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The Bone Metabolism and Osteoporosis Clinic (Mondays) is directed by Dr. D. Goltzman and is also attended by Drs. L. Vautour and S. Morin (Internal Medicine Osteoporosis specialist). It provides consultations and follow-ups for around 700 patients annually with a variety of bone diseases, but especially osteoporosis. The clinic provides instructions to residents and has been instrumental in developing new hormone assays for PTH and vitamin D and for testing and validating new biochemical assays for bone resorption. The director has been at the forefront of basic research.

A Pediatric to Adult Care Transition Clinic is held once a month on a Monday afternoon, where patients turning 18 are referred by our colleagues from the Montreal Children’s Hospital. The focus is on Type 1 Diabetes. Drs. N Garfield and W. Hu participate in this clinic, along with other endocrinologists with an interest in Type 1 diabetes (Dr. M-D Eid and S. Michaud) and pediatric endocrinologist Dr. M. Nakhla.

An Endocrine Oncology Clinic is held on Tuesday AMs by Dr D Morris in the Oncology Centre, where trainees can see patients with endocrine adverse events of immune checkpoint inhibitors, steroid-induced hyperglycemia in cancer patients, and other endocrine complications in patients with cancer.

The Antenatal Clinic, held jointly with the Obstetrics and Gynecology department, is directed by Dr. R Bond and provides specialized care for around 2,300 outpatient visits for women with gestational diabetes and other endocrine problems associated with pregnancy. This is a multidisciplinary clinic comprised of an endocrinologist, a maternal fetal medicine specialist, nurses and dieticians. The clinic includes a teaching component and has been renowned throughout the province for the fastidious care provided.

A Multidisciplinary Adrenal Clinic is held on Tuesday afternoons once a month by Dr J Rivera and S Larose, with Endocrine Surgeons, Drs. E Mitmaker and Rajam Raghunathan, minimally invasive surgery specialist and Surgeon in-Chief, Dr. Liane Feldman, and urologic oncology surgeon, Dr. Alexis Rompré-Brodeur. In this clinic, trainees can see patients with various adrenal tumors, including aldosteronomas, cortisol-secreting adenomas, macronodular adrenal hyperplasia with and without mild autonomous cortisol secretion, pheochromocytomas, myelolipomas, non-secreting adenomas, adrenal metastasis, and cortico-adrenal carcinomas. At this clinic, trainees will have plenty of opportunity to learn everything about the work-up of adrenal masses, adrenal vein sampling modalities and interpretation, adrenal imaging, perioperatory management of functional adrenal masses, prescribing and monitoring therapy with mitotane. This is also a unique experience to learn interdisciplinary care involving endocrinologists, surgeons and radiologists.

A Thyroid Clinic is held on Fridays by Dr J Rivera, where trainees can learn and practice neck ultrasonography, the technique of ultrasound-guided fine needle aspiration (USG-FNA) of thyroid nodules, and advanced management of thyroid cancer. Similarly, ENT thyroid specialist Dr R Payne welcomes our Endocrinology residents to attend his thyroid biopsy clinic on Tuesdays, where they can also practice USG-FNA. This is a very busy clinic with 25-30 patients booked in one day. Additionally, Dr JW Yang welcomes our trainees to her Tuesday AM Thyroid clinic, where they can see patients with various thyroid pathologies including hyperthyroidism, hypothyroidism, thyroid nodules and cancer.

An Obesity Clinic is held by Drs. V Tardio and W Hu on Tuesday afternoons, where trainees can assess patients with obesity, including the metabolic and mechanical complications of this condition. They can also suggest lifestyle management approaches, medical therapies or bariatric surgeries to these patients.

The multidisciplinary approach in the Endocrinology outpatient clinic at the MUHC-RVH allows for continuous input from physicians, nurses, dieticians and educators to improve the patient's clinical care. Thirty to forty diabetic patients are seen daily by various physicians. A Diabetes Teaching Clinic directed by Dr. J.-F. Yale, held on Wednesday mornings, sees new and interesting referrals and provides follow-up for complex diabetic problems and formal teaching to residents. Drs. N Garfield, V Tardio, S Meltzer, and G. Fantus participate in this Diabetes teaching clinic.

The Neuroendocrine Teaching Clinic (Wednesday afternoons) is directed by Dr. N. Garfield and sees approximately 60 new patients and 300 to 400 follow-up visits annually, comprising patients with complex pituitary and hypothalamic disorders. The clinic attracts new patients from neurosurgeons, neurologists, neuro-ophthalmologists, the Fertility Clinic, general surgeons, and private physicians both from within and outside the hospital. The clinic has a strong educational component for residents. Drs J Rivera and N Garfield participate in this teaching clinic.

The Lipid Teaching Clinic (Thursdays) is directed by Dr. M. Sherman. It provides diagnosis, treatment and follow-up for around 170 new patients and around 1,500 follow-up visits for patients with complex lipid disorders. The clinic is staffed by specialists from endocrinology and biochemistry (Drs. A. Baass and D Blank). The clinic provides instruction for senior medical residents and supplies patients for multi-center lipid treatment research studies.

The Reproductive Endocrine Clinic (Thursday PM) is directed by Dr. R. Bond, and additionally attended by Dr. I. Albanese, who sees approximately 500 new and follow-up cases annually. Common problems encountered here are amenorrhea, infertility, hirsutism, polycystic ovary syndrome and transgender patient care. The clinic is closely interfaced with the large, well-established in-vitro fertilization program in the Department of Obstetrics & Gynecology. In their first year of training, endocrinology residents undertake a formal 4-week rotation through the clinic. Here they interact with the endocrinologists, fertility specialists, as well as fellows in reproductive endocrinology and infertility.

The program director oversees the Residents Teaching Clinic, but the staff on-call provides direct supervision. It operates once a week with residents in endocrinology and internal medicine. It serves as a referral base for new endocrine consultations originating from the Emergency Room and Ambulatory Clinics from within the hospital and outside physicians. The clinic allows residents to see new consultations and follow interesting patients discharged from the hospital.

Endocrine Tumors Clinic - Patients with neuroendocrine tumors (both hormone-producing and nonfunctional NETs) are seen by Dr J Rivera in his Monday clinic. These disorders are rare, and the personal experience of individual endocrinologists may be limited. Dr. J. Rivera has extensive knowledge and expertise in these tumors and has acquired a reputation for diagnosing and managing these difficult problems.

Diabetes Clinic – There is a well-developed and busy diabetes teaching clinic, which is held once weekly on Tuesday mornings under the direction of Dr. N. Garfield. This clinic has a multidisciplinary team approach with physicians, nurse educators and dieticians contributing. A weekly teaching session on a topic related to diabetes is held prior to the clinic.

Neuroendocrinology Clinic – Neuroendocrinology has a significant and strong presence at the MGH through the interest, expertise and input of Dr. S. Marcovitz, who directs the weekly neuroendocrinology-teaching clinic. Our trainees are exposed to a wide array of interesting neuroendocrine problems, and they gain first-hand experience through our busy, pituitary dynamic testing center and collaborative / consultation with neuro-radiologists.

Dr S Larose holds a weekly Adrenal Clinic on Wednesday AMs, where trainees can see patients with various adrenal pathologies including aldosteronism, Cushing syndrome, pheochromocytoma, nonfunctional adrenal nodules, adrenal carcinoma, etc.

The program director oversees the Residents Teaching Clinic, but direct supervision is provided by the staff on call. It operates once a week on Wednesday PMs with residents in endocrinology and internal medicine. It serves as a referral base for new endocrine consultations originating from the Emergency Room and Ambulatory Clinics from within the hospital and outside physicians. The clinic allows residents to see new patients and follow up with interesting patients discharged from the hospital.

Drs. V Tardio, M Tsoukas, and W Hu run a busy Multidisciplinary Bariatric Surgery and Obesity Clinic on Thursdays, where obese patients are seen preoperatively and postoperatively after a bariatric surgery (Roux-en-Y Gastric Bypass or Sleeve Gastrectomy). They work with a multidisciplinary clinic at the Montreal General Hospital with bariatric surgeons, dieticians and psychologists.

Thyroid Clinic – The MGH rotation brings unique expertise in diagnosing and treating thyroid diseases, including nodules, cancer and hyper/hypothyroidism. Patients with thyroid disorders account for approximately a quarter of all outpatient visits, and Dr. J. How has one of the largest thyroid practices in the country and directs the MUHC Thyroid Teaching Clinic. The patient is seen simultaneously at the same visit by a thyroidologist (Dr. J. How) and thyroid surgeons (Dr. R. Tabah or E Mitmaker). The thyroid clinic attracts a diverse range of both common and complex thyroid problems and provides regular instruction to the endocrine fellows, including fine needle aspiration biopsy and radioactive iodine therapy for thyroid cancer.

On Mondays, a Multidisciplinary Pituitary Clinic is held by Dr V Larouche and Dr S. Di Maio (Neurosurgery) in the Neurosurgery Department. Trainees can see a variety of patients with Pituitary disorders, ranging from prolactin-producing pituitary neuroendocrine tumors (PitNETs) to nonfunctional PitNETs, acromegaly, Cushing disease, craniopharyngiomas, Rathke’s Cleft Cyst and other CNS tumors arising in the sellar area. Patients see both the endocrinologist and neurosurgeon in the same visit for streamlined care. Around 600 patient visits are seen annually in the Multidisciplinary Pituitary Clinic.

Thyroid diseases account for about 40% of our consultations. The JGH has unique expertise in the diagnosis and management of thyroid disease, including thyroid nodules, cancer and hypo/hyperthyroidism. A weekly Teaching Thyroid Clinic (Tuesday) run by Dr. M. Tamilia incorporates common thyroid cases equally with referrals of complex cases, both from within the institution and from other centers. The Clinic is structured to allow time to review cases and the pertinent areas of cytology and pathology. Trainees also have the opportunity to learn the fine needle aspiration biopsy technique and examine interesting cell aspirates with Dr. M. Tamilia.

The Antenatal Endocrinology and Gestational Diabetes Clinic is run jointly with the Department of Obstetrics and Gynecology by Drs. A Majdan, J Pancer and T Peters. This accounts for around 2,000 visits per year of patients with gestational diabetes and pregnant patients with other endocrinopathies. (Tuesday AM, Wednesday AM, Friday AM)

A Multidisciplinary Diabetic Foot Care Clinic is held by our colleague, Dr. R. Chaytor, in the Orthopedic Surgery department on Wednesday mornings. Trainees have the opportunity to see patients with diabetic foot conditions, including neuropathic ulcers, Charcot foot, diabetic foot infections, and to observe the role of orthopedic surgeons for debridement and other surgical procedures, wound care specialists, etc.

A Lipid Teaching Clinic is directed by Dr. M. Schweitzer (Wednesday PM). This clinic concentrates on a range of internal and external referrals, including more difficult dyslipidemia management cases, including familial hypercholesterolemia, hypertriglyceridemia, statin-intolerant patients, etc.

A Diabetes Teaching Clinic is held by Dr T Peters on Thursday afternoons. Trainees can see more complex diabetic patients with her, including patients with Type 1 diabetes, patients on insulin pumps and continuous glucose monitoring devices. They can also familiarize themselves with the outpatient management of Type 2 diabetes.

As noted above, general outpatient General Endocrinology Teaching is available throughout the week. The attending endocrinologist on service triages new referrals (from the outside – this does not include consults on inpatients) and sees those that seem more urgent with the endocrine resident and other rotating residents. In addition, trainees are called when a staff member sees patients with interesting findings during the ongoing practices around the week.

A Residents' Teaching Clinic is held either on Thursday AM or Friday AM, at the discretion of the attending staff endocrinologists. Urgent new outpatient cases are seen in this clinic, and teaching is done around the cases for the trainees on the consultation service.