Endocrinology is the field of medicine which looks after patients with problems related to the production of hormones or tumours within hormone secreting glands. Hormones are chemicals which are made by glands within the body. Glands release a variety of hormones which play important roles in how the body functions. If a gland over-produces or under-produces hormones, or if they grow and develop tumours within them, this can lead to a variety of health problems. Endocrine disorders may be difficult to diagnose and some conditions are rare.
More information about endocrine disease can be found at the Your Hormones website.
Find out more about:
- Endocrine cancers
- Thyroid cancers and some thyroid disorders. We do not routinely treat patients with hypothyroidism.
- Parathyroid disorders
- Pituitary gland disorders
- Adrenal disorders
- Neuroendocrine tumours
- Multiple endocrine neoplasia syndromes (MEN1 and MEN2)
- Von Hippel Lindau syndrome
- Familial Paraganglioma Syndrome eg SDH mutations
- Other inherited endocrine conditions: Carney complex, McCune-Albright syndrome
- Cancer late effects
Types of endocrine conditions and treatments
Thyroid
The thyroid gland is a butterfly-shaped organ which sits at the front of the neck. It produces thyroid hormone. Most thyroid tumours (sometimes referred to as nodules) are not cancerous.
1. Differentiated thyroid cancer
There are two types of differentiated thyroid cancer: papillary and follicular cancer. For the majority of patients with differentiated thyroid cancer, treatment will involve surgery and radioactive iodine therapy, together with long term support and follow up. Every year we administer approximately 100 doses of radioactive iodine for patients with differentiated thyroid cancer.
2. Medullary thyroid cancer
This is a very rare type of thyroid cancer. The most effective treatment is surgery. Some patients will need radiotherapy, chemotherapy and radionuclide therapy. For some patients, the cancer may be caused by a genetic mutation which can be inherited and this possibility will be considered.
3. Anaplastic thyroid cancer
Anaplastic thyroid cancer is another very rare type of thyroid cancer. Surgery, radiotherapy and insertion of a tracheostomy may all play a role for certain patients.
Parathyroid
The parathyroid glands are attached to the back of the thyroid gland. Tumours of the parathyroid glands cause high calcium which can lead to problems with your bones and kidneys. Most parathyroid tumours are not cancerous but do require thorough and careful evaluation and imaging. This is because they are very small glands and it can be hard to find the one which is causing the problem. It is also essential to help guide effective/curative surgery. Occasionally the gland enlargement can be cancerous and treatment may, in addition to surgery, include radiotherapy.
Pituitary
The pituitary gland is a small gland at the base of the brain which is vital for controlling the secretion of many of the hormones in the body. Tumours affecting the gland are usually not cancerous and small. Most commonly the tumours make a hormone called prolactin and these tumours can be controlled by medication alone. Larger tumours can cause problems of:
- local effects due to their size, particularly affecting vision
- overproduction of certain hormones (eg the conditions of acromegaly and Cushing’s disease)
- underproduction of hormones
The Bart Health Endocrine department is one of only a few centres in the UK to have all the necessary specialists for dealing with the larger more complex tumours. We can offer complex endocrine tests, dedicated imaging, neurosurgery, radiotherapy and gamma knife radiosurgery. Our surgeons routinely perform pituitary surgery using an endoscopic approach and the gamma knife centre now treats complex pituitary tumours from around the country. Many patients have their initial assessments and surgery here with multi-disciplinary input. Following treatment, subsequent follow up can happen with your local endocrinologist.
Adrenal
Adrenal lesions
Most adrenal lesions are not cancerous. Patients need careful evaluation to ensure that the lesion is not producing excessive amounts of hormones and to ensure that their radiological characteristics are benign. Adrenal conditions that we treat include congenital adrenal hyperplasia, hyperaldosteronism, Addison’s disease and Cushing’s syndrome.
Adrenal cancer
Adrenal cancer is a very rare condition and may, in some cases, be associated with excessive production of certain adrenal hormones. Surgery, chemotherapy and radiotherapy may all be used for the treatment of this rare type of cancer. Patients with the possibility of this type of cancer will undergo extensive investigation and imaging in order to help guide treatment decisions.
Phaeochromocytoma
Phaeochromocytoma are rare tumours which usually arise in the adrenal glands but may occur at other sites in the body when they are called paragangliomas. The tumours may make the hormones adrenaline and noradrenaline which can cause many symptoms and elevated blood pressure. They are usually non-cancerous. A proportion of people may develop the tumours as part of an underlying genetic condition and careful assessment, localization and treatment prior to surgical removal are essential.
Neuroendocrine Tumours
Neuroendocrine tumours (NETs) are a group of tumours that start in the cells of the neuroendocrine system. These tumours most commonly arise from cells in the lung, bowel or pancreas. They may make hormones which can cause problems such as diarrhoea, flushing and wheezing. Treatment is aimed at controlling these symptoms in addition to the size and/or spread of the NET. Treatment may include surgery, radiofrequency ablation (heating of the tumour until it dies), hepatic embolisation (blocking blood supply to parts of the liver), chemotherapy, radiotherapy and radio-nuclide therapy. In addition, medicine to control the hormone secretion may be necessary.
Multiple Endocrine Neoplasia syndromes (MEN1 and MEN2)
These are familial, inherited conditions with the development of at least two endocrine tumours. They can be of malignant or benign nature. MEN1 includes pituitary adenomas, parathyroid hyperplasia, angiofibromas and pancreatic tumours. MEN2 is split into MEN2A (medullary thyroid cancer, parathyroid hyperplasia and phaeochromocytoma) and MEN2B (medullary thyroid cancer, neuromas, phaeochromocytoma and marfanoid body habitus). We work very closely with our geneticist and we usually look after family groups with this condition with early monitoring of family members at risk.
Familial Paraganglioma Syndromes
These are rare inherited condition associated with the development of phaeochromocytomas and paragangliomas. The commonest gene affected is Succinate Dehydrogenase (SDH). Patients are monitored regularly with blood and urine tests as well as radiological imaging and some lesions will need to be excised under the expert hands of our endocrine surgeons.
Von Hippel-Lindau disease
A very rare inherited condition that predisposes to benign cysts in the kidneys and pancreas which has the potential to become malignant. Other tumours include haemangioblastomas found along the central nervous system and in the eye. They also develop phaeochromocytomas and pancreatic neuroendocrine tumours.
Late effects of cancer treatment
Recent evidence shows that some of the treatments used for cancer both in children and in adults can have late effects on various aspects of health including the endocrine system. We offer a specialist joint clinic to evaluate and treat patients who have or may be at risk of these conditions.
Specialist clinics
- Radioiodine for thyroid disease clinic [link to ‘our services’]
- Endocrine Antenatal clinic
- MEN clinic
VHL clinic: Our centre received comprehensive care status from the international vHL Alliance on account of the multi-disciplinary, patient-friendly way the clinic is set up and run. We have an experienced paediatric endocrinologist in the clinic, so that patients from across generations can be seen as families and we try our best to ensure that patients see many different specialists for different aspects of the condition on the same day for convenience and continuity of care.
SDH clinic: Affected patients are offered surveillance screening to pick up tumours early and the necessary scans and blood tests are coordinated to ensure only one hospital visit is required prior to the clinic. We hold a monthly clinic to review affected family members after their routine surveillance screening. We coordinate this so that family members can be seen together if they wish and also run joint clinics with a paediatric endocrinologist so that children can be seen in the same clinic as their parents.
Specialist nurses
Our specialist nurses act as our patient’s key workers with the following remit:
- To help you to coordinate your care.
- To talk through the information you have been given.
- To gather further information and specialist nursing advice, or help you find the information you require.
- To link with all health professionals involved in your care.
- To be a single point of contact for you offering support for you and your family from the point of diagnosis throughout your treatment and follow up.
- Holistic Needs Assessment
Aldons Carlo Chua
Endocrine CNS - Adrenals (Benign) / MEN
Mobile: 07779345539
Email: aldonscarlo.chua@nhs.net
Tatenda Kanyasa
Pituitary CNS
Mobile: 07711369660
Email: tatenda.kanyasa@nhs.net
Nadia Nikolova
Endocrine CNS - NETs / ACC / PPGL / VHL.
Mobile: 07568117016
Email: nadia.nikolova1@nhs.net
Carmel Brennan
Endocrine CNS for thyroid and Endocrine cancers
Mobile 07917613537
Email: Carmel.brennan@nhs.net
Charge Nurse Luis Floristo is in charge of our endocrine day case unit. This is a nurse-led clinic for medication administration and contact details can be found below.
Specialist procedures
- Venous sampling (for pituitary, adrenal and parathyroid conditions)
- Nuclear medicine scans (I-123, MIBG, Octreotide, sestaMIBI and Gallium Dotate)
- Radionuclide therapies for patients with neuroendocrine tumours
- Radioiodine therapies for thyroid disease including thyrotoxicosis, multinodular goitres and thyroid cancers
- Non-invasive radiosurgery (known as ‘gamma knife’) for patients with pituitary tumours.
Your outpatient clinic appointment
Your first appointment with us will usually be for blood tests. A consultant will read your referral letter and decide if blood tests are needed before we see you in clinic to help us to manage your condition. This means that you will get the most out of your consultation with the doctor in clinic. The blood test will take place on Francis Fraser Ward, Radiotherapy Department, Basement Level, King George V Building, St Bartholomew's Hospital. On the day of your blood test, you will be given an appointment to see the doctor in clinic. Clinic appointments take place in Clinic 6, Ground Floor, East Wing, Barts Hospital. We are a teaching hospital and you will be seen in clinic by a consultant or a doctor in training. Every patient is discussed with a consultant. If you are seen by a doctor in training at your first clinic visit, your case will be discussed in detail with the consultant responsible for your care. You will also usually meet the consultant responsible for your care during the first clinic appointment. We will aim to make sure that you stay under the care of the consultant that you meet in clinic.
Changing your clinic appointment
Please do not contact central appointments to change your appointment. We manage all of our appointments within the department.
We need a minimum of 7 days notice to change a clinic appointment. If you give us less notice and fail to attend your appointment then we will discharge you.
Please contact us as soon as you know that you need to change your appointment so that we can offer you a new date in good time. You can contact our administration team via phone or email.
For appointment queries or to speak to a member of the endocrine administration team: bhnt.endocrine@nhs.net or call 0203 765 8568 Monday to Friday 8.30am-5pm
Please leave a message and a member of the team will contact you.
Your inpatient stay
Our patients are admitted on a planned basis for investigations and management. Patients who are due to be admitted will be asked to attend a pre-admission visit a few weeks before the admission. This is an afternoon visit where our doctors will take a thorough history and examination and ensure that all the investigations required are booked for the inpatient period.
Staying with us during your tests
If you are having tests at St Bartholomew's Hospital (spread over a few days) and do not live near the hospital, you may be able to stay in the hospital hostel.
This newly-refurbished hostel, within the grounds of Barts Hospital, provides free overnight accommodation for patients requiring a series of tests but live far from the hospital.
Accommodation comprises single rooms equipped with wash-hand basins, a television and tea/coffee making facilities. There are separate bathrooms for male and female patients, and a shared kitchen for the preparation of meals, with an on-site housekeeper service.
If you stay at the hostel, you will be given contact details for staff in case you become unwell at any time. If necessary, you will be admitted and given a hospital bed.
Endocrinology Department
St Bartholomew's Hospital
Email: bhnt.endocrine@nhs.net
Tel: 0203 765 8568 / 0203 765 8531
Monday to Friday, 9am-5pm
For appointment queries or to speak to a member of the endocrine administration team.
Francis Fraser Ward (day unit)
Radiotherapy Department
Basement Level
King George V Building
St Bartholomew’s Hospital
London, EC1A 7BE
Tel: 020 3465 6547
