Metabolic & Endocrinology Guidance Material

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on metabolic and endocrine conditions

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 ³ 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

Information sheet for pilots

UK CAA Certification of Obesity flow chart

Medical Flight Test - Musculoskeletal

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
UK CAA Guidance on Thyroid Dysfunction

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.

UK CAA Diabetes certification guidance

Briefing Sheet for pilots with diabetes

Medical reports - diabetes

Medical Flight Test - diabetes

(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.