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Endocrinology

Suggested investigations| | Service notes| | Alternative services| 

Conditions treated

 Hyperthyroidism

 Hypothyroidism

 Goitre

 Thyroid nodule(s)

 Thyroiditis

 Thyroid cancer

 Abnormal thyroid function tests

Polycystic ovary syndrome

HRT

Menopause (early or natural)

Delayed puberty

Precocious puberty

Primary amenorrhoea

Turner's syndrome

Klinefelter's syndrome

Gonadal dysgenesis

Testicular feminisation

Hermaphroditism

Transsexualism 

Masculinising tumours

Testicular tumours

Impotence

Pituitary tumour

Prolactinoma 

Acromegaly

Cushing's syndrome

Non functioning tumour

Normoprolactinaemic galactorrhoea

Pituitary apoplexy

Craniopharyngioma

Hypophysitis

Hypopituitarism

Diabetes insipidus

Hypothalamic syndromes

Adrenal adenoma

Phaeochromocytoma

Addison’s disease

Adrenal carcinoma

Congenital adrenal hyperplasia

Bartter's syndrome

Gitelmann's syndrome

Hyperparathyroidism

Malignant hypercalcaemia

Hypercalciuria

Hypoparathyroidism

Osteomalacia

Hypoglycaemia

Insulinoma

Zollinger-Ellison syndrome

Anorexia nervosa

Gynaecomastia

Carcinoid syndrome

Pancreatic endocrine tumour

Multiple Endocrine Neoplasia Types I/II

8. Growth disorders

9. Neuroendocrine tumours

Suggested investigations

Category	Disease	Investigations
1. Thyroid disorder	Thyrotoxicosis	Gastric parietal cell AB, thyroid AB, TSH, free T4, free T3
	Hypothyroidism/Goitre	Thyroid AB, gastric parietal cell AB, free T4, TSH, 9am cortisol
2. Gonadal disorders	Hirsutism/PCOS (off pill 6/52)	testosterone, DHEAS, androstenedione, SHBG, prolactin, LH, FSH, oestradiol, 17-OH progesterone
	Female hypogonadism	prolactin, LH, FSH, oestradiol
	Impotence	FSH, LH, testosterone, oestradiol, prolactin
	Male hypogonadism	PSA, LFTs, ferritin, gamma GT
3. Pituitary disorders	Raised prolactin	TSH, free T4, FSH, LH, oestradiol, prolactin, testosterone
	Pituitary/? Hypopituitarism	9am cortisol, TSH, free T4, FSH, LH, oestradiol, testosterone, prolactin, HGH, IGF1
	Acromegaly	GH, IGF1, 9am cortisol, prolactin, FSH, LH, oestradiol, testosterone, FSH, free T4
4. Adrenal disorders	Conn's	U&Es, spot urine for sodium and potassium
	Addison's	TSH, free T4, 9am cortisol, 9am ACTH
5. Calcium (parathyroid) disorders	Hypercalcaemia	PTH, calcium, phosphate, alk phos, U&Es, albumin, immunoglobulins, electrophoresis, CRP, sACE, 2 x 24 hour urinary calcium

Service notes

We run an email consultation service, staffed by our SPRs and consultants, which aims to give a 24 hour email enquiry return time.

Subfertility or hirsutism plus menstrual disorders are often best seen initially in the endocrine clinic. Some patients may need to be referred directly to the gynaecologist depending on the nature of their presentation.

Please always supply information on any medications given in the last three months that may elevate prolactin (consulting BNF if necessary).

• A 9.00am cortisol < 100 nmol/L consider urgent.
• Prolactin > 3000 mU/L consider urgent.

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Alternative services

• Osteoporosis and metabolic bone disease – seen at the Nuffield Orthopaedic Centre, Professor John Wass.
• Paediatric endocrinology – seen by Dr Fiona Ryan, John Radcliffe Hospital.
• Euthyroid nodules – consider referral to Mr Greg Sadler, Endocrine Surgeon at the John Radcliffe Hospital under specialty surgery not otherwise specified.  Clinic type Endocrine Surgery.