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Growth hormone deficiency in children and adolescents is treated with recombinant growth hormone injections, with the aim of helping patients reach a final height that falls within their genetically predicted adult height. While this treatment is very successful, overcoming issues of patient adherence is a challenge at each stage of the treatment journey, from early childhood to adulthood. An advisory board of senior endocrine nurses convened to discuss what strategies and tools work well in achieving adherence, and the best practices they identified—including the key strategies of choice, information, teamwork, and support—were presented at the 2016 meeting of The Endocrine Society. The advisers agreed that key steps to improve adherence include: patient/carer-centric endocrine nursing services, good-quality education and support, patient autonomy (where possible), broader treatment choice (in terms of device and self-injection), optimal follow-up from childhood to adulthood, and sharing of best practices.

Endocrinology nursing is an ever-evolving specialty. This chapter provides expert and innovative practice-based nursing information. It provides nursing care for thyroid surgery and disorders, facilitating investigation and education about pituitary function and specialist nurse management of different conditions. Education on visual field deficits and minimum driving standards are covered. The full roles of the nurse in pituitary surgery is explained, from pre-op to post-op care. Diabetes insipidus is covered. Responsibilities and possible pathways for managing male fertility, testosterone replacement, and gender dysphoria are all described. Finally, role development and nurse led clinics are examined.

This chapter introduces evidence-based practice and research, explaining the nurse’s role in accessing and appraising evidence for endocrinology nursing practice. The contribution of different types of research studies to the evidence base is discussed. The chapter considers how best evidence can be implemented in practice, with reference to quality improvement methods. Nurses are in a good position to identify gaps in the available evidence and identify new research questions. Clinical academic roles provide the opportunity for nurses to take forward their research ideas and combine clinical nursing with research. Clinical research is essential for finding new treatments and improving patient care and so clinical research nurses make a vital contribution, focusing on the care of research participants within clinical research studies. All research must be conducted in accordance with international standards for research ethics and local processes for ethical scrutiny. This chapter’s sections on evidence-based practice, clinical academic roles and clinical research nursing all include application to endocrinology nursing.

Hyponatraemia is common in the hospital settings. This is one of the endocrine emergencies where poor diagnosis, treatment and management can have profound outcomes for this group of patients. The mortality rate of this group of patients consistently show poorer outcomes compared to other disorders. The Endocrine Society and European Society of Endocrinology recently published comprehensive and complex recommendations to guide clinicians and healthcare professions to adopt more cohesive strategies to deal with the challenging nature of this medical emergency. Implementation of these recommendations will require a systematic approach and teameffort to ensure these guidelines are translated in day-to-day use. Endocrine nurses, who often work closely with endocrine colleagues, need to understand the implication of these guidelines in their roles and duties. The first step requires an understanding of the diagnosis and treatment process to treat this condition then to follow up the support within the team to ensure the clinical management plan is executed in line with clinical guidelines. The cycle of audit plays an important role to ensure the guidelines are robust so that further changes may bring about better outcomes for patients with hyponatraemia.

Pituitary conditions are associated with several physical, psychological, and social symptoms. Treatment involves surgery, medical treatment, and/or radiotherapy. Most patients with pituitary conditions have permanent hypopituitarism (congenital or acquired) and require lifelong hormone replacement therapy. Polypharmacy with multiple daily dosing and complex treatment regimens are common and patients may often require more than five different medications daily.

Background: Subjects with non-functioning pituitary adenomas (NFAs) frequently develop growth hormone deficiency due to tumour expansion or as a consequence of tumour therapy. The safety of growth hormone replacement (GHR) in these individuals remains unclear. Objective: To assess the effect of GHR on tumour recurrence in patients with NFAs solely treated by surgical removal. Patients and methods: The study involved all patients with NFA who presented to the Department of Endocrinology in Oxford between January 1989 and July 2005 and were treated solely by surgical removal of the tumour. Patients with follow up less than one year were excluded. Recurrence was diagnosed on the basis of radiological appearances (detectable tumour after gross total removal or regrowth of pre-existing residue) on regular imaging surveillance. Results: One hundred and thirty patients were included in the study, and were followed up for a mean period of 6.8 +/- 4.2 years (median 5.7, range 1.2-17.6). Twenty-three patients received GHR [16 male, 7 female, mean age at tumour diagnosis 53.7+/- 14.6 years (range 20-80)]. The mean duration of GHR was 4.6 +/- 2.5 years (median 5.3, range 0.4-8.7). One hundred and seven subjects did not receive GH therapy [61 male, 46 female, mean age at tumour diagnosis 56.2+/-14.0 years (range 20-87)]. Tumour regrowth occurred in 38 non-GH treated subjects (36%) and 8 GHR subjects (35%). Regrowth was detected at a mean of 4.8+/-2.8 years (range 1-11 years) in the non-GH treated group, and at 6.5+/-2.3 years in the GHR group. In the GHR group, recurrence occurred after a mean of 2.9+/-2.2 years (range 0.4-5.9 years) following commencement of GH treatment. The Cox regression analysis showed that after adjusting for sex, age at tumour diagnosis, cavernous sinus invasion at diagnosis and type of tumour removal (partial or complete based on post-operative scan), GH treatment was not a significant independent predictor of recurrence (p=0.09; hazard ratio=0.51; 95% CI, 0.24 to 1.12). Conclusion: Growth hormone replacement in patients with NFA treated by surgery alone is not associated with an increased risk of tumour recurrence.

OBJECTIVE: To evaluate and compare MRI-based ovarian morphology in groups of women with polycystic ovary syndrome (PCOS) and controls. METHODS: All PCOS cases (n = 44) had oligo-amenorrhoea and hyperandrogenism irrespective of ovarian morphology, and fulfilled NIH/Rotterdam diagnostic criteria for PCOS. All control women (n = 40) had normal menses and normoandrogenaemia. All subjects were of white British/Irish origin and pre-menopausal. Group comparisons were based on independent-sample t tests. Polycystic ovarian morphology was defined by at least 12 follicles 2-9 mm in diameter and/or an ovarian volume greater than 10 cm(3). RESULTS: Ovarian morphology differed significantly in PCOS cases and controls (follicle number geometric mean [SD range] 18.6 [9.9, 35.0] vs 6.6 [3.1, 14.2], unadjusted P = 1.3 x 10(-16); calculated ovarian volume 8.8 cm(3) [5.0, 15.5] vs 5.1 cm(3) [2.5, 10.3], unadjusted P = 3.0 x 10(-7); peripheral follicle location in 55% vs 18% of ovaries, P = 7.9 x 10(-6); visible central ovarian stroma in 61% vs 24% of ovaries, P = 2.3 x 10(-5)). Follicle number and calculated ovarian volume were not concordant with clinical/biochemical assignment of PCOS/control status in 36 (23%) and 52 (34%) of ovaries, respectively. CONCLUSION: Ovarian morphology overlaps in PCOS cases and controls, emphasising the importance of considering clinical/biochemical presentation together with imaging ovarian morphology in the diagnosis of PCOS.

Summary Background A significant number of patients with craniopharyngioma are GH deficient. The safety of GH replacement in these subjects has not been established. Objective To assess the effect of GH replacement upon recurrence in patients with craniopharyngioma. Patients and methods All the patients with craniopharyngioma followed-up at the Departments of Endocrinology or Paediatrics in Oxford and treated or not with GH were studied retrospectively. These were recruited from the databases of the departments consisting of subjects diagnosed between January 1964 and July 2005. The impact of GH replacement upon recurrence was evaluated after adjusting for possible confounding factors. Results Forty-one subjects received GH replacement. Nine of them did not have follow-up imaging during GH therapy and were not included in the statistical analyses. The remaining 32 (22 males/10 females) received GH for a mean period of 6·3 ± 4·6 years (median 5·1, range 0·8–22); 21 started during childhood (13 of them continued after the achievement of final height with an adult dose) and 11 during adult life. The mean duration of their follow-up (from surgery until last assessment) was 10·8 ± 9·2 years (range 1·9–40). Fifty-three subjects had not received GH therapy (30 men/23 women). The mean duration of their follow-up (from surgery until last assessment) was 8·3 ± 8·8 years (range 0·5–36). During the observation period, 4 patients treated with GH and 22 non-GH treated ones developed tumour recurrence. After adjusting for sex, age at tumour diagnosis and type of tumour therapy (gross total removal, partial removal, surgery + irradiation), GH treatment was not a significant independent predictor of recurrence (P = 0·06; hazard ratio = 0·309). Similar results were obtained when the impact of GH replacement was assessed according to its duration (P = 0·18; hazard ratio = 0·991/month of treatment). None of the nine patients with insufficient imaging data for inclusion in the statistical analyses [5 men/4 women, 3 treated with GH during childhood/6 during adult life, mean duration of GH therapy 2·9 ± 2·4 years (median 1·8, range 0·4–7)] showed clinical features suggestive of recurrence during the period of GH replacement. Conclusion Based on the data of the craniopharyngiomas database in Oxford, there is no evidence that GH replacement is associated with an increased risk of tumour recurrence.