Cairns Endocrinology

Type 1 Diabetes: :

We manage glycaemic control, complications, annual screening, driving licence certification, Insulin pump (new start and ongoing management)

For new diagnosis of a suspected Type 1 Diabetes, please Call Dr Nandi or Dr Sinha, directly for their immediate attention.

Useful investigations: HbA1c, capillary ketone (if not available - urine ketone), Anti GAD, Anti IA2 antibodies, Insulin (prior to commencing on Insulin), C peptide (prior to commencing on Insulin), ELFTs, fasting lipids, TSH, anti TPO/TG antibodies, B12, Celiac serology with IgA level

Type 2 Diabetes:

We manage glycaemic control, Insulin and other non-Insulin medication management, complications, annual screening, driving licence certification, weight management Useful investigations: HbA1c, FBC, eLFT, fasting lipids with HDL/LDL, Urine Albumin creatinine ratio, TSH, B12

Diabetes in Pregnancy:

Gestational Diabetes, Type 1 & type 2 Diabetes A tight glycemic control is required in order to have a successful uncomplicated pregnancy. Blood glucose target: Fasting <5.5 mmol/L, 2 hurs post meals < 7 mmol/L Whereever appropriate, a consultation with the diabetes educator is arranged at no additional cost

Hypothyroidism::

Useful investigations: TSH, T4, Anti TPO/TG antibody, fasting lipids with HDL/LDL, B12, Celiac serology with IgA level, FBC eLFT

Hyperthyroidism::

Useful investigations: T4, T3, TSH, ESR, TSH receptor antibody, FBC, eLFT, B12, anti-transglutaminase Ab, IgA, Thyroid nuclear scan Technetium scan (if done. Please ask you patient to bring the scans)

Thyroid nodules: :

Useful investigations: Thyroid ultrasound(s), thyroid nuclear scan, TSH, T4, FBC, eLFT, CT Neck if symptoms of neck pressure, barium swallow if concerns of swallowing problems, Flow-Loop ventilation tests if symptoms of shortness of breath

Osteoporosis: :

Risk assessment, pharmacological and non-pharmacological management, future fracture prevention strategies Useful investigations: Last BMD and films, Vit D, PTH, FBC, eLFT, TSH, celiac serology with IgA level, ESR, serum protein electrophoresis, serum free light chains, for male osteoporosis testosterone level

Weight loss and Obesity::

Risk assessment, management of comorbidities associated with obesity, sustainable non-pharmacological and pharmacological management and referral to bariatric surgeon where appropriate. Useful investigations: FBC, ELFT, TFT, HbA1c, Lipid profile, Insulin level, Body Mass Index, Body Fat measurement by DEXA, echocardiogram on selected patients

Hypercalcaemia: :

Investigation, management and referral to specialist endocrine surgeon where appropriate ELFT, ionised calcium, PTH, Vit D, activated Vitamin D, spot urine Ca:Cr (paired with eLFT) BMD (if done) ESR sEPP, serum ACE, FBC

Androgen insufficiency: :

8-9am testosterone and free testosterone levels, FSH, LH, Prolactin, TSH, T4, sleep study (if done), FBC ELFT, fasting lipids with HDL LDL

Pituitary disorders:

Investigation, management and referral to specialist endocrine surgeon where appropriate, for wide range under or over secretion of Pituitary hormones including Prolactin, Growth Hormone, ACTH & cortisol, ADH (Diabetes insipidus/SIADH) Useful investigations: Pituitary profile - TSH (+T4), GH (+ IGF1), ACTH (+ cortisol), Prolactin, LH, FSH,

Adrenal Disorders - Adrenal insufficiency: :

Investigation, management including arranging short synacthen test (SST) Useful investigations: Morning cortisol, ACTH, SST, adrenal antibodies

Cortisol excess (Cushing's syndrome)::

Investigations to confirm diagnosis & etiology as well as management Useful screening test: Late night salivary cortisol, 24 hour urinary cortisol, 1 mg dexamethasone suppression test, paired ACTH

Hyponatremia:

Useful test: Paired serum and urine electrolytes, TSH, Glucose/HbA1c

Endocrine Disorders in Pregnancy:

Pre-conception counselling, antenatal management, peri partum management including inpatient management, post-partum and long term care