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ACHIEVEMENTS I N ENDOCRINOLOG Y In 1974 , endocrinolog y wa s alread y a n estab lished discipline in the Department of Medicine. A metabolic ward and a hormone laboratory established i n th e earl y 1960 s provided facilitie s for patient management, opportunities for training and stimulus for research. However, research efforts were mainly focused on carbohydrate metabolism an d thyroi d disorders . Fro m 197 4 t o 1989, endocrinology in the Department of Medicine underwent considerable expansion and diversification . Researc h direction s no w include : carbohydrate metabolism , thyroi d disorders , neuroendocrinology, metabolic bone diseases and reproductive endocrinology and infertility. Our role in patient care expanded fro m th e original two clinics (diabetes and thyroid) in 1974 to the present of eight clinics including diabetes: general , home monitoring and gestational; thyroid; endocrine; osteoporosis ; mal e infertility ; an d growth and puberty clinics. The latter two clinics are organized in conjunction with the Department o f Obstetric s an d Gynaecolog y an d th e Department of Paediatrics respectively. The team currently comprises 5 full tim e and 2 part tim e teachers, 2 registrars in training, 3 technical staff and 6 research assistants. The following is a brief description of the contributions of the endocrine division from 1974 to 1989. Carbohydrate Metabolism The department continued its efforts on the characterization of diabetes mellitus and its complications i n th e Chinese i n Hong Kon g (1-8). More recent studies showed a strong association of HLA DR3/DRw9 with insulin dependent diabetes mellitus (9). The department played a leading rol e i n organizin g educatio n programme s for diabetic educators resulting in the establishment o f diabeti c nurse s i n majo r governmen t hospitals. The earlier description of hypoglycaemia associated with hepatocellular carcinoma was followed by studies on the mechanism causing the hypoglycaemia (10-12 ) as well as abnormalities in carbohydrate metabolism in post-necrotic cirrhosis of the liver (11,13,14). We also reported the occurrence of hypoglycaemia in patients with insulin autoimmunity (15) . Studies of hypogly caemia occurring in uraemic patients examined the changes in insulin, C-peptide and cyclic adenosine monophosphate levels as well as other metabolic substrates in these patients. These studies led to the finding o f the important rol e of P adrenergic blocker s in th e generation o f hypo glycaemia in haemodialysis patients (16-20). Thyroid Diseases The department was well known for its earlier study on the clinical features o f thyrotoxi c periodic paralysi s and thes e were described i n reviews and books (21,22). The protective role of P adrenergic blocking agents in thyrotoxic periodic paralysis was further examined. Changes in the muscl e calciu m pum p an d erythrocyt e so dium pump activities were observed (23,24) and these shed som e light on the pathogenesis an d genetic basi s o f thi s commo n complicatio n o f thyrotoxicosis i n th e Orientals . Followin g th e interest of the department in hypokalaemic periodic paralysis, the occurrence of thi s conditio n in association with primary hyperaldosteronism (25), renal tubular acidosis (26) and chroni c ingestion of gossypol for contraception (27 ) were reported. Studies on the changes in thyroid stimulat ing antibod y activitie s i n patient s wit h thyro toxicosis treated wit h antithyroid drugs , radioactive iodine, and subtotal thyroidectomy and in neonatal Graves ' diseas e wer e fundamenta l i n defining the role of immunoglobulins in the pathogenesis of thyrotoxicosis (28-31). Other studies described th e incidenc e o f hypothyroidis m after radioactiv e iodin e treatment o f thyrotoxi cosis (32) and acute myopathy in hypothyroid ism (33). We also documented the association of HLA Bw46 in thyrotoxicosis (34 , 35) and HL A DRw9 in Hashimoto's thyroiditis in Hong Kong (36). In addition, we reported th e effect o f stress (37) and heroin addiction (38 ) on pituitary thy roid function ; th e determination o f response of thyroid stimulatin g hormon e an d it s a an d p subunits t o thyrotrophi n releasin g hormon e i n patients with various thyroid disorders (39); stud- 38 R.T.T. Young, C Wang, K.S.L. Lam, K.K. Pun & A.W.C Kung ies of thyroi d hormon e level s in patient s wit h familial goitr e due to organification defec t (40); the...

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