This guidance relates to endocrine conditions, excluding the ongoing management of Type 1 Diabetes Mellitus, which is undertaken by the specialist team.
| Type 1 Diabetes Mellitus – SAME DAY EMERGENCY REFERRAL Any possible new diagnosis of type 1 diabetes mellitus is a medical emergency. If you suspect a child or young person has diabetes, please check the blood glucose and if > 11 mmol/l, then this requires urgent, same day attendance at A&E. Please also see the Diabetes Diagnosis page. All patients in Lothian are seen at the Royal Hospital for Children and Young People (RHCYP) up to their 16th birthday. Any patients with Type 1 diabetes requiring inpatient care will also be admitted to the RHCYP, again up to their 16th birthday. Please contact the diabetes team Monday to Friday 09:00 to 17:00 (bleep 9187), on 0131 3120460 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 Dalhousie ward at the RHCYP. |
Endocrinology Guidance:
This guidance relates to endocrine conditions excluding type 1 diabetes mellitus which is fully managed by the RYCYP diabetes team.
Paediatric endocrinology at the RHCYP provides specialist services for children and young people across the Southeast Scotland region; and tertiary endocrine support for hospitals in NHS Fife, Tayside, Highlands, the Borders, and Dumfries and Galloway. The team provides assessment and management support for a range of endocrinology conditions – please see Referral Guidance below.
The RHCYP endocrinology service operates Monday to Friday, 09:00 to 17:00. Please see contact details below.
The team considers referrals up to the age of 16 years; and up to 18 years if the referral relates to pubertal delay, issues regarding growth or primary amenorrhoea. Young people over the age of 16 years who are post-menarche, 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.
A reminder of the Children’s phlebotomy service where that is needed.
Contacts
Office hours (Mon-Fri 09:00- 16:30):
- Endocrine Consultant can be contacted on 0131 312 0443 or by email at loth.rhcypendocrine@nhs.scot (professional use only)
- Endocrine Registrar – via Switchboard 0131 536 1000 – bleep 9187
- Endocrine Nurse Specialist – 0131 312 0461
- Outpatient Appointments, RHCYP – 0131 312 1547
Clinical queries can also be sent to a generic endocrine email (loth.rhcypendocrine@nhs.scot) and these will be reviewed and responded to by the endocrine consultant on for service. The mailbox is reviewed twice a day at around 09.00 and 13.00 Monday to Friday and is for professional use only.
Out-of-Office hours:
Outside office hours, the general paediatric on-call team take acute referrals and manage inpatients, as there is no formal out-of-hours service for paediatric endocrinology.
Who to refer:
- Those with potential endocrine problems up to the age of 16 years
- Those up to 18 years with pubertal delay, issues regarding growth or primary amenorrhoea
If there are any doubts, please contact the endocrinology team for advice.
Urgent Referrals
Most endocrine conditions can be safely referred for outpatient review, but certain conditions need to be seen urgently, or as a same day emergency. These include:
- Diabetes Mellitus
- Acute adrenocortical insufficiency
- Thyrotoxicosis
- Severe hypothyroidism
- Difference of sex development
- Hypo / hypercalcaemia
- Hypo / hypernatraemia: suspected SIADH / arginine vasopressin deficiency (diabetes insipidus).
Non-Urgent or Outpatient Referrals
Referrals for the following endocrine problems are considered:
- Short and tall stature
- Advanced and delayed puberty
- Adrenarche (but see ‘Who Not to Refer’ and guideline)
- Thyroid disorders (non-urgent)
- Excess thirst and urination in well children (with normal glucose)
- Syndromes with an endocrine component
- Gynaecomastia in boys
- Hirsutism
- Suspected Cushing’s syndrome
- Primary or secondary amenorrhoea
- Heavy menstrual bleeding (under the age of 16)
If you have any doubts regarding who or where to refer to, please discuss with the paediatric endocrinology team (contact details as above) for advice.
Who not to refer:
- Young people 16 years or over who are post-menarche, with concerns regarding heavy menstrual bleeding or features of polycystic ovary syndrome. Please refer to Medical Gynaecology at Chalmers.
Certain paediatric endocrine problems can sometimes be safely managed by general practice or general paediatric teams, or investigations initiated ahead of referral. Guidelines for these are under development, but please remember the advice option where that would help.
How to refer:
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 Monday to Friday. Outside these hours, they will be seen by the general paediatric on-call team. They will initially be assessed in A&E or sometimes in the outpatient department or planned investigation unit (Dirleton ward).
For routine referrals:
- Outpatient referrals are via SCI Gateway to RHCYP Endocrinology or by letter.
- Telephone and email advice can be accessed using details above.
Advice
Advice may be all that is required, and we are happy to offer advice by telephone or e-mail.
Blood Tests
Phlebotomy: click here for the Outpatient Phlebotomy Service https://apps.nhslothian.scot/refhelp/guidelines/paediatricphlebotomy/
Edinburgh Centre for Endocrinology and Diabetes (ECED) www.edinburghdiabetes.com
Scottish Paediatric Endocrine Group: Managed Clinical Network (SPEG MCN) www.speg.scot.nhs.uk
British Society for Paediatric Endocrinology and Diabetes (BSPED) www.bsped.org.uk
European Society for Paediatric Endocrinology (ESPE) www.eurospe.org
Lothian Joint Formulary www.ljf.scot.nhs.uk
Get Going www.nhslothian.scot.nhs.uk/getgoing
You and Your Hormones (official public information website of the Society for Endocrinology) www.yourhormones.info
