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SickKids

Endocrinology

Phone:
416-813-6217
3 smiling medical colleagues in a meeting

The Division of Endocrinology at SickKids is dedicated to improving the health of children and adolescents with endocrine disorders. Our mission is to provide the best in family-centered, compassionate care, to lead in scientific and clinical advancement, and to prepare the next generation of leaders in Paediatric Endocrinology. Paediatric Gynaecology & the SickKids Team Obesity Management Program are subsections of this program.  

The Division of Endocrinology provides state-of-the-art comprehensive inpatient and ambulatory care to infants, children and teens across the full spectrum of endocrine disorders.  We have a large interdisciplinary diabetes health-care team involved in the care of children with type 1 and type 2 diabetes. We also participate in specialized clinics, including Multidisciplinary Urogenital Disorders, Calcium and Bone Health, Transgender, Endocrine-Gynaecology, STOMP and Oncology Aftercare, where clinicians from different specialties come together to provide care for families. 

The Division is very active in many research endeavors in both diabetes and endocrinology. We also have a Subspecialty Fellowship Training Program that is fully accredited by the Royal College of Physicians and Surgeons of Canada.  

What we do

The Division of Endocrinology functions as a strong interdisciplinary team in endocrinology and diabetes. The major areas of focus of the division's clinical activities include: comprehensive care of children and teens with disorders of the endocrine system, including diabetes, disorders of growth, thyroid, puberty, pituitary, and calcium and bone.  

The Division has a Nurse Practitioner who facilitates a Congenital Hypothyroidism clinic and our staff participate in specialized interdisciplinary clinics throughout the hospital. The Division also has strongly integrated clinical research as part of our model of care. 

Please visit our Meant2Prevent Resource Hub where families and healthcare professionals can find truusted youth-focused resources that promote healthy living and lifestyle habits.

Meant2Prevent Resource Hub

Programs and resources

Expand each section below for valuable resources related to Endocrinology.

The Endocrine Clinic provides care to children and adolescents with a variety of endocrine conditions involving hormone function. This may include conditions related to growth and puberty, as well as pituitary, adrenal and thyroid function. 

For specific instructions regarding your next visit, please visit the Endocrine Clinic on our SickKids Clinic Directory.

We are receiving many questions about Coronavirus (COVID-19) and implications for individuals with diabetes and/or adrenal insufficiency. 

Advice for people with diabetes and/or adrenal insufficiency aligns with general COVID-19 advice: 

  • Wash hands frequently 
  • Maintain social distance 
  • Self-isolate and seek care quickly if you think you may be infected with COVID-19 (following directions of your local health authority). 
  • SickKids is closely monitoring the COVID-19 situation and taking precautions to maintain safe and effective care. We will be in touch with you prior to your child’s next clinic appointment to assess the possibility of completing a virtual visit. The date and time of your/your child’s appointment would stay the same, but the doctor would connect with you by phone or video chat. 
  • Before coming to SickKids, learn more about visitor restrictions, screening and virtual care options on our Coronavirus (COVID-19) Information page. 
Guidance for individuals with diabetes: 

Those living with type 1 diabetes (T1D) are not at increased risk of acquiring COVID-19.

  • As with other infections, people with poorly controlled T1D or with complications (such as renal failure) might be at heightened risk once infected with COVID-19. 
  • Viruses, in general, can cause blood glucose disturbances such as hyperglycemia, Diabetic ketoacidosis (DKA), etc., sometimes leading to hospitalization. 
  • It is important to follow the management guidelines for sick days with diabetes. For more information, please review the resources below. 
  • Stock your cupboards with items that will support a healthy intake of carbohydrates and ensure you have diabetes medical supplies on hand for at least 14 days if you are quarantined. 
  • Have your diabetes team phone numbers handy. For non-urgent questions, please contact them during the daytime.  
    For more urgent concerns (vomiting or diarrhea for more than six hours; large levels of ketones; and an inability to keep food or liquid down) patients followed at SickKids can call Hospital Locating and ask to speak to the Diabetes doctor on-call. 
    Patients that are not currently followed at SickKids are advised to consult their current health teams. 
  • Review your supply of insulin and diabetes supplies to ensure that you have an adequate supply for the next 1-2 months.  
    For current SickKids patients: If you are running low, please check if you have refills available on-file with your pharmacy (will appear on the label as R:) and have the pharmacy send a refill request form to the Division of Endocrinology fax at 416-813-6304 if refills are needed. 

We have reached out to type 1 diabetes device and insulin manufacturers to inquire whether supply could be affected by disruptions in manufacturing or shipping related to COVID-19. All those we have heard from to-date have assured us there is no concern about supply in Canada. 

Diabetes resources 
Resources from AboutKidsHealth
Guidance for individuals with adrenal insufficiency: 

Individuals with adrenal insufficiency are no more likely to get the COVID-19 virus than others.  If such individuals do become sick, however, it is important to apply stress-dose guidelines as prescribed by your physician. For more information, please review the resources below. 

  • If you do not remember your stress dose for illness, contact your physician or nurse to get this information. 
  • Anyone with fever, vomiting or diarrhea should adhere to their stress-doses. If your child is ill and you are unsure if they require stress dosing with hydrocortisone, patients followed at SickKids can call hospital locating and ask to speak to the Endocrine doctor on-call. Patients that are not currently followed at SickKids are advised to contact their current health teams. 
  • Review your supply of steroid medications (both oral and injectable) to ensure that you have an adequate supply for the next 1-2 months and that the injection is not expired (or near expiration).   
    For current SickKids patients: If you are running low, please check if you have refills available on-file with your pharmacy (will appear on the label as R:) and have the pharmacy send a refill request form to the Division of Endocrinology fax at 416-813-6304 if refills are needed. 
  • It is important to know that ambulance paramedics are permitted to administer injectable hydrocortisone, if supplied by a patient (they do not stock hydrocortisone on the ambulances). 

For emergencies, patients that are currently followed at SickKids can contact the on-call Endocrine doctor at any time by calling Hospital Locating.  Given the high number of calls, we ask that you contact your health-care team during the daytime if your question is not urgent so that we may direct our attention to those in most immediate need of care. 
Patients that are not currently followed at SickKids are advised to consult their current health teams. 

Adrenal insufficiency resources 
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young girl writing at her desk

Endocrinology workshops

After the Honeymoon

A workshop for families who have a child/teen that has been diagnosed with diabetes for at least 6 months. •Members of the diabetes team will answer your questions and discuss the challenges you may face in dealing with diabetes as the honeymoon period comes to an end •As well, this session will give you an opportunity to meet other families who are facing similar challenges and to share ideas in managing common issues.

Family Diabetes Day

A day for families to connect and learn about advances in diabetes research and day-to-day care.

Who we are

The staff in the Division of Endocrinology provide state-of-the-art comprehensive inpatient and ambulatory care to infants, children and teens across the full spectrum of endocrine disorders.  

Because SickKids is a teaching hospital, all staff are affliated with Endocrinology at the University of Toronto.

Dozens of blood samples with red, orange and purple lids

Research activities

Expand each section below to see what our acclaimed staff are researching. 

Dr. Jill Hamilton’s research and clinical interests focus on children and adolescents at risk for the development of type 2 diabetes and weight-related health issues.

This includes children and adolescents with complex obesity due to hypothalamic tumors or genetic causes of hypothalamic dysregulation.  The main areas of research include (i) evaluation of the determinants of metabolic risk and mechanisms for weight gain (ii) food intake and appetite hormone regulation, and (iii) treatment of complex obesity and type 2 diabetes. I have over 150 peer-reviewed publications and have received research funding from agencies including Canadian Institutes for Health Research (CIHR), National Institute of Health (NIH), Heart and Stroke Foundation and Canadian Diabetes Association. 

Dr. Mahmud's current research focuses on diabetes, specifically clinical and lifestyle-based interventions in high risk pediatric groups, and translational research relating to co-morbid autoimmune conditions and social determinants including the early evaluation and prevention of related complications.

He is the lead investigator for the Adolescent Type 1 diabetes Treatment with SGLT2i for hyperglycEMia & hyPerfilTration (ATTEMPT) study, an international, double-blind, randomized control trial. Dr. Mahmud also serves as principal investigator of the Adolescent Diabetes Cardio-Renal Intervention Trial (AdDIT) Expansion in Canada, and is currently engaged with the CanSOLVE CKD-SPOR Initiative.  

Dr. Mahmud has a longstanding interest in Celiac Disease as an association with Type 1 Diabetes. He serves as principal investigator of a dietary intervention study, the Celiac Disease and Diabetes - Dietary Intervention and Evaluation Trial (CD-DIET), which has now concluded, and its ongoing follow-up study the Celiac Disease and Diabetes Longitudinal Follow-Up Evaluation (CD-LiFE).    

Dr. Mahmud is also leading the Diabetes Registry, a platform designed to expand patient access to diabetes-related research at SickKids, and is currently serving as chair for the 2020 International Society for Pediatric and Adolescent Diabetes (ISPAD) virtual conference

Dr. Palmert has a long-standing interest in the regulation and disorders of pubertal timing. He has conducted clinical studies of precocious and delayed puberty and in parallel has directed a laboratory-based program designed to identify and understand genetic factors that regulate the onset of puberty.

His interest in the regulation of pubertal timing and in male-female differences in its onset has led to the expansion of his laboratory-based program to include investigation of the bases of sex differences in the brain, including examination of the effects of sex steroids and sex chromosomes on brain structure and function. In the clinical realm, Dr. Palmert has conducted research focused on improving outcomes of youth with type 1 and type 2 diabetes, improving the care of transgender adolescents, and optimizing the use of resources and diagnostic tests within the endocrine clinics.   

Dr. Shulman’s research program is focused on developing and evaluating health services interventions to improve health outcomes and the quality of care for youth living with diabetes as they transition to adult care. She is particularly interested in developing and evaluating interventions that leverage existing population-level administrative datasets to inform health system change. She works with teams of researchers from disciplines including health service research, implementation science, and quality improvement.   

Currently, Dr. Shulman has two multi-centre research studies with active participant recruitment, one called "Bridging the gap to optimize care and outcomes for youth with diabetes between pediatric and adult diabetes care (BTG)", which is a survey study investigating the gaps in services and other issues that young adults with type 1 diabetes face during their transition to adult care. The second is called "Keeping in Touch (KiT) with Young Adults as They Transition Through Type 1 Diabetes Care (KiT)" which is a research study that builds and tests a digital app to improve the process and health outcomes of adolescents and young adults living with T1D as they transition to adult care. 

Dr. Sochett conducts research in a variety of areas with a special interest in the early pathophysiology of diabetic nephropathy, cardiovascular disease and bone health in adolescents with type 1 diabetes, as well as other bone health disorders particularly looking at the genetic contribution to juvenile idiopathic osteoporosis, idiopathic infantile hypocalcaemia and glucocorticoid induced osteoporosis. 

Dr. Diane Wherrett's research interests are focused on type 1 diabetes with the goal of delaying and preventing progression of the disease. She is the Centre Director and Steering Committee Member for Type 1 Diabetes TrialNet, an international research organization which shares this mission.

She is the lead investigator for all eleven TrialNet sites across Canada. Dr. Wherrett is chair of TrialNet's NIH funded, risk screening study "Pathway to Prevention" which offers unique screening that can identify the early stages of T1D years before any symptoms appear and can assess an individual's personal risk of developing the disease. Dr. Wherrett is also involved in several ongoing clinical trials which aim to slow down or stop early stage T1D from progressing to clinical diagnosis. 

Empty lecture hall of 15 rows and a speaking podium

Education and training opportunities

The Division of Endocrinology is accredited by the Royal College of Physicians and Surgeons of Canada for the training of individuals interested in pursuing a career in Paediatric Endocrinology and Metabolism. In addition, the Division offers educational experience in pediatric endocrinology to residents in general pediatric training programs, medical students, allied health members and observers. 

The fellowship program aims to provide broad training in clinical pediatric endocrinology with opportunities to develop clinical, research and education skills. The program is two or more years of training. The first year is predominantly a clinical year, with the second year of training tailored to the trainee’s career goals in either clinical endocrinology, clinical or basic research, education or quality improvement. There may be a possibility of further research training dependent on the availability of funding.

Clinical training

The clinical training for fellows offers an extensive exposure to both in-patient and ambulatory pediatric diabetes and endocrinology.  

  • Diabetes Service: three diabetes clinics a week that take place in the context of a large multidisciplinary team of endocrinologists, diabetes nurse educator, dietitians, social workers and psychologists 
  • General endocrine service: follows children with all type of endocrine disorders with four general endocrine clinics a week 
  • Subspecialty endocrine clinics: in addition to general endocrine clinics, there are subspecialty clinics which the trainees will have exposure to including: Bone Health, Calcium disorders, Endocrine-gynecology clinics, Late Effects of Cancer therapy, Complex Obesity, Transgender and Multi-disciplinary Urogenital clinics. 
Research training 

Primary research activities in the Division of Endocrinology occur in a variety of different areas of clinical investigation. Further research opportunities may also be available with other researchers within the University of Toronto. 

Application process 

Canadian trainees are to apply through CaRMS.

To apply to the program, please submit your fellowship application through our online form and include the following attachments: 

  • Current Curriculum Vitae 
  • Copy of Medical Degree 
  • Academic Transcripts (undergraduate and postgraduate) 
  • Copy of Paediatrics Specialty Certificate (if you are currently a Paediatric trainee, please arrange for your Program Director to provide us with a letter of good standing) 
  • Letter of Intent describing your interest in endocrinology and career interests 

Endocrinology Fellowship Application

In addition, please ask three individuals who know you well to send confidential letters in support of your application to endo.program@sickkids.ca. One letter should come from your residency program director. Your referees should comment upon your interpersonal skills, clinical skills and provide us with some insights regarding your background or potential for research.  

Applicants will need to have completed pediatric training by the time fellowship training begins.

If you have applied to the U.S Match through the National Residency Matching Program (NRMP), please be advised that the University of Toronto is a participating institution and adheres to the match policy.

The policy states that "applicants who have matched to a program or have accepted a position during the Supplemental Offer and Acceptance Program (SOAP), shall not apply for, discuss, interview for, or accept a concurrent year position in another program prior to the NRMP granting the requested waiver." 

The elective program is geared towards Paediatric Residents training in Canada as well as Canadian and International Medical Students. This is a three to four-week elective designed to be a mix of clinics plus inpatient service. The rotation is not divided into separate clinics and service weeks. This is to maximize clinical exposure and introduce residents to the organizational skills required to balance inpatient and outpatient work, which many Pediatricians need to manage. There will be hands on patient care, ward rounds, divisional rounds and attendance at diabetes and endocrine clinics. Students are also exposed to the academic activities of the Division of Endocrinology, including case discussions, case reviews and journal clubs. This elective is coordinated though the Electives Office at the University of Toronto in consultation with Dr. Jennifer Harrington, Program Director.  

Due to the lengthy process required for permits, licensing and registrations, the Division of Endocrinology currently does not accept international Paediatric Resident Electives. However, we do have an Observership Program (detailed in the next section). 

Application procedures for Paediatric Residents training in Canada
Application procedures for Medical Students
  • Applications for Canadian medical students are submitted through MEDSIS. 
  • Applications for international medical students are submitted through the AFMC Portal. Please note that international medical students will be required to submit their CV showing their past clinical experience as well as their TOEFL scores. 

The observership program is designed to help non-licensed International Medical Graduates gain experience in the Canadian healthcare system. The Division of Endocrinology supports this endeavour through a 2-4 week observership where the individual observes activities in clinics, ward and divisional rounds. These physicians must be in a pediatric endocrinology training program or currently practicing in pediatric endocrinology and meet the criteria for an observership in our division. 

We are only able to accept a limited number of observers into our division, due to the overwhelming number of applications for observerships, and the large number of trainees and elective medical students and residents rotating through our busy subspecialty program. 

For more information, please contact: 

Dr. Diane Wherrett, Training Program Director
Enza Andreacchi, Education Administrative Coordinator

Paediatric Endocrinology Training Program 
The Hospital for Sick Children 
The University of Toronto 
Phone: 416-813-5991 
Email: endo.program@sickkids.ca

Contact Endocrinology at SickKids

 

Educational Programendo.program@sickkkids.ca 

416-813-5991  

Main Administrative Office 

416-813-6217 

Clinic: 

416-813-5592 

Our history

The Division of Endocrinology can trace its roots to the early days after the discovery of insulin by doctors Banting and Best at the University of Toronto. In 1923, Dr. Fred Banting was appointed physician in charge of diabetes at The Hospital for Sick Children (SickKids), and a specialized diabetes clinic was established the following year. This made it possible to carry out metabolic studies that helped establish the principles of care for children with juvenile diabetes.  

Endocrinology research became more firmly established at SickKids with the appointment of Dr. A. L. Chute to the Department of Physiology in 1939 and the establishment of a semi-autonomous Research Institute in 1953. Throughout his long and illustrious career at SickKids, Dr. Chute conducted landmark clinical studies which led to a better understanding of the long-term complications of juvenile diabetes and the efficacy of animal growth hormone in treating children with pituitary deficiency, among other things. He was also instrumental in the formation of the Canadian Diabetes Association. 

The Division became a formal entity in 1970, and quickly became known as a pioneering centre for paediatric endocrine research and clinical studies. Of particular note was the establishment, in the mid-70s, of a newborn screening program for congenital thyroid deficiency.  

The diabetes program has continued to be a focal point of the Division's activities. Close to 100 children and adolescents with new-onset diabetes are assessed every year, and over 800 receive comprehensive tertiary care at SickKids.  

Our program has evolved over the years and includes complex care of children and adolescents with diabetes and endocrine disorders and development of new interdisciplinary speciality clinics.  Over the years, we have trained several generations of Paediatric Endocrinologists from around the world. 

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