Although the paediatric endocrine service was first established in 1982,
the interest of staff of our department on childhood nutrition and growth
dates back to the 1960s through the landmark research of growth on Hong
Kong children conducted by Prof C Elaine Field and Dr Flora Baber.
The endocrine division provides a comprehensive service of inpatient
management, consultations and outpatient assessment and long term follow
up of patients with different endocrine disorders, diabetes mellitus
and inherited metabolic disease.
The endocrine division of our department is recognized for its excellence
in service delivery both locally and in the Asia Pacific Region. Our
division has received referral for care of endocrine patients from Asia,
Australia, Europe and North America. Most Macau patients with complex
endocrine problems are referred by the Macau SAR Government to our division
for assessment and follow-up.
In addition to our inpatient service, staff of the endocrine division
provides care to around 230 new patients and over 4000 follow up cases
annually in our outpatient clinics. Each year, about 230 comprehensive
endocrine assessments on patients with a variety of endocrine problems
are carried out in the day bed area of the general paediatric ward.
A certificate course on endocrine investigations was held by our department
in 2003. Six nurses in the paediatric unit were certified to perform
these investigations after assessment.
A multidisciplinary diabetic clinic is held twice a month and patients
with type 1 and type 2 diabetes are seen every two to three months by
a team of paediatric endocrinologists, paediatric diabetes nurse educators
and dietitian. A paediatric clinical psychologist provides an excellent
service to our endocrine and diabetic patients on a consultative basis.
The three trained paediatric diabetes nurse educators are responsible
for the inpatient/outpatient instruction on diabetes care for patients
and their parents, and they are also responsible for the co-ordination
and annual assessment of diabetic complications in our patients.
The diabetes nurse educator and on-call paediatric endocrinologist are
responsible for the 24-hour diabetes hotline service, which was initiated
in December 1997.
new edition of the instruction booklet on the management of childhood
diabetes (兒童糖尿病手冊) for the use by children and parents was published
in 2003. This important education booklet was written by Dr Elaine Kwan
and edited by Dr Elaine Kwan and Prof Louis Low. This educational booklet
has been distributed widely to paediatric endocrine units throughout
A Parent Support Group has been established since 1995 with the help
of staff of the division and Dr E Kwan. This group holds regular meetings
to enhance psychosocial support and to encourage active participation
An Adolescent Self Help Group has been established since December 1995
and group functions are regularly held to encourage treatment compliance,
to impart a positive outlook in life and to increase responsibility
For many years, the staff of the endocrine division had been responsible
for annual diabetes camps and annual Christmas functions for children
and adolescents with diabetes attending Queen Mary Hospital and the
Pamela Youde Nethersole Eastern Hospital.
Since the inauguration of the Hong Kong Juvenile Diabetes Foundation
in 2001, staff of the division has been actively supporting the activities
of this association in addition to the activities organized by the Childhood
Chapter of Diabetes Hong Kong.
A multidisciplinary consultative clinic involving paediatric endocrinologists
from different HA hospitals, paediatric surgeons and clinical psychologists
is held once every two months to discuss on the management of patients
with disorder of sexual differentiation and difficult endocrine problems.
Another initiative is the establishment of the Metabolic clinic in 2003
for the management of patients with inherited metabolic diseases, who
were previously followed up at the general endocrine clinic. Doctors
from the prenatal diagnostic unit, clinical biochemistry department,
paediatric neurology service will join the team every two months to
discuss new cases seen at the clinic and progress of follow-up patients.
A resource manual of nutritional therapy in inherited metabolic diseases
was complied by the Dietetics Department together with the input from
the staff of the endocrine division. The patients are seen by a paediatric
endocrinologist and a clinical biochemist at this clinic. We intend
to include the services of a dietitian in this joint clinic in the future
so that we can provide a one-stop service to these patients with rare
Our unit has close collaboration with Prof Xuefan Gu of the Shanghai
Institute of Paediatric Research and Prof Xiaoping Luo of Tongji Medical
College, Huazhong University of Science and Technology; we hope to establish
some collaborative research on the molecular genetic of these diseases.
Grant & Awards
The staff of the endocrine division has a long-term interest in research
in disorders of growth and puberty. With the recent increase in the
prevalence of obesity worldwide, we have been studying the metabolic
and psychological consequences of childhood and adolescent obesity.
Dr E Kwan, on behalf of the Hong Kong Society of Paediatric Endocrinology
and Metabolism and in collaboration with the Student Health Service
has initiated a protocol for targeted screening for type 2 diabetes
mellitus among at risk obese adolescents attending the Student Health
Service in Hong Kong.
We have also initiated a study on the activity level of aerobic fitness
in Hong Kong school children before and after a school based programme
to promote physical activity organized by the Leisure and Cultural Services
Department. It is collaborated with Dr Alison MacManus of Institute
of Human Performance of the University of Hong Kong. The pilot study
has already been completed and the results will be analyzed.
Another area of interest is the long-term health consequences of growth
retardation in utero and early childhood. Follow-up of some children
initially seen by Professor Field and Dr Baber in their adult life has
been completed. Result showed individuals who were born small for gestational
age and had poor catch-up growth in childhood would be at risk of having
higher blood pressure and being more insulin resistant.
Staff of the endocrine division has been the co-ordinator of a study
on care of type 1 and type 2 diabetes in Hong Kong. It is part of the
two international benchmarking studies on diabetes care in the Western
Pacific region (Childhood and Adolescence Diabcare 2001 and Childhood
and Adolescence Diabcare 2003) initiated by the International Diabetes
Our Division has focused on developing comprehensive molecular genetic
studies to complement the ongoing clinical and research programmes.
Core molecular laboratory services have been provided by Dr PT Cheung
and Mr Chan Koon Wing, and strengthened by collaboration with Prof V
Chan of Department of Medicine and the Human Genome Centre of the University
of Hong Kong and Prof Dennis Lo of the Chinese University of Hong Kong.
Currently a wide range of techniques have been adopted including the
state of the art fluorescent based genotyping, automated sequencing,
single cell PCR based genotyping, assessment of circulating plasma nucleic
acid and high throughput single nucleotide polymorphism analysis. We
are regularly performing mutational analysis of a variety of endocrine
and metabolic disorders including sitosterolaemia, congenital adrenal
hyperplasia, androgen receptor insensitivity, spinal and bulbal muscular
atrophy, disorders of sexual differentiation, campomelic dysplasia,
short stature due to SHOX haploinsufficiency, CFTR gene mutation and
other inborn error of metabolism disorders. We have also built up an
intimate link with the Prenatal Diagnosis team at Tsan Yuk Hospital,
and with the two Departments of Obstetrics and Gynaecology of both University
Medical Schools of Hong Kong, Assisted Reproduction Team and aided the
prenatal diagnosis of 21 -hydroxylase deficiency, urea cycle disorder
and 6-pyruvoyl-tetrahydropterin synthetase deficiency.
Research programmes are actively ongoing to delineate the genetic mutations
of sitosterolaemia and other genetic determinants of hypercholesterolaemia,
idiopathic short stature and Type I diabetes Mellitus. Dr PT Cheung
is a member of an International Research Group set up to delineate the
genetics of Type I diabetes- the Type I Diabetes Genetic Consortium
Prof Louis Low has been actively involved in the planning for the formation
of the Asia Pacific Paediatric Endocrine Society (APPES) together with
a group of paediatric endocrinologists of the Asia Pacific region since
1995. The APPES was inaugurated in 1999 in Kuala Lumpur and Prof Low
was elected as the Founding President of the Society.
Chairman of Scientific Committee, Endolink Synposium - New Insights
and Practical Issues is Growth and Endocrine Disorders in Children,
Bali, Indonesia June 2005.
Chairman, Organizing Committee and members of the Scientific Committee
Fourteen International Xiuhua Congress of Endocrinology, Hong Kong,
China December 2006.
8 Member of the International
Organizing Committee and Scientific Committee, Fourteen APPES Biennial
Scientific Meeting in Pattaya Thailand November 2006.
Members of the endocrine division of our department has been actively
involved in the organization and participation as teaching faculty in
the regional paediatric endocrinology educational activities, especially
those organized by the Asia Pacific Paediatric Endocrine Society.
In the APPES Training Workshops,
about 36 trainees from different countries of the Asia Pacific region
join 8 faculties in a 3-day interactive case-based paediatric endocrinology
training programme. Members of the endocrine division had participated
as faculty at these meetings in Kuala Lumpur in Malaysia (1999), Shanghai
in China (2001), Cairns in Australia (2002), Seoul in Korea (2003),
Awaji Island in Japan (2004), Wuhan in China (2005) and Pattaya in Thailand
& Scientific activities
Participation in the organization of other educational and scientific
activities by members of the endocrine division:
of International Organizing Committee and Scientific Committee, First
Asia Pacific Paediatric Endocrine Society Scientific Meeting, Malaysia,
of Organizing Committee, Molecular Laboratory Research Course for
Clinical Endocrinologists, Hong Kong, May 2000.
of Organizing Committee, Second International Xinhua Congress of Endocrinology,
Hong Kong, December 2001.
of International Diabetes Federation Clinical Update Workshop for
Nurses and Dietitians Working with Young People with Diabetes, Singapore,
- 2nd APPES (Carries Australia November 2002)
of International Organizing Committee and Scientific Committee of
the Third APPES Biennial Scientific Meeting, Kobe, Japan, September
- Member of the Scientific Committee, International Society Paediatric
and Adolescent Diabetes, Annual Meeting Kraokon Poland, September 2005.
the endocrine division have also participated as faculty in continuing
medical education workshops in paediatric endocrinology held in Shanghai,
Wuhan, Guangdong in China. They have at one time or the other served as
office bearers and council members of the Hong Kong Society of Paediatric
Endocrinology and Metabolism, Hong Kong Society of Endocrinology, Metabolism
and Reproduction and as advisors to Diabetes Hongkong and the Hong Kong
Juvenile Diabetes Association. Dr. PT Cheung is the President of the Hong
Kong Society of Endocrinology Metabolism and Reprodution and also the
Hong Kong Society of Paediatrics Endocrinology Metabolism.
They serve as editors for international paediatric endocrinology subspecialty
journals like Pediatric Diabetes, Journal of Paediatric Endocrinology
and Metabolism and Paediatric Endocrine Reviews. They also serve as members
of the Scientific Committee of the International Society of Pediatric
and Adolescent Diabetes (ISPAD) and members of the IDF Consultative Section
on Childhood and Adolescent Diabetes Western Pacific Region Leadership
Needs Assessment Workshops.
Both Dr E Kwan and Prof L Low had participated in the two international
benchmarking audit of diabetes care in the Western Pacific region organized
by the International Diabetes Federation.
Another recent collaboration is a cross-cultural comparison of eating
disorder among adolescents with diabetes mellitus in Hong Kong and Canada,
with Prof Gary Rodin of the University of Toronto.