Conditions we treat

Adrenal

Adrenal glands are small, triangular-shaped glands located on top of both kidneys. They produce several hormones that help regulate your metabolism, immune system, blood pressure, response to stress and other essential functions. These hormones, include adrenal steroids, such as aldosterone and cortisol, and adrenaline.

Adrenal disorders 
Adrenal conditions that we treat include primary adrenal insufficiency where the adrenal gland itself is not working. This is most commonly due to an autoimmune inflammation of the adrenals (often referred to as Addison’s disease) or to inborn disorders that impact the ability of the adrenal glands to produce cortisol, these conditions are called congenital adrenal hyperplasia. We put a lot of work in patient education as it is very important for patients with adrenal insufficiency to avoid a potentially life-threatening adrenal crisis, which can occur when increased demands for cortisol in stress and illness are not met by an appropriate increase in cortisol replacement. We regularly run patient education sessions including training on hydrocortisone self-injection.

Adrenal tumours

Most adrenal lesions are incidentally discovered and, therefore, often called adrenal “incidentalomas”. The overwhelming majority of these nodules are not cancerous. Patients need careful evaluation to ensure that the lesion is not producing excess amounts of hormones and to ensure that their radiological characteristics indicate a benign tumour.

Adrenal tumours that arise from the outer zone of the adrenal gland, the adrenal cortex, can overproduce hormones such as cortisol (Cushing’s syndrome) or aldosterone (Conn’s syndrome). Often lesions that overproduce aldosterone are quite small and sometimes can be found in both adrenal glands, which requires careful assessment.
Adrenal cancer (also called adrenocortical carcinoma, ACC) is a very rare condition and may, in some cases, be associated with excessive production of certain adrenal hormones. Surgery, chemotherapy and radiotherapy may all be used for the treatment of this rare type of cancer. Patients with the possibility of this type of cancer will undergo detailed investigation and imaging in order to help guide treatment decisions.

Phaeochromocytomas are rare tumours which usually arise in the centre of the adrenal glands, the adrenal medulla. However, similar tumours may occur at other sites in the body when they are called paragangliomas. These tumours often produce the hormones adrenaline and noradrenaline which can cause many symptoms and elevated blood pressure. They are usually, but not always, non-cancerous. A proportion of people may develop the tumours as part of an underlying genetic condition and careful assessment including expert genetics advice, localization and treatment prior to surgical removal are essential.

The UHB Endocrine Department is one of the largest adrenal tumour centres in the UK and we have extensive specialist expertise in the management of adrenal cancer. All adrenal tumours are discussed in our regular Adrenal Multi-Disciplinary Team meetings and we offer a broad range of diagnostic tools, including biochemical tests and different imaging modalities. We regularly carry out adrenal vein sampling to determine whether aldosterone excess originates from one or both adrenals. We have excellent success rates, partly due to intraprocedural cortisol measurements that helps us to quickly determine whether the catheter is placed in the correct location.

All adrenal tumour patients are offered the opportunity to participate in research, which is carried out in collaboration with both national and international networks, namely the European Network for the Study of Adrenal Tumours (ENSAT), whose efforts have brought about many of the important breakthroughs for patients with adrenal tumours.

Neuroendocrine Tumours

Neuroendocrine tumours (NETs) are a group of tumours that start in the cells of the neuroendocrine system. These tumours most commonly arise from cells in the lung, bowel or pancreas. They may make hormones which can cause problems such as diarrhoea, flushing and wheezing. Treatment is aimed at controlling these symptoms in addition to tumour control. Treatment may include surgery, hormone injections, radiofrequency ablation (heating of the tumour until it dies), hepatic embolisation (blocking blood supply to parts of the liver), chemotherapy, radiotherapy and radio-nuclide therapy. 

Multiple Endocrine Neoplasia syndromes (MEN1 and MEN2)       
These are familial, inherited conditions with the development of at least two endocrine tumours. They can be of malignant or benign nature. MEN1 includes pituitary adenomas, parathyroid hyperplasia, angiofibromas and pancreatic tumours. MEN2 is split into MEN2A (medullary thyroid cancer, parathyroid hyperplasia and phaeochromocytoma) and MEN2B (medullary thyroid cancer, neuromas, phaeochromocytoma and marfanoid body habitus). We work very closely with our geneticists and we usually look after family groups with this condition, with early monitoring of family members at risk.

Familial Paraganglioma Syndromes     
These are rare inherited conditions associated with the development of phaeochromocytomas and paragangliomas. The commonest gene affected is Succinate Dehydrogenase (SDH). Patients are monitored regularly with blood and/or urine tests as well as radiological imaging, and some lesions will need to be excised under the expert hands of our endocrine surgeons.

Von Hippel-Lindau disease          
A very rare inherited condition that predisposes to benign cysts in the kidneys and pancreas which has the potential to become malignant. Other tumours include haemangioblastomas found along the central nervous system and in the eye. Patients may also develop phaeochromocytomas and pancreatic neuroendocrine tumours.

There are 4 parathyroid glands that are attached to the back of the thyroid gland.

Overactivity or underactivity of the parathyroid glands can occur. Overactivity is termed hyperparathyroidism and is very common. When parathyroid glands are unable to produce enough parathyroid hormone (PTH), the condition is termed hypoparathyroidism; this is an uncommon problem that requires long-term medical treatment.

Parathyroid tumours

Tumours of the parathyroid glands cause raised blood calcium, which can lead to problems with bones and kidneys. Most parathyroid tumours are not cancerous but do require thorough and careful evaluation. They are very small glands and it can be hard to identify the gland(s) causing the problem. Surgery is highly effective in offering an effective cure.

The pituitary gland is a small gland at the base of the brain which is vital for controlling the secretion of many of the hormones in the body. Hypopituitarism occurs when the pituitary gland fails to produce one or more of the hormones it normally produces. This can be caused by pituitary tumours, certain medication, inflammation of the pituitary gland, head injury and head/neck irradiation.  

Pituitary tumours

Tumours affecting the gland are usually small and not cancerous. Most pituitary tumours are non-functioning, meaning they do not produce any extra hormone. The most common functional pituitary tumours produce a hormone called prolactin in excess and these tumours can be controlled by medication alone. In other cases, surgery may be required. Pituitary tumours can cause problems of:

1.    local effects due to their size, particularly affecting vision

2.    overproduction of certain hormones (eg the growth hormone in acromegaly and adrenocorticotrophic hormone that drives cortisol excess in Cushing’s disease)

3.    underproduction of hormones

The UHB Endocrine Department is one of only a few centres in the UK to have all the necessary specialists for dealing with the larger more complex pituitary tumours. We can offer specialised endocrine tests, dedicated imaging, neuroophthalmology assessment, pituitary surgery, radiotherapy and cyber knife radiosurgery. Our surgeons routinely perform pituitary surgery using an endoscopic approach and the cyber knife centre treats complex pituitary tumours from around the country. Many patients have their initial assessments and surgery here with multi-disciplinary input. Following treatment, subsequent follow up can happen with your local endocrinologist.

Polycystic ovary syndrome is a lifelong metabolic disorder that most commonly manifests during the reproductive years of a woman’s life, with irregular menstrual bleeds and signs of excess production of androgens (sometimes resulting in male pattern body hair growth, loss of scalp hair and acne). The name of the condition is due to the polycystic appearance of the ovaries when looking at them by ultrasound; however, the little “cysts” are not real cysts, but follicles that get stuck in their development before they release an egg that can be fertilised. Increased male hormones drive the early phase of ovarian follicle development but inhibit the later stages, which means that women with PCOS have irregular bleeds and often struggle with fertility. Women with PCOS are more likely to have obesity and a reduced ability to handle sugar, a condition termed insulin resistance. Research has shown that women with PCOS have an increased risk of type 2 diabetes, high blood pressure, high cholesterol and, later in life, fatty liver disease.

We run a multi-disciplinary PCOS clinic with joint involvement of endocrine specialists from UHB and fertility and obstetrics specialists from the Birmingham Women’s Hospital. We also see adolescent girls with signs and symptoms of PCOS in a specialist clinic run by doctors from the Birmingham Women’s and the Birmingham Children’s Hospitals. We first assess the needs of the patient and undertake detailed blood tests in our PCOS diagnostic assessment clinic. All patients are offered the opportunity to participate in the multi-centre cohort study DAISy-PCOS, which is led by Birmingham. Patients are then either provided with advice that can be followed up by their primary care physician (GP) or they are referred on to our multi-disciplinary PCOS specialist clinics that focus on weight loss, skin problems and fertility problems, respectively.

The thyroid gland is a butterfly-shaped organ which sits at the front of the neck. It produces thyroid hormones.

Thyroid disease encompasses thyroid enlargement (tumours) and thyroid hormonal dysfunction. Over-activity of the thyroid gland causes hyperthyroidism caused by excess circulating thyroid hormones. Thyroid gland underactivity is called hypothyroidism.

Thyroid tumours

Most frequently thyroid tumours (sometimes referred to as nodules) are not cancerous and do not require invasive treatment.

1. Differentiated thyroid cancer  

There are two types of differentiated thyroid cancer: papillary and follicular cancer. For the majority of patients with differentiated thyroid cancer, treatment will involve surgery. For more advanced cases radioactive iodine therapy may be given, together with long term support and follow up.  Every year we administer approximately 100 doses of radioactive iodine to treat patients with differentiated thyroid cancer.

2. Medullary thyroid cancer  

This is a very rare type of thyroid cancer. The most effective treatment is surgery. Some patients will need radiotherapy, chemotherapy and targeted biological therapy. In some cases, medullary thyroid cancer may be caused by a genetic alteration which can be inherited and this possibility will be considered.

3. Anaplastic thyroid cancer      
Anaplastic thyroid cancer is another very rare type of thyroid cancer. Surgery, radiotherapy and insertion of a tracheostomy may all play a role for certain patients.

Recent evidence shows that some of the treatments used for cancer both in children and in adults can have late effects on various aspects of health including the endocrine system. We offer a specialist joint clinic to evaluate and treat patients who have or may be at risk of these conditions.