Study Guide Block Endocrine Semester V

Study Guide Endocrine System, Metabolism and Disorders
1. PREFACE
Endocrinology is an expanding science with new concepts and ideas appearing in the
literature almost daily. The term endocrine denotes internal secretion of biologically active
substances. Basically, the endocrine system uses hormones to convey information between
different tissues. Hormones are released by endocrine glands and transported through the
bloodstream to tissues where bind to specific receptor molecules and regulate the target
tissues function. In addition to this traditional views, hormones can also act locally by
binding to receptors that are expressed by cells that are close to the site of release, remain
in the membranes of the one cell, acts on receptors located in the same cell, or can act
inside the cell without being released. The action is called paracrine, juxtacrine, autocrine,
or intracrine.
In this block, we will learn about the basic of hormone synthesis, release and action,
continue with discussing of each endocrine organs and their hormones and diseases
including pituitary organ and disorders, diabetes mellitus, lipid metabolism, energy balance:
obesity and metabolic syndrome, thyroid and parathyroid gland and disorders, adrenal
gland and disorders, and also congenital hypothyroid and ambiguous genital.
This block will take 16 meeting to be completed, each meeting consist of introductory
lecture continued by individual learning, single group discussion and self assessment,
ending with plenary session. In each topic there will be a list of tasks to discuss which some
of them are based on a case that commonly find in clinical practice. There will also a simple
clinical problem that you need to discuss and respond, each part will be given a cut of
clinical information for you to be responded.
Evaluation in this block will be formative and summative. The formative evaluation is
directive and will take as checklist and peer assessment, while summative will be conducted
at the end of this block.
We believe that the basic of endocrinology that you will learn in this block will impulse you to
learn more about it to help you dealing with endocrine problems in patients.
Good luck,
Planner team
Udayana University Departement of Medicine Education, DME
2. LIST OF CONTENT
List
Page
no.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Cover
Preface
List of Contents
Planners Team
Facilitators
Seven General Core Competency
Curriculum Block: The endocrine system, metabolism, and disorders
General Learning Outcome
Time Table
2
3
4
5
6
7
10
11
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21
Meeting of student representatives

Assessment method
Content outline
Learning Tasks
Problem Based Learning
Clinical skills
References
Standard of medical competence
Block evaluation form
Paper (article review) format
Article review assessment form
Final examination question plan
14
14
15
19
31
32
38
39
40
43
45
46
3. PLANNERS TEAM
No.
NAME
DEPARTEMENT
PHONE
1.
Dr. dr. Made Ratna Saraswati, SpPDKEMD (Head)

Dr. dr. Desak Made Wihandani, M.Kes
(Secretary)
Dr. IGN Mayun, PHK
Prof.Dr.dr. Ketut Suastika,SpPDKEMD
Prof.Dr.dr. AAG Budiartha,SpPDKEMD
Dr. dr. Wira Gotera,SpPD-KEMD
Dr. Pande Dwipayana, SpPD
Dr. Made Arimbawa, SpA
Dr. I Wayan Bikin Suryawan, SpA
Dr. I Wayan Surudarma, M.Si
Dr. IA Dewi Wiryanthi, M.Biomed
Internal Medicine
08123814688
Biochemistry
081338776244
Histology
Internal Medicine
08155715359
0811380916
Internal Medicine
0811398205
Internal Medicine
Internal Medicine
Pediatric
Pediatris
Biochemistry
Biochemistry
08155736480
08123657130
081338596115
081338465525
081338486589
081239990399
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
4. FACILITATORS
Regular Class
NO
1
2
3
4
5
6
7
8
9
10
11
12
NAME
dr. Ni Nyoman Mahartini, Sp.PK
dr Ni Nyoman Metriani Nesa,
M.Sc.,Sp.A
dr. I Dewa Ayu Inten Dwi
Primayanti, M.Biomed.
dr. I Wayan Surudarma, M.Si
dr. I Wayan Niryana, Sp.BS, M.
Kes.
Dr.dr. Susy Purnawati, MKK
dr. Anak Agung Ayu Yuli
Gayatri, Sp.PD
dr. I Gede Ngurah Harry Wijaya
Surya, Sp.OG
Dr. dr. Made Sudarmaja, M.Kes
dr. I Wayan Juli Sumadi, Sp.PA
dr. Anak Agung Mas Putrawati
Triningrat, Sp.M (K)
dr. I Gusti Ngurah
Pramesemara , M.Biomed
GROUP
DEPT
PHONE
A1
Clinical
Pathology
081337165577
A2
Pediatric
081337072141
A3
Fisiology
081337761299
A4
Biochemistry
081338486589
A5
Surgery
08179201958
A6
Fisiology
08123989891
A7
Interna
08123803985
A8
Obgyn
0814386935
A9
Parasitology
08123953945
A10
Anatomy
Pathology
082237407778
A11
Opthalmology
08123846995
A12
Andrology
081338605087
GROUP
DEPT
PHONE
B1
Neurology
0811388818
B2
Interna
081803651656
B3
Histology
085104550344
B4
Interna
08123853700
B5
Forensic
081916613459
B6
Interna
08123814688
B7
Clinical
Pathology
08155237937
B8
Opthalmology
085238238999
B9
Psychiatry
08123813831
A10
Radiology
08164745561
A11
Interna
081916253777
B12
Surgery
081236288975
ROOM
3rd floor
R.3.01
3rd floor
R.3.02
3rd floor
R.3.03
3rd floor
R.3.04
3rd floor
R.3.05
3rd floor
R.3.06
3rd floor
R.3.07
3rd floor
R.3.08
3rd floor
R.3.20
3rd floor
R.3.21
3rd floor
R.3.22
3rd floor
R.3.23
English Class
NO
1
2
3
4
5
6
7
8
9
10
11
12
NAME
Dr. dr. A.A. Ayu Putri
laksmidewi, Sp.S(K)
dr. Ni Made Renny Anggreni
Rena , Sp.PD
dr. I G A Dewi Ratnayanti ,
M.Biomed
dr. I Ketut Mariadi, Sp.PD
dr. Ida Bagus Alit, Sp.F, DFM
Dr. dr. Made Ratna
Saraswati, Sp.PD-KEMDFINASIM
dr. Anak Agung Wiradewi
Lestari , Sp PK
dr. Putu Budhiastra, Sp.M(K)
dr. Ida Ayu Kusuma Wardani,
Sp.KJ, MARS
dr. Sri Laksminingsih Sp. Rad
dr. Tjok. Istri Anom Saturti,
Sp.PD
dr. I Made Suka Adnyana,
Sp.BP-RE
ROOM
3rd floor
R.3.01
3rd floor
R.3.02
3rd floor
R.3.03
3rd floor
R.3.04
3rd floor
R.3.05
3rd floor
R.3.06
3rd floor
R.3.07
3rd floor
R.3.08
3rd floor
R.3.20
3rd floor
R.3.21
3rd floor
R.3.22
3rd floor
R.3.23
5. THE SEVEN GENERAL CORE COMPETENCY

1. Patient care
Demonstrate capability to provide comprehensive patient care that is compassionate,
appropriate, and effective for the management of health problems, promotion of health
and prevention of disease in the primary health care settings.
2. Medical knowledge base
Mastery of a core medical knowledge which includes the biomedical sciences,
behavioral sciences, epidemiology and statistics, clinical sciences, the social aspect of
medicine and the principles of medical ethics, and apply them
3. Clinical skill
Demonstrate capability to effectively apply clinical skills and interpret the findings in the
investigation of patient.
4. Communication
Demonstrate capability to communicate effectively and interpersonally to establish
rapport with the patient, family, community at large, and professional associates, that
results in effective information exchange, the creation of a therapeutically and ethically
sound relationship.
5. Information management
Demonstrate capability to manager information which includes information access,
retrieval, interpretation, appraisal, and application to patients specific problem, and
maintaining records of his or her practice for analysis and improvement
6. Professionalism
Demonstrate a commitment to carrying out professional responsibilities and to personal
probity, adherence to ethical principles, sensitivity to a diverse patient population, and
commitment to carrying out continual self-evaluation of his or her professional standard
and competence
7. Community based and health systembased practice
Demonstrate awareness and responsiveness to larger context and system of health
care, and ability to effectively use system resources for optimal patient care
6. CURRICULUM BLOCK:
THE ENDOCRINE SYSTEM, METABOLISM AND
DISORDERS
Learning
Outcome
1. Comprehend
the hormone
action
2. Summarize
the pituitary
gland function
and provide
initial
management
and/or refer
patient with
pituitary
disorders
3. Summarize
the insulin
action, provide
initial
management
and/or refer
patient with
diabetes
mellitus (DM)
Learning Objectives
Educational
strategy
Learning
Resourc
es
Student
assess
ment
1.1. Describe the transport of hormone in

the blood
1.2. Describe the control of hormone
secretion
1.3. List the endocrine disease
1.4. Mention the therapeutic strategies in
endocrine disorders
2.1. Recognize the anatomy of pituitary
2.2. Summarize the pituitary hormone
axis
2.3. Recognize the type of pituitary tumor
and differential diagnosis of pituitary
tumor
2.4. Interpret the endocrine tests of
hypothalamic-pituitary function
2.5. Describe the clinical features of
pituitary adenoma
2.6. Summarize the course and the
condition associated with pituitary
adenoma, including prolactinoma,
acromegaly, gigantisme, growth
hormone deficiency.
2.7. Summarize the normal physiologic
hormone function of posterior pituitary
2.8. Describe the clinical features of
diabetes insipidus
3.1 Recognize the characteristics of
pancreas and the secretory product
associated with each cell type
3.1. Understand major stimuli and
inhibitors of insulin secretion.
Summarize the cellular mechanism
involved in glucose-induced insulin
secretion
3.2. Understand major biologic actions of
insulin and the target organs. Able
indicate which metabolic pathways of
fuel metabolism are affected by
insulin
3.3. Explain how the blood glucose
control by insulin
3.4. Recognize the major biologic actions
of glucagon and the target organs,
indicate which metabolic pathway of
fuel metabolism are affected by
glucagons
0 Intro.le
c
1 IL
2 SGD
3 Pleno
Refferen
ces
MCQ
4 Intro.le
c
5 IL
6 SGD
7 SE
8 Pleno
MCQ
9 Intro.le
c
10
IL
11SGD
12
Pl
eno
PBL
13
MCQ
4. Summarize
and select the
appropriate
drug in patient
with lipid
metabolism
disorders
5. Summarize the
energy
balanced and
heat
metabolism,
and provide
management
in patient with
obesity and
metabolic
syndrome
3.5. Summarize the pathophysiologic

basis for the major symptoms of
diabetes mellitus
3.6. Mention the diagnostic criteria of
prediabetes and diabetes
3.7. Describe the clinical features of type
1 and type 2 diabetes and other types
of diabetes
3.8. Summarize the pathogenesis of beta
cell dysfunction and insulin resistance
(glucose toxicity and lipotoxicity of the
beta cell)
3.9. Recognize the acute and chronic
complication of diabetes
3.10.Plan the prevention of type 2
diabetes
3.11.Plan the strategy of therapy in
diabetes
3.12.Recognize the drugs use in treatment
of diabetes (insulin secretogogues,
insulin sensitiziser,
thiazolidinediones, alfa glucosidase
inhibitor)
3.13.Summarize the acute and chronic
complication of diabetes
3.14.Plan the management of
hypoglycemia and acute
hyperglycemia
4.1. Summarize the lipid transport and the
role of plasma lipoprotein
4.2. Recognize the disorders of
lipoprotein metabolism
4.3. Summarize the mechanism of action
of drugs in lipid disorder
4.4. Describe the prevention of lipid
disorder
4.5. Plan a rational drugs treatment
regimen based on a set of baseline
serum lipid values
5.1. Summarize the mechanism of heat
production and body heat loss
5.2. Summarize the energy metabolism
5.3. Define the criteria obesity
5.4. Describe the pathogenesis of obesity
5.5. Recognize the complication of
obesity
5.6. Define the criteria of metabolic
syndrome
5.7. Describe the pathogenesis of
metabolic syndrome
14
In
tro.lec
15
IL
16
S
GD
17
Pl
eno
18
C
BL
MCQ
19
In
tro.lec
20
IL
21
S
GD
22
P
leno
23
C
BL
MCQ

6. Provide initial
management
and/or refer
patient with
thyroid
disorders
7. Summarize the
mineral
metabolism
(calcium and
phosphate)
and
parathyroid
hormone
functions
8. Provide initial
management
and/or refer
patient with
adrenal
disorders
9. Provide initial
management
and/or refer
patient with
congenital
hypothyroid
and
ambiguous
genital
6.1. Summarize the organization of the

thyroid and secretory cells present in
thyroid
6.2. Recognize the function of a thyroid
follicle cells and follow the different
process involved in this function with
particular emphasis on the location of
each action within the cell or follicle
6.3. Summarize the biosyntesis, transport,
and autoregulation of thyroid
hormone
6.4. Explain the thyroid hormone action
6.5. Recognize the disorder of thyroid
gland, including problem of
over/undersecretion and thyroid
nodule
6.6. Describe the clinical features
(symptoms, signs, and laboratory
findings) and the management of
Graves disease
6.7. Describe the clinical features and
management of hypothyroidism
7.1. Summarize the mineral metabolism,
including calcium and phosphate and
the rule of hormones
7.2. Describe the secretion and action of
PTH
7.3. Summarize the rule of PTH, Ca, vit D,
and calcitonin.
24
In
tro.lec
25
IL
26
S
GD
27
P
leno
28
C
BL
8.1. Summarize the regulation of

synthesis and secretion of cortisol,
aldosterone, and the weak androgen
DHEA.
8.2. Summarize the major actions of
glucocorticoid on metabolism,
inflammation, permissive effects and
the stress concept..
8.3. Summarize the mechanisms of action
for mineralocorticoids
8.4. Summarize the pathophysiology and
clinical features of cushing syndrome
8.5. Recognize the diagnostic test for
cushing syndrome
9.1. Recognize clinically, laboratory and
provide initial management, and refer
patient with abnormalities in sexual
determination and differentiation
33
tro.lec
34
35
GD
36
leno
MCQ
29
In
tro.lec
30
IL
31
S
GD
32
P
leno
In
IL
S
P
37
In
tro.lec
38
IL
39
S
GD
40
P
leno
MCQ

41
42
Note:
Intro. Lec
= Introductory lecture
0 IL = Individual learning
1 SGD
= Single group discussion
2 Pleno
= Plenary lecture
3 PBL
= Problem based learning
7. GENERAL LEARNING OUTCOME
Mastery of Basic Knowledge with Its Clinical and Practical Implication

1. Comprehend the hormone action
2. Summarize the pituitary gland function, provide initial management, and/or refer
patient with pituitary disorders
3. Summarize, provide initial management, and/or refer patient with diabetes mellitus
4. Summarize and select the appropriate drugs in patient with lipid metabolism
disorders
5. Summarize the energy balanced and heat metabolism, and provide management in
patient with obesity and metabolic syndrome
6. Provide initial management and/or refer patient with thyroid disorders
7. Summarize the mineral metabolism (calcium and phosphate) and parathyroid
hormone function
8. Provide initial management and/or refer patient with adrenal disorders
9. Provide initial management and/or refer patient with congenital hypothyroid and
ambiguous genital
Skills
1. History taking
2. Physical examination of metabolic syndrome (waist circumference, body mass
index), thyroid nodule
3. Interpreting the laboratory result of blood sugar, A1C, lipid profile, hormone level
4. Communication with patient, family and community
5. Assessing data base, extracting relevant information
Personal behavior
Awareness to:
1. Lifestyle as a risk factors of diabetes mellitus and metabolic syndrome
2. Early treatment and proper management of metabolic disease to prevent chronic
complication of diabetes mellitus, metabolic syndrome, and other hormonal disorder.
Community aspect:
1. Risk assessment and disease screening of diabetes mellitus and metabolic
syndrome
2. Cost effectiveness of prevention, screening, and treatment of the disease
3. Utilization of health system facilities
4. Health prevention and health promotion
10
8. TIME TABLE
Day
Date
Topic
Monday,
Oct, 26,
2015
Introduction
(The hormone
action)
Tue, Oct,
27, 2015
Histology and
Anatomy of the
endocrine system
Wed,
Oct, 28,
2015
The pituitary gland

and disorders
Thursday
, Oct, 29,
2015
Carbohydrate
metabolism
Friday,
Oct, 30,
2015
Insulin secretion,
insulin action.
Monday,
Nop, 02,
2015
Pathogenesis and
diagnosis of
diabetes
Tue,
Nop,03,
2015
Management of
Diabetes
Wed,
Nop, 04,
2015
PBL 1
5 Nop
Clinical skills 1:
Insulin injection
Management of
Diabetes in
Children
10
Thursday
, Nop,
05, 2015
Acute and chronic

complication of
diabetes
Learning
situation
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
SGD
Pleno
SP
Clinical
Skills
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
English Class
Regular Class
PIC
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-09.45
09.45-10.30
10.30-12.30
12.30-14.00
14.00-15.00
15.00-16.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Suastika/Ratna
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Bikin/Arimbawa
Yuliana
Mayun
Ratna
Dewi Wiryanthini
Suastika/Ratna
Suastika/Ratna
Suastika/Pande
Budhiarta
Pande
Budhiarta
11

11
Monday,
Nov, 09,
2015
PBL2
Clinical skill 2:
self monitoring
blood glucose
Lipid metabolism
12
Tue,
Nov, 10,
2015
13
Wed,
Nov, 11,
2015
Lipid metabolism
and disorder
14
Thursday
, Nov,
12, 2015
The energy
balance
15
Friday,
Nov, 13,
2015
PBL3
16
Monday,
Nov, 16,
2015
Clinical skills 3:
Diabetic Foot
Examination
Obesity and
metabolic
syndrome
17
Tue,
Nov, 17,
2015
Iodine metabolism,
and thyroid hormon
function
18
Wed,
Nov, 18,
2015
Calcium,
phosphate, and
vitamin D
metabolism, PTH
function
19
Thursday
, Nov,
19, 2015
The thyroid and

parathyroid
hormone disorders
20
Friday,
Nov, 20,
2015
The Adrenal gland

and adrenal
hormone function
SGD
Pleno
SP
Clinical
Skills
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
IL & L task
SGD
SP
Pleno
SGD
Pleno
SP
Clinical
Skills
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Surudarma
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Budhiarta
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
Intro. Lect
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-08.45
08.45-09.30
09.30-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
09.30-10.15
10.15-11.00
11.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Wihandani
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Ratna
Wiragotera
Pande
Suastika/Pande
Adiputra
Suastika/Ratna
Pande
Sutadarma
Wira Gotera
12

21
Monday,
Nov, 23,
2015
Cushing syndrome
Adrenal Crisis
Intro. Lect
IL & L task
SGD
SP
Pleno
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
Ratna
22
Tue,
Nov, 24,
2015
Congenital
hypothyroid and
disorder of sex
development (DSD)
Wed,
Nov, 25,
2015
PBL3
08.00-09.00
09.00-11.30
11.30-13.00
13.00-14.00
14.00-15.00
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
09.00-10.00
10.00-12.30
13.30-15.00
12.30-13.30
15.00-16.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Bikin/
Arimbawa
23
Intro. Lect
IL & L task
SGD
SP
Pleno
SGD
Pleno
SP
Clinical
Skills
SGD
Pleno
SP
Clinical
Skills
08.00-09.30
09.30-11.30
11.30-12.00
12.00-15.00
11.00-12.30
13.00-15.00
12.30-13.00
08.00-11.00
Suastika/Ratna
Pleno
08.00-13.00
08.00-13.00
Lecturers and
Fasilitators
24
Thursday
, Nov,
26, 2015
25
Friday.
Nov, 27,
2015
26
Monday,
Nov, 30,
2015
Clinical skills 4:
Thyroid Nodule
Examination
PBL 4
Clinical Skills 5:
Lab result
interpretation
(case studies)
Student project
presentation
Evaluation
Suastika/Ratna
Pande
Pande
Team
13
MEETING OF THE STUDENT REPRESENTATIVES AND

MEETING OF THE FACILITATORS
Meeting of the student representatives
One student from each group discussion will invited to discuss the block activities with
members of the block planners every Saturday, in block-coordinators room.
Meeting of the facilitators
The meeting between block planners and facilitators will take every Saturday after meeting
of the student representatives, in block-coordinators room.
10. ASSESSMENT METHOD

Assessment in this thema consists of:
SGD
: 5%
Paper (review article) : 15%
Final examinations
: 80%.
Final exam will be carried out on (Monday, 29th November 2015). There will be 100
questions consisting mostly of Multiple Choice Questions (MCQ) and some other types of
questions. The minimal passing score for the assessment is 70.
The requirement for taking the final exam:
- join 75% of total student activities
- uniform: white shirt, black trouser/skirt, shoes
- bring student ID card with photo
- be present 15 minute before examination starting time
Other than the examination score, your performance and attitude during group discussions
will be considered in the calculation of your average final score.
14
11. CONTENT OUTLINE

1. The hormone action
The endocrine system uses hormones to convey information between different tissues.
Hormones derive from the major classes of biologic molecules, this can be proteins
(including glycoproteins), peptides or peptide derivatives, amino acid analogs, or lipids.
Endocrine hormones are part of a large complement of small intercellular signaling
molecules.
The system of internal hormone secretion is subject to complex regulatory
mechanisms that govern receptor activity and hormone synthesis, release, transport,
metabolism, and delivery to the target cells. Hormones bind specifically to hormone
receptors and translate the signal into biologic activity. The receptors can be expressed on
the cell surface or within the cell.
Hormone response is regulated by hormone concentration. This in turn is governed
by hormone production, efficiency of delivery and metabolism. The classic disorders of the
endocrine system arise from state of excess or deficiency of hormones, however resistance
to hormones also play a role. Disorders of the endocrine system will discuss in each part of
the gland.
2. Pituitary gland (and hypothalamus)

The pituitary gland lies on the base of the skull in a portion of the sphenoid bone called the
sella tursica. The hypothalamus and pituitary gland form a unit which exerts control over the
function of several endocrine glands: thyroid, adrenal, and gonads, as well as a wide range
physiologic activities. This unit constitutes a paradigm of neuroendocrinology: brainendocrine interactions.
The hypothalamic hormones can be divided into those secreted into hyppophysial
portal blood vessels and those secreted by the neurohypophysis directly into the general
circulation. The hypophysiotropic hormones regulate the secretion of anterior pituitary
hormones, include growth hormone-releasing hormone (GHRH), thyrotropin-releasing
hormone (TRH), corticotrophin-releasing hormone (CRH), and gonadotropoin-releasing
hormone (GnRH). The six major anterior pituitary hormones are adrenocorticotropic
hormone (ACTH), growth hormone (GH), prolactin (PRL), TSH, LH, and FSH. The posterior
pituitary hormones are antidiuretic hormone (ADH) and oxytocin.
Hypothalamic and pituitary lesions present with a variety of manifestations, including
pituitary hyper- and hyposecretion, sellar enlargement, and visual loss.
PRL hypersecretion is the most common endocrine abnormality due to
hypothalamic-pituitary disorders, and PRL is the hormone most commonly secreted in
excess by pituitary adenoma. GH-secreting adenomas are second in frequency to
prolactinoma and cause the classic syndromes of acromegaly and gigantism.
The major effect of ADH is to increase the water permeability of the luminal
membrane of the collecting duct in the kidney. Diabetes insipidus is a disorder resulting from
deficient ADH action and is characterized by the passage of amounts of very dilute urine.
3. Pancreas and Diabetes mellitus

The pancreas is made up of two functionally different organs: exocrine and endocrine. The
major product of exocrine pancreas is the digestive enzims. The endocrine pancreas
consists of 0.7-1 million small endocrine glands the islets of Langerhans scattered within
the glandular substance of the exocrine pancreas. The product of endocrine pancreas are:
insulin, glucagon, somatostatin, and pancreatic polypeptide.
15

Clinical diabetes mellitus is a syndrome of disordered metabolism with inappropriate
hyperglycemia due either to absolute deficiency of insulin secretion or a reduction in the
biologic effectiveness of insulin (insulin resistance), or both. Type 1 diabetes is the severe
form of diabetes mellitus and is associated with ketosis in the untreated state. While type 2
diabetes previously classified as non-insulin-dependent-diabetes (NIDDM) afflict patient
with insulin resistance who generally have relative insulin deficiency. There are also other
types of diabetes. Patient with diabetes needs a proper diet, exercise, and also
pharmacologic agent, such as insulin or oral anti diabetes. Oral anti diabetes fall into three
categories: 1) drugs that stimulate insulin secretion, 2) drug that alter the insulin action, 3)
drug that principally affect absorption of glucose.
In most patient with diabetes, a number of pathologic changes occur at variable
intervals during the course of the disease. There are also acute complications either cause
by hypoglycemia or hyperglycemia.
4. Lipid metabolism and disorders
The clinical importance of dislipidemia is mainly from the role of lipoprotein in
atherosclerosis. Because lipid are relatively insoluble in water, they are transported in
association with proteins. The simplest complexes are those formed between unesterified or
free, fatty acids (FFA) and albumin, which serve to carry the FFA from peripheral adipocytes
to other tissue. Cholesterol in the atheroma originates in circulating lipoprotein. Atherogenic
lipoproteins include low-density (LDL), intermediate density (IDL), very low density (VLDL),
and Lp(a) species.
Initial treatment in all forms of hyperlipidemia is an appropriate diet. Patient with
severe hypercholesterolemia will require drug therapy. The increased risk of acute
pancreatitis associated with hypertriglyceridemia is another indication for intervention.
5. Energy balance and metabolism disorder, obesity and metabolic syndrome
The energy balance equation is dynamic and this may explain why there is a long-term
relative stability of body weight and fat stores. The three determinants of body fat stores are
intake, expenditure, and nutrient partitioning, each under complex control.
Obesity is a disorder of body composition defined by relative or absolute excess of
body fat and characterized by several remarkable features. It is difficult to certain the
relationship between obesity and disease, because it is confounded by many metabolic and
hormonal that either contribute to or derive from excess adiposity. Obesity and abdominal
obesity are closely associated with dyslipidemia, hypertension, insulin resistance, and
diabetes. The abdominal adipose tissue has several features of interest in connection with
the metabolic syndrome. This is the reason of The ATP III definition of the metabolic
syndrome lists the waist circumference as a diagnostic factor of the metabolic syndrome.
6. Thyroid gland
Thyroid gland is the largest organ specialized for endocrine function in the human body. The
major function of thyroid gland is to secrete a sufficient amount of thyroid hormones, which
promote normal growth and development, regulate a number of homeostatic function
including energy and heat production.
Patient with thyroid disease will usually complain of thyroid enlargement (diffuse or
nodular), symptoms of thyroid deficiency (hypothyroidism), symptoms of thyroid hormone
excess (hyperthyroidism), or complication of specific form of Graves disease. Thyrotoxic
crisis (thyroid storm) is one of an acute state that requires vigorous management.
16
7. Mineral metabolism and parathyroid gland

Four parathyroid glands located adjacent to the thyroid gland. The two superior glands are
usually found near the posterior aspect of the thyroid capsul, and the inferior glands are
located most often located near the inferior thyroid margin. The parathyroid gland composed
of epithelial cell and stromal fat. The epithelial cell consist of chief cell and oxyphil cell, both
contain of parathyroid hormone (PTH). The function of PTH is to regulate serum calcium
levels by concerted effects on three target organs: bone, intestinal mucosa, and kidney.
8. Adrenal gland and disorders
The adrenal cortex produces many steroid hormones, the most important are cortisol,
aldosterone, and the adrenal androgen. Disorders of the adrenal glands lead to a classic
endocrinopathies such as Cushings syndrome, Addisons disease, hyperaldosteronism and
the syndrome of congenital adrenal hyperplasia.
The adrenal medulla is a specialized part of the symphathetic nervous system that
secretes catecholamines. Pheochromacytoma is tumors that arise from the adrenal
medulla, may present at any age. Screening for pheochromacytoma should be considered
for such patients with severe hypertension and also for hypertensive patients with
suspicious symptoms, e.g., headache, palpitation, sweating episodes, or unexplained bouts
of abdominal or chest pains.
9. Congenital hypothyroid and ambiguous genital
Congenital hypothyroidism (CH) occurs in babies who are born without the ability to produce
adequate amounts of thyroid hormone. Thyroid hormone is important for normal function of
all of the body's organs and is essential for normal brain development. CH affects about one
in every 3,500 babies. The most common cause of primary CH is dysgenesis (various
abnormalities in the formation of the thyroid gland). If detected early a child will develop
normally. Treatment is thyroid medication daily. Deficiency of thyroid hormone may result in
mental and growth retardation. If CH is not diagnosed and treated early in life, most infants
will still appear clinically normal before 3 months of age, by which time some brain damage
has usually occurred.
Symptoms or signs, when present, may include prolonged neonatal jaundice,
constipation, lethargy and poor muscle tone, poor feeding, a large tongue, coarse facies,
wide fontanelle, distended abdomen and umbilical hernia. Ideally a neonatal screening
(TSH screening) for CH should be routinely done in all children as treatment of affected
infants within 45 days of birth leads to normal mental development. The TSH should be
done 3 to 5 days after birth and patients with TSH levels more than 20-25 mU/L should be
assessed further.
Once clinically suspected or a positive neonatal screening test; the diagnosis is
confirmed by serum T4 and TSH levels. The TSH will be elevated (>10 mcU/ml) and T4 will
be low (<6.5 mcg/dl) in neonatal period in patients with CH. 20% of the infants may have
normal T4 with modest TSH elevations. Such infants may require repeat examinations to
establish a diagnosis of CH. Treatment should be started as soon as diagnosis is confirmed.
The goal of therapy is early, adequate thyroid hormone replacement. It is desirable
to maintain the serum T4 in the upper half of normal range in infants. An initial dose of
thyroxine at 10-15 mcg/kg/day is recommended to minimize IQ loss. T4 and TSH should be
monitored at regular intervals. Over treatment should be prevented and can be recognized
by signs such as tachycardia, excessive nervousness, disturbed sleep pattern, advanced
bone age and craniosynostosis.
17
Disorder of sex development (DSD)

In human sexual development, the female phenotype represents the default pathway.
therefore, a failure of testis determination results in the development of the female
phenotype, while genetic alterations resulting in partial testicular development can give rise
to a wide spectrum of masculinization. In addition to defects in peptide hormones and their
receptors, timing of hormonal exposure is also critical to appropriate development. Genital
anomalies are estimated to occur in 1 in 4500 births.
Disorder of sex development (DSD) is a medical term referring to "congenital

conditions in which development of chromosomal, gonadal, or anatomical sex is atypical.
Patients with ambiguous genitalia have disorders of sexual development (DSD), that
previously termed intersex conditions. The term DSD in lieu of potentially pejorative and
confusing terms such as intersex, pseudohermaphroditism, hermaphroditism, sex reversal,
and gender-based diagnostic labels. For clinical purposes, DSDs in newborns are classified
according to karyotype. Based on the various steps of sex differentiation and development,
we suggest the following classification: (A) DSD with a 46,XY karyotype (formerly referred to
as male pseudohermaphroditism, undervirilization of an XY male and undermasculinization
of an XY male. In 46,XY DSD the bipotential gonads differentiate to variable degrees into
testes), (B) DSD with a 46,XX karyotype (formerly referred to as female
pseudohermaphroditism or masculinization of an XX female. In 46,XX DSD the bipotential
gonads usually differentiate into ovaries but with abnormally increased androgen exposure
and (C) DSD with an unusual karyotype such as mosaicism (45,XO/46,XY or 46,XX/46,XY),
transposition of genes (46,XX, SRY+) or chromosome deletions that include one of the
genes necessary for sex determination and differentiation.
For optimal clinical management of individuals with DSD, the consensus statement
recommends the following: Avoid gender assignment in newborns before expert evaluation.
Conduct evaluation and long-term management at a center with an experienced
multidisciplinary team, including pediatric subspecialists in endocrinology, surgery or urology
or both, psychology/psychiatry, gynecology, genetics, neonatology, and, if available, social
work, nursing, and medical ethics. Give a gender assignment to all individuals. Openly
communicate with patients and families and encourage their participation in decision
making. Respect patient and family concerns, and address them in strict confidence.
10. Drug treatment in endocrine disorders

In physiological state, the function of body organs adopts to the activity of the body. Organs
that are involved in physiologic adaptation of the body (especially in metabolism) are the
endocrine glands such as the hypophysis, thyroid gland, pancreas and adrenal glands.
Dysfunction of the endocrine glands leads to metabolic disturbances, depending on the
function of the hormone of the gland and produces specific syndrome. The syndrome can
be manage by using specific drugs: hormone or anti hormonal drugs. Many drugs act
through pharmacodynamic and pharmakinetics mechanism. For example, drugs are used
for managing diabetes mellitus and lipid metabolism disorders.
18
12. LEARNING TASKS

Day 1.
The hormone action
Case : A woman with decreased body weight

A woman 22 year old, complained of reduced body weight aggressively in a few weeks,
tremble, and diarrhea 2 or 3 times a day. She has slightly enlargement of her neck.
Laboratory result showed high level of thyroid hormone (FT4/free thyroxine) and very low
level of thyroid stimulating hormone (TSHs).
Learning Task:
1. Explain the classical endocrine glands and each hormone be secreted.
2. Explain the concept of endocrine, paracrine, and autocrine in hormone action; and
each examples of hormone or molecules
3. Explain the concepts of ligand, receptor, effector, and second messenger
4. Based on location of receptor in hormone action, how many kinds of hormone are
there? Explain briefly the mechanism each hormone action and example of its
hormones
5. Explain two major types of control of endocrine gland function
6. Associated with hypothalamic-pituitary-target gland system, what level of the
disorder was occurred (at hypothalamus, pituitary or thyroid gland) in above case?
Draw a figure of the disorder and explain briefly.
Self assessment:
1. What is the hormone function in our body, and give example of hormone for each
function?
2. Explain the differences between signaling by hormones, local mediators, and
neurotransmitters!
3. Describe the transport of hormone in the blood!
4. What do you know about ligand, receptor, effector, first-second messenger?
5. Explain about the control of hormone secretion! Give an example of feed back
negative mechanism of hormone secretion!
6. Make a list of the endocrine disease!
Day 2.
Anatomy of The Endocrine System
Learning Task:
1. Discuss the structure of thyroid and parathyroid gland, include the vascularisation
and identify their position in the neck
2. Discuss anatomical structures of pituitary gland and hypothalamus
3. Discuss anatomical structures of pancreas
4. Discuss anatomical structures of adrenal gland
Self assessment:
1. Decribe the structure of thyroid and parathyroid gland, include the vascularisation
and identify their position in the neck
2. Describe anatomical structures of pituitary gland and hypothalamus
3. Describe anatomical structures of pancreas
4. Describe anatomical structures of adrenal gland
19

Learning Task Histology:
1. Discuss the general characteristic of endocrine glands!
2. Discuss pancreas as exocrine and endocrine organ! Types of cells in its endocrine
part and hormone produced.
Day 3.
The Pituitary gland and disorders
Case : a woman with increasing shoe size

A 40 year old female has noticed an increase in her shoe size from 38 to 42, and her weight
also increased excessively from 62 to 84 kg. Her menstrual period has stopped 6 months
ago.
Physical examination found her 158 cm. Although a large woman, she doesnt look obese.
Her blood pressure was 140/80 mmHg. Neck demonstrated diffuse thyromegaly, but the
TSHs and FT4 test was normal. Her face demonstrated thickening of the nasolabial fold and
prominence of the supraorbital ridge. Compare to her picture 5 years before, her face
showed a striking change in facial feature. She did not show hirsutism. Her hands and feet
had a rubbery consistency.
Learning task:
1. What is the most likely disorder of this woman?
2. What may cause this disorder?
3. What laboratory and radiology test would you do for the patient to workup the
diagnosis?
4. Is she has thyroid problem? Why?
5. Why she stopped menstruating?
Self assessment:
1. Explain the hypothalamus pituitary target organ axis.
2. Summarize the course and the condition associated with pituitary adenoma,
including prolactinoma, acromegaly, gigantisme, growth hormone deficiency.
3. Summarize the normal physiologic function of posterior pituitary hormone.
4. Describe the clinical features of diabetes insipidus.
Day 4.
Carbohydrate metabolism
Learning Task:
1. Red blood cell is the simplest cell in the body in term of its structure and metabolism.
Please elaborate that statement!
2. What are the differences of carbohydrate metabolism in red blood cell compare to
brain cell or hepatocyte?.
3. Explain what happened during investment stage, splitting stage and yield stage on
glycolisis.
4. What enzymes are regulating glycolisis and what are their functions?
5. Explain about glycogenesis, glycogenolysis and hormonal control of glycogenolysis!
6. Where is Pentosa phosphate pathway started and what are the main products?
Explain why its called shunt?
7. How many ATP produced from one molecule glucose metabolized at Krebs cycle?
20

Self assessment:
1. Explain, why is NaF as the most preferred anticoagulant used for glucose
examination?
2. Like in Munir case, as indicated by autopsy results undergone at Netherland,
revealing arsenic concentration above normal level as the cause of death. Explain,
why arsenic can be so fatal if exist in high concentration in blood?
3. Explain, how the mechanism of bacteria extermination by phagocytosis?
4. Why hemolytic anemia can be caused by deficiency of G6PDH enzyme?
5. Explain about HbA1c and its normal concentration.! Why normal blood glucose
concentration result not directly follow by normal concentration of HbA1c?
6. Explain pathogenesis process of chronic complication of DM?
7. Explain the role of glycated protein to longterm complication of DM
Day 6. Insulin secretion, insulin action, pathogenesis and

diagnosis of diabetes
Case : a man with weight loss and polyuria
Data 1
Mr. AB, 43-year-old male has no prior medical problems feel fatigue this last few months.
On further questioning, he admitted having incessant thirst, and polyuria over the last month
with a 6-kgs weight loss (before he was 76 kg, 160cm in height). He denied having any
history of diabetes. He did not realize any family history with diabetes.
Generally examination is unremarkable. A rountine urinalysis demonstrates 4+ glycosuria.
Learning Task:
1. Does this man has diabetes mellitus?
a. Explain why and why not?
b. What are other conditions may cause glycosuria?
c. How to establish the diagnosis of diabetes?
Data 2
A glucometer reading was unmeasureable. This was confirmed by blood glucose serum 580
mg/dL. He does not feel ill and this week he planned to start his new job.
Learning Task:
2. Does he have diabetes mellitus?
If so, does he have type 1 diabetes or type 2 diabetes?
Self assessment:
1. Explain the cells types and hormone secreted by islets of Langerhans!
2. Describe how insulin secretion is regulated!
3. Describe the metabolic action of insulin!
4. Describe how glucagon release is regulated and summarize its main action!
5. What is the major symptom of diabetes mellitus?
6. Mention the diagnostic criteria of prediabetes and diabetes!
7. What is the clinical features difference of type 1 and type 2 diabetes?
21
Day 7.
Management of Diabetes
Case: A man with diabetes

Mr. C, 45-year-old, has diabetes since 3 months ago, at that time his random blood glucose
was 212mg/dL .
His glucometer reading yesterday was unmeasureable. This was confirmed by blood
glucose serum 580 mg/dL. He feels like lack of energy during the day, and difficulty to sleep
due to frequent urinating. Generally examination is unremarkable.
Learning Task:
1. What should you do for Mr C:
a. Should you admit him to the hospital or send him home with some
medication? Explain your answer.
b. What is your plan for treatment?
c. What is the choice of treatment for his diabetes: insulin or oral antidiabetes?
Self assessment:
Explain the management of diabetes! Refer to the available guideline.
Day 8.
PBL 1 and Clinical skills 1: Insulin injection
n 1: A man with high blood sugar, fever and vomiting

PBL
Introduce trigger
A man 52 years old, government employee, visited a general practitioner due
to loss of body weight about 7 kg in last two months.
a. Search any information of some kind of health problems or diseases
related relatively weight loss abruptly
b. How the mechanisms of weight loss in each suggested diseases
Day 9.
Acute and chronic complication of diabetes
Case: A man with diabetes for 12 years.

Mr. B has been diagnosed with diabetes for 12 years. His fasting blood sugar normally
between 90-120 mg/dL, with medication: glibenclamide 5 mg twice a day. Sometime in the
day, he feels shaky and trembeling, followed by blurred visin and headache, which
normally resolved after he has lunch.
Last laboratory result showed A1C was 9.1%, urinalysis revealed a proteinuria +1. Other
result, including lipid profile, renal function and liver function, still in aceptable range.
Learning Task:
1. What is the acute complication of diabetes?
2. What is the chronic complication of diabetes?
3. In above case, list the possible acute and chronic diabetes complication.
4. Mention the 4 strategy therapy in diabetes and explain the concept of each strategy!
5. List the name of four major classes of OAD (oral anti diabetic) agents, and describe
the mechanism of action of each class.
6. What is the indication of intensive insulin therapy?
7. How to diagnose hypoglycemia? Describe the management of hypoglycemia!
22
Day 10.
Drug treatment in endocrine disorders
Case: A lady with hypothyroid

Ms. N has been diagnosed with hypothyroid for 2 years, after a total thyroidectomy. She has
levothyroxine a day for her thyroid hormone replacement.
Learning Task:
1. Describe the principles of hormonal and anti hormonal drugs used for patient with
endocrine disorders
2. Describe the side effects of hormonal and anti hormonal drugs used for patient with
endocrine disorders
3. In above case, when would be the best time to take levothryoxine?
4. Differentiate pharmacodynamic of insulin and OAD
5. Differentiate pharmacokinetic of insulin and OAD
6. Make a scheme which summarized the differences between pharmacodynamic and
pharmacokinetic of insulin and OAD
7. Describe pharmacodynamics and pharmacokinetic of hypolipidemic drugs
Day 11.
PBL 2 and Clinical skills 2: Self monitoring blood
glucose
n
Day 12.
Lipid metabolism
Learning Task:
1. Explain about beta and alpha oxidation of lipid metabolism!
2. Explain the relation between carbohydrate and lipid metabolism!
3. What are the function of carnitin and what happened if carnitin deficiency occured?
4. Explain the interrelation between obesity and lipid metabolism!
Day 13.
Lipid metabolism disorders
Case
Data 1
A 45 years, male patient with history of diabetes type 2 since 5 years carried out routine
laboratory examination. Serum total cholesterol result is 259 mg/dL
Learning Task:
What other laboratory assay you will suggest to patient to complete lipid profile of this
patient? How to interpret each of it?
Data 2
Lipid profile results as follow :
Total cholesterol 250 mg/dL
Cholesterol LDL 110 mg/dL
Cholesterol HDL 17 mg/dL
Trigliserida 210 mg/dL
23

Learning task:
1. Interpretate those results!
2. Explain the treatment that you recommend to patient!
3. Explain the targets to manage this patient lipid profile!
Self assessment:
1. Describe the lipid transport and the role of plasma lipoprotein!
2. Mention the disorders of lipoprotein metabolism!
3. List the name of drugs treatment of lipid disorder and describe the mechanism of
action of each class!
Day 14.
The energy balance
Learning Task:
1. Explain adenosine triphosphast (ATP) functions as an energy in metabolism
2. Explain phosphocreatine functions as an accessory storage depot for energy and as
ATP buffer
3. Explain aerobic and unaerobic energy
4. Explain about metabolic rate
5. Explain energy metabolism factors that influence energy output
6. Describe the mechanism of heat production
7. Explain the body temperature is controlled by balancing heat production against heat
loss
8. Explain the mechanism of bodily heat loss
9. Describe the pathogenesis of obesity
Day 15.
Day 16.
PBL 3 and Clinical Skills 3: Measurement of obesity

Obesity and metabolic syndrome
Data 1
A 45 years male patient, complain body weakness and sometime difficulty in breathing when
sleeping. On physical examination, body weight 92 kg, height 162 cm and waist
circumference 105 cm. Patients has 1 brother and 1 sister. His brother died due to heart
attack at age of 52 year. All of them are fat since they were child. Patient weight increases
since he married and starts to neglect exercise.
Learning Task:
1. What are the problems of this patient?
2. What are factors contribute to those problems?
3. What are the possible risks that this patient will face in the future?
24

Data 2
Further examination reveals that blood pressure 145/90 mmHg, fasting blood glucose
concentration 129 mg/dl, 2 hour post prandial blood glucose concentration 185 mg/dl,
trigliserida 165 mg/dl, cholesterol-HDL 32 mg/dl and cholesterol LDL- 235 mg/dl.
Learning Task:
1. What syndrome is this patient suffered?
2. How the mechanism that this syndrome could occur?
3. What factors contribute to the increase of blood glucose in this patient?
4. Explain briefly about the management of this patient!
Data 1 .
A 36 years male patient, complain snoring and difficulty in breathing when sleeping. Almost
all patient family are fat. Patient himself alredy fat since he was child and his body weight
even more increasing after he married. His present body weight is 98 kg with height 165 cm,
and waist circumference 108 cm. Patient feel less self confidence due to dark appearance
on the neck skin just like untreated well..
Learning Task:
1. What are the problems of this patient?
2. What are additional data that you need to diagnose this patient?
Data 2.
Patient blood pressure 150/90 mmHg.
Random blood glucose concentration 130 mg/dL, 2 hour post prandial 180 mg/dL, but he
never complain frequent urinating or thirsty. Trigliserida 170 mg/dL, HDL 25 mg/dL,
cholesterol LDL 250 mg/dL
Learning Task:
1. What is the sndrome that this patient suffered?
2. What are the causes of this syndrome?
3. Explain the management of this patient?
Self assessment:
1. Define the criteria of obesity for Asia Pacific region!
2. Explain the pathogenesis of obesity (nutrient balance or homeostatic model)!
3. What is the complication of obesity?
4. Mention the criteria of metabolic syndrome by adult treatment panel III National
Cholesterol Education Program (ATP III-NCEP)!
5. Explain the treatment of metabolic syndrome!
25
Day 17.
Iodine metabolism, thyroid hormone synthesis and
secretion, thyroid
hormone function
Learning Task:
1. Explain step by step the synthesis of thyroid hormone !
2. What is thyroglobulin? What is the function in synthesis of thyroid hormone?
3. What is meant by iodinize and deiodinize in thyroid gland?
4. Explain the secretion process of tiroksin!
5. Explain the transport of thyroid hormone!
6. Explain how thyroid secretion is controlled
7. Explain the main action of thyroid hormone
8. Describe the main consequence s of abnormal thyroid function
Self assessment:
1. Explain about the axis of hypothalamic-pituitary-thyroid system and its regulatory
function of thyroid hormone secretion!
2. Describe the schema of biosynthesis of thyroid hormone!
3. Explain about transport of thyroid hormone in the blood!
Day 18. The Parathyroid hormone function

Calcium and phosphate metabolism
Learning Task:
1. Explain about secretion and mechanism of action of parathyroid hormone
2. Explain about the synthesis and mechanism of action of vitamin D.
3. What do you know about calcium as second messenger and why extracellular (Ca++)
in tightly regulation (main consequences of abnormal Ca control)?
4. List the essential mineral and vitamin for normal bone growth and osteoporosis
prevention!
5. Describe the main consequence s of abnormal parathyroid function
Day 19.
Thyroid and parathyroid gland disorder
Case : a lady with increasing body weight and first degree AV block
Data 1.
A 45 year female patient come clinic with complaining weakness, difficult to concentrate and
increase of body weight. On physical examination, blood pressure 100/70mmHg, pulse 52
x/minutes,regular with edema at both legs. Laboratory result reveal that total cholesterol 460
mg/dL.
Learning Task:
1. What is the diagnose of this patient?
2. What are other examinations that you need to confirm the diagnose? (3 items)
26

Further laboratory examination reveals FT4, FT3, TSHs concentration below normal value.
ECG reveal first degree AV block.
Learning Task:
3. What is the diagnose of this patient?
4. What other examination requiered to locate the disorder?
Data 3.
Serum TRH level within normal range.
Learning task:
5. What is your conclusion regarding the location of hormonal disorder of this patient?
Case: a young female with sweating and decreasing body weight
Data 1.
22 years, young female patient come with palpitation, both hands shaking frequently with
sweating although the environment not too hot. Her body weight decreasing eventhough
she eats a lot. She felt her neck enlarge since 3 month but she cant palpate any lump. She
also feel that her eyes are more prominent than her coworkers that made her less confident.
Learning Task:
1. What is the possible diagnose of this patienti?
2. What are other examination required to confirm the diagnose?
Data 2.
ECG reveal AF (atrial fibrilation) with fast response 130 times per minutes.
Laboratory examination result FT4 serum concentration is high and TSHs concentration
below normal value.
Learning Task:
3. What is the posible diagnose of this patient?
4. What are other examination required to determine the cause of this case?
5. What are your management plan to this patient?
Self assessment:
1. Identify the diseases caused by: over secretion and under secretion of thyroid
hormone!
2. Mention the clinical condition associated with thyrotoxicosis!
3. Describe the clinical features (symptoms, signs, and laboratory findings) of Graves
disease!
4. List the drug treatment of Graves disease and explain the mechanism of action and
side effect of each drug!
5. Describe the course and complication of hyperthyroidism (thyroid crisis)
6. Describe the diagnostic algorhythm of hypothyroidism
7. Explain about the treatment of hypothyroidism!
27
Day 20. The Adrenal gland and Adrenal Hormone Function

.
The adrenal gland and adrenal hormone function
Learning Task:
1. Explain the gross structure of the adrenal gland and mention the adrenal hormone
produced by each part!
2. Describe the regulation of cortisol synthesis and secretion through hypothalamus,
pituitary and adrenal axis!
3. Explain the inflammatory properties of cortisol!
4. Explain the role of physical and emotional stress in cortisol secretion!
Day 21. Cushing Syndrome

.
Learning Task:
Case: A young lady with moon face
Data 1.
A 22 years,female patient come with complaining her cheek getting fatter (moon face) and
in some of her body like shoulder,upper part of her back and tummy, also getting fatter than
before. On skin of her tummy also appear lines like pregnant woman.
Blood pressure was 140/90 mmHg, random blood sugar was 220 mg/dL.
Learning Task:
1. What is the possible syndrome that this patient suffered?
2. Is there any additional information that you need from this patient?
Data 2.
Before these symptoms appear, she often complains a lot of sneezing and running nose in
the morning, along with allergic symptoms whole bodies: redness and itchy. Each time she
felt this symptom she always see a dNopor at Primary Health Centre. She has been treated
with dexametasone. This tablet worked good on her symptoms. She did not visit the dNopor
regularly. Each time she stopped the tablet, symptoms often recurrent. She increased the
dose by herself. She prepared herself with this tablet that she bought from pharmacy.
Therefore, if she suffered from her allergic symptoms, instead of visited the dNopor, she
treated herself.
3. What is the most possible diagnosis to this patient?
4. What would you do to confirm the diagnosis?
5. What is your plan toward for this patient?
Self assessment:
1. Mention the classification of cushing syndrome!
2. Explain the pathophysiology of cushing syndrome!
3. Describe the clinical features of cushing syndrome!
28
Day
22.
Clinical skill 4: Thyroid gland
examination
and student project presentation 1
physical
Day 23. Clinical skills 5: Lab result interpretation and student

project presentation 1
Day 24. Student Project Presentation 3, PBL 4

.
Day 25. Congenital hypothyroid and ambiguous genital
Learning Task:
1. Explain factors to determine gender!
2. Explain gender differentiation process intrauterine!
3. Explain about DSD/interseks classification!
4. Explain the etiology of neonatal DSD!
Case:
A 23 days baby referred to Child endocrine outpatient clinic with diagnose Ambigous
Genitalia. When the baby turns to 14 days, he/she vomiting, less drinking and very weak.
One week later he/she vomit again and hospitalized. Laboratory result revealed low natrium
and high kalium concentration. On physical examination (age 3 month), general appearance
is fine, no abnormality in ear, nose and throat as well as lung, heart and abdomen. On
external genetalia examination finding reveal enlargement of clitoris, hipospadia and
unpalpable testicles.
From the following statements, which are TRUE and FALSE?
1. First step must be done is evaluating blood 17-OH progesterone concentration.
2. Chromosome assay unnecessary to be performed.
3. Others supporting evaluation are ultrasound and genitography examination.
4. This baby possibly suffering Congenital Adrenal Hiperflasia (CAH)
5. This baby categorized as 46XX DSD (female pseudhermaphroditism) according to
DSD/intersex classification.
6. This baby does not need surgery.
Day 26: Evaluation
29
13. PROBLEM BASED LEARNING

PBL:
PROBLEM BASED LEARNING 2015
BLOCK: ENDOCRINE SYSTEM AND METABOLISSM AND ITS DISORDERS
Objective
1. To understand that excessive urination and thirsty is one of chief complaints of patients
in medical practice
2. Capable to search underlying diseases related to excessive urination and thirsty
3. To know several diseases as the most important causes of excessive urination and
thirsty and capable to differentiate them based on the probability
4. Capable to confirm diagnosis the certain disease and exclude other diagnosis by history
taking, physical examination and supporting studies (electrocardiography, laboratory and
imaging studies)
5. Capable to manage the patient as a primary care physician
6. To understand the clinical course of the disease without treatment
Learning Task
There are four sessions to completely discuss the case, starts from distributing the trigger
problem at the first meeting and ends by the plenary session to overcome the case problem
based on students discussion.
Trigger problem: Excessive urination and thirsty
A female 22 years old, study in university, visited a general practitioner due to
excessive urination since last two weeks. She had problem in concentrating to her
campus activity since she need to go toilet many times. She was feeling thirsty all
the time and almost every 30 minutes she had to drink a bottle of water (about
750cc) and preferred sugary drink. Her body weight lost 2 kg in 1 week.
c. Search any information of health problems or diseases related to excessive
urination and thirsty.
d. Explain the mechanisms of excessive urination in each disease that you
suggested.
First Session
Small Group Discussion: discuss Task 1a and 1b and prepare group presentation in
plenary meeting.
New data will be distributed after plenary meeting for next session
30
14. CLINICAL SKILLS

BASIC CLINICAL SKILLS TEACHING PROGRAM
BLOCK ENDOCRINE
Topics:
1. Insulin injection
2. Self monitoring blood glucose
3. Measurement of Obesity: Waist circumference and BMI calculation
4. Thyroid gland physical examination
5. Laboratory result interpretation
Clinical Skill 1. Insulin injection

Learning task:
1. Define the site of subcutaneous insulin injection
2. Practice preparing and administering insulin using insulin needle 1 cc
1.
8 unit of rapid human insulin
2.
Mixed of 6 unit rapid insulin and 14 unit NPH insulin
3. Practice preparing and administering insulin using insulin pen (solostar,
humapen, or novolet/flexpen), in this case try 6 unit.
31
Clinical Skill 2. Self monitoring blood glucose

Self monitoring blood glucose (SMBG) is an important component of modern therapy for
diabetes mellitus. SMBG is recommended for people with diabetes and their health care
professionals in order to achieve a specific level of glycemic control and to prevent
hypoglycemia.
The test most commonly involves pricking a finger with a lancet device to obtain a small
number of blood sample, applying a drop of blood onto a reagent strip, and determining the
glood glucose concentration by inserting the strip into a reflectamce photometer for an
automated reading.
Test results are then recorded in a logbook or stored in the glucose meters electronic
memory.
People with diabetes can be taught to use their SMBG to correct any deviations out of a
desire range by changing their carbohydrate intake, exercising, or using more or less
insulin.
Learning task:
1. Practice measuring blood glucose using glucometer.
2. Below are data of a diabetes patient.
Mr. B, 48 years old, diabetes for 7 years. Now on glibenclamide 5 mg twice a
day. He has tried metformin and acarbose for few months, then stopped due
to diarrhea.
Body weight 78 kg, height 168 cm.
Laboratory result:
- Fasting BS 198 mg/dL, 2 hours post prandial 202 mg/dL, A1C 12.0%
- Urinalysis: protein +2, creatinin serum 2.0 mg/dL
Task:
a. What do you think about his diabetes control?
b. Do you think he needs a home monitoring blood sugar? Why?
c. How would you suggest him for his diabetes medication?
32
Clinical skill 3. Measurement of Obesity : Waist circumference and BMI

calculation
Obesity is defined as a condition in which there is an excess of body fat. The operational
definition of obesity and overweight however are based on body size or body mass index
(BMI) which is closely related to body fatness.
These BMI cut off point are arbitrary along a continuum of increasing risk with increasing
BMI. Cut offs used for the definition of obesity can be based on:
1. Statistical data from reference population
2. or on the excess morbidity and mortality associated with increasing body fat
content.
a. BMI (body mass index)
Height and weight are the most simple and commonly used measures. A number of
weight for height indices have been developed of which the body mass index (BMI)
define as this following formula:
Body weight (kg)
Height (m)
= BMI (kg/m2)
b. WC (waist circumference) and WHR (waist to hip ratio)

To determine the risk associ, we need to measured the distribution of body fat.
Abdominal or visceral fat is associated with the cardiovascular rsik of the metabolic
syndrome.
For WC, the subject stands with feet 25-30 cm apart, weight evenly distributed.
Measurement is taken midway between the inferior margin of the last rib and the crest of
the ilium in the horizontal plane. The measurer sits by the side of the subject and fits the
tape snugly but not compressing soft tissues. Circumference is measured to nearest 0.1
cm
For hip circumference the measure is taken around the pelvis at the point of maximal
protrusion of the buttocks.
Ratio of waist to hip ratio (WHR) is calculate by:
Waist circumference
Hip circumference
= WHR
Tabel 1. Classification of Weight by BMI and Waist Circumference in Adult Asians

Classification
Underweight
BMI (kg/m2)
< 18.5
Normal range
Overweight
At risk
Obese I
Obese II
Waist circumference
18.5 22.9
> 23
23 24.9
25 29.9
> 30
Normal
< 90 cm (men)
< 80 cm (women)
WHR
Risk of co-morbidities
Low (but increased risk of
other clinical problem)
Average
Increased
Moderate
Severe
Abdominal obesity
> 90 cm
> 80 cm
> 1.0 (men)
> 0.85 (women)
33
Learning task:
Check your body mass index, waist circumference and waist to hip ratio, and
interpretate the result.
Clinical skill 4. Thyroid gland physical examination

a. Inspect the neck for the thyroid gland
Tip the patients head back a bit. Using tangential lighting derected downward from the
tip of the patients chin, inspect the region below the cricoid cartilage for the gland.
Goiter is a general term for an enlarged thyroid gland.
Ask the patient to sip some water and to extend the neck again and swallow. Watch for
upward movement of the thyroid gland, noting its contour and symmetri
The thyroid cartilage, the cricoid cartilage, and the thyroid gland all rise with swallowing
and then fall to their resting positions.
b. Palpation
-
Steps for palpating the thyroid gland:

Ask the patient to flex the neck slightly forward to relax the sternomastoid muscles.
Place the fingers of both hands on the patients neck so that your index fingers are just
below the cricoid cartilage
Ask the patient to sip and swallow water as before. Feel the thyroid isthmus rising up
under your finger pads. It is often but not always palpable.
Displace the trachea to the right with the fingers of the left hand; with the right hand
fingers, palpate laterally for the right lobe of the thyroid in the space between the
displaced trachea and the relaxed sterbomastoid. Find the lateral margin. In similar
fashion, examine the left lobe.
The lobe are somewhat harder to feel than the isthmus, so practice is needed.
The anterior surface of a lateral lobe is approximately the size of the distal
phalanx of the thumb and feels somewhat rubbery.
Note the size, shape, and consistency of the gland and identify any nodules or
tenderness.
Soft in Graves disease
Firm in Hashimotos thyroiditis, malignancy
Benign and malignant nodules
Tenderness in thyroiditis.
Note: The thyroid gland is usually easier to feel in a long slender neck than in a short stocky
one. In shorter necks, added extension of the neck may help.
In some persons, however, the thyroid gland is partially wholly substernal and not amenable
to physical examination.
34

c.
Auscultation
If the thyroid gland is enlarged, listen over the lateral lobes with a stethoscope to detect
a bruit, a sound similar to a cardiac murmur but of noncardiac origin.
A localized systolic or continuous bruit may be heard in hyperthyroidism.
Learning task:
Try the physical examination of your friends thyroid gland and note the
size, shape, and consistency of the gland and identify any nodules or
tenderness.
Clinical skill 5. Laboratory result interpretation

Case 1.
Female 15 years old came to hospital with decrease of consciousness. One day before
admission, she through up everything she ate and had a very bad pain in her stomach.
Since this last one month, she was very weak and could not do her daily activity very well.
She had never been diagnosed with any specific illness before.
Laboratory result:
Blood sugar random 645 mg/dL
Urinalysis
keton +3
Blood gas analysis pH
7.12
(normal: 7.35-7.45)
pO2 97
(normal: 80 105)
HCO3- 3.00 mEq/L (normal: 21-30)
Learning task:
1. What is the diagnosis of this case?
2. After insert the intravenous line and rehidration, you decide to give an
insulin therapy. Is there any laboratory data that you need before
administering insulin in this patient?
Case 2.
Male 44 years old came to outpatient clinic with an acute swelling and pain of his thyroid
nodule.
The first laboratory result was:
TSHs 0.023 uIU/ml (normal range: 0.25 5 uIU/ml)
FT4 20.51 ug/dl
(normal range: 5.13 14.06 ug/dl)
The second laboratory result after 3 months was:
TSHs 7.23 uIU/ml (normal range: 0.25 5 uIU/ml)
FT4 2.33. ug/dl
Learning task:
1. What is the meaning of the first result and the second result?
2. Why this patient come up with the different result after 3 months?
3. What do you think the diagnosis of this case?
35

Case 3.
Female 22 years old, came to outpatient clinic with chief complain palpitation, nervous, and
decrease of body weight. Her eyes look bigger than before since last 6 months.
Laboratory result:
TSHs <0.005 uIU/ml (normal range: 0.25 5 uIU/ml)
FT4 12.51 ug/dl
Learning task:
1. What is the interpretation of laboratory finding?
2. What other laboratory examination do you suggest?
36
15. REFFERENCES
Student Standard References:
Basic & Clinical Endocrinology, 9th ed, Lange Medical Publication
Additional Recommended Reading
1. Essential Clinical Anatomy, 2 nd ed. Lippincott Williams & Wilkins, Philadelphia. 2002.
2. Fawcett DW, Jenish RP : Bloom and Fawcett`s Concise Histology, 2 nd ed, London,
Arnold, 2002. p. 220-221, 251-266.
3. Guyton A. C and Jhon E. Hall Textbook of Medical Physiology:Page: 836-914
4. Harper, 25 ed.p.451-626
5. Baynes J; Dominiczak Marek H. Medical Biochemistry.1999. chapter 12, chapter 17,
and chapter 23 page 297-304
6. Robbins Basic Phatology, 7 ed, 2003.p.221-225
7. Henry JB; Alexander ; Eng C D. Evaluation of Endocrine function In : Henry JB Ed.
Clinical Diagnosis and Management by Laboratory Method. 19th Ed.1996. p.322-373
8. Gartner LP, Hiatt JL : Color Text Book of Histology, 2 nd ed, Philadelphia, W.B.
Saunders, 2001,p. 301-324.
9. Wales J.K H, 1996. Pediatric endocrinology and growth: Abnormal Genitalia; 99-116
10.
Styne DM, 2004. Handbooks in Pediatric endocrinology: Disorders of sexual
differentiation; 134-158
Reference Clinical Skills
1. Bickley LS, Szilagyi PG. Bates Guide to Physical Examination and History Taking. 8th
eds. Lippincott William & Wilkins. Philadelpia, 2003.
2. American Diabetes Association. Clinical Practice Recommendations 2015. Diabetes
Care 2015
3. The Asia-Pacific perspective: Redefining Obesity and its treatment, 2000.
37
16.
STANDARD OF MEDICAL COMPETENCE
Endocrine ,metabolism and disorders

Endocrinological disorders
Diabetes Mellitus tipe 1
Diabetes Mellitus tipe 2
DM tipe lain (intoleransi glukosa
akibat penyakit lain atau obatobatan)
Ketoasidosis diabetikum nonketotik
Hiperglikemia hiperosmolar
Hipoglikemia ringan
Hipoglikemia berat
Diabetes insipidus
Akromegali, gigantisme
Defisiensi hormon pertumbuhan
Hyperparathyroidism
Hypoparathyroidism
Hyperthyroid
Thyrotoxicosis
Goiter
Thyroiditis
Cushing's disease
Adrenal Crisis
Addison's disease
Precocious puberty
Hypogonadism
Prolactinoma
Thyroid Adenoma
Thyroid Carcinoma
4A
4A
3A
3B
3B
3B
4A
1
1
1
1
3A
3A
3B
3A
2
3B
3B
1
2
2
1
2
2
Expected level of competence:

1. Able to recognise and organized clinical features of disease.
In case, it appeared in literature or correspondence, he knows how to organize these
clinical features and how to get further information. This level indicates an overview level. If
these clinical features found on patient, dNoper able to recognize it, suspect the diagnosis
and reffered immediately.
2. Able to make clinical diagnosis based on physical examination and additional investigation
requested by dNoper e.g. routine laboratory assay or X-ray. DNoper able to reffer patient to
relevant specialist immediately and capable to follow up afterward.
3A. Able to make clinical diagnosis based on physical examination and additional investigation
requested by dNoper e.g. routine laboratory assay or X-ray. DNoper able to decide and give
initial treatment also reffer to relevant specialist for non-emergency cases.
3B. Able to make clinical diagnosis based on physical examination and additional investigation
requested by dNoper e.g. routine laboratory assay or X-ray. DNoper able to decide and give
38

initial treatment also reffer to relevant specialist for emergency cases.
4. Able to make clinical diagnosis based on physical examination and additional
investigation requested by dNoper e.g. routine laboratory assay or X-ray. . DNoper
able to decide and manage the case independently.
17.
BLOCK EVALUATION FORM
Evaluation form of Block of Endocrinology, Metabolism, and Disorders

Please fill the form according to the real condition. This evaluation will not influence your
final block result.
Please cross on the score column that suitable with your judgment.
No
Point being evaluated
A
1.
2.
3.
4.
5.
Topic
Introduction ( The hormone action)
The pituitary gland and disorder
Anatomy & Histology of islet cells
Insulin secretion, insulin action and Pathogenesis and
Diagnosis of diabetes mellitus (DM)
Acute and chronic complication of diabetes
Drug treatment in endocrine disorder
Lipid metabolism
Lipid metabolism and disorder
6.
7.
8.
9.
10
.
11.
12
.
13
.
14
.
15
.
16
.
17
.
18
.
19
.
B
1.
2.
3.
4.
5.
6.
Score
2
3
4
The energy balance

Obesity and metabolic syndrome
Anatomy and histology of thyroid and parathyroid gland
Iodine metabolism, and thyroid hormone function
Calcium and phosphate metabolism, PTH function
The thyroid and parathyroid hormone disorders
The adrenal hormone function
Adrenal disorders (Cushings syndrome)
Congenital hypothyroid and ambiguous genital
Learning strategy
Lecture
Independent learning
Small group discussion
Learning task
Case based learning
Problem based learning
39

C.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
.
11.
12
.
D.
E.
Lecturer
Prof.DR.dr. K Suastika,SpPD-KEMD
Prof.Dr.dr. AAG Budiartha,SpPD-KEMD
dr. Made Ratna Saraswati, SpPD-KEMD
dr. Desak Made Wihandani, M.Kes
dr I Gst Ngr Mayun Sp.HK
Dr. I Wayan Surudarma, M.Si
dr. Yuliana
Dr. IA Dewi Wiryanthini, M.Biomed
Prof.dr. N Adiputra, MOH
Dr. I Wayan Bikin Suryawan, SpA
dr. Arimbawa, SpA
Dr. Pande Dwipayana, SpPD
Facilitator
Name of your group facilitator
:
Assessment
Time provided
Suitability of questions with topic given
Score :
1. Bad or not suitable with expectation
2. Insufficient or inadequate with expectation
3. Sufficient or adequate with expectation
4. Good or suitable with expectation
5. Excellent or exceed expectation
40

Problems you found during Block of Endocrinology, metabolism, and disorders for each
point evaluated above:
Topic
Learning strategy
Lecturer
Facilitator
Assessment
Your suggestion/input:
Topic
Learning strategy
Lecturer
Facilitator
Assessment
TITLE
41

(subject/topic: choose from compentency list)
Name
NIM
Faculty of Medicine, Udayana University
2015
______________
1.
2.
3.
4.
Introduction (Pendahuluan)
Content (Isi, sesuai topik yang dibahas)
Summary (Ringkasan)
Refferences: (Daftar Pustaka) Van Couver style
Example:
Journal
Sheetz MJ, King GL. Molecular understanding of hyperglycemias adverse effect for
diabetic complications. JAMA. 2002;288:2579-86.
Textbook
Libby P. The Pathogenesis of atherosclerosis. In: Braunwald E, Fauci A, Kasper D,
Hoster S, Longo D, Jamason S (eds). Harrisons principles of internal medicine. 15 th
ed. New York: McGraw Hill; 2001. p. 1977-82.
Internet
WHO. Obesity: preventing and managing the global epidemic. Geneva: WHO 1998.
[cited
2005
July].
Available
from:
http://www.who.int/dietphysicalactivity/publications/facts/ obesity/en.
6 10 pages, 1.5 space, Times new romance 12
42
Title of student project

Group discussion
19.
Topic
A1
1. Diabetes insipidus
A2
2. Acromegaly ,gigantism
A3
3. Prolactinoma
A4
4. Growth hormone deficiency
A5
5. Hypopituitarism
A6
6. Hyperparathyroid
A7
7. Hypoparathyroidism
A8
8. Hypothyroidism
A9
9. Thyroiditis
A10
10. Thyroid nodule
A11
11. Imaging in Pituitary disorders
A12
12. Obesity in Children
B1
13. Cushing's disease
B2
14. Primary hyperaldosteroidism
B3
15. Phaeochromocytoma
B4
16. Precocious puberty
B5
17. Testycular feminization syndrome
B6
18. Hypogonadism
B7
19. Adrenogenital syndrome
B8
20. Addison's disease
B9
21. Multiple endocrinological neoplasia (men syndrome)
B10
22. Tumor with ectopic production of hormone
B11
23. Hyperaldosteronism
B12
24. Genetic in Diabetes
ARTICLE REVIEW ASSESSMENT FORM
43
Article Review Assessment Form

Faculty of Medicine, Udayana University
_________________________________________________________________________
__
Block
Name
: Endocrine System, Metabolism and Disorders

: ________________________________________
Student No. (NIM)
: ________________________________________
Facilitator
: ________________________________________
Title
:-
__________________________________________________
__________________________________________________
__________________________________________________
Time table of consultation
Point of discussion
1. Title
2. Refferences
3. Outline of paper
4. Content
5. Final discussion
Week
1
2
3
4
5
Assessment
A. Paper structure
B. Content
C. Discussion
:
:
:
Total point
Date
7
7
7
8
8
8
Tutor sign
9
9
9
10
10
10
( A + B + C ) : 3 = _____________
Denpasar, ______________________
Facilitator,
20.
FINAL EXAMINATION QUESTION PLAN
44

Type: Multiple choice questions
No
.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Topic
No of question
Introduction (hormone action)

Anatomy of Endocrine System
Histology of Endocrine System
The pituitary gland and disorder
Insulin secretion, Patogenesis and diagnosis
DM
Management of Diabetes in Children
Acute and chronic complication of Diabetes
Lipid metabolism
Lipid metabolism disorders
The Energy balance
The Obesity and Mets
Iodine metabolism
Calcium and phosphate metabolism
Thyroid and parathyroid hormone disorders
Adrenal hormone function
Cushing syndrome and addison disease
Congenital hypothyroid and DSD
TOTAL
PIC
5
4
4
5
5
7
Suastika
Yuliana
Mayun
Ratna
Dewi Wiryanthini
Ratna
7
5
6
5
6
5
6
5
5
6
5
5
6
Suastika/Pande
Bikin/Arimbawa
Budhiarta
Surudarma
Suastika/Pande
Adiputra
Budhiarta
Desak
Suta
Wiragotera
Ratna
Ratna
Bikin/Arimbawa
100 soal
~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
45
10
Senior Clerkship
Senior Clerkship
Senior clerkship
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Elective Study III

(6 weeks)
Clinic Orientation
(Clerkship)
(6 weeks)
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The
Cardiovascular
System and
Disorders
(4 weeks)
The Urinary
System and
Disorders
(3 weeks)
The Reproductive
System and
Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System,
Metabolism and
Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition
and Disorders
(2 weeks)
BCS (1 weeks)
BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(2 weeks)
BCS (1 weeks)
Health Systembased Practice
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
BCS (1 weeks)
Elective Study
II
(1 weeks)
5
BCS (1 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
Pendidikan Pancasila & Kewarganegaraan (3 weeks)
46

Study Guide Block Endocrine Semester V

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Study Guide Block Endocrine Semester V

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Study Guide Endocrine System, Metabolism and Disorders

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

Meeting of student representatives

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

Dr. dr. Made Ratna Saraswati, SpPDKEMD (Head)

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

5. THE SEVEN GENERAL CORE COMPETENCY

Study Guide Endocrine System, Metabolism and Disorders

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

1.1. Describe the transport of hormone in

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

3.5. Summarize the pathophysiologic

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

6.1. Summarize the organization of the

8.1. Summarize the regulation of

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

7. GENERAL LEARNING OUTCOME

Mastery of Basic Knowledge with Its Clinical and Practical Implication

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

The pituitary gland

Acute and chronic

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

The thyroid and

The Adrenal gland

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

MEETING OF THE STUDENT REPRESENTATIVES AND

10. ASSESSMENT METHOD

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

11. CONTENT OUTLINE

2. Pituitary gland (and hypothalamus)

3. Pancreas and Diabetes mellitus

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

7. Mineral metabolism and parathyroid gland

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

Disorder of sex development (DSD)

Disorder of sex development (DSD) is a medical term referring to "congenital

10. Drug treatment in endocrine disorders

Udayana University Departement of Medicine Education, DME

Study Guide Endocrine System, Metabolism and Disorders

12. LEARNING TASKS

The hormone action

Case : A woman with decreased body weight

Anatomy of The Endocrine System