Approximately 1000 new general endocrine outpatients are referred to the Endocrine Departments at Charing Cross and Hammersmith Hospitals annually. Both hospitals hold two endocrine out-patient clinics a week and a weekly post-clinic meeting is held at each hospital. The post-clinic meetings are attended by all the junior and senior members of the department. These informal and lively meetings form a major component of the ongoing clinical endocrine teaching for the SpRs. They provide an excellent opportunity to discuss all aspects of endocrine investigation and management and help regularly update all the team on our current endocrine protocols. The case mix of the general endocrinology is extremely varied and, apart from paediatric cases, which are seen in a separate clinic, both hospitals are in a position to investigate and manage the entire spectrum of clinical cases referred.

The endocrine in-patient services have approximately 5-10 endocrine patients in the wards at each of the hospitals undergoing either investigations or surgery. Examples of the case mix of the patients admitted include Cushing's syndrome, neuroendocrine tumours and patients undergoing pituitary surgery and embolisation for metastatic disease. The clinical experience gained by the SpRs from the in-patient endocrinology at our two hospitals is unmatched.


Both sites give the SpR exposure to all aspects of thyroid disease. The Charing Cross SpRs perform Fine Needle Aspiration (FNA) of thyroid masses and are taught by Dr. Livni, consultant cytologist, about immediate interpretation of the cytology to ensure a good yield from the FNA. The department of nuclear medicine on both sites plays a major role in the diagnosis and definitive management of thyrotoxicosis and thyroid carcinoma. The Hammersmith site is a tertiary referral centre for Multiple Endocrine Neoplasia, hence the SpR has exposure to managing medullary cell carcinoma of the thyroid. Dr. Graham Williams is an expert in both the academic and clinical aspect of thyroid disease, ensuring that the SpR is aware of the latest advances in this field. The thyroidectomies are performed by Mr. Lynn, consultant endocrine surgeon. He is a national leader in thyroid surgery, having performed 170 thyroidectomies last year. Mr. Lynn provides a remarkable general endocrine service, taking on the most difficult cases which are often referred by his surgical colleagues elsewhere.

ENDOCRINOLOGY  (Pituitary) (page 6)