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Diabetes, Endocrinology and Metabolism - Royal North Shore Hospital

Ambulatory Care Centre (outpatient clinics)

Level 3 (main entry level)

Acute Services Builidng (main building)

Royal North Shore Hospital

Reserve Road

St Leonards

2065

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Diabetes, Endocrinology and Metabolism - Royal North Shore Hospital

Contact Us 

General enquiries: (02) 9463 1680 

After hours/urgent contact: (02) 9926 7111 and ask for the on-call endocrinologist 

Fax: (02) 9463 1045 

Email: NSLHD-Endocrinology@health.nsw.gov.au 

NSLHD-Diabeteseducation@health.nsw.gov.au 

 

Opening Hours 

 

Monday - Friday: 08:00 - 16:00 

 

You will be booked into the most appropriate clinic for your condition. 
 

 What we do

We provide treatment for: 

  • Diabetes - type 1, type 2 and gestational diabetes 
  • Other disorders of the pancreas 
  • Thyroid diseases including cancer, under/active thyroid 
  • Hormone diseases e.g. Cushings Addisons  
  • Metabolic bone disease including osteoporosis, Paget's disease and osteomalacia 
  • Parathyroid disorders 
  • Pituitary disorders 
  • Weight management e.g obesity 
  • Polycystic ovarian syndrome (PCOS) 
  • Other gonadal disorders 
  • Adrenal diseases 
  • Hereditary endocrine disorders 
  • Late effects on the endocrine system after cancer treatment 

We also care for people with the following: 

  • People requiring a bone density scan 

 What to bring

  • Relevant images/scans/blood test results (including CT or MRI scan of affected area) 
  • Relevant test results (If you have diabetes, please bring your blood glucose records and monitoring equipment) 
  • List of current medications and drug allergies 
  • Your referral letter from your GP/Specialist 
  • If your referral is for a Bone Density Scan please ensure GP referral is within 12 months of the date of your appointment and if from a specialist, the referral is within 3 months of date of your appointment 
  • Medicare/DVA card 

 When to visit us

Your GP or non-GP specialist is always your first step in seeking treatment for any condition. You will be referred to our service if your treating doctor feels that your treatment requires the input of Endocrinology. Once we receive the referral it will be reviewed by a doctor and you will be notified of the outcome and next steps. Please allow at least 4 weeks for this process to be undertaken. We see patients either face to face or via telehealth – our team will let you know what the best option is for you. 

  

Please note that phone calls from the hospital will appear as a blocked number. 

  

If you have a scheduled appointment, you will receive a reminder text message. 

  

Please allow a full morning or afternoon for your appointment. Some patients require a longer review and delays can occur. 

 How to visit us

Turn off of Pacific Highway onto Reserve Road in St Leonards

Bus Route 114 stops directly at the hospital

The hospital is close to St Leonards train station

The hospital is a 5 minute walk from St Leonards Station

Street and multi storey car parking are available on the Royal North Shore hospital campus. Fees apply, so please check signage. Concession parking rates are available for patients and carers. Click here for more details.

The Endocrinology Clinic is located at Check in A.

 

When you enter the hospital walk past the yellow lifts. The Ambulatory Care Centre will be on your right-hand side between the orange and green lifts. Check in A can be found by turning right after you pass the enquiries desk.

 Referral information

Indications for referral for clinic appointment

 

Please note: Patients will be offered the model of care that the Endocrinology Team deem to be most appropriate based on the information contained in the referral letter. Possibilities include face to face appointments, telehealth appointments, case conferences and group education sessions.

 

Condition

Referral accepted

Referral not accepted

Type 1 Diabetes

  • All patients with Type 1 diabetes >16 y, including patients in transition from paediatric to adult endocrinology care
  • Age < 16 years of age

Type 2 Diabetes

  • Aged 16 or older with one or more of the following
    • Acute symptomatic hyper or hypoglycaemia not fulfilling criteria for ED referral – refer urgently – phone endocrinologist on-call through switch (9926 7111)
    • Difficulty attaining individualised glycaemic/HbA1c targets despite maximally tolerated oral therapy and GLP-1RA injectables
    • Multiple drug intolerances to glucose-lowering medications, or contraindications
    • Recurrent symptomatic hypoglycaemia while on therapy
    • Development of diabetes complications where glycaemic targets are not being met (note: patients with diabetic foot complications may be referred to RNSH High Risk Foot Service [hyperlink])
    • Hyperglycaemic during hospitalisation
    • Co-morbidity impacting management of diabetes (including use of oral corticosteroids)
    • Pregnancy planning
    • Suspicion of unusual variants, such as LADA, MODY, or secondary diabetes
  • HbA1c at target (individualised, but in general target is <53 mmol/mol [7%] if achievable without undue risk of hypoglycaemia, or <64 mmol/mol [8%] if at high risk of hypoglycaemia)
  • Poor quality referral without appropriate information or investigations

Adrenal Disease

  • Addison’s disease and other causes of primary adrenal insufficiency
  • Congenital Adrenal Hyperplasia
  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
  • Adrenal tumour/mass lesion – refer urgently – phone endocrinologist on-call through switch (9926 7111)

 

Phaeochromocytoma

  • Confirmed or suspected Phaeochromcytoma - Refer urgently – phone endocrinologist on-call through switch (9926 7111)

  • Known Phaeochromocytoma – usual referral process

 

Gonadal Disease

  • Turner’s syndrome
  • Virilization, including polycystic ovary syndrome
  • Unexplained primary or secondary amenorrhoea
  • Premature menopause
  • Male hypogonadism

 

Pituitary disorders

  • Pituitary tumour
  • Prolactinoma
  • Acromegaly
  • Cushing’s disease
  • Hypopituitarism
  • Diabetes insipidus
  • Hypothalamic disorders (tumours, hypophysitis)

 

Thyroid disorders

  • Known or suspected carcinoma 
  • Thyroid nodules (other than clearly benign (Ti-Rads 1 or 2) appearance on Ultrasound)
  • Goitre suspicious for obstruction*
  • Severe hypothyroidism or not responding as expected to Thyroxine replacement
  • Thyrotoxicosis
  • Unusual TFT results confirmed on repeat testing with a second laboratory

*Endocrinology and Endocrine Surgery run a multidisciplinary service for these patients

  • Subclinical hypothyroidism
  • Positive antibodies in setting of normal thyroid hormone levels

Calcium, electrolyte and metabolic bone disorders

  • Hypercalcaemia including primary hyperparathyroidism
  • Hypocalcaemia
  • Paget’s disease
  • Osteomalacia
  • Hypophosphataemia
  • Rare metabolic bone diseases including X-linked hypophosphataemic rickets, tumoral calcinosis, hypophosphatasia, fibrodysplasia ossificans progressiva
  • Hyponatraemia
  • Normocalcaemic hyperparathyroidism

Osteoporosis

  • T-score < -2.5 or absolute ten-year fracture risk >20%, with failure to respond or intolerance to first line treatment with anti-resorptive medication
  • Please note: any patient with a recent minimal trauma fracture who has osteoporosis can be referred through Osteoporosis Refracture Prevention Service
  • RACF residents will be seen by orthogeriatrics team – please make residential status clear on referral
  • Major trauma fractures
  • Pathological fractures
  • Known metastatic of myeloma bone disease
  • Age less than 16 years old

Osteoporosis Refracture Prevention (ORP) Service

  • Anyone with a minimal trauma fracture who is
    • aged 50 years or older, or
    • aged under 50 and post-menopausal
  • Anyone who is continuing to fracture despite 1 year of anti-resorptive treatment
  • Major trauma fractures
  • Pathological fractures
  • Known metastatic of myeloma bone disease
  • Nursing home resident
  • Age less than 16 years old

Obesity

  • Age 18-60 years
  • BMI > 35kg/m2 with T2DM or BMI >45kg/m2 and 2 obesity related comorbidities known to improve with weight loss
  • BMI > 35kg/m2 and Pregnancy planning
  • Age less than 18 or greater than 60 years

Any endocrine condition in pregnancy

  • These referrals will be sent on to the RNSH Specialist Obstetric Clinic

 

Hereditary endocrine disorders

  • Any patient >16 y with Multiple Endocrine Neoplasia Types1 or 2
  • Any patient >16 y with Hereditary Phaeochromocytoma, paraganglioma syndromes
  • Any patient >16 y with Hereditary Jaw Tumour-Hyperparathyroidism syndrome
  • Any patient >16 y with MODY
  • Any patient >16 y with Thyroid Hormone Resistance syndromes
  • Any patient >16 y with Osteogenesis Imperfecta

 

Neuroendocrine Tumours

  • Insulinomas – all patients with recurrent symptomatic hypoglycaemia should be assessed
  • Gastrinomas
  • Glucagonomas

 

Endocrine complications of medical therapies

  • Complications of prolonged corticosteroid use
  • Endocrine complications of Lithium treatment
  • Amiodarone-induced thyroid disorders
  • Endocrine complications of immunotherapies
  • Endocrine complications of chemotherapy and radiotherapy

 

 

Indications for urgent referral to local Emergency Department

  • Addisonian crisis
  • Diabetic foot ulcer with evidence of systemic infection, e.g., fever, hypotension
  • Diabetic ketoacidosis, with or without hyperglycaemia (i.e. euglycaemic diabetic ketoacidosis) 
  • Hyperosmolar hyperglycaemia
  • Rapidly enlarging thyroid mass or symptoms of acute airway obstruction
  • Sodium < 120 mmol/L or symptomatic hyponatraemia < 130 mmol/L
  • Severe symptomatic hypercalcaemia (serum calcium > 2.9 mmol/L)
  • Severe symptomatic hypoglycaemia
  • Severe symptomatic thyrotoxicosis or hypothyroidism

 

Exclusion criteria

  • See table, above

 

Out of NSLHD

  • Reason must be stated explicitly 
  • Resident of other LHD that does not provide the clinical service
  • Continuing care of existing condition already managed by NSLHD
  • Demonstrated complexity requiring services of NSLHD
  • Compassionate circumstances, e.g. family, proximity, staff

 

The following information must be included for referral to be accepted:

  • Assessment findings
  • History of symptoms, including duration, progression and response to any treatments tried
  • Relevant pathology and imaging

 

Providing more information will aid the triage process and make it more likely that your patient will be seen in the most timely manner possible

Please submit referrals using the eReferral system through HealthLink, which can be accessed through most clinical software systems

 

Alternatively, address letters to Head of Department  A/Prof Sarah Glastras or one of the endocrinologists listed in “Other Information”, below. 
Fax (02) 94631045 
Email: NSLHD-Endocrinology@health.nsw.gov.au   

NSLHD-Diabeteseducation@health.nsw.gov.au 

 
Referrals will be triaged and your patient will be notified of the outcome as soon as possible. This process may take between 1-4 weeks. You will be contacted if more information is needed. 
  
Telehealth services are available, please indicate on the referral if you feel this would be suitable for your patient’s appointment. 

 Other information

Your Team

Endocrinologists:

  • A/Prof Sarah Glastras (Head of Department) - General Endocrine, Diabetes, Obesity and Pregnancy
  • Professor Roderick Clifton Bligh General Endocrine, Bone, Endocrine genetic disorders 
  • Professor Greg Fulcher – Diabetologist 
  • A/Prof Venessa Tsang – General Endocrine, Diabetes, Thyroid, Pancreatic Disease 
  • Dr Lyndal Tacon – General Endocrine, Thyroid, Menopause 
  • Dr SallyAnne Duke – General Endocrine, Diabetes in Young Adults 
  • Dr Matti Gild – General Endocrine, Thyroid Cancer 
  • Dr Emma Scott – General Endocrine, Diabetes 
  • Dr Lucy Ding – Obesity 

 

Diabetes Team:

  • Sally Inglis - Nurse Manager Endocrinology  
  • Elline Pamplona – Nurse Practitioner 
  • Grace Bucholtz – Clinical Nurse Consultant, Diabetes 
  • Grace Park – Clinical Nurse Consultant, Diabetes 
  • Sarah Bowes – Clinical Nurse Consultant, Diabetes 
  • Sandy Wu – Clinical Nurse Consultant, Integrated Care 
  • Nick Grech - Diabetes Educator 
  • Nicole Macdonald - Diabetes Educator 
  • Stephen Woodward - Diabetes Educator 
  • Ruth Morgan- Diabetes Educator 
  • Lucy Green - Diabetes Educator 
  • Kylie Alexander - Dietitian 
  • Celina Wang - Dietitian 
  • Malu Alvarez – Endocrine Nurse 
  • Muriel Almeida – Endocrine Nurse    

 

Bone Density Technicians

  • Seth Healey 
  • Jenny Fisher
  • Lynda Wells 

 

Endocrine Research Team:

  • Ms Liza Nery (Manager) 
  • Mrs Rhonda Siddall 
  • Mrs Jean Doyle 
  • Ms Yue Zhao 
  • Ms Nannette Lacson 
  • Ms Samantha Hand 
  • Mr Mitchell Pederson   

 

Administration: 

  • Mrs Crala Sim 
  • Mrs Rashmi Arkai 
  • Mr Amit Dahal 
  • Mr Nassif El-Assaad