Endocrinology

I have now moved from the VA wards to a month of endocrinology. Endocrinology, as best as I can tell, can be simplified to the diagram above. Hormone regulation is tightly modulated such that outputs change the strength of inputs. As endogenous steroids are released by our adrenal glands, our hypothalamus and pituitary sense this and downregulate those factors that trigger steroid release. This occurs across multiple axes in the human body, changes predictably with medications, and guides the principles of testing. For the engineering-minded, it's the perfect specialty. It's also a fascinating specialty for the general practitioner because it spans every organ system and covers both common diseases (hyperlipidemia, diabetes) and the rare (pheochromocytoma, craniopharyngioma).

Overall, it's a light outpatient elective rotation. Each day of the week, we have a half-day of clinic, seeing patients with diabetes, thyroid disorders, surgical resections of their pituitary, and other rarer hormonal imbalances. These occur at all the different hospitals, including Santa Clara Valley Medical Center. In the afternoons, we field endocrine consults for management of inpatient endocrine disorders; many of these are from the surgical services. Overall, the day is educational and moves at a fairly manageable pace.

Image is in the public domain, from Wikipedia.