis G. Pagrindinių laboratorinių tyrimų žinynas. Vilnius 2002.
 Barauskas
Additional reading:
 Abraitis
l-la, 1999.
R., Cibas P., Gronow G. ir kt. Žmogaus fiziologija. Kaunas, KMU
Beiša V., Bubnys A., Ališauskas H., Žeromskas P. Grįžtamojo
gerklų nervo vientisumo atstatymo rezultatai. Lietuvos endokrinologija,
1998, 5, 1-2, 157-161.

Beiša V., Bubnys A., Žeromskas P., Migauskas G. Skydliaukės
citologinio tyrimo vertė. Lietuvos endokrinologija, 1999, 6, 1-2, 19—21.

C., Sarr M.G. editors. The Pancreas, vol.2. Blackwell Science, 1998

Carter D., Russell R.C.G., Pitt H.A., Bismuth H. editors.
Hepatobiliary and Pancreatic Surgery. London, Chapman & Hall Medical,
1996.

Chapuis Y., Peix J.L. Chirurgie des Glandes Surrenales. Rapport
presente au 96 Congres Francais de Chirurgie, Paris, 1994.
 Corning H.K. Lehrbuch der topographischen Anatomie. München, 1931.
 Danilevičius J., Grudzinskienė D., Petrauskienė N., Vasiliauskienė Z. Kai
kurie hipotirozės diagnostikos ir gydymo klausimai. Medicina, 1995, 31, 10,
783-790.

Duh Q-Y., Siperstein A., Clark H. et al. Laparoscopic
Adrenalectomy. Comparison of the Lateral and Posterior Approaches. Arch.
Surg., 1996,131, 870-876.
 Fernandez-Cruz L., Saenz A., Benarroch G. et al. Laparoscopic Unilateral
and Bilateral Adrenalectomy for Cushing’s Syndrome. Ann. Surg., 1996,
224, 6, 727-736.
 Furrer M., Leutenegger A.F., Rüedi Th. Thoracoscopic resection of an
ectopic giant parathyroid adenoma: indication, technique, ant three years
follow-up. Thorac. Cardiovasc. Surgeon, 1996, 44, 208-209.

Hofmockel G., Heimbach D., Bussen D., Reincke M., Frohmüller
H.G.W. Operative Eingriffe an der Nebenniere. Urologe, 1994, 33, 505-511.
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Kadziauskienė K., Astrauskienė A. Jodo trūkumo maiste problema.
Lietuvos endokrinologija, 1999, 6, 1-2, 98-101.

Kazanavičius G. Skydliaukės aspiracinė biopsija citologiniam ir
histologiniam ištyrimui. Lietuvos endokrinologija, 1999, 6, 1-2, 105-111.

Kazanavičius G. Skydliaukės aspiracinė biopsija citologiniam ir
histologiniam ištyrimui. Lietuvos endokrinologija, 1999, 6, 1-2, 105-111.

Kišš F. Topografičeskaja anatomija. Budapešt, Vengrijos MA l-la,
1962.

Kovanov V.V. Operativnaja chirurgija i topografičeskaja anatomija.
M., “Medicina”, 1978.

Krasauskas V. Difuzinio ir mazginio tirotoksinio gūžio chirurginis
gydymas bei jo rezultatai. Medicina, 1997, 33, 2, 32-35.

Lennquist S., Smeds S. The superior laryngeal nerve in thyroid
surgery. Surgery, 1987, 102, 999-1008.
 Mettler F.A., Guibetreau M.J. Essentials of nuclear medicine imaging. 4th
ed. Philadelphia, W.B. Saunders, 1998, p.115-123.
 Meyer G., Schardey H.M., Schildberg F.W. Die laparoskopische
transperitoneale Adrenalektomie. Chirurg, 1995, 66, 413-418.

Pavilionis S., Burneckis E., Gavelis V. ir kt. Žmogaus anatomija.
V., “Mokslas”, 1984.

Peterson B.E., Čissov V.I., Pačes A.I. ir kt. Atlas onkologičeskich
operacij. M., Medicina, 1987.

Platzer W. Atlas of Topographical Anatomy. Stuttgart, Thieme
Verlag, 1985.

Rice D.H. Surgery of the parathyroid glands. Otolaryngologic
clinics of North America, 1996, 29, 4, 693-699.

Rude R.K. Hyperparathyroidism. Otolaryngologic clinics of North
America, 1996, 29, 4, 663-679.
 Sabiston D.C. editor. Textbook of surgery. 15th ed. W.B. Saunders
Company, 1997. (CD-ROM versija).
 Šidlauskas V., Šlapikienė A. Lietuvos gyventojų skydliaukės vidutiniai
voliumetriniai duomenys. Lietuvos endokrinologija, 1999, 6, 1-2, 10-12.
 Sutkus A., Kuprionis G. Skydliaukės tyrimų radiojodu ir radiotechneciu
diagnostinė vertė. Lietuvos endokrinologija, 1999, 6, 1-2, 16-18.
 Trede M., Carter D.C., Longmire Jr. W.P. editors. Surgery of the Pancresas.
New York, Churchill Livingstone, 1997.
 Uloza V., Balsevičius K. Abipusio gerklų paralyžiaus sukeltos gerklų
stenozės gydymas balso klostės laterofiksacija. Lietuvos bendrosios praktikos
gydytojas, 1999, 3, 6, 547-550.

Vdovičenko I., Jurkienė N., Kiudelis J. ir kt. Prieskydinių liaukų
adenomos radionuklidinė diagnostika. Galimybės ir privalumai. Medicina,
2000, 36, 10, 1130-1139.
 Vileišis A., Kazakevičius R., Kondrotas A. ir kt. Patologinė fiziologija. V.,
“Mokslas”, 1991.

Wong C.K.M., Wheeler M.H. Thyroid nodules: rational management.
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
Yamashita H., Noguchi S., Tahara K. et al. Postoperative tetany in
patients with Graves disease: a risk factor analysis. Clin. Endocrinol., 1997,
47, 71-77.

Žeromskas P., Bubnys A., Beiša V. Skydliaukės dydžio įvertinimo
būdai. Lietuvos endokrinologija, 1998, 5, 1-2, 129-133.
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
7. Seminars
8. Examination questions
8.1. Endocrinology
1. Feedback principles in diagnostics of endocrine diseases
2. Hormones of the pituitary and mechanisms of their action
3. Neuroendocrine regulation, levels of its disorders. Use of feedback principles
in diagnosis of endocrine diseases
4. Diagnostic methods and their importance in thyroid diseases.
5. Causes of thyrotoxicosis
6. Pathogenesis, clinical manifestation, diagnosis of diffuse toxic goitre (Grave's
disease)
7. Treatment guidelines of diffuse toxic goirte (Grave's disease)
8. Clinical manifestation and diagnostics of endocrine ophthalmopathy
9. Treatment guidelines of endocrine ophthalmopathy
10. Clinical manifestation of thyroiditis
11. Treatment guidelines of thyroiditis
12. Hypothyroidism: causes and clinical manifestation
12. Laboratory diagnostics and treatment guidelines of hypothyroidism
13. Thyroid nodules: clinical manifestation and diagnostics
14. Thyroid nodules: treatment
15. Causes and clinical manifestation of chronic adrenocortical insufficiency
16. Diagnostic tests of chronic adrenocortical insufficiency
17. Chronic adrenocortical insufficiency: treatment guidelines
18. Acute adrenocortical insufficiency: causes and treatment guidelines
19. Cushing's syndrome: causes and clinical manifestation
20. Cushing's syndrome: differential diagnosis and tests
21. Cushing's syndrome and Cushing’s disease: treatment guidelines
22. Pheochromocytoma: causes and clinical manifestation
23. Pheochromocytoma: diagnostic tests and treatment guidelines
24. Causes and clinical manifestation of hyperprolactinaemia
25. Prolactinoma: diagnostic tests and principles of treatment
26. Acromegaly: etiology and clinical manifestation
27. Acromegaly: diagnostic tests and principles of treatment
28. Pituitary hypofunction: etiology and clinical manifestation
29. Pituitary hypofunction: diagnostic tests and principles of treatment
30. Hyperparathyroidism: etiology and clinical manifestation
31. Hyperparathyroidism: diagnostic tests and principles of treatment
32. Hypoparathyroidism: causes, clinical manifestation, diagnosis and principles
of treatment
33. Description and diagnostic criteria of metabolic syndrome
34. Etiology and risk factors of obesity
35. Conservative treatment of obesity
8.2. Diabetology
1. Classification of diabetes
2. Diagnosis of type 1 diabetes mellitus: clinical manifestation, diagnostic tests
3. Diagnosis of type 2 diabetes mellitus clinical manifestation, diagnostic tests
4. Risk factors of diabetes
5. Prevention of diabetes
6. Diabetic retinopathy: classification
7. Diabetic retinopathy: prevention and treatment guidelines
8. Diabetic nephropathy: stages, treatment guidelines
9. Classification of diabetic neuropathy
10. Diabetic peripheral neuropathy: diagnosis
11. Diabetic peripheral neuropathy: clinical manifestations.
12. Diabetic autonomic neuropathy: clinical manifestations, diagnosis.
13. Classification of diabetic foot
14. Diabetic foot: diagnosis and treatment modalities
15. Classification of insulin preparations, examples.
16. Principles of treatment with insulin in type 1 diabetes
17. Indications for the treatment of insulin with type 2 diabetes
18. Treatment of diabetes mellitus with oral drugs, principles of their mode of
action
19. Causes and diagnostics of diabetic ketoacidosis
20. Principles of treatment of diabetic ketoacidosis
21. Hypoglycemia in diabetes: symptoms and causes
8.3. Pediatric endocrinology
1. Clinical manifestation and diagnostics of childhood diabetes.
2. Importance of self-control and psychosocial factors in children with diabetes.
3. Growth failure in children: etiology and differential diagnosis.
4. Normal puberty: thelarche, gonadarche and pubarche,
5. Precocious puberty: causes, diagnosis and treatment.
6. Delayed puberty: etiology, diagnosis and treatment.
7. Congenital hypothyroidism: etiology and clinical presentation.
8. Congenital hypothyroidism: diagnosis, newborn screening and treatment.
9. Congenital adrenal hyperplasia: etiology and clinical forms.
10. Congenital adrenal hyperplasia: signs and symptoms, diagnosis and treatment.
8.4. Endocrine surgery and mamology
1. Surgical anatomy, blood flow of thyroid gland and it’s produced hormones
2. Methods of examination in thyroid diseases and their diagnostic value
3. Conservative treatment of thyrotoxic goiter
4. Indications for thyroid operations
5. Volume of thyroid operations
6. Complications of thyroid operations
7. Morphological forms of thyroid cancer and principles of treatment
8. Surgical anatomy, blood flow of adrenal gland and it’s produced hormones
9. Cushing’s syndrome, classification, clinical manifestation and principles of
treatment 10. Indications for operations of adrenal glands
11. Open and laparoscopic adrenal surgery, the indication of their choice
12. Primary hyperparathyroidism: etiology, clinical syndromes
13. Primary hyperparathyroidism: diagnosis and principles of treatment
14. Insulinoma: clinical manifestation, diagnosis, principles of treatment
15. WHO body weight classification
16. Etiology of obesity and the factors promoting obesity
17. Comorbidity associated with obesity. Influence of obesity on survival
18. The conservative treatment of obesity. Comparison of effectiveness of
conservative and surgical treatment
19. Indications and prerequisites for surgical treatment of obesity
20. Classification of Operations on Obesity. Benefits of laparoscopic approach
21. Efficiency of obesity operations. The adjustable gastric ring, gastric bypass
operations: their advantages and disadvantages
22. Therapeutic goals of breast cancer combined treatment and methods applied to
achieve those goals
23. Goals and methods of surgical treatment of breast cancer.
24. Indications, techniques and contraindications of guard lymph node biopsy
25. Diagnostics of breast diseases, instrumental diagnostic methods and their
limitations
26. The purpose, subject and frequency of selective mamographic examination
9. Supplement
9.1. Procedures of study in module
Work in wards
On days when according schedule students come into Endocrinology clinic for
practicals or tutorial classes, they also have to examine and follow up patients in
designated wards.
Working day in Endocrinology Clinic starts at 8:00 with morning conference of staff
in auditorium, followed by examination of patients in wards, rounds with visiting
professor, doctor or resident, participating in investigation or treatment procedures.
During studies period student chooses and writes one academic medical case history
of the patient who was followed during the cycle.
Attendance
Attendance of the sessions in the module’s structure is compulsory
Evaluation
In practicals, the academic knowledge of students is assessed on a daily basis: in
written form and oral discussion, during discussion following patient examination.
Student is allowed to pass the exam if he/she:
• Attended all sessions provided;
• Actively participated in practicals and tutorials;
Was possitively assessed for theoretical preparation during every practical
• Presented academic patient's medical history and was positively assessed
9.2. The final evaluation
Practical examination
During the practical examination the student demonstrates acquired practical
knowledge and the ability to put into practice the theoretical knowledge by the use of
clinical cases of the patients curated during the cycle. Examination is held at the end
of the cycle, when the student has completed the study program; 10 points system is
used for evaluation. Student's knowledge and skills are evaluated by the doctor and
the resident, student was assigned to in the beginning of the cycle.
The score of the practical examination has the value of 15 % of total general
endocrinology and endocrine surgery cycle points value.
Evaluation criteria:
4 points - practical skills to the patient's bed – general and specific clinical
examination of the endocrine patient.
4 points – application of theoretical knowledge into practice (sustantiated examination
protocol, selection of treatment and dose, long-term treatment and monitoring
recommendations for selected clinical).
2 points – evaluation of student’s practical work during the full cycle.
The practical exam situations are selected from the patients curated by the student
during the cycle.
The examination score formula:
Theoretical examination: 4x15 % = 60 %.
Clinical situation: 15 %.
Practical examination: 15 %.
Academic medical case history of the patient curated during the cycle: 10 %.
Final evaluation is the mean of marks for:
1. Mark 1-10 for academic patient's medical history
2. Mark 1-10 for discussion on clinical case (preliminary diagnosis, plan of
examination, interpretation of results, clinical diagnosis, plan of immediate treatment,
possible outcomes, plan of follow up).
3. Four theoretical questions: 2 from 8.1 list, 1 from 8.2 list and 1 from 8.3 list.
Theoretical questions are answered in written form in 60 minutes. Each answer is
evaluates 1-10.
If answers to two questions are evaluated less than 5 points, student fails the
examination.
Examination can be repeated once with the permission from responsible persons.