GEM - Curriculum Statement 15.6 metabolic problems

Knowledge Base for the nMRCGP

Curriculum Statement 15.6 Metabolic Problems

The knowledge base Symptoms:

Patients with metabolic problems are frequently asymptomatic or have non-specific symptoms, such as tiredness, malaise, weight loss or gain, etc. Certain symptoms raise clinical suspicion of metabolic problems: .

• Diabetes mellitus – tiredness, polydipsia, polyuria, weight loss, infections
  • diabetes section from GPnotebook
• Hypothyroidism – tiredness, weight gain, constipation, hoarse voice, dry skin and hair, menorrhagia
  • hypothyroidism section from GPnotebook
• Hyperthyroidism – weight loss, tremor, palpitations, hyperactivity, exophthalmos, double vision
  • hyperthyroidism section from GPnotebook
• Hyperlipidaemia – xanthelasma
  • hyperlipidaemia section from GPnotebook
  • xanthelasma section from GPnotebook
  • familial hypercholesterolaemia section from GPnotebook
  • familial combined hyperlipidaemia section from GPnotebook
• Hyperuricaemia – gout
  • hyperuricaemia section from GPnotebook
  • gout section from GPnotebook
• Individual endocrine disorders have typical symptom complexes.

Common and/or important conditions:

• Obesity
  • obesity section from GPnotebook
• Diabetes mellitus – Type 1 and 2
  • diabetes section from GPnotebook
• Impaired glucose tolerance
  • impaired glucose tolerance section from GPnotebook
• Thyroid disorders – hypothyroidism, hyperthyroidism, goitre, nodules
  • hypothyroidism section from GPnotebook
  • hyperthyroidism section from GPnotebook
  • goitre section from GPnotebook
• Hyperlipidaemia
  • hyperlipidaemia section from GPnotebook
• Hyperuricaemia
  • hyperuricaemia section from GPnotebook
• Endocrine problems – pituitary disease (e.g. prolactinoma, acromegaly, diabetes insipidus), adrenal disease (e.g. Cushing’s syndrome, hyperaldosteronism, Addison’s disease, phaeochromocytoma) and parathyroid disease
  • prolactinoma section from GPnotebook
  • acromegaly section from GPnotebook
  • diabetes insipidus section from GPnotebook
  • Cushing's syndrome section from GPnotebook
  • hyperaldosteronism section from GPnotebook
  • Addison's disease section from GPnotebook
  • phaeochromocytoma section from GPnotebook
  • hyperparathyroidism section from GPnotebook
  • hypoparathyroidism section from GPnotebook

Investigations:

• Body mass index calculation
  • body mass index section from GPnotebook
• WHO diagnostic criteria for diabetes mellitus
  • diagnosis of diabetes section from GPnotebook
• Near patient capillary glucose measurement (including patient self-monitoring)
  • capillary glucose measurement section from GPnotebook
• HbA1c and fructosamine to assess glycaemic control
  • HbA1c section from GPnotebook
  • fructosamine section from GPnotebook
• Albumin: creatinine ratio or dipstick for microalbuminuria
  • urine albumin ratio section from GPnotebook
  • microalbuminuria section from GPnotebook
• Interpret serum electrolyte and urate results
  • renal function tests section from GPnotebook
• Interpret thyroid function tests and understand their limitations – TSH, T4, free T4, T3, auto-antibodies
  • thyroid function tests section from GPnotebook
• Interpret lipid profile tests – total cholesterol, HDL, LDL, triglycerides
  • lipid carrying particles section of GPnotebook
• Visual acuity and retinal photography
• Knowledge of secondary care investigations including the glucose tolerance test, thyroid ultrasound and fine needle aspiration, specialised endocrine tests
  • glucose tolerance test section from GPnotebook

Treatment:

• Understand principles of treatment for common conditions managed largely in primary care – obesity, diabetes mellitus, hypothyroidism, hyperlipidaemia, hyperuricaemia
  • obesity section from GPnotebook
  • diabetes section from GPnotebook
  • hypothyroidism section from GPnotebook
  • hyperthyroidism section from GPnotebook
  • gout section from GPnotebook
• Chronic disease management including specific disease management, systems of care and multidisciplinary teamwork for people with established metabolic problems
• Communication with patients and their families, and interprofessional communication both within the primary healthcare team and between primary and secondary care

Emergency care:

• Acute management of diabetic emergencies
  • hypoglycaemia, hyperglycaemic ketoacidosis and hyperglycaemic hyperosmolar non-ketotic coma
    • diabetic emergencies section from GPnotebook
• Acute management of thyroid emergencies
  • myxoedema coma and hyperthyroid crisis
  • myxoedema coma section from GPnotebook
  • hyperthyroid crisis section from GPnotebook
• Recognition and primary care management of Addisonian crisis
  • Addisonian crisis section from GPnotebook

Prevention:

• Health promotion activities include dietary modification and exercise advice
• Understand when prevention of hyperuricaemia is appropriate, e.g. patients treated for myelo/proliferative disorders
• Obesity and diabetes mellitus are risk factors for other conditions, so optimal management is preventative
  • obesity section from GPnotebook
  • exercise section from GPnotebook

Related GEMs:

• diabetes the basics - part one
• diabetes the basics - part two including ABC guidelines
• difficult diabetes part one
• difficult diabetes part two
• lipid lowering treatment part one
• lipid lowering treatment part two