SPECIALTIES & SERVICES
Endocrinology
The endocrinology service provides tertiary level care in hormonal and metabolic disorders. Our team comprises doctors with varied and complementary interests in different aspects of endocrinology. We are committed to medical excellence and providing our patients with well-rounded care to ensure that their medical needs are taken care of.
Apart from multidisciplinary services for diabetes care at the Diabetes Clinic, we see a wide range of general and subspecialty endocrinological disorders, which are listed under our services list.
We provide a comprehensive range of inpatient and outpatient services for patients with endocrine disorders. Examples of our services include:
- Diabetes
Patients with diabetes related disorders are seen at the Diabetes Centre which provides a comprehensive range of services.
- Lipid Disorders
Hypercholesterolemia, suspected familial causes of hypercholesterolemia and hypertriglyceridemia and usage of statins in patients with transaminitis.
- Thyroid Disorders
Hyperthyroidism, hypothyroidism, thyroid nodules and thyroid cancers
- Calcium and Bone Disorders
Osteoporosis, hypercalcemia, hypocalcemia, suspected cases of osteomalacia and hyperparathyroidism
- Pituitary Disorders
Hypopituitarism, pituitary tumours such as incidentally discovered pituitary tumours, Cushing’s disease, acromegaly, prolactinomas, hyperprolactinemia
- Adrenal Disorders
Suspected primary aldosteronism, pheochromocytoma, incidentally discovered adrenal tumours, hypocortisolism, Cushing’s syndrome
- Female Reproductive Endocrinology
Premature menopause, amenorrhoea, thyroid dysfunction in pregnancy, hirsutism
- Male Hormonal Disorders
Hypogonadism, gynaecomastia
- Endocrine Hypertension
Hypertensive patients suspected of having a secondary endocrinological cause of hypertension
- Water and Electrolyte Imbalance
Hyponatraemia, hypokalaemia
- Other general hormonal and metabolic disorders
Our unit places a strong emphasis on medical education and training. We regularly offer training posts for medical students, internal medicine residents, medical officers and advanced specialty trainees. Clinical teaching takes place in the clinics and wards, where our trainees are exposed to a wide spectrum of endocrine diseases. In addition, they are rotated through the various allied health services and education programmes in the Diabetes Centre to obtain a holistic appreciation of diabetes management.
Sample Weekly Schedule for Medical Officer Endocrinology Posting
|
Week |
Mon |
Tue |
Wed |
Thur |
Fri |
|
8-11am |
Diabetes Clinic
|
Diabetes Clinic
|
Project Work
|
Diabetes & Endocrine Clinic
|
Departmental Meeting (7.30–8.30am) |
|
11am-1pm |
Inpatient Diabetes Management & Blue Letter Consultations |
Inpatient Diabetes Management & Blue Letter Consultations |
Inpatient Diabetes Management & Blue Letter Consultations |
Thyroid FNAC Clinic (Alternate Fridays)
|
|
|
1-2pm |
Professorial Clinical Tutorials |
|
|
Clinical Approaches Tutorials |
Data Interpretation Tutorials |
|
2-4pm |
Weeks 1, 3, 5 Carousal Clinic
Weeks 2, 4 Diabetes Clinic |
Diabetes Centre Staff Teaching |
Endocrine Clinic |
Weeks 1, 3, 5 Diabetes Clinic
Weeks 2, 4 Diabetic Kidney Disease Clinic |
Dietitian/DNE/Podiatrist |
|
4-5pm |
Endocrine Journal Club |
Teaching Curriculum for Advanced Specialty Trainees in Endocrinology
New Case Tutorial
Endocrine-Radiology Meeting
Journal Club
Topic Review and Case Discussion
Diabetes Centre Staff Teaching
Combined Renal-Endocrine Journal Club
The division has a strong culture of research and is well-supported by a team of research technicians, including post-doctoral fellows. Our endocrinologists and trainees are regular recipients of national grants and collaborate with other national centres and institutions. Research interests range from basic science research in genetics and cell signaling to principal investigator (PI) initiated clinical trials.
Funding Bodies
National Medical Research Council
National Kidney Foundation
Endocrine and Metabolic Society of Singapore
Key Publications
Diabetes
Tavintharan S, Chi LS, Fang SC, Arunmozhiarasi A, Jeyaseelan K. Riboregulators and metabolic disorders: getting closer towards understanding the pathogenesis of diabetes mellitus? Curr Mol Med. 2009 Apr;9(3):281-6.
Stahl D, Sum CF, Lum SS, Liow PH, Chan YH, Verma S, Chua HC, Chong SA. Screening for depressive symptoms: validation of the center for epidemiologic studies depression scale (CES-D) in a multiethnic group of patients with diabetes in Singapore. Diabetes Care. 2008 Jun;31(6):1118-9.
Lim SC, Lekshminarayanan R, Goh SK, Ong YY, Subramaniam T, Sum CF, Ong CN, Lee BL. The Effect of Coenzyme Q10 on Microcirculatory Endothelial Function of subjects with Type 2 Diabetes Mellitus. Atherosclerosis. 2008 Feb;196(2):966-9.
Lim SC, Morgenthaler NG, Subramaniam T, Wu YS, Goh SK, Sum CF. The relationship between Adrenomedullin, Metabolic Factors and Vascular Function in Individuals with Type 2 Diabetes. Diabetes Care. 2007 Jun;30(6):1513-9.
Lim VC, Sum CF, Chan ES, Yeoh LY, Lee YM, Lim SC. Lactate Levels in Asian Patients with Type 2 Diabetes Mellitus on Metformin and its Association with Dose of Metformin and Renal Function. Int J Clin Pract. 2007 Nov; 61(11):1829-33
Diabetic Foot
Tavintharan S, Nang EEK, Lim SC, Wu Y, Khoo CM, Lee J, Heng D, Chew SK, Wong TY, Tai ES. Distribution of ankle brachial index and the risk factors of peripheral artery disease in a multi-ethnic Asian population. Vascular Medicine 2011; in press
Lekshmi Narayanan RM, Koh WP, Phang J, Subramaniam T. Peripheral arterial disease in community-based patients with diabetes in Singapore: Results from a Primary Healthcare Study. Ann Acad Med Singapore. 2010 Jul;39(7):525-7.
Tavintharan S, Ning Cheung, Su Chi Lim, Tay W, Shankar A, Shyong Tai E, Wong TY. Prevalence and risk factors for peripheral artery disease in an Asian population with diabetes mellitus. Diab Vasc Dis Res. 2009 Apr;6(2):80-6.
Diabetic Nephropathy
Lim SC, Liu JJ, Low HQ, Morgenthaler NG, Li Y, Yeoh LY, Wu YS, Goh SK, Chionh CY, Tan SH, Kon YC, Soon PC, Bee YM, Subramaniam T, Sum CF, Chia KS. Microarray analysis of multiple candidate genes and associated plasma proteins for nephropathy secondary to type 2 diabetes among Chinese individuals. Diabetologia 2009; 52: 1343 – 1351.
Lim SC, Koh AF, Goh SK, Chua CL, Heng BL, Subramaniam T, Sum CF. Angiotensin receptor antagonist vs. angiotensin-converting enzyme inhibitor in Asian subjects with type2 diabetes and albuminuria - a randomized crossover study. Diabetes, Obesity and Metabolism. 2007 Jul;9(4):477-82.
Lim SC, Goh SK, Lai YR, Tee WW, Koh A, Xu XH, Wu YS, Yap E, Subramaniam T, Sum CF. Relationship between common functional polymorphisms of the p22phox gene (-930A>G and +242C>T) and nephropathy as a result of Type 2 diabetes in a Chinese population. Diabet Med. 2006 Sep;23(9):1037-41.
Exercise Metabolism
Goh KP, Sum CF. Connecting the dots: molecular and epigenetic mechanisms in type 2 diabetes. Curr Diabetes Rev. 2010 Jul 1;6(4):255-65.
Goh KP, Chew K, Koh A, Guan M, Wong Y S, Sum CF (2009) The relationship between ACE gene ID polymorphism and aerobic capacity in Asian rugby players. Singapore Med J. 2009; 50(10): 997-1003.
Lipidology and Atherosclerosis
Tavintharan S, K Woon, LT Pek, X Dong, N Jauhar, Lim SC, Sum CF. Niacin results in reduced monocyte adhesion in patients with type 2 diabetes mellitus. Atherosclerosis (doi.org/10.1016/j.atherosclerosis.2010.12.020)
Tavintharan S, Lim SC, Sum CF. The effects of niacin on cell adhesion and early atherogenesis: biochemical and functional findings in endothelial cells. Basic Clin Pharmacol Toxicol. 2009 Mar;104(3):206-10.
Tavintharan S, Ong CN, Jeyaseelan K, Sivakumar M, Lim SC, Sum CF. Reduced mitochondrial coenzyme Q10 levels in HepG2 cells treated with high-dose simvastatin: a possible role in statin-induced hepatotoxicity? Toxicol Appl Pharmacol. 2007 Sep 1;223(2):173-9.
Tavintharan S, Sivakumar M, Lim SC, Sum CF. Niacin affects cell adhesion molecules and plasminogen actiator inhibitor-1 in HepG2 cells. Clin Chim Acta. 2007 Feb;376(1-2):41-4.
Tavintharan S, Lim SC, Chan YH, Sum CF. Apolipoprotein E genotype affects the response to lipid-lowering therapy in Chinese patients with type 2 diabetes mellitus. Diabetes Obes Metab. 2007 Jan;9(1):81-6.
Ganji SH, Tavintharan S, Zhu D, Xing Y, Kamanna VS, Kashyap ML. Niacin non-competitively inhibits diacylglycerol acyltransferase-2 (DGAT2) but not DGAT1 activity in HepG2 cells. J. Lipid Res.2004; 45: 1835–1845.
Moti L Kashyap, Tavintharan S, Kamanna VJ Optimal therapy of low levels of HDL Cholesterol Am J Cardiovasc Drugs 2003, 3(1): 53-64
Pancreatic and Islet Cell Transplant
Peter A. Senior, Tatsuya Kin, James Shapiro, Angela Koh. Islet Transplantation at the University of Alberta: Status Update and Review of Progress over the Last Decade. Can J Diabetes 36 (2012) 32-37.
Gala-Lopez BL, Senior PA, Koh A, Kashkoush SM, Kawahara T, Kin T, Humar A, Shapiro AM. Late Cytomegalovirus Transmission and Impact of T-Depletion in Clinical Islet Transplantation. Am J Transplant. 2011.
Senior PA, Koh A, Shapiro AM. Remission of Alopecia Universalis Following Successful Clinical Islet Transplantation. Am J Transplant. 2011:11: 2536-7.
A. Jermendy, E. Toschi, T. Aye, A. Koh, C. Aguayo-Mazzucato, A. Sharma, G. C. Weir, D. Sgroi, S. Bonner-Weir. Rat neonatal beta cells lack the specialised metabolic phenotype of mature beta cells. Diabetologia. 2011;54(3):594-604.
D. M. Zuk, A. Koh, S. Imes, A. M. J. Shapiro and P. A. Senior. Three Cases of Alopecia Following Clinical Islet Transplantation. American Journal of Transplantation 2011; 11: 163–168.
C. Aguayo-Mazzucato, A. Koh, I. El Khattabi, W.-C. Li, E. Toschi, A. Jermendy, K. Juhl, K. Mao, G. C. Weir, A. Sharma & S. Bonner-Weir. Mafa expression enhances glucose-responsive insulin secretion in neonatal rat beta cells. Diabetologia . 2011;54(3):583-93.
Angela Koh, Sharleen Imes, Tatsuya Kin, Parastoo Dinyari, Andrew Malcolm, Christian Toso, AM James Shapiro, Peter Senior. Supplemental islet infusions restores insulin independence after graft dysfunction in islet transplant recipients. Transplantation 2010 Feb 15;89(3):361-5.
Angela Koh, Sharleen Imes, Tatsuya Kin, Parastoo Dinyari, Andrew Malcolm, Christian Toso, AM James Shapiro, Peter Senior. Insulin-Heparin infusions peri-transplant improve single donor clinical islet transplant success. Transplantation. 2010 Feb 27;89(4):465-71.
*Eman Alfadhli, *Angela Koh, Waleed Albaker, Ravi Bhargava, Thomas Ackerman, Charlotte McDonald, Edmond A.Ryan, A.M. James Shapiro, Peter A. Senior. High prevalence of ovarian cysts in pre-menopausal women receiving sirolimus and tacrolimus after clinical islet transplantation. Transplant Int 2009 , 22:622- 625. (*co-1st authors)
Angela Koh, Tatsuya Kin, Sharleen Imes, A.M. James Shapiro, Peter Senior. Islets isolated from donors with elevated HbA1c can be successfully transplanted. Transplantation 2008; 86(11):1622-4.
Krishnamurthy J, Ramsey MR, Ligon KL, Torrice C, Koh A, Bonner-Weir S, Sharpless NE. p16INK4a induces an age-dependent decline in islet regenerative potential. Nature. 2006 Sep 28; 443(7110): 404-5
Pituitary
Holdaway IM, Rajasoorya RC, Gamble GD. Factors influencing mortality in acromegaly. J Clin Endocrinol Metab. 2004 Feb;89(2):667-74.
Holdaway IM, Rajasoorya CR, Gamble GD, Stewart AW. Long-term treatment outcome in acromegaly. Growth Horm IGF Res. 2003 Aug;13(4):185-92.
Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary. 1999 Jun;2(1):29-41.
Wrightson P, Rajasoorya C, Holdaway IM, Scott DJ. Acromegaly: factors affecting the long term outcome after surgical treatment. J Clin Neurosci. 1994 Jul;1(3):164-72.
Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinol (Oxf). 1994 Jul;41(1):95-102.