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Clinical Sub-specialties
Endocrinology and Metabolism (內分泌科)

Endocrinology and Metabolism Team Heads
Prof Louis Low
Chair Professor & Head
盧忠啟教授
Dr Pik-to Cheung
Associate Professor
張璧濤醫生
Fellow:
Dr Grace Poon
Diabetes Nurse Educators:
Ms Kar-bik Lee
Ms Ivy Mei-yee Au Yeung
Ms Wendy Wan-yee Kwan


Endocrine Team 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.

Activity & Service
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.

Strength & Development
Diabetic Clinic
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.

DM HandbookA 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 Hong Kong.

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 in self-care.

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 in self-care.

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.

Intersex Clinics
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.

Metabolic Clinic
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 metabolic diseases.

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.

Research/ 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 Federation.

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 (TIDGC).

Collaboration
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 (2006).

Education & Scientific activities
Participation in the organization of other educational and scientific activities by members of the endocrine division:

  1. Member of International Organizing Committee and Scientific Committee, First Asia Pacific Paediatric Endocrine Society Scientific Meeting, Malaysia, July 1999.
  2. Chairman of Organizing Committee, Molecular Laboratory Research Course for Clinical Endocrinologists, Hong Kong, May 2000.
  3. Member of Organizing Committee, Second International Xinhua Congress of Endocrinology, Hong Kong, December 2001.
  4. Faculty of International Diabetes Federation Clinical Update Workshop for Nurses and Dietitians Working with Young People with Diabetes, Singapore, April 2002.
  5. 2nd APPES (Carries Australia November 2002)
  6. Member of International Organizing Committee and Scientific Committee of the Third APPES Biennial Scientific Meeting, Kobe, Japan, September 2004.
  7. Member of the Scientific Committee, International Society Paediatric and Adolescent Diabetes, Annual Meeting Kraokon Poland, September 2005.
Members of 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.