ANNUAL REVIEW 2004 - St Vincent's University Hospital

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Department of Endocrinology and Diabetes Mellitus Departmental Review Staff Consultants Specialist Registrars Registrars Research Registrars Professor T.J. McKenna, Dr Malachi McKenna, Dr Donal O’Shea Lecturers, Department of Medicine,U.C.D.: Dr James Gibney and Dr Diarmuid Smith Dr Kevin Moore, Dr Chong Yew Tan Dr Montasir Hammam, Dr Sally Daly Dr Twani Tuthill, Dr Tom Cawood Diabetes Centre Nurses Ms Deirdre Gleeson, Ms Moira Haran, Ms Nora Collis, Ms Phil Sharkey, Ms Joanne O’Neill, Ms Maureen Quill, Primary Care Liaison Ms Deirdre Hall Dieticians Diabetes Liaison Psychiatrist Dr. Eamon Kenny Secretarial Staff Endocrine and Diabetes Research Nurse Ciara O’Dwyer. Ms Maeve Moran; Primary Care Liaison, Ms Yvonne Ryan Ms Geri Daly, Ms Patricia Sinnott, Ms Brenda Sullivan, Ms Marie McCarrick, Ms Joyce Doyle, Ms Catherine Brady, Ms Fiona Whelan, Ms Michelle Keane, Ms Heather Bailey. Endocrine Laboratory Dr.Tom Smith, Principal Biochemist; Anne Dickinson, Senior Medical Scientist Anne-Marie Glynn, James Connolly, Martina Cassidy, Paddy Doran, Sheila McKeon Research-Graduate Students Sinead Kelly and Lucille Kavanagh. Weekly Departmental Academic Events Monday lunchtime – Diabetes Team Meeting Monday - 2.00 p.m. – Laboratory/Research Meeting Tuesday Noon – Endocrine Conference Friday – 11.00 a.m. – Departmental Journal Club Outpatient Clinics 3 Diabetes Clinics per week 1 Joint Endocrinology Clinic (Prof. McKenna and Dr. O’Shea) Weekly multidisciplinary group education sessions for newly diagnosed patients with Type 2 diabetes. Monthly group education session on cholesterol management and diet. Quarterly group education sessions for patients with newly diagnosed impaired glucose tolerance. Service Developments/ Activities Diabetes Service The Diabetes Service is based on the combination of formal clinical consultation, one to one and group problem solving, education and counselling sessions delivered by Diabetes Nurse Specialists and the Diabetes Centre Dietician, Maeve Moran. This system is further supported by a telephone contact service which has grown in response to need over several years. During this year an audit of this service was set in place and there are plans to develop a more formal and efficient telephone-based service. Dr Kevin Moore and Dr Sally Daly undertook an audit to assess the service performance with regard to achieving treatment targets for diabetic patients. During the year continuous blood glucose monitoring was introduced which will be helpful in assessing the possibility of silent hypoglycaemia inpatients with type 1 diabetes particularly. While there has been a general increase in Diabetes Centre activities, patient encounters have increased by 25% over the last year. Clearly, additional personnel will be required to serve continued growth at this level. Endocrine Service The Endocrine Service is delivered on an almost exclusively out-patient basis in line with international trends. Particular expertise exists in the area of thyroid disorders, disorders of reproductive endocrinology, disorders of the adrenal glands and pituitary. Disorders of metabolism, including obesity, metabolic bone disease and calcium disorders all enjoy a national profile.With the critical co- Departmental Review 115
Department of Endocrinology and Diabetes Mellitus operation of the Radiology Department and the Endocrine Laboratory, investigation of hypoglycaemia, and particularly the search for insulin-secreting pancreatic tumours, has been developed. This essentially involves arterial catherisation of blood vessels feeding the various sections of the pancreas with infusion of calcium and simultaneous sampling of blood from the portal venous system insulin secreting tumours too small for detection by conventional imaging may be localised when calcium stimulates the insulinoma to secrete insulin. This investigation has attracted national attention. The Endocrine Laboratory experienced an overall 9% growth rate. The Endocrine Laboratory continues to provide HbA1c measurement for diabetes patients, in addition to a full array of steroid and glycoprotein measurements. Research Projects 1. Control of Adrenal Steroidogenesis: (Ms Sinead Kelly) Sinead Kelly is currently investigating the role of these orphan nuclear receptors and their co-activator proteins in regulating key steroidogenic enzymes and subsequent production of cortisol and adrenal androgens. 2. Characterisation of Macroprolactin: (Ms Lucille Kavanagh) (a) Findings suggest an autoimmune susceptibility in macroprolactinaemic patients. (b) The much reduced bioactivity apparent in vivo may be due to nonbioavailability rather than intrinsic inactivity of prolactin in macroprolactin. 3. Androgen-secreting Tumours: (Dr D Smith) The importance of the findings in this study is that it supports the policy of restricting comprehensive evaluation of patients presenting with signs of androgen excess to a relatively small percentage of patients with a high likelihood of identifying a disorder other than polycystic ovary syndrome. 4. Bone Disease:Thyroid Disorders: (Dr D Smith, Ms Barbara Murray, Metabolic Laboratory) The usefulness of indices developed in the Metabolic Laboratory for the assessment of bone turnover and bone remodelling balance have also been assessed and applied to patients with Paget’s Disease, hyperparathyroidism and eating disorders. 5. Bone Biomarkers in the Assessment of Breast Cancer Patients: (Dr J Gibney, Ms Barbara Murray, Metabolic Laboratory, Dr D Smith) Over 100 patients have entered in a study, whereby the sensitivity of bone biomarkers for the detection of bone metastases in breast cancer patients with normal bone scan is ongoing. This study will take several years to yield a result. 6. Thyroid Eye Disease: (Dr T Cawood) Dr Cawood will examine the inflammatory cytokines that mediate the early stages of this condition in the hope that more targeted treatments can be developed to interrupt the process. 7. Diabetes Clinical trials are currently being conducted to assess the efficacy of newly introduced long-acting anologue insulins which have reported the value in reducing the frequency of hypoglycaemia, particularly through the night, reduced weight gain, improved metabolic control with more reproducible glycaemic profiles. A study is also ongoing to assess the impact of analogue insulin in combination with fish oils, or fish oils alone or neither treatment in-patients with mild diabetes and evidence of vascular risk. Achievements and Distinctions Professor T J McKenna is President of the Royal College of Physicians of Ireland. Professor McKenna is a member of The National Taskforce on Medical Manpower and a member of its Medical Education and Training Group. He is also on the Editorial Boards for the journals, Clinical Endocrinology (Oxford) and The Endocrinologist (U.S.). He is a member of the Students Affairs Committee of the Endocrine Society (U.S.). Professor McKenna was invited assessor of quality for the Department of Medicine, University College Galway. Dr Donal O’Shea is a member of the Eastern Regional Health Authority Diabetes Review Committee. Dr O’Shea is Secretary of The Irish Endocrine Society. He is also a member of the National Taskforce on Obesity and Chairman of the Detection and Treatment Subgroup. Dr O’Shea is Chairman of the Nutrition Council of the Irish Heart Foundation and Chairman of the St Vincent’s Healthcare Group Drugs and Therapeutics Committee. He received an under-graduate-nominated Premier Award for Teaching Excellence from the Faculty of Medicine, UCD. Dr Tom Smith is Chairman of the Association of Clinical Biochemists, Republic of Ireland Region. Dr James Gibney was appointed Consultant Endocrinologist, Adelaide & Meath Hospital incorporating the National Childrens Hospital,Tallaght. Ms Maire Culliton was appointed Chief Medical Scientist, National Maternity Hospital, Holles Street. Martina Cassidy was awarded MSc in Biomedical Science by the University of Ulster, Coleraine, Co Derry. Sinead Kelly submitted a Thesis entitled "Transcriptional regulation of key steroidogenic enzymes in the human adrenal gland" for consideration for the PhD degree to The Department of Pharmacology, UCD. Tom Cawood was awarded the Ritchie Research Scholarship by the Royal 116 St Vincent’s Healthcare Group
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