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Diagnosis of Cushing’s syndrome

Treatment of Cushing’s syndrome

Primary hyperaldosteronism

Phaeochromocytoma and paraganglioma

Primary Adrenal Insufficiency

Congenital Adrenal Hyperplasia (Updated 2018)

Primary Hyperparathyroidism

Paget’s disease (2014)

Osteoporosis in men (2012)

Thyroid dysfunction in pregnancy & post partum

Treatment of gender dysphoric/incongruent patients

Diagnosis and Treatment of Polycystic Ovarian Syndrome (2013)

Evaluation and Treatment of Hirsutism in pre-menopausal women (2018)

Testosterone therapy in Men with Hypogonadism (2018)

Treatment of menopause symptoms (2015)

Evaluation and management of adult Hypoglycaemic Disorders (2009)

Treatment of Diabetes in Older Adults (2019)

Evaluation and treatment of Hypertriglyceridaemia (2012)

Endocrine and Nutritional Management of Post-bariatric surgery Patient (2010)

Acromegaly

Hyperprolactinaemia

Pituitary incidentaloma

Adult growth hormone deficiency

ESE guidelines on hyponatraemia

EUGOGO guidelines on thyroid eye disease

Vitamin D National Osteoporosis Society guidance

Pituitary apoplexy

Acute adrenal insufficiency (crisis)

Acute hypercalcaemia

Acute hypocalcaemia

Severe symptomatic hyponatraemia

Primary hypothyroidism

Thyroid cancer

ATA Diagnosis and Management of Thyroid Disease During Pregnancy & the Postpartum

Diabetes in children and young people

Diabetes in pregnancy

Type 1 diabetes in adults

Type 2 diabetes in adults

Diabetic foot prevention and management

Islet cell transplantation

Familial hypercholesterolaemia

Hypoglycaemia management

DKA management 

HHS management

Management of patients undergoing surgery

Management in enteral feeding 

Steroid induced hyperglycaemia

Variable rate insulin infusion

Management on the haemodialysis unit

Management of diabetes on pregnancy wards and labor

Diabetes in patients with mental health issues

As you may know, the UK is very fortunate to have the world’s first government-funded islet transplant service dedicated to patients with type 1 diabetes and recurrent severe hypoglycaemia. Here is a summary of who to refer and how to refer.

Since the year 2000, 54 islet transplants have been performed on 34 patients in the UK; and of these, 34 transplants have been performed over the past three years. An audit of islet transplant recipients from our seven UK centres (April 2008 – April 2011) showed that 96% of all transplants were functioning at one month, and this has been maintained long-term in the vast majority (>18 months follow-up so far). Severe hypoglycaemia was reduced by >95%; HbA1c was reduced from 66 mmol/mol (8.2%) to 51 mmol/mol (6.8%) and overall insulin requirement was halved. In addition, significant numbers of patients are becoming insulin-independent. Therefore, it is clear that for the majority of patients, the UK clinical islet transplant programme has attained its goals of preventing recurrent severe hypoglycaemia, improving glycaemic control and maintaining satisfactory graft function.

Referral criteria

The following patients with type 1 diabetes might be suitable: Those with:

• Two or more episodes of severe hypoglycaemia (requiring other people to help) within last 2 years
• Impaired awareness of hypoglycaemia
• Severe hypoglycaemia/impaired awareness who have a functioning kidney transplant
• Ideally we like patients to have had a prior trial of insulin pump therapy, and we can arrange this if necessary. However, we are happy to assess any patient who is unsuitable, or has strong views against a trial of pump therapy.

The following patients are probably not suitable:

Those who:

• require >0.7 units/kg/day of insulin  (~50 units/day for a 70 kg patient)
  weigh more than 85 kg
  have poor kidney function (in general this means a GFR <60 ml/min)
• These criteria are somewhat flexible; we always assess the overall risks and benefits for individual patients. If you are unsure whether your patient might be suitable then please contact the clinical lead at one of the UK Islet
• Transplant Consortium centres (below). We will be very pleased to discuss any potential patient.

Where to refer

There are six islet cell transplant centres in England and one in Scotland:

Bristol:
Dr Richard Smith, Richard Bright Renal Unit, Southmead Hospital, Southmead Road , Westbury-on-Trym, Bristol, BS10 5NB. Richard.Smith@bristol.ac.uk  Tel: 0117 3235434

Edinburgh:
Mr John Casey, Transplant unit, Royal infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA. jcasey@staffmail.ed.ac.uk. Tel: 0131 242 1714

London:
Dr Yee Cheah, Department of Diabetes, Kings College Hospital, Denmark Hill, London, Greater London SE5 9RS. y.cheah@nhs.net. Tel: 020 7848 5651.

Dr Miranda Rosenthal, Diabetes Department, Royal Free Hospital, Pond Street, London, NW3 2QG. miranda.rosenthal@nhs.net .  Tel: 020707794 0500 x 33325

Manchester:
Dr Martin Rutter, Manchester Diabetes Centre, 193 Hathersage Road, Manchester, M13 0JE. martin.rutter@cmft.nhs.uk.  Tel: 0161 276 6709

Newcastle:
Prof James Shaw, Institute of Transplantation, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN. Jim.Shaw@newcastle.ac.uk. Tel: 0191 222 7019 / 8129

Oxford:
Prof Paul Johnson, Nuffield Department of Surgical Sciences, Level 6, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU. paul.johnson@nds.ox.ac.uk .  Tel: 01865 221291

We would be very pleased to receive referrals from you, or to discuss potential referrals with you.

With best wishes,

Richard Smith, John Casey, Miranda Rosenthal, Pratick Choudhary, Martin Rutter, Jim Shaw and Paul Johnson

On behalf of the UK Islet Transplant Consortium

https://www.mrcpuk.org/mrcpuk-examinations/specialty-certificate-examinations/specialties/endocrinology-and-diabetes-0