Endocrinology and Metabolism | Clinical Activities

The division provides specialty care services and consultative services for the population cared for by St. Louis Children's Hospital and Washington University School of Medicine. This includes a population of approximately 2 million from the Greater St. Louis area and additional referrals from the surrounding areas of Missouri, central and southern Illinois, western Indiana, northern Arkansas and western Kentucky. Although all faculty and staff participate in clinical care and teaching activities related to all aspects of endocrinology and metabolism, the clinical services can loosely be divided into the general endocrinology service and the diabetes service. The outpatient clinical services are operated from the ambulatory office suites and meet four half-days per week at St. Louis Children's Hospital and approximately five half-days per month at Missouri Baptist Medical Center in western St. Louis County. These services account for approximately 4,000 patient visits per year. Approximately 40 percent of these represent patients with diabetes and approximately 700 of these represent new patient consultations with other endocrine-related disorders or growth problems.

The outpatient endocrinology and diabetes services are staffed during each session with three attending physicians, two or three fellowship physicians, and pediatric residents and medical students as assigned to the service. In addition, the outpatient sessions devoted to diabetes are staffed by two diabetes clinical nurse specialists, a nutritionist and a social worker. In general, diabetic patients are primarily seen during four to five half-day sessions per month with the remaining sessions devoted to other endocrinology and metabolism cases. The division provides clinical nurse specialists, nutritionists, a social worker and a psychologist to assist in the care of chronic diseases, especially diabetes.

The outpatient Endocrinology Service evaluates and follows children with all types of endocrine disorders. These include children with disorders of growth, pubertal development (delayed or early), thyroid disorders, adrenal disorders (including adrenal insufficiency, Cushings syndrome, and congenital adrenal hyperplasia), hypopituitarism, and disorders of bone and mineral metabolism. In addition, children with metabolic diseases or hormonal abnormalities associated with hypoglycemia are also evaluated and followed.

The Diabetes Service acts as a referral service following a wide variety of diabetic children and teenagers. The Diabetes Service operates in close collaboration with the primary care physician in the community but offers a full range of services related to the diabetes care. Currently, there are approximately 1,200 patients with diabetes followed and 700 to 800 of these are seen regularly two to five times per year. The division provides 24-hour, on-call coverage to all of our patients, including those with diabetes.

The inpatient Endocrinology and Metabolism Service at St. Louis Children's Hospital is staffed by the same physicians and other personnel as the outpatient service. The inpatient service consists primarily of children with diabetes mellitus who are admitted for initiation of therapy and training at the time of diagnosis or are admitted subsequently because of diabetes-related or other medical problems. In addition, the inpatient service serves as a consultative service for other divisions and departments within the hospital. These patients include a wide breadth of disorders. The inpatient consultation endocrinology service works especially closely with the Department of Neurology and the Department of Neurosurgery in the management of children with pituitary/hypothalamic disorders as a result of tumors or other CNS lesions, and also works closely with the Cystic Fibrosis service and Division of Allergy and Pulmonary Medicine in the management of patients with cystic fibrosis-related diabetes and those undergoing lung transplantation.

The clinical service in the Division of Pediatric Endocrinology and Metabolism has three regularly scheduled conferences each week. One is devoted to the discussion and planning of services related to the diabetic population. A second is devoted to discussion of new and interesting cases seen within the Division during the previous week. The third is a weekly discussion, in collaboration with the Division of Endocrinology, Metabolism and Diabetes in the Department of Internal Medicine, to discuss interesting cases from the previous week. These conferences represent an important component of the clinical service as well as the endocrinology training program.

Specialized Clinical Services

The Division performs a wide variety of endocrine diagnostic testing procedures including growth hormone provocative testing (clonidine, arginine, L-dopa, insulin, glucagon), GnRH testing (to evaluate early and delayed puberty), ACTH testing (to evaluate for primary and secondary adrenal insufficiency and congenital adrenal hyperplasia) and water deprivation testing. These tests are carried out at the Infusion Center of St. Louis Children's Hospital, and are planned, supervised, and subsequently interpreted by the physicians within the Division.

The Division operates an American Diabetes Association (ADA) accredited diabetes care and education service. This is a multidisiplinary team of physicians, diabetes educators and nurses, a dietitian/nutritionist, and a social worker who work together to provide comprehensive diabetes-related care, education and self-management training to children and adolescents with all forms of diabetes mellitus. The diabetes team meets weekly to plan care for the upcoming patients and discuss patient problems and other issues. In addition to providing inpatient and outpatient education and care, the diabetes team provides: 24-hour per day telephone coverage for our patients, a parent support group, and, along with the American Diabetes Association, educational sessions for school teachers and nurses, grandparents, baby sitters and teenage diabetic subjects themselves.

The Division (represented by Dr. Abby Hollander) actively participates as part of the Pediatric Neuro-oncology group at St. Louis Children's Hospital. This group works as a multidisciplinary group to coordinate the care of brain tumor patients, many of whom develop or are at high risk for the development of endocrine disorders.