Range of Services

A. Regional Paediatric Services

Our team receives referrals for specialty services encompassing the following hormonal conditions:

• Child and Adolescent Diabetes: 
  
• Screening for children and adolescents who are at risk of developing diabetes.
  
• Management of all types of childhood and adolescent diabetes, including type 1 diabetes, type 2 diabetes mellitus and maturity onset diabetes of the young (MODY) with up-to-date medications.
  
• Insulin pump therapy for suitable patients.
  
• Formal transition diabetes clinics to ensure seamless transition to the adult endocrinologists specialising in diabetes when the time is right. 
  
• Comprehensive diabetes education and counselling, including chronic care management workshops for diabetic children, adolescents and their parents.
• Growth issues: Assess and manage children with short or tall stature, providing individualised therapy. 
  
• Pubertal issues: Manage delayed and precocious (early) puberty.
  
• Thyroid issues: Manage the whole spectrum of thyroid disorders affecting neonates, children or adolescents, including Congenital or Acquired Hypothyroidism, Autoimmune Thyroiditis and Hyperthyroidism (Graves' Disease).
  
• Disorders of Sex Development and Genital Ambiguity: Comprehensive assessment for the Disorders of Sex Development at our regional referral centre for the past 30 years.
• Adrenal issues: Manage disorders including Congenital Adrenal Hyperplasia, Congenital Adrenal Hypoplasia and Cushing Syndrome.
  
• Obesity: Multidisciplinary weight management clinic to help children who are overweight and manage complications related to the metabolic syndrome, including hypertension, lipid disorders and fatty liver disease.
  
• Bone problems: Assess and manage disorders of bone mineralisation including Osteogenesis Imperfecta, juvenile and secondary osteoporosis.
  
• Cancer late effects and fertility preservation: Specialist clinics screening and managing the growth and hormonal disorders for patients who have undergone chemotherapy and radiotherapy for cancer
  

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

• 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 pheochromocytoma

B. 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 or 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 or 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, MODY, 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.

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. 

Youth Lifestyle Change Clinic (Weight Management Clinic)

The multidisciplinary weight management team consists of paediatricians specialising in endocrine disorders in children, a dietitian, an occupational therapist, a physiotherapist and a nurse clinician. Our team provides a one-stop weight management 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 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 complications of obesity.

There is an annual combined renal-diabetes camp for children and teenagers with diabetes. Our division also organises an annual day camp for children with diabetes. These activities aim to provide opportunities for the children to interact with each other and other patients with chronic disease.

The younger children learn to administer injections independently and cope better with their condition. Connecting diabetic teenagers together helps them to realise that there are other teenagers who are coping well with diabetes; they are not 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.

• Diabetes Nurse Educators: 
• Nurse Clinician Annette Su
• annette_su@nuhs.edu.sg
  
• Senior Staff Nurse Yang Xiuji
  
• xiuji_yang@nuhs.edu.sg
  
  

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.

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