Endocrinology

For the majority of young people, puberty is a transition to adulthood posing challenges that are managed well by families or within the primary care setting.

There are however, a number of children who require further assessment to support early diagnosis and treatment and to exclude the possibility of more serious illness. The Endocrinology and Gynaecology Departments at Alder Hey have developed a unique service for girls presenting to their GPs with the following problems:

• Obesity with either delayed menarche or oligomennorrea
• Absence of periods by the age of 15
• Evidence of virilisation
• Continued menstrual problems not responding to standard treatment
• No signs of puberty by age 13 years

We also see parents of girls with severe learning difficulties to discuss options to halt menstruation.

The aims of our service are to:

• Provide prompt diagnosis and treatment by clinicians trained in paediatric endocrinology and gynaecology
• Provide a positive experience of care by adopting an age and gender appropriate approach to support young people and their families with sensitive issues
• Treat with evidenced based guidlines to improve outcomes
• Educate the patient about their condition, enabling them to gain confidence and independence
• Work wtih referring colleagues to encourage joint management plans and transition into adult services if required

If you would like to find out more about the service, please call us on 0151 252 5281 (ext. 2281) to arrange a time for one of the team to contact you.

The regional metabolic bone service is run by Dr Poonam Dharmaraj, Dr Renuka Ramakrishnan and Endocrine Nurse Specialist Lynne Hatchard at Alder Hey Children’s Hospital.

The service sees new and follow-up patients with disorders of calcium, phosphate and bone metabolism and includes the following patient groups:

• Osteogenesis Imperfecta (OI)
• Osteoporosis (primary and secondary)
• Osteoporosis of immobility or associated with syndromes
• Hereditary Hypophosphataemic rickets
• Vitamin D deficiency
• Skeletal dysplasias
• Fibrous dysplasia
• Disorders of calcium (pseudohypoparathyroidism, hypoparathyroidism, calcium sensing receptor mutations)
• Hypophosphatasia
• Metabolic bone disease of prematurity
• Other disorders of phosphate metabolism

The team work closely with Dr Caren Landes (radiologist with expertise in skeletal dysplasias and interpretation of DEXA and QCT scans), clinical genetics colleagues and orthopaedic colleagues (particularly Mr Leroy James who has a special interest in surgical management of OI).

The management of severe, complex and atypical OI is nationally commissioned to four centres. We work closely with Sheffield Children’s Hospital metabolic bone team who are a supra-regional centre.

This involves two multidisciplinary clinics each year where the Sheffield team visit Liverpool to see patients. The management of newborns with severe OI is also coordinated with the Sheffield team.

The Alder Hey service is happy to receive referrals from Merseyside, Cheshire and North Wales and already collaborates closely with Paediatricians in these areas.

Our weekly nurse-led congenital hypothyroid clinic is the first autonomous service where a specialist nurse is responsible for care of a newly diagnosed patient from infancy until transition to adult services.

The nurse-led service is designed to provide safe and sustainable outcomes for patients and to provide continuity of care throughout their journey.

Alder Hey has a transition arrangement with two adult endocrine units at Royal Liverpool and Broadgreen University Hospital and Aintree University Hospital, with a number of clinics held at the three hospitals.

We run transition clinics for numerous patients groups:

• Multiple pituitary hormone deficiency
• Endocrine-Gynaecology patients
• Neuroendocrine patients
• Calcium and metabolic bone disease
• Congenital Hyperinsulinemia
• Children born with disorder of sexual differentiation