Endocrinology

Endocrine cancers

Our department works closely with the Barts oncology service and radiology department, as well as with services in other hospitals, to deliver world-class, coordinated care for patients with endocrine cancers such as adrenal cancer, thyroid cancer and neuroendocrine tumours.

Thyroid cancers and some thyroid disorders

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.

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.

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.

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 gland disorders

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 gland disorders

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 disorders 

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.

Von Hippel-Lindau syndrome 

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.

Familial Paraganglioma Syndromes (E.g. SDH mutations)

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.

Other inherited endocrine conditions: Carney Complex, McCune Albright Syndrome

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

Our service provides dedicated specialist clinics for

• Radioiodine for thyroid disease
• Endocrine Antenatal care
• Multiple endocrine neoplasia (MEN) care
• Androgen disorders
• Late effects of cancer treatment

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 run joint clinics with a paediatric endocrinologist so that children can be seen in the same clinic as their parents.

Referrals

To refer a patient to St Bartholomew’s Endocrinology Department please do not contact central appointments. We manage our referrals within the department.

GPs

For Adult patients only

Please refer via the NHS e-Referral Service

For appointment queries please contact a member of the endocrine administration team.

Consultants

For adult patients only, please email a referral letter.

For appointment queries please contact a member of the endocrine administration team.

MDT

We have the following weekly MDTs:

• Pituitary disease: Wednesday morning
• Adrenal disease: Wednesday morning
• Parathyroid disease: Wednesday morning
• Thyroid surgery and cancer: Friday afternoon
• NET: Friday afternoon

We are more than happy to review an outside case at any of our MDTs. To refer a patient from outside Barts for discussion at one of our MDTs, please email a referral marked for the attention of Dr Waterhouse.

To refer to the MDTs from within the Trust, referrals to the pituitary, adrenal and parathyroid endocrine-radiology MDT, please email no later than midday Monday for discussion the following Wednesday. It is the referrer’s responsibility to attend the MDT and carry out the recommended actions.

For a referral to the thyroid surgery and cancer MDT and NET MDT, please email following discussion with an endocrine consultant. Referrals should be made prior to 09:00 on a Thursday morning, for discussion the following day.

References for Trainees

The North East London Deanery provides a rich and holistic training programme for Diabetes and Endocrine trainees. Prospective trainees can contact our registrar representative, Dr Fernyhough for further information.

Existing registrars can access education and clinical resources via our SharePoint.