• The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the metabolic and endocrine systems.

    Implementing Rules

    Acceptable Means of Compliance

    Guidance Material

    MED.B.025 Metabolic and Endocrine Systems

    (a) Applicants shall not possess any functional or structural metabolic, nutritional or endocrine disorder which is likely to interfere with the safe exercise of the privileges of the applicable licence(s).

    (b) Applicants with metabolic, nutritional or endocrine dysfunction may be assessed as fit subject to demonstrated stability of the condition and satisfactory aero-medical evaluation.

    Class 1

    (a) Metabolic, nutritional or endocrine dysfunction

    Applicants with metabolic, nutritional or endocrine dysfunction should be assessed as fit if the condition is asymptomatic, clinically compensated and stable with or without replacement therapy, and regularly reviewed by an appropriate specialist.

    Benign Pituitary Tumours Class 1 and 2

    Applicants with symptoms and/or on first diagnosis should be assessed as unfit.

    A fit assessment can be considered subject to a satisfactory endocrinologist’s report and visual fields assessment after 3 months of being stable on treatment.

    Annual follow-up with endocrinology report and visual fields is required.

    Class 2

    (a) Metabolic, nutritional or endocrine dysfunction

    Metabolic, nutritional or endocrine dysfunction is disqualifying. A fit assessment may be considered if the condition is asymptomatic, clinically compensated and stable.

    Cabergoline is used for the treatment of microprolactinomas. It is acceptable for any class of certification, providing the pilot has been stabilised on this medication for a period of not less than three months on the ground and has no adverse side-effects from the therapy.

    Class 1

    (b) Obesity

    Applicants with a Body Mass Index greater than 35 may be assessed as fit only if the excess weight is not likely to interfere with the safe exercise of the applicable licence(s) and a satisfactory cardiovascular risk review has been undertaken.

    Obesity Class 1 and 2

    Download our Information sheet for pilots (PDF)

    Download the UK CAA Certification of Obesity flow chart (PDF)

    Download information on the Medical Flight Test - Musculoskeletal (PDF)

    Class 2

    (b) Obesity

    Obese applicants may be assessed as fit only if the excess weight is not likely to interfere with the safe exercise of the applicable licence(s).

    Implementing Rules Acceptable Means of Compliance Guidance Material
    Class 1

    (c) Addison’s disease

    Addison’s disease is disqualifying. A fit assessment may be considered, provided that cortisone is carried and available for use whilst exercising the privileges of the licence. Applicants may be assessed as fit with a multi-pilot limitation.

    Class 2

    (c) Addison’s disease

    Applicants with Addison’s disease may be assessed as fit provided that cortisone is carried and available for use whilst exercising the privileges of the licence.

    Class 1

    (d) Gout

    Applicants with acute gout should be assessed as unfit. A fit assessment may be considered once asymptomatic, after cessation of treatment or the condition is stabilised on anti-hyperuricaemic therapy.

    Class 2

    (d) Gout

    Applicants with acute gout should be assessed as unfit until asymptomatic.

    Class 1

    (e) Thyroid dysfunction

    Applicants with hyperthyroidism or hypothyroidism should be assessed as unfit. A fit assessment may be considered when a stable euthyroid state is attained.

    Thyroid Dysfunction Class 1 and 2

    Download UK CAA Guidance on Thyroid Dysfunction (PDF)

    Class 2

    (e) Thyroid dysfunction

    Applicants with thyroid disease may be assessed as fit once a stable euthyroid state is attained.

    Implementing Rules Acceptable Means of Compliance Guidance Material
    Class 1

    (f) Abnormal glucose metabolism

    Glycosuria and abnormal blood glucose levels require investigation. A fit assessment may be considered if normal glucose tolerance is demonstrated (low renal threshold) or impaired glucose tolerance without diabetic pathology is fully controlled by diet and regularly reviewed.

    Abnormal Glucose Metabolism Class 1 and 2

    Glycosuria should always be investigated with a minimum of random blood sugar. Symptomatic individuals should have an oral glucose tolerance test.

    Class 1 applicants with impaired glucose tolerance should be reviewed annually.

    Class 2

    (f) Abnormal glucose metabolism

    Glycosuria and abnormal blood glucose levels require investigation. A fit assessment may be considered if normal glucose tolerance is demonstrated (low renal threshold) or impaired glucose tolerance is fully controlled by diet and regularly reviewed.

    Implementing Rules Acceptable Means of Compliance Guidance Material

    (c) Diabetes mellitus

    (1) Applicants with diabetes mellitus requiring insulin shall be assessed as unfit.

    (2) Applicants with diabetes mellitus not requiring insulin shall be assessed as unfit unless it can be demonstrated that blood sugar control has been achieved.

    Class 1

    (g) Diabetes mellitus

    Subject to good control of blood sugar with no hypoglycaemic episodes:

    (1) applicants with diabetes mellitus not requiring medication may be assessed as fit;

    (2) the use of antidiabetic medications that are not likely to cause hypoglycaemia may be acceptable for a fit assessment with a multi-pilot limitation.

    Download the UK CAA Diabetes certification guidance (PDF)

    Download Medical reports – diabetes (PDF)

    Download information about the Medical Flight Test – diabetes (PDF)

    (d) Aero-medical assessment:

    (1) applicants for a class 1 medical certificate requiring medication other than insulin for blood sugar control shall be referred to the licensing authority;

    (2) fitness of class 2 applicants requiring medication other than insulin for blood sugar control shall be assessed in consultation with the licensing authority.

    Class 2

    (g) Diabetes mellitus

    Applicants with diabetes mellitus may be assessed as fit. The use of anti-diabetic medications that are not likely to cause hypoglycaemia may be acceptable.