Endocrinology

Paediatric Endocrinology

This page was updated Nov 2018 and is currently under further Referral Advisor review

Type 1 Diabetes Mellitus

Any possible new diagnosis of Type 1 Diabetes Mellitus is a medical emergency. Please contact the diabetes team Monday to Friday, 09:00 to 17:00 (bleep 9187), or the on-call medical registrar (bleep 9424) at all other times. There is a 24-hour advice line for any known diabetes patient who is acutely unwell, via switchboard or ward 1 at RHCYP. Any known patients with Type 1 Diabetes Mellitus, who require hospital admission, will be admitted to the Royal Hospital for Children & Young People up to the age of 16 years.

Endocrinology Services

This guidance relates to endocrine conditions excluding diabetes mellitus.

Paediatric endocrinology at the Royal Hospital for Children & Young People (RHCYP) provides specialist services for children and young people across the South East Scotland region. We are affiliated with the Edinburgh Centre for Endocrinology and Diabetes (ECED), which delivers care across NHS Lothian.

The RHCYP endocrinology service operates Monday to Friday, 09:00 to 17:00. The service covers the following areas:

General endocrinology outpatient clinics
Acute inpatient management
Outpatient management in the community
Dynamic endocrine function testing
Specialist endocrinology clinics:
- Turner syndrome
- Metabolic bone disease
- Disorders of sexual development
- Endocrine late effects of childhood cancer
- Adolescent gynaecology

Outside office hours, the general paediatric on-call team take acute referrals and manage inpatients, as there is no formal out-of-hours service.

Age of referrals:

We routinely accept referrals up to the age of 16 years; and up to 18 years if the referral relates to pubertal delay, issues regarding growth or absent vaginal bleeding. Girls over the age of 14 years who are postmenarcheal, with concerns regarding heavy menstrual bleeding or features of polycystic ovary syndrome, should be referred to the gynaecology team at Chalmers Centre. If there are any doubts, please contact the endocrinology team for advice.

We normally transition young people with chronic endocrine conditions once they are at final height, to relevant adult services within the region.

Endocrine Consultants based at RHSC are:

Consultant of the week model:
- Dr Louise Bath
- Dr Harriet Miles
- Dr Daniela Elleri
Dr Amanda Drake
Dr Paula Midgley
Dr Rod Mitchell

We provide tertiary endocrine support for hospitals in Fife, Tayside, Highlands, the Borders, and Dumfries and Galloway.

Colleagues with a special interest at these hospitals are:

Dr Anthony Tasker, Consultant Paediatrician, Victoria Hospital, Kirkcaldy
Dr Joanna Watt, Consultant Paediatrician, Victoria Hospital, Kirkcaldy
Dr Clare Webster, Consultant Paediatrician, Ninewells Hospital, Dundee
Dr Nicky Conway, Consultant Paediatrician, Ninewells Hospital, Dundee
Dr Victoria Franklin, Consultant Paediatrician, Raigmore Hospital, Inverness
Dr Graeme Eunson, Consultant Paediatrician, Borders General Hospital, Melrose
Dr Loveline Ayuk, Consultant Paediatrician, Dumfries and Galloway Royal Infirmar

Contacts

On-Service Endocrine Consultant – 0131 536 0611
Marion Henderson – Endocrine Team Leader Secretary – 0131 536 0611
Endocrine Registrar – 0131 536 0000 – bleep 9187
Barbara Wardhaugh – Endocrine Nurse Specialist – 0131 536 0807
Jennifer Roach – Endocrine Nurse Specialist – 0131 536 0807
Outpatient Appointments, RHSC – 0131 536 0150

Who to refer:

Urgent Referrals

While most endocrine conditions can be safely referred for outpatient review, certain conditions need to be seen urgently. These include:

Acute adrenocortical insufficiency
Thyrotoxicosis
Severe hypothyroidism
Disorders of sexual development
Hypo / hypercalcaemia
Hypo / hypernatremia (suspected SIADH / diabetes insipidus)

Children and young people with endocrine problems who need to be seen acutely can be discussed directly with the endocrine registrar on bleep 9187 between 09:00 and 17:00. Outside these hours, they will be seen by the general paediatric on-call team. In both cases, they will initially be assessed in A&E or sometimes in the outpatient department or planned investigation unit (PIU).

Non-Urgent or Outpatient Referrals

In addition to urgent referral, we accept referrals for the following endocrine problems:

Short and tall stature
Advanced and delayed puberty – as opposed to adrenarche
Adrenarche (but see ‘Who Not to Refer’ and guideline in the resource section
Thyroid disorders (non-urgent)
Problems with excessive thirst and urination
Syndromes with an endocrine component
Gynaecomastia in boys
Hirsutism
Suspected Cushing’s syndrome

As with urgent referrals, these should be made to the RHSC endocrinology team for children and young people in Lothian.

If you have any doubts regarding who or where to refer to, please discuss with the paediatric endocrinology team and we can offer advice.

Who not to refer:

Certain paediatric endocrine problems can sometimes be safely managed by general practice or general paediatric teams, or investigations initiated ahead of referral. Guidelines are available for these conditions and are listed below. These guidelines give advice regarding initiating first line investigations and treatment, if required, and may avoid the need for referral. In each guideline, there is information regarding when a referral would be appropriate- please see the resource section for more detail.

Conditions covered include:

Vitamin D deficiency
Obesity
Early onset pubic hair / body odour / acne after certain ages (Adrenarche)
Irregular menstrual bleeding in adolescents (guideline in development – in the meantime, please e-mail for advice)
Borderline abnormal thyroid function, including patients with Trisomy 21

How to refer:

Outpatient referrals are via SCI Gateway.
Telephone and e-mail advice can be accessed via the endocrine registrar, specialist nurses or on-service consultant, as detailed above.

Advice

Advice may be all that is required and we are happy to offer advice by telephone or e-mail.

Paediatric Phlebotomy Service changing from 17 Sept 19 – see details below

PHLEBOTOMY SERVICE IN OPD

As of the 17th September 2019 OPD will not be running a drop in Phlebotomy service.

We will be moving to an appointment only system.

GP’s who require their patients to have a blood test will need to book this appointment or advise the parent/ carer to do.

The appointment number – 0131 536 0814.

The appointments will run on the following days.
Monday from 1.30pm-4.30pm
Tuesday from 1.30pm-4.30pm
Wednesday from 9.10am-12.30pm
Thursday All day from 9.10-4.30pm

Friday All day from 9.10-4.30pm

GP’s will still be required to complete a blood form or send the patient with a letter on headed note paper detailing the patients demographics, the GP requestor details and the required blood tests.

Our system is unable to read ICE labels, so these CANNOT be accepted from GPs and patients who attend for their appointment with these will be asked to book a new appointment and return with the correct paperwork.

GP’s will also be required to prescribe EMLA and appropriate dressings for application an hour before the appointment.

Please could you also ensure that parents are advised of the correct way to apply the cream. We would recommend this is applied on both antecubital fossae – please ask parents/crers to do so.