Paediatric Endocrinology

 

In the beginning

The Paediatric Endocrinology service was established at the Queen Victoria Memorial Hospital in the mid 1970’s, under the leadership of Dr Hugo Gold, a general paediatrician with a keen interest in Paediatric Endocrinology. At that time Dr Gold was treating children and teenagers with human derived growth hormone, first used in Melbourne just a few years earlier by Melbourne’s first Paediatric Endocrinologist, Dr Norman Wettenhall, at the Royal Children’s Hospital and Dr Kevin Catt, Professor Bryan Hudson and Professor Henry Burger at Prince Henry Hospital from 19651***. Professor Burger also set up Melbourne’s first growth hormone immunoassay at that time, to enable growth hormone provocative tests to be carried out to investigate short children.

The Australasian Paediatric Endocrine Group (APEG) Connection

Dr Wettenhall, Professor Burger and Dr Gold were all founding members of the Australasian Paediatric Endocrine Group (APEG), (of which Associate Professor Christine Rodda later was to become President in 1999 – 2001). Professor Burger was a member of the Growth Hormone Subcommittee of the Human Pituitary Advisory Committee from 1968 to 1985 , and chaired it from 1974. This committee subsequently became the present day APEG Growth Hormone Advisory Committee).

Thyroid Newborn Screening and the Early Years at Queen Victoria Medical Centre:

In 1976 routine screening for congenital hypothyroidism was added to the Victorian Newborn Screening Program established some years earlier for a rare metabolic syndrome PKU (phenylketonuria), for all babies born in Victoria (the heel prick Guthrie Test).[1]****Dr Gold was responsible for all babies detected in the south-east of Victoria, and the Paediatric Endocrine Unit at Southern Health has maintained this function of early detection, preventing mental retardation (“cretinism”) resulting from impaired development of the central nervous system. Following the retirement of Dr Hugo Gold from Monash Medical Centre in 2002 the follow up of this condition has been co-ordinated by Paediatric Endocrinologist and Adolescent Physician Dr Phil Bergman. [2]***

The Move To Clayton

Monash paediatric services moved to the Clayton site in 1986. At that time the Unit was predominantly a small outpatient service, however Hugo Gold championed the expansion of the service, attracting additional consultant staff over the following years. In 1991, the current Unit Head (from 1999), Christine Rodda returned from post graduate training in Boston, to join the Monash University Department of Paediatrics, under the Chairmanship of Professor Arthur Clark, and to rejoin Hugo Gold in the Paediatric Endocrinology Unit where she first worked in 1980 as a Paediatric Resident.

Endocrinology Service and Research Opportunities from “conception to the grave” with the Prince Henry move to Clayton

Prince Henry Hospital moved to the Clayton site in 1991, enabling a rich clinical interaction with the internationally regarded adult Endocrine Unit which Professor Burger had built up over the preceding 25 years. With the merger with Prince Henry Hospital, endocrinology laboratory support strengthened considerably with development of extensive paediatric endocrine testing with provision of age-appropriate reference ranges, and Associate Professor Boyd Strauss was able to provide DXA bone density measurements also with paediatric reference ranges. Both these clinical support services contributed greatly to the quality of service and clinical research that could be undertaken by Paediatric Endocrinology and Diabetes Unit. At that time 8-10 patients were seen in weekly combined paediatric endocrinology and diabetes clinics, with approximately 6 newly diagnosed children and adolescents admitted annually, and a total of 60 children and adolescents with diabetes, with diabetes nurse education covered within adult diabetes services.

YADS (Young Adult Diabetes Service) and the evolution of Transition Services at Monash Medical Centre

In 1992, Associate Professor Caroline Clarke was appointed as the inaugural Head of Adolescent Medicine and Paediatric and Adolescent Endocrinologist (1992 – 2005), establishing three sessional paediatric endocrinologists at MMC. The culmination of all these factors led to an exponential growth in the Paediatric and Adolescent Endocrinology and Diabetes Service of the following years. The highlights of Caroline’s Clarke’s legacies to our Unit was the establishment in 1992 of our Young Adult Diabetes transition clinic (YADS; for 15 – 25 years of age), which has developed into a highly successful multidisciplinary clinic attended by both adult and paediatric endocrinologists and diabetes nurse educators. This clinic model has subsequently been adopted by other Melbourne metropolitan public hospitals. In the last 18 years our paediatric diabetes service has grown to currently almost 1000 children and young adults aged less than 25 years, with 65 – 70 aged less than 19 years newly diagnosed annually.

DACS - Paediatric and Adolescent Diabetes Ambulatory Care Service 

Caroline Clarke’s other major initiative was the establishment of our Diabetes Ambulatory Care Service (DACS), the first public hospital based, integrated ambulatory service established for children and adolescents with diabetes mellitus in Victoria, following provision of Victorian State Government Funding of almost $1million over 3 years, received July 1st, 2002. At that time we had already appointed our first dedicated paediatric nurse educator, Emma White RN. Our first paediatric diabetes dietician Liz Mount, DNE Meagan Buszard and DACS administrative assistant Nellie Balm were also appointed at this time. By early to mid 2003, we had established an ambulatory stabilisation service for children and adolescents aged between 2 and 19 years, with newly diagnosed insulin dependent diabetes mellitus (IDDM), presenting in a clinically stable condition, together with an ambulatory assessment and support programs for established paediatric and young adult patients aged less than 25 years. Previously within Southern Health, all children and adolescents presenting with newly diagnosed insulin dependent diabetes mellitus (IDDM) to Monash Medical Centre were admitted via the Emergency Department, and remained an inpatient for 4 to 10 days.


Alarming Increase In T1DM in Melbourne Children and Adolescents:

The incidence of childhood type 1 diabetes mellitus (T1DM) in Australia has risen by 29 per cent in the last decade, posing major clinical challenges and research questions. Australia is ranked as a high incidence country for Type 1 diabetes [3]*and in Victoria over 200 children now develop T1DM each year, with a doubling of the incidence among children below 5 years of age since the late 1990s. [4] One third of these children are managed within our Unit at Monash Children’s. The demands of optimal T1DM management in affected children and young people involves every aspect of their lives 24 hours a day 365 days a year for the rest of their lives, and they are entirely dependent on insulin via injection or more recently via insulin infusion pumps, adjusted according to regular home blood glucose monitoring. Multidisciplinary care utilising the expertise of highly trained paediatric nurse educators, dieticians, social workers and psychologists, in addition to the input from paediatric endocrinologists (Christine Rodda, Phil Bergman and Justin Brown) and back-up support from the Department of Child Psychiatry, provided in DACS in recent years is vital to support optimum care for children and young adults with this complex and demanding condition, [5] as expressed in our Unit logo “DACS – supporting better living with diabetes”. Phil Bergman also has an appointment as an adolescent physician at Monash Children’s, and he has particular expertise in increasingly recognised eating disorders in T1DM. Routine monitoring continues to be provided by multidisciplinary outpatient assessments 3 – 4 times annually. Inpatient care is still required for major intercurrent illness and unstable diabetes, usually presenting in diabetic ketoacidosis, with DACS support provided also provided to children and adolescents with T1DM in the Emergency Department, ICU and the children’s wards.


Paediatric Endocrinology as a core specialty supporting normal growth and pubertal development at Monash Children’s:

Endocrinology is the study of the hormones governing many bodily processes including growth and sexual development, through highly regulated secretion into the blood stream by glands including the pituitary, thyroid, adrenals, ovaries, testes, parathyroid and pancreas. Paediatric endocrinology is a core specialty since achievement of normal growth and pubertal development is the common goal of all paediatric clinical care. The Monash Children’s paediatric endocrinology unit provides collaborative care with most Monash Children’s clinical units namely newborn services, gastroenterology (6% of our diabetes patients have coeliac disease), Thalassaemia Services, cystic fibrosis service and respiratory medicine, clinical genetics, metabolic medicine, haemato-oncology, nephrology, orthopaedics/rehabilitation, neurosurgery and neurology. The Monash Children’s Paediatric Endocrinology Unit is one of two paediatric Growth Clinics in Victoria, and Associate Professor Christine Rodda, together with Paediatric Endocrinologists, Drs Phil Bergman and Justin Brown provide a service for children with growth disorders, including those with congenital growth hormone deficiency, panhypopituitarism, Turner’s syndrome, (characterised by short stature and ovarian failure in girls with only one “X” chromosome), pituitary disorders and growth failure associated with chronic disease such as chronic renal failure. Since 1985, following the description of rare cases of the slow virus Creutzfelt Jacob Disease contaminating human derived growth hormone, recombinant growth hormone, as a pharmaceutical benefit, has been used and is currently being prescribed to approximately 50 children and teenagers at Monash Children’s.

Monash Children’s paediatric endocrinologists also provide outreach consultant support to Peninsula Health and the Gippsland corridor. Early onset of puberty, has been effectively treated at Monash with Zolodex implants for over 15 years and sex hormone replacement is given for pubertal delay and hypogonadism (failure of ovarian or testicular function), in addition, to managing adrenal disorders, and obesity. Christine Rodda obtained a PhD in calcium metabolism, which led to her specific interest in disorders of bone and mineral metabolism. A multidisciplinary paediatric metabolic bone clinic was established in 1999 to assess and manage complex disorders of calcium metabolism and metabolic bone disease, in collaboration with Dr David Mc Credie, Paediatric Nephrologist from RCH, paediatric orthopaedics and dentistry. More recently a multidisciplinary Paediatric Endocrinology and Nutrition Clinic has been established with dietetics and is led by Justin Brown, to manage the growing numbers of obese children and adolescents, and immigrant babies in particular with vitamin D deficiency rickets.

Diabetes and Endocrinology Transition at MMC

Transition to adult services into internationally recognised endocrinology, diabetes, (including gestational diabetes) and assisted fertility services at Monash Medical Centre ensure that the young adults leaving our paediatric services are provided with excellence in their long term adult clinical care.

Footnotes

[1] The investigation and treatment of pituitary dwarfism: preliminary experience with human growth hormone. Burger HG. Catt K. Connelly JF. Hudson B. Martin FI. Melick R. Taft HP. Wettenhall HB. Medical Journal of Australia. 1(15):739-42, 1967 Apr 15.
[2] Research boost for paediatric unit’, Monash Medical Centre Quarterly, Winter 1991, pp. 2-3.
[3] http://www.southernhealth.org.au/children.htm as accessed 22/12/2008. Murdoch Children’s Research Institute, Discovery, Autumn Edition, Issue 30, May 2009, p. 2 and Murdoch Children’s Research Institute, Discovery, Issue 28, November 2008, p. 3.
[4] Murdoch Children’s Research Institute, Discovery, Issue 28, November 2008, p. 3.
[5] Ross Curnow, ‘Diabetes a daily ordeal’, Moorabbin Standard, 21 July 1998.
Dr Hugo Gold at his retirment from Monash Medical Centre in 2002.

Dr Hugo Gold on his retirement
from MMC in 2002

(LR) Professor Richard Larkins (Vice Chancellor, Monash University), Christine Rodda, and Professor Stan Capp (CEO) DACS Official Opening, 16 July 2003

 

In the beginning The Paediatric Endocrinology service was established at the Queen Victoria Memorial Hospital in the mid 1970’s, under the leadership of Dr Hugo Gold, a general paediatrician with a keen interest in Paediatric Endocrinology. At that time Dr Gold was treating children and teenagers with human derived growth hormone, first used in Melbourne just a few years earlier by Melbourne’s first Paediatric Endocrinologist, Dr Norman Wettenhall, at the Royal Children’s Hospital and Dr Kevin Catt, Professor Bryan Hudson and Professor Henry Burger at Prince Henry Hospital from 19651***. Professor Burger also set up Melbourne’s first growth hormone immunoassay at that time, to enable growth hormone provocative tests to be carried out to investigate short children. The Australasian Paediatric Endocrine Group (APEG) Connection Dr Wettenhall, Professor Burger and Dr Gold were all founding members of the Australasian Paediatric Endocrine Group (APEG), (of which Associate Professor Christine Rodda later was to become President in 1999 – 2001). Professor Burger was a member of the Growth Hormone Subcommittee of the Human Pituitary Advisory Committee from 1968 to 1985 , and chaired it from 1974. This committee subsequently became the present day APEG Growth Hormone Advisory Committee). Thyroid Newborn Screening and the Early Years at Queen Victoria Medical Centre: In 1976 routine screening for congenital hypothyroidism was added to the Victorian Newborn Screening Program established some years earlier for a rare metabolic syndrome PKU (phenylketonuria), for all babies born in Victoria (the heel prick Guthrie Test). ****Dr Gold was responsible for all babies detected in the south-east of Victoria, and the Paediatric Endocrine Unit at Southern Health has maintained this function of early detection, preventing mental retardation (“cretinism”) resulting from impaired development of the central nervous system. Following the retirement of Dr Hugo Gold from Monash Medical Centre in 2002 the follow up of this condition has been co-ordinated by Paediatric Endocrinologist and Adolescent Physician Dr Phil Bergman. *** The Move To Clayton……………….. Monash paediatric services moved to the Clayton site in 1986. At that time the Unit was predominantly a small outpatient service, however Hugo Gold championed the expansion of the service, attracting additional consultant staff over the following years. In 1991, the current Unit Head (from 1999), Christine Rodda returned from post graduate training in Boston, to join the Monash University Department of Paediatrics, under the Chairmanship of Professor Arthur Clark, and to rejoin Hugo Gold in the Paediatric Endocrinology Unit where she first worked in 1980 as a Paediatric Resident. Endocrinology Service and Research Opportunities from “conception to the grave” with the Prince Henry move to Clayton Prince Henry Hospital moved to the Clayton site in 1991, enabling a rich clinical interaction with the internationally regarded adult Endocrine Unit which Professor Burger had built up over the preceding 25 years. With the merger with Prince Henry Hospital, endocrinology laboratory support strengthened considerably with development of extensive paediatric endocrine testing with provision of age-appropriate reference ranges, and Associate Professor Boyd Strauss was able to provide DXA bone density measurements also with paediatric reference ranges. Both these clinical support services contributed greatly to the quality of service and clinical research that could be undertaken by Paediatric Endocrinology and Diabetes Unit. At that time 8-10 patients were seen in weekly combined paediatric endocrinology and diabetes clinics, with approximately 6 newly diagnosed children and adolescents admitted annually, and a total of 60 children and adolescents with diabetes, with diabetes nurse education covered within adult diabetes services. YADS (Young Adult Diabetes Service) and the evolution of Transition Services at Monash Medical Centre: In 1992, Associate Professor Caroline Clarke was appointed as the inaugural Head of Adolescent Medicine and Paediatric and Adolescent Endocrinologist (1992 – 2005), establishing three sessional paediatric endocrinologists at MMC. The culmination of all these factors led to an exponential growth in the Paediatric and Adolescent Endocrinology and Diabetes Service of the following years. The highlights of Caroline’s Clarke’s legacies to our Unit was the establishment in 1992 of our Young Adult Diabetes transition clinic (YADS; for 15 – 25 years of age), which has developed into a highly successful multidisciplinary clinic attended by both adult and paediatric endocrinologists and diabetes nurse educators. This clinic model has subsequently been adopted by other Melbourne metropolitan public hospitals. In the last 18 years our paediatric diabetes service has grown to currently almost 1000 children and young adults aged less than 25 years, with 65 – 70 aged less than 19 years newly diagnosed annually. DACS - Paediatric and Adolescent Diabetes Ambulatory Care Service: Caroline Clarke’s other major initiative was the establishment of our Diabetes Ambulatory Care Service (DACS), the first public hospital based, integrated ambulatory service established for children and adolescents with diabetes mellitus in Victoria, following provision of Victorian State Government Funding of almost $1million over 3 years, received July 1st, 2002. At that time we had already appointed our first dedicated paediatric nurse educator, Emma White RN. Our first paediatric diabetes dietician Liz Mount, DNE Meagan Buszard and DACS administrative assistant Nellie Balm were also appointed at this time. By early to mid 2003, we had established an ambulatory stabilisation service for children and adolescents aged between 2 and 19 years, with newly diagnosed insulin dependent diabetes mellitus (IDDM), presenting in a clinically stable condition, together with an ambulatory assessment and support programs for established paediatric and young adult patients aged less than 25 years. Previously within Southern Health, all children and adolescents presenting with newly diagnosed insulin dependent diabetes mellitus (IDDM) to Monash Medical Centre were admitted via the Emergency Department, and remained an inpatient for 4 to 10 days. DACS Team June 2005: Back Row L – R: Chris Muske R.N. (Research Nurse), Rachael Eggleton (Social Worker), Eliza Bourke R.N. (DNE), Julie Barrington, Clinical Psychologist, Fran Mouat, and Zahida Ahmad (Paediatric Endocrine Fellows), Phil Bergman, Paediatric and Adolescent Endocrinologist, Front Row L – R: Meredith Williamson R.N. (Diabetes Nurse Manager), A/Prof Caroline Clarke, Paediatric and Adolescent Endocrinologist, Liz Mount, Paediatric Dietician, Meagan Buszard R.N. Paediatric DNA (Christine Rodda absent - on sabbatical leave) Alarming Increase In T1DM in Melbourne Children and Adolescents: The incidence of childhood type 1 diabetes mellitus (T1DM) in Australia has risen by 29 per cent in the last decade, posing major clinical challenges and research questions. Australia is ranked as a high incidence country for Type 1 diabetes ****and in Victoria over 200 children now develop T1DM each year, with a doubling of the incidence among children below 5 years of age since the late 1990s. One third of these children are managed within our Unit at Monash Children’s. The demands of optimal T1DM management in affected children and young people involves every aspect of their lives 24 hours a day 365 days a year for the rest of their lives, and they are entirely dependent on insulin via injection or more recently via insulin infusion pumps, adjusted according to regular home blood glucose monitoring. Multidisciplinary care utilising the expertise of highly trained paediatric nurse educators, dieticians, social workers and psychologists, in addition to the input from paediatric endocrinologists (Christine Rodda, Phil Bergman and Justin Brown) and back-up support from the Department of Child Psychiatry, provided in DACS in recent years is vital to support optimum care for children and young adults with this complex and demanding condition, as expressed in our Unit logo “DACS – supporting better living with diabetes”. Phil Bergman also has an appointment as an adolescent physician at Monash Children’s, and he has particular expertise in increasingly recognised eating disorders in T1DM. Routine monitoring continues to be provided by multidisciplinary outpatient assessments 3 – 4 times annually. Inpatient care is still required for major intercurrent illness and unstable diabetes, usually presenting in diabetic ketoacidosis, with DACS support provided also provided to children and adolescents with T1DM in the Emergency Department, ICU and the children’s wards. Paediatric Endocrinology as a core specialty supporting normal growth and pubertal development at Monash Children’s: Endocrinology is the study of the hormones governing many bodily processes including growth and sexual development, through highly regulated secretion into the blood stream by glands including the pituitary, thyroid, adrenals, ovaries, testes, parathyroid and pancreas. Paediatric endocrinology is a core specialty since achievement of normal growth and pubertal development is the common goal of all paediatric clinical care. The Monash Children’s paediatric endocrinology unit provides collaborative care with most Monash Children’s clinical units namely newborn services, gastroenterology (6% of our diabetes patients have coeliac disease), Thalassaemia Services, cystic fibrosis service and respiratory medicine, clinical genetics, metabolic medicine, haemato-oncology, nephrology, orthopaedics/rehabilitation, neurosurgery and neurology. The Monash Children’s Paediatric Endocrinology Unit is one of two paediatric Growth Clinics in Victoria, and Associate Professor Christine Rodda, together with Paediatric Endocrinologists, Drs Phil Bergman and Justin Brown provide a service for children with growth disorders, including those with congenital growth hormone deficiency, panhypopituitarism, Turner’s syndrome, (characterised by short stature and ovarian failure in girls with only one “X” chromosome), pituitary disorders and growth failure associated with chronic disease such as chronic renal failure. Since 1985, following the description of rare cases of the slow virus Creutzfelt Jacob Disease contaminating human derived growth hormone, recombinant growth hormone, as a pharmaceutical benefit, has been used and is currently being prescribed to approximately 50 children and teenagers at Monash Children’s. Monash Children’s paediatric endocrinologists also provide outreach consultant support to Peninsula Health and the Gippsland corridor. Early onset of puberty, has been effectively treated at Monash with Zolodex implants for over 15 years and sex hormone replacement is given for pubertal delay and hypogonadism (failure of ovarian or testicular function), in addition, to managing adrenal disorders, and obesity. Christine Rodda obtained a PhD in calcium metabolism, which led to her specific interest in disorders of bone and mineral metabolism. A multidisciplinary paediatric metabolic bone clinic was established in 1999 to assess and manage complex disorders of calcium metabolism and metabolic bone disease, in collaboration with Dr David Mc Credie, Paediatric Nephrologist from RCH, paediatric orthopaedics and dentistry. More recently a multidisciplinary Paediatric Endocrinology and Nutrition Clinic has been established with dietetics and is led by Justin Brown, to manage the growing numbers of obese children and adolescents, and immigrant babies in particular with vitamin D deficiency rickets. Diabetes and Endocrinology Transition at MMC: Transition to adult services into internationally recognised endocrinology, diabetes, (including gestational diabetes) and assisted fertility services at Monash Medical Centre ensure that the young adults leaving our paediatric services are provided with excellence in their long term adult clinical care.

      DACS Team June 2005