Endocrinology

Our endocrinology service offers treatment and care for some of the rarer endocrine conditions. Endocrinology is the study and management of rare and complex diseases that affect the glands of the body. Glands regulate vital functions of the body through a controlled release of chemicals called hormones. Some of these vital functions include how we balance fluid and salt in our blood vessels, maintain blood pressure, control growth and metabolism, and manage ill health, stress and shock.

The St Bartholomew’s team is one of the largest in the UK and consists of specialists in endocrinology, radiology, surgery, oncology and pathology. This means that any decisions made about your care are fully discussed in our multi-disciplinary meetings, ensuring that you have the best treatment and outcomes possible. We have access to gold standard diagnostic tests that are not widely available across the UK. We are one of the few endocrine centres in the country that has a dedicated day unit, where endocrine investigations are performed by our experienced nurses. We also have a dedicated inpatient ward where we look after our most complex cases.

The ethos of the department is to deliver consultant led care in the inpatient and outpatient setting. We work closely with our dedicated team of endocrine clinical nurse specialists who will expertly support, inform and guide you through and beyond your diagnosis and ensure that you are able to make informed choices about your treatment and care.

Our department has helped pioneer research and treatments in endocrinology. Our reputation for clinical expertise is such that we accept referrals from across the UK and beyond, and we strive to offer every patient the best treatment available.

Why choose us

We offer very specialist care and treatment for patients with complex endocrine conditions, seeing over 2000 new patients a year. We have a dedicated endocrine investigation unit and inpatient ward run by a team of specialist nurses. 

For endocrine cancers, which are very rare, we see and treat approximately 200 new cases per year. All our cases are discussed in our multi-disciplinary team meeting, incorporating clinical expertise for all aspects of the disease with the use of state of the art facilities. The multi-disciplinary team includes endocrinologists, dedicated surgeons, oncologists, radiologist, nuclear medicine physicians, pathologists, biochemists, geneticists and specialist endocrine and cancer nurses.

The ethos of the department is to deliver consultant led care in the inpatient and outpatient setting. Our department has helped pioneer research and treatments in endocrinology. Our reputation for clinical expertise is such that we accept referrals from across the UK and beyond, and we strive to offer every patient the best treatment available.

For patients

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:

Conditions we treat

  • 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:

  1. local effects due to their size, particularly affecting vision
  2. overproduction of certain hormones (eg the conditions of acromegaly and Cushing’s disease)
  3. 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.

Services we offer

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

Specialist Endocrine nurse for pituitary tumours

Marianna Shiafkou
Mobile 07711369660
Fax: 02034656804
Email:  Marianna.shiafkou@bartshealth.nhs.uk

CNS office
Level 5
King George V Building
St Bartholomew's Hospital
London, EC1A 7BE

Specialist Endocrine nurse for thyroid and other endocrine cancers

Carmel Brennan
Mobile 07917613537
Fax: 02034656804
Email:  Carmel.brennan@bartshealth.nhs.uk

CNS Office
Level 5
King George V Building
St Bartholomew's Hospital
London, EC1A 7BE

Specialist Endocrine nurse for patients with MEN, VHL and Familial Paraganglioma Syndromes

Lorraine McAndrew
Mobile 07568117016
Fax: 02034656804
Email:  Lorraine.McAndrew@bartshealth.nhs.uk

CNS office
Level 5
King George V Building
St Bartholomew's Hospital
London, EC1A 7BE

  • Endocrine Day Case Unit (Francis Fraser Ward)
  • Charge Nurse Luis Floristo
  • Nurse-led clinics for medication administration

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.

What to expect

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, 3rd floor, East Wing, Barts 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.

Contact us

Endocrinology Department
St Bartholomew's Hospital
Email: bhnt.endocrine@nhs.net
Tel:  0203 765 8568 
Monday to Friday, 8.30am-5pm 

For appointment queries or to speak to a member of the endocrine administration team.

Francis Fraser Ward
Floor 3
East Wing
St Bartholomew’s Hospital
Tel: 020 3465 6598

Garrod Ward on 5B Ward,
Floor 5
King George V block
St Bartholomew’s Hospital

For clinicians

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 email a referral letter to bhnt.endocrine@nhs.net

For appointment queries or to speak to a member of the endocrine administration team 
Tel:  0203 765 8568 Monday to Friday, 8.30am-5pm 

Consultants: 

For adult patients only
Please email a referral letter to bhnt.endocrine@nhs.net

For appointment queries or to speak to a member of the endocrine administration team
Tel: 0203 765 8568 Monday to Friday 8.30am-5pm

For referrals to St Bartholomew’s Endocrine MDTs

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 in for discussion at one of our MDTs, please email a referral marked for the attention of Dr Waterhouse to bhnt.endocrine@nhs.net