Endocrinology

2016-11-14

The Department of Endocrinology of Zhongshan Hospital affiliated to Fudan University is a national key clinical discipline of the Ministry of Health, a doctoral degree granting institute of Fudan University, a clinical pharmacological research center of the State Food and Drug Administration, the leader of the Hepatopathy and Metabolomics Group of Chinese Society of Endocrinology, and the Fatty Liver Diagnostic and Treatment Center of Chinese Medical Doctor Association. The department was founded in 1989 and it is a well-known diagnostic and treatment center of endocrinology. We have accumulated rich experience in the diagnosis and treatment of diseases related to metabolic and endocrine systems, developed comprehensive subspecialities and formed our own characteristics in the diagnosis and treatment of endocrine and metabolic diseases. We were the first in China in the following areas: we used nuclear magnetic resonance spectroscopy to measure liver fat content in 2005; we developed a special CT-guided diagnostic and treatment plan for endocrine hypertension in 2007; we invented the method of ultrasound quantification of liver fat in 2011; we established the platform of fine needle aspiration for thyroid nodules to detect BRAF mutation in 2012; we performed the laparoscopic sleeve gastrectomy and bypass operation for a morbidly obese patient in 2013; and we invented a stable PET/CT-guided imaging of brown fatin 2014. The diagnosis and treatment level of the department is in the national foreground among the general hospital endocrinology departments.

There are at present 5 professors and chief physicians, 6 associate professors and associate chief physicians, 5 doctors-in-charge, among whom 2 are doctoral supervisors and 3 master supervisors. The current director is Gao Xin and associate directors are Lu Zhiqiang and Bian Hua. We have 51 hospital beds with over 2200 discharged patients annually.

We provide specialty clinic services on mornings from Monday to Saturday and expert outpatient clinic services from Monday to Friday. We treat over 120,000 outpatients and emergency patients every year suffering from various endocrine and metabolic disorders including diabetes, obesity, non-alcoholic fatty liver diseases, lipid metabolism disorders, diseases of adrenal gland, thyroid diseases, gonadopathy, hypothalamic-pituitary diseases, diseases of parathyroid gland, hyperuricemia and gout, osteoporosis, endocrine hypertension, metabolic disturbances of calcium and phosphorus, gastrointestinal endocrine tumors and some rare endocrine and metabolic diseases. We are able to effectively diagnose and treat the multi-system endocrine diseases, having reached international advanced level in the diagnosis and treatment of non-alcoholic fatty liver diseases and metabolic diseases, and playing a leading role in China in the clinical diagnosis and treatment of various endocrine diseases.

The subspecialities in the department include: metabolic disorders of obese fatty liver (ranges of diagnosis and treatment: obesity, non-alcoholic fatty liver diseases, type 2 diabetes, dyslipidemia, bariatric/metabolic surgeries); endocrine tumors (ranges of diagnosis and treatment: endocrine tumors of adrenal gland, thyroid, gastrointestinal tract, gonad, pituitary and parathyroid gland, etc.); diabetes and chronic complications (ranges of diagnosis and treatment: all diabetic types and major diabetic vasculopathy, renal lesions, peripheral neuropathy, etc.); thyroid diseases; osteoporosis; hyperuricemia and related diseases, etc. We have also established over 10 specialized clinics for specific diseases including obesity-related metabolic syndrome, thyroid nodule, endocrine hypertension, pituitary tumor, endocrine osteoporosis, diabetic education, hyperlipidemia, insulin fine regulation, obesity polycystic ovarian syndrome, perimenopausal syndrome and hyperuricemia, etc.

In the diagnosis and treatment of the following diseases, we have demonstrated the unique advantages of the department with the good curative effects achieved.

1) The comprehensive diagnosis and treatment of non-alcoholic fatty liver disease: We have a specialized fatty liver diagnostic and treatment center of fatty liver, which has been authorized by Chinese Medical Doctor Association to be the only one among 18 centers nationwide that is set up in the Department of Endocrinology. We were the first department in China that introduced and developed the technique of measuring noninvasively and precisely liver fat content using H-magnetic resonance spectroscopy and the first internationally to use standardized ultrasound method to measure liver fat content. As the leader unit of Hepatopathy and Metabolomics Group of Chinese Society of Endocrinology, we are in the national forefront in the diagnosis and treatment of fatty liver, making standardized plans for the diagnosis and treatment of fatty liver diseases and metabolic disorders, and improving the diagnosis, treatment and control rate of fatty liver. With advanced diagnostic techniques and rich experience, we provide every fatty liver patient with precise evaluation on the severity of fatty liver and relevant metabolic complications as well as an individualized treatment plan.

2) The diagnosis and treatment of obesity and related metabolic diseases: Considering the increasing cases of obesity and relevant diseases, we set up a specialized clinic for the diagnosis and treatment of obesity and relevant metabolic diseases. We diagnose and treat all types of obesity, including: simple obesity; obesity following a variety of endocrine diseases, such as Cushing’s syndrome, hypothyroidism, polycystic ovarian syndrome, growth hormone deficiency, hypothalamus syndrome, etc.; some congenital endocrine syndromes with combined obesity. Based on our rich experience in the clinical practice of obesity treatment and a multidisciplinary research team which keeps up with the forefront of international standards, the clinical center provides every patient with an individualized, multi-aspected and systematic medical plan including: ó┘a dietary therapy plan designed by professional dietician; ó┌various safe and effective weight-reducing medicine; ó█metabolic surgery for severely obese patients and obese diabetic patients. With multifaceted and individualized obesity therapies and the cooperation of multidisciplinary teams, we can provide obese patients with or without coexisting fatty liver, diabetes or hyperlipemia with a safe, effective, feasible and individualized treatment plan, and thereby greatly improve the long-term quality of life for patients with chronic metabolic diseases.

3) Metabolic surgery: The center has established a metabolic surgery treatment modality using multidiscipline team approach (Department of General Surgery, Department of Endocrinology, Department of Anesthesiology, ICU, Nutritional Department and Endoscopy Center). Our featured services include: joint clinic between Department of General Surgery and Department of Endocrinology with surgeons responsible for the operation while endocrinologists are in charge of the overall evaluation of the patient’s metabolic status before and after the operation and the long-term follow-up so as to ensure the long-term treatment effect and safety of the patient. Meanwhile, before and after the operation, we organize multidisciplinary consultation (Department of General Surgery, Department of Endocrinology, Department of Anesthesiology, ICU, Nutritional Department and Endoscopy Center), which plays a crucial role in reducing the operation risks and complications in the perioperative period. The effects of our obesity therapy are guaranteed with few complications and as many as 95% of the patients are in complete remission of diabetes. The operations have a high safety profile with no complications.

4) The diagnosis and treatment of diabetes and diabetic complications: We have a solid clinical foundation for the diagnosis and treatment of diabetes, especially in its management, publicity, nutrition, early prevention and treatment as well as the prevention and treatment of diabetic complications. We receive over 60,000 diabetes patients from all over the country every year. We have various endocrine biochemical criterion, immunity index, complete testing equipment and comprehensive examination methods in relevant departments, which warrants thorough screening and accurate diagnosis of diabetes and its complications. We were the first in China to use fundus vessel diameter measurement to study its relationship with glycemic control and with diabetic complications. We explored and developed independently “the Treatment of Diabetic Complications with Combined C-peptide and Insulin and the Genetic Engineering of New Drugs with C-peptide” and “Qinghuo Number 1” prescription for treating diabetic complications, the research findings of which obtained two national patents and won the second prize of Shanghai Medical Science and Technology Award, the second prize of Science and Technology Progress Award from the Ministry of Education and the third prize of Shanghai Science and Technology Award for Chinese Integrative Medicine. We are in the national forefront in our ability for early diagnosis and prevention of diabetic complications and are in the international leading position in the monomer screening and mechanism research of traditional Chinese medicine.

5) Endocrine tumors: Considering the difficulties in the diagnosis and treatment of endocrine tumors of all glands, we set up a special diagnostic and treatment center of endocrine tumors. We have accumulated rich experience in the diagnosis and treatment of adrenal tumors, pituitary tumor, gonad tumors, parathyroid tumors, pancreatic endocrine tumors, multiple endocrine neoplasia and ectopic endocrine tumors. We have a multidisciplinary team, uniting the experts from Department of Neurosurgery, Department of Urology, Department of Interventional Therapy, Department of General Surgery, Department of Orthopedics and Department of Pathology to make an all-inclusive comprehensive evaluation of the patient’s condition and come up with the best diagnostic and treatment plan.

6) Secondary hypertension: We use CT as the first choice to screen adrenal lesions and endocrine hypertension and have formed our unique methodology in the screening, diagnosis and treatment of endocrine hypertension. We provide systematic screening of secondary hypertension for patients who developed the disease at young age, have an obvious family history with/without unique clinical manifestations (obesity, emaciation, edema, fatigue, perspiration, headache, the growth in hands and feet in adulthood, feminization, virilization, etc.), and patients who are resistant to antihypertensives. We also provide systematic diagnosis and treatment for patients with confirmed primary hyperaldosteronism, hypercortisolism, pheochromocytoma and somatotropinoma, etc. We cooperate with the Department of Urinary Surgery to form standardized protocols and proceedings for the treatment process. Sharing the hospital resources has allowed us to greatly improve the diagnostic rate for operable tumors, make proper treatment plans, and systematize and regulate post-operation follow-up.

7) Thyroid diseases: We cooperate with Department of Ultrasound, Department of Nuclear Medicine and Department of Pathology to diagnose and treat thyroid diseases using ultrasonic contrast imaging and elasticity imaging, radionuclide imaging and genetic testing techniques. We are especially well-known for the differential diagnosis of malignant versus benign thyroid nodule as well as standardized treatment.

8) The diagnosis and treatment of metabolic bone diseases: Considering the complexity associated with osteoporosis and the fact that patients usually have to go to different departments for treatment which poses difficulties and inconvenience, we cooperated with Department of Geriatrics, Department of Orthopedics, Rehabilitation Department and Department of Rheumatism and launched a one-stop service-- “Integrated Outpatient Osteoporosis Clinic” and established a standard medical process for osteoporosis patients. The doctors in Department of Endocrinology are in charge of the initial diagnosis or differential diagnoses. Then, based on the severity, diseased regions and whether there is fracture, referred doctors from the above-mentioned departments will treat the patients, which reduces the inconvenience of visiting different clinics. We optimize the process for diagnosis and treatment and promote standardized diagnosis and treatment, which has improved the osteoporosis care quality in the entire hospital.

9) Rare endocrine syndromes: We have well-equipped endocrine functional laboratory and advanced testing methods such as chromosome classification and gene mutation. We have accumulated certain experience in the diagnosis and treatment of rare endocrine syndromes, including Turner’s syndrome, VHL syndrome, Kallmann syndrome, Wolfram syndrome, Laurance-Moon-Biedl syndrome and Prader-Willi syndrome, etc. We have also achieved some success in treating some of these rare endocrine syndromes.

The department is in the leading position in the country in standardizing diagnosis and treatment of endocrine and metabolic diseases. The department also utilizes to the fullest extent the hospital’s multi-discipline advantage and organizes “multidisciplinary teams for comprehensive treatment”. For example, we cooperate with Department of General Surgery, ICU, Endoscopy Center, Department of Anesthesiology and other departments to perform metabolic surgery to treat diabetes; we work with Nutritional Department to carry out nutritional therapy for obesity, diabetes and hyperuricemia; we team with Department of Orthopedics and Department of Rheumatism to launch one-stop services for the treatment of osteoporosis; we organize “metabolic disease multi-discipline group” (including Department of General Surgery, Department of Geriatrics, Department of Liver Disease and Tumor, etc.) to carry out the prevention and treatment of chronic and metabolic diseases; we have achieved remarkable results in our cooperation with Department of Urinary Surgery in the screening of adrenal lesions and the diagnosis and treatment of endocrine hypertension; we cooperate with Department of Ultrasound, Department of Nuclear Medicine and Department of Pathology to carry out differential diagnosis of malignant and benign thyroid nodule, which has become a characteristic of our department; we coordinate with Department of Neurosurgery and have improved the diagnosis and treatment of pituitary diseases and reduced operative complications; we also work with Department of General Surgery to jointly treat pancreatic endocrine tumors. We combine the comprehensive advantages of the surgical departments (for endocrine tumor of gastrointestinal tract, thyroid tumor, parathyroid tumor), Department of Urinary Surgery (for adrenal tumor) and Department of Cranial Surgery (for pituitary neoplasm) and have established an “endocrine tumor multi-discipline group”. These accomplishments have earned the department its top-ranking position in China in both clinical treatment and scientific research of endocrine diseases. 

The department demonstrates robust scientific research power. We have undertaken many projects at national and provincial levels, including key projects of the Ninth Five-Year Plan, the Tenth Five-Year Plan and the Eleventh Five-Year Plan, projects of 973 Program of Ministry of Science and Technology (as leader unit), projects of 985 Program, projects from Natural Science Foundation of China, Doctoral Education Foundation and Project of Ministry of Education, key projects and major projects from Science and Technology Commission Of Shanghai Municipality, Health Bureau, and Shanghai Municipal Commission of Health and Family Planning as well as Science and Technology Commission of Shanghai Municipality. We have cultivated 27 doctoral graduates, 1 postdoc, 50 master’s degree graduates. There are at present 7 doctoral students and 7 master students studying in the department.

Over the years’ development, we have formed a professional academic team. Prof. Gao Xin, the academic leader of the discipline, is also the vice superintendent of Fudan University affiliated Zhongshan Hospital, director of Fudan-Netherlands Erasmus University Rotterdam Medical Research Center, director of the endocrine and metabolic discipline of Zhongshan Hospital, Clinical Pharmacological Research Center, Fudan University, member of the standing committee of Society of Endocrinology, Chinese Medical Association, vice chairman of Endocrinology Divsion of Chinese Medical Doctor Association, leader of Hepatopathy and Metabolomics Group of Endocrinology Division of Chinese Medical Association, chairman of Shanghai Society of Endocrinology, chairman of Specialized Committee of Clinical Pharmacology of Shanghai Pharmaceutical Association. Under Prof. Gao’s leadership, a group of knowledgeable professors and associate professors have become the backbones in the clinical practice, education and scientific research of the department. In recent years, the young medical workers are growing fast academically. Full of vigor, they constantly strive for progress and spare no effort to explore new areas, exhibiting the sustainable development potential of the department.

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