The Charing Cross site provides a unique opportunity for the SpR to learn about the diagnosis, management and long-term follow up of patients with pituitary disease. Nigel Mendoza has performed 130 pituitary operations in four years* and has a pituitary list every week. The SpR is responsible for the perioperative medical supervision of these patients. The SpR learns the management of perioperative diabetes insipidus and steroid replacement. The follow up of the pituitary patients involves looking for postoperative hypopituitarism and checking that the acromegalic and Cushings' patients have been clinically and biochemically cured. The pituitary commitments are a very popular aspect of the SpRs clinical duties.


The management of Cushings' syndrome is very much a combined effort between the Charing Cross and Hammersmith Sites. The selective petrosal and adrenal venous sampling and adrenalectomies are carried out at the Hammersmith site. The pituitary surgery for ACTH secreting adenomas occurs at the Charing Cross site. The full range of adrenal, pathology is seen at both sites including Cushings' syndrome, congenital, adrenal hyperplasia, androgen secreting tumours and primary and secondary hypoadrenalism.


Mr. Lynn performed 100 parathyroidectomies last year. The Sestamibi scans performed by the nuclear medicine department are particularly useful for those patients who have had previous neck surgery, where previous exploration of the neck may have distorted the anatomy. Parathyroid hyperplasia secondary to MEN is seen commonly at the Hammersmith site. For patients who have had previous neck surgery, localisation of further parathyroid adenomas is facilitated by selective venous sampling and rapid PTH assay

*A recent pituitary audit has shown that Charing Cross has amongst the highest cure rates for acromegaly and Cushing's disease and hence will be one of the few major neurosurgical centres in the country which should manage pituitary disease.

ENDOCRINOLOGY  (Neuroendocrine tumours: page 7)