{"id":23581,"date":"2025-04-01T14:09:35","date_gmt":"2025-04-01T13:09:35","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=23581"},"modified":"2025-09-22T16:52:44","modified_gmt":"2025-09-22T15:52:44","slug":"paediatric-endocrinology-diabetes","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/","title":{"rendered":"Endocrinology &amp; Diabetes (Paediatrics)"},"content":{"rendered":"\n<p>This guidance relates to endocrine conditions, excluding the ongoing management of Type 1 Diabetes Mellitus, which is undertaken by the specialist team.<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-alert-red-color has-text-color has-link-color has-fixed-layout\"><tbody><tr><td><strong><u>Type 1 Diabetes Mellitus \u2013 SAME DAY EMERGENCY REFERRAL<\/u><\/strong> <br><strong>Any possible new diagnosis of type 1 diabetes mellitus is a <u>medical emergency<\/u>.&nbsp;If you suspect a child or young person has diabetes, please check the blood glucose and if &gt; 11 mmol\/l, then this requires urgent, same day attendance at A&amp;E. Please also see the <\/strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/diabetes\/diabetes-diagnosis\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>Diabetes Diagnosis<\/strong><\/a><strong> page.<\/strong> <br><br><strong>All patients in Lothian are seen at the Royal Hospital for Children and Young People (RHCYP) up to their 16<sup>th<\/sup> birthday.<\/strong> <strong>Any patients with Type 1 diabetes requiring inpatient care will also be admitted to the RHCYP, again up to their 16<sup>th<\/sup> birthday. &nbsp;<\/strong> <br><br><strong>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. &nbsp;There is a 24-hour advice line for any known diabetes patient who is acutely unwell, via switchboard or Dalhousie ward at the RHCYP.&nbsp;<\/strong><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Endocrinology Guidance:<\/strong><strong><\/strong><\/h4>\n\n\n\n<p>This guidance relates to endocrine conditions excluding type 1 diabetes mellitus which is fully managed by the RYCYP diabetes team.<\/p>\n\n\n\n<p>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 \u2013 please see Referral Guidance below.<\/p>\n\n\n\n<p>The\u00a0RHCYP endocrinology service operates Monday to Friday, 09:00 to 17:00.\u00a0Please see contact details below. Out with these hours we offer urgent telephone advice to colleagues in secondary care.<\/p>\n\n\n\n<p>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.&nbsp;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.&nbsp; If there are any doubts, please contact the endocrinology team for advice.<\/p>\n\n\n\n<p>A reminder of the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricphlebotomy\/\" target=\"_blank\" rel=\"noreferrer noopener\">Children\u2019s phlebotomy service<\/a> where that is needed.<\/p>\n\n\n\n<p><strong>Contacts<\/strong><\/p>\n\n\n\n<p>Office hours (Mon-Fri 09:00- 16:30):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Endocrine Consultant can be contacted on 0131 312 0443 or by email at <a href=\"mailto:loth.rhcypendocrine@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.rhcypendocrine@nhs.scot<\/a> (professional use only)<\/li>\n\n\n\n<li>Endocrine Registrar \u2013 via Switchboard 0131 536 1000 \u2013 bleep 9187<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Endocrine Nurse Specialist \u2013 0131 312 0461<\/li>\n\n\n\n<li>Outpatient Appointments, RHCYP \u2013 0131 312 1547<\/li>\n<\/ul>\n\n\n\n<p>Clinical queries can also be sent to a generic endocrine email (<a href=\"mailto:loth.rhcypendocrine@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.rhcypendocrine@nhs.scot<\/a>) &nbsp;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 <strong><em>and is for professional use only.<\/em><\/strong><\/p>\n\n\n\n<p>Out-of-Office hours:<\/p>\n\n\n\n<p>Outside office hours, the general paediatric on-call team take acute referrals. They can escalate concerns and access telephone advice from the on-call paediatric endocrinologist if required.\u00a0<\/p>\n\n\n\n<p><strong>C.M. &amp; E.B. 09-05-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who to refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Those with potential endocrine problems up to the age of 16 years<\/li>\n\n\n\n<li>Those up to 18 years with pubertal delay, issues regarding growth or primary amenorrhoea<\/li>\n<\/ul>\n\n\n\n<p>If there are any doubts, please contact the endocrinology team for advice.<\/p>\n\n\n\n<h4 class=\"wp-block-heading has-alert-red-color has-text-color has-link-color wp-elements-e62285bd4c712af1fa68bebc5ea3b978\"><strong>Urgent Referrals<\/strong><\/h4>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-482d3e2ab677c67c58fafab5f0323c1a\"><strong>Most endocrine conditions can be safely referred for outpatient review, but certain conditions need to be seen urgently, or as a same day emergency.&nbsp; These include:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-61e0829a1cd99a704a602099ebd56373\"><strong>Diabetes Mellitus<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-beab2f60f41752d828fa35057a04bd3a\"><strong>Acute adrenocortical insufficiency<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-02f065c65ee40cfcbac64b2b5e1eddca\"><strong>Thyrotoxicosis<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-5e7e8662821354d1d841a45ef348ccd8\"><strong>Severe hypothyroidism<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-5e4e644d6c2f676c179c5e22fa9a5ef8\"><strong>Difference of sex development<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-f7e562c429a5e4852752a1aaa23afe51\"><strong>Hypo \/ hypercalcaemia<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-d23b9d9afb5aa2fe53be20392e401cd4\"><strong>Hypo \/ hypernatraemia: suspected SIADH \/ arginine vasopressin deficiency (diabetes insipidus).<\/strong><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Non-Urgent or Outpatient Referrals<\/strong><\/h4>\n\n\n\n<p>Referrals for the following endocrine problems are considered:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Short and tall stature<\/li>\n\n\n\n<li>Advanced and delayed puberty<\/li>\n\n\n\n<li>Adrenarche (but see &#8216;Who Not to Refer&#8217; and guideline)<\/li>\n\n\n\n<li>Thyroid disorders (non-urgent)<\/li>\n\n\n\n<li>Excess thirst and urination in well children (with normal glucose)<\/li>\n\n\n\n<li>Syndromes with an endocrine component<\/li>\n\n\n\n<li>Gynaecomastia in boys<\/li>\n\n\n\n<li>Hirsutism<\/li>\n\n\n\n<li>Suspected Cushing&#8217;s syndrome<\/li>\n\n\n\n<li>Primary or secondary amenorrhoea<\/li>\n\n\n\n<li>Heavy menstrual bleeding (under the age of 16)<\/li>\n<\/ul>\n\n\n\n<p>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.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p>Certain paediatric endocrine problems can sometimes be safely managed by general practice or general paediatric teams, or investigations initiated ahead of referral.&nbsp; <em>Guidelines for these are under development, but please remember the advice option where that would help.<\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer<\/strong>:<\/h4>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-5c359596e2e254d3990df448afd45bac\"><strong>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.&nbsp; Outside these hours, they will be seen by the general paediatric on-call team.&nbsp; They will initially be assessed in A&amp;E or sometimes in the outpatient department or planned investigation unit (Dirleton ward).<\/strong><\/p>\n\n\n\n<p><strong>For routine referrals:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Outpatient referrals are via SCI Gateway to RHCYP Endocrinology or by letter.<\/li>\n\n\n\n<li>Telephone and email advice can be accessed using details above.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Advice<\/h4>\n\n\n\n<p>Advice may be all that is required, and we are happy to offer advice by telephone or e-mail.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Blood Tests<\/h4>\n\n\n\n<p>Phlebotomy: click here for the Outpatient Phlebotomy Service <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricphlebotomy\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricphlebotomy\/<\/a><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Edinburgh Centre for Endocrinology and Diabetes (ECED)<a href=\"http:\/\/www.edinburghdiabetes.com\/\" target=\"_blank\" rel=\"noreferrer noopener\"> www.edinburghdiabetes.com<\/a><\/p>\n\n\n\n<p>Scottish Paediatric Endocrine Group: Managed Clinical Network (SPEG MCN) <a href=\"http:\/\/www.speg.scot.nhs.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.speg.scot.nhs.uk<\/a><\/p>\n\n\n\n<p>British Society for Paediatric Endocrinology and Diabetes (BSPED) <a href=\"http:\/\/www.bsped.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.bsped.org.uk<\/a><\/p>\n\n\n\n<p>European Society for Paediatric Endocrinology (ESPE)<a href=\"http:\/\/www.eurospe.org\/\" target=\"_blank\" rel=\"noreferrer noopener\"> www.eurospe.org<\/a><\/p>\n\n\n\n<p>Lothian Joint Formulary<a href=\"http:\/\/www.ljf.scot.nhs.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\"> www.ljf.scot.nhs.uk<\/a><\/p>\n\n\n\n<p>Get Going <a href=\"http:\/\/www.nhslothian.scot.nhs.uk\/getgoing\" target=\"_blank\" rel=\"noreferrer noopener\">www.nhslothian.scot.nhs.uk\/getgoing<\/a><\/p>\n\n\n\n<p>You and Your Hormones (official public information website of the Society for Endocrinology) <a href=\"http:\/\/www.yourhormones.info\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.yourhormones.info<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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 &ndash; SAME DAY EMERGENCY REFERRAL Any possible new diagnosis of type 1 diabetes mellitus is a medical emergency.&nbsp;If you suspect a child or young person has diabetes, please check<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":18302,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1241],"class_list":["post-23581","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-paediatric-endocrinology-diabetes"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/https-apps-nhslothian-scot-refhelp-paediatric-endocrinology-diabetes\/\" rel=\"tag\">Endocrinology &amp; Diabetes\/<\/a>","rttpg_excerpt":"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 &ndash; SAME DAY EMERGENCY REFERRAL Any possible new diagnosis of type 1 diabetes mellitus is a medical emergency.&nbsp;If you suspect a child or young person has diabetes, please check","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/23581","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=23581"}],"version-history":[{"count":9,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/23581\/revisions"}],"predecessor-version":[{"id":25395,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/23581\/revisions\/25395"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18302"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=23581"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=23581"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}