Range of Services

A. Regional Paediatric Services

Our team receives referrals to these specialty services encompassing the following hormonal problems:

• Child and Adolescent Diabetes: The team offers the following services:
• We screen children and adolescents who are at risk to develop diabetes.
  
• We manage type 1 and type 2 diabetes mellitus and maturity onset diabetes of the young with up-to-date medications.
  
• We initiate the insulin pump with continued follow-up care.
• Being a general hospital, we organise formal transition diabetes clinics to ensure seamless transition to the adult endocrinologists specialising in diabetes at our hospital.
• We provide comprehensive diabetes education and counselling, including chronic care management workshops for diabetic children, adolescents and their parents.
• Growth issues: We assess and manage short and tall children.
• Pubertal issues: We manage delayed and precocious (early) puberty.
• Disorders of Sex Development and Genital Ambiguity: We have been the regional referral centre which offers comprehensive assessment for the Disorders of Sex Development for the past 25 years.
• Adrenal issues: We manage disorders including Congenital Adrenal Hyperplasia, Congenital Adrenal Hypoplasia and Cushing Syndrome.
• Obesity: We have a multidisciplinary weight management clinic to help children who are overweight and manage complications related to the metabolic syndrome, including lipid disorders.
• Bone problems: We assess and manage disorders of bone mineralisation including Osteogenesis Imperfecta, juvenile and secondary osteoporosis.

B. Other Specialised Paediatric Endocrine Services

Our team also offers the full compendium of services which include management of the following:

• Thyroid disorders including Congenital or Acquired Hypothyroidism, Autoimmune Thyroiditis and Hyperthyroidism (Graves' Disease)
• Calcium disorders including Hypocalcaemia, Hypercalcaemia and Rickets
• Pituitary disorders including Panhypopituitarism and Central Diabetes Insipidus which require pituitary hormone replacement
• Disorders of hyperinsulinism and hypoglycaemia
  
• Endocrine tumours of the pituitary gland, thyroid and parathyroid gland, adrenal gland and phaeochromocytoma

C. Comprehensive Diagnostic Testing for Children with Endocrine Issues

Our team of specialty doctors and nurses perform the following essential endocrine diagnostic tests with close supervision of the children and adolescents during the tests:

• Dynamic stimulation tests of endocrine deficiency
• Hormonal suppression tests of endocrine hypersecretion
• Water deprivation test

General Paediatric Endocrinology Clinic

We manage children and adolescents with growth and pubertal issues, thyroid disorders, pituitary disorders and adrenal disorders. We perform the dynamic stimulation tests including the exercise growth hormone stimulation test, insulin and glucagon growth hormone stimulation tests, synacthen stimulation test, LHRH stimulation test for precocious puberty, as well as the dexamethasone suppression tests for Cushing syndrome. Various treatments are available for hormonal deficiencies including male hormone replacement for Hypogonadism, GnRH analogues for central precocious puberty and growth hormone therapy for growth hormone deficiency, Turner syndrome, chronic renal failure, Prader Willi syndrome, children who are small for gestational age and children with idiopathic short stature.

Children and Adolescent Diabetes Clinic

This is a one-stop clinic for children and adolescents with diabetes mellitus (Type 1, Type 2, drug-induced, cystic fibrosis related or others). A team comprising paediatricians specialising in diabetes, dietitians and diabetes nurse educators work together to provide a holistic approach for our patients and their families. There is also a special insulin pump clinic reserved for the assessment and follow-up of patients with diabetes using the insulin pump.

Late Effects Clinic

With the improved medical treatment for childhood cancers, there is an increasing number of cancer survivors suffering from the endocrine effects of their previous treatment. The Late Effects Clinic reviews the hormonal problems encountered by these survivors of childhood malignancy who have suffered from the effects of cranial irradiation and chemotherapy.

Transition Clinic

The Transition Clinic ensures that adolescents with chronic endocrine issues (including diabetes mellitus) are formally introduced to an adult endocrinologist at NUH once they reach adulthood. This ensures seamless continuation of medical care. Started in 2012 (followed by the diabetes transition clinic in 2014), the Transition Clinic is in line with our philosophy of extending holistic care to all our patients.

Youth Lifestyle Change Clinic (Weight Management Clinic)

The multidisciplinary obesity team consists of a paediatrician specialising in endocrine disorders in children, a dietitian, an occupational therapist, a physiotherapist and a nurse clinician. Our team provides a one-stop obesity clinic with access to the full range of services. The paediatrician is the main coordinator of care, monitoring and treating complications of obesity. The dietitian customises and individualises a healthy diet for each obese child based on food preferences. The role of the occupational therapist is to motivate the child and provide parents with valuable strategies to reinforce the child's healthy living. The physiotherapist advises on the exercise regimen and encourages the child to maintain the exercise programme. As a team, together with the child and family, we aim to combat obesity, improve the quality of life and prevent the complications of obesity.

Believing that treating a patient goes beyond the acute setting, our Division of Paediatric Endocrinology extends patient care through two support groups that engage our patients and their families:

• Child and Adolescent Diabetes Support Group
• NUH Turner Syndrome Support Group

Child and Adolescent Diabetes Support Group

The Child and Adolescent Diabetes Support Group organises an annual combined renal-diabetes camp for children and teenagers with diabetes. The aim is to provide an opportunity for them to interact with others who also have diabetes. The younger children learn to administer injections independently and cope better with their diabetes. Connecting diabetic teenagers together helps them to realise that there are other teenagers who are coping well with diabetes; they are not fighting alone and can provide each other with emotional support.

The camp also encourages them to maintain a positive outlook, despite their medical condition. The most important message, which is subconsciously reinforced, is that good diabetes control can delay the onset of complications such as diabetic nephropathy (kidney damage caused by diabetes).

We have developed a Chronic Disease Self-Management Programme (CDSMP) which organises group-based workshops to address the concerns and issues encountered by teenagers with both Type 1 and Type 2 Diabetes Mellitus. It focuses on empowering them with the ability to make rational decisions with regard to important aspects of their lives such as diet, exercise and communication skills with family and friends. This programme also teaches them techniques to cope with fatigue, frustration, pain and isolation.

Our Diabetes Adolescent Transition Clinic is headed by an Advanced Practice Nurse who is trained in both diabetes education and adolescent medicine. This special transition clinic aims to provide a planned and structured process to assess the teenager's level of maturity and address his or her needs. This is to ensure that there will be uninterrupted continuity of care when the diabetic teenager transits into the adult diabetes clinic.

For more information on the Child and Adolescent Diabetes Support Group, please contact:

• Advanced Practice Nurse: Senior Nurse Clinician Betty Kek Lay Kee
• lay_kee_kek@nuhs.edu.sg
• Diabetes Nurse: Nurse Clinician Annette Su
• annette_su@nuhs.edu.sg
• Endocrine Specialty Nurse: Staff Nurse Xiuji Yang
  
• xiuji_yang@nuhs.edu.sg
  

NUH Turner Syndrome Support Group

The NUH Turner Syndrome Support Group was set up in 1997 to help patients with Turner Syndrome and their families. We organise support group meetings to allow the patients and families to meet so as to help the girls get to know each another.

Turner Syndrome is not a disease but a genetic condition associated with some medical problems. We want to help these girls know that they can realise their fullest potential even with Turner Syndrome. Click here to find out more about Turner Syndrome.

For more information on the NUH Turner Syndrome Support Group, please contact Dr Cindy Ho at cindy_ho@nuhs.edu.sg.

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At your first appointment, your child will be seen by a paediatrician specialising in endocrine disorders in children who will conduct a comprehensive review of his or her medical condition. Investigations including dynamic tests of endocrine function will be ordered if required.

At subsequent appointments, the investigation results will be explained to the family, including the diagnosis, with recommendations on how to manage the condition.

• Influenza Vaccine for Children with Diabetes
  

Khoo Teck Puat – National University Children’s Medical Institute

Click here for directions on how to get to the Khoo Teck Puat – National University Children’s Medical Institute from the MRT, for drop off as well as parking.

For more information on our clinics or how to contact us, click here.

Click here to make an appointment online.