Emerging therapies & exam strategy
What's changing in each specialty: the trials, agents and guideline shifts most likely to matter for the FRACP Divisional Written Exam.
Hyperthyroidism and Graves' Disease
The core treatments for hyperthyroidism — antithyroid drugs, radioactive iodine, and surgery — remain unchanged in principle, but the fastest-moving area is the immune-targeted therapy of Graves'…
Thyroiditis
Management of the thyroiditides is largely supportive and hormone-replacement-based, with interest in adjuncts and precision approaches. For Hashimoto's thyroiditis with overt hypothyroidism,…
Thyroid Nodules
The management of thyroid nodules has moved decisively toward avoiding overtreatment — both overdiagnosis and overly aggressive surgery. On the diagnostic side, ultrasound risk-stratification systems…
Pituitary Adenomas
Pituitary adenomas — now often termed pituitary neuroendocrine tumors (PitNETs) under the updated WHO classification — are managed according to hormone secretion and mass effect. Transsphenoidal…
Hypopituitarism
Hypopituitarism is managed by replacing the deficient hormones — glucocorticoids for ACTH deficiency, levothyroxine for TSH deficiency, sex steroids for gonadotropin deficiency, and growth hormone…
Pituitary Apoplexy
The central question in pituitary apoplexy — whether to operate — has been substantially clarified by recent evidence. A prospective multicenter observational study found that surgical and…
Empty Sella Syndrome
Empty sella is a common radiographic finding — present in up to a third of the general population — and is frequently incidental and asymptomatic. Management hinges on identifying the minority of…
Diabetes Insipidus and SIADH
The disorders of water balance have seen both a change in nomenclature and new therapeutic options. Reflecting a 2022 international consensus, central diabetes insipidus is increasingly termed…
Primary Hyperparathyroidism
Parathyroidectomy remains the definitive treatment for primary hyperparathyroidism (PHPT), achieving biochemical cure in around 96% of cases and improving bone mineral density; it is recommended for…
Secondary Hyperparathyroidism
Secondary hyperparathyroidism (SHPT) in chronic kidney disease is managed by controlling the disturbances that drive PTH excess. Calcimimetics are central: oral cinacalcet lowers PTH without raising…
DiGeorge Syndrome (22q11.2 Deletion)
DiGeorge syndrome (22q11.2 deletion) is a multisystem disorder, and its management has advanced most notably in immunology and in the physiologic replacement of the hormones it disrupts. For the rare…
Pseudohypoparathyroidism
Pseudohypoparathyroidism is defined by resistance to parathyroid hormone rather than its deficiency — most often from mutations in the GNAS gene (which encodes the α-subunit of the stimulatory G…
Familial Hypocalciuric Hypercalcemia
Familial hypocalciuric hypercalcemia (FHH) is a benign, autosomal dominant condition caused chiefly by inactivating mutations in the calcium-sensing receptor gene (CASR, causing FHH1), with rarer…
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