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
- Hypothyroidism – tiredness, weight gain, constipation, hoarse voice, dry skin and hair, menorrhagia
- Hyperthyroidism – weight loss, tremor, palpitations, hyperactivity, exophthalmos, double vision
- Hyperlipidaemia – xanthelasma
- Hyperuricaemia – gout
- Individual endocrine disorders have typical symptom complexes.
Common and/or important conditions:
- Obesity
- Diabetes mellitus – Type 1 and 2
- Impaired glucose tolerance
- Thyroid disorders – hypothyroidism, hyperthyroidism, goitre, nodules
- Hyperlipidaemia
- Hyperuricaemia
- 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
- WHO diagnostic criteria for diabetes mellitus
- Near patient capillary glucose measurement (including patient self-monitoring)
- HbA1c and fructosamine to assess glycaemic control
- Albumin: creatinine ratio or dipstick for microalbuminuria
- Interpret serum electrolyte and urate results
- Interpret thyroid function tests and understand their limitations – TSH, T4, free T4, T3, auto-antibodies
- Interpret lipid profile tests – total cholesterol, HDL, LDL, triglycerides
- Visual acuity and retinal photography
- Knowledge of secondary care investigations including the glucose tolerance test, thyroid ultrasound and fine needle aspiration, specialised endocrine tests
Treatment:
- Understand principles of treatment for common conditions managed largely in primary care – obesity, diabetes mellitus, hypothyroidism, hyperlipidaemia, hyperuricaemia
- 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
- 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
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
Related GEMs:
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