Inpatient Activities

The endocrinology and metabolism training program in the Division of Endocrinology and Diabetes is designed to provide broad clinical training and education in the field of endocrinology and metabolism. The standard endocrinology and metabolism training program is two years in length, although trainees may elect to undertake focused training in clinical or bench research and complete their clinical training over a three-year period. In either case, the program’s curriculum is organized into four basic components: 1) inpatient and consultative services; 2) outpatient clinics; 3) didactic lectures and conferences; and 4) research. Clinical training primarily occurs in three settings: LAC+USC Medical Center, USC University Hospital and USC/Norris Cancer Hospital.

Our three hospitals provide trainees with exposure to a wide range of endocrine and metabolic diseases in patients from varied ethnic and socioeconomic backgrounds. Research training is provided through the Clinical Research Center at LAC+USC Medical Center and through the basic science laboratories of the Division of Endocrinology and Diabetes at the Keck School of Medicine at USC.

Outpatient Activities

LAC+USC Medical Center Endocrine and Diabetes Clinics and Comprehensive Care Clinics: Outpatient clinics are held at two Comprehensive Health Centers (Roybal and Hudson) two days a week and a comprehensive diabetes care program at Roybal CHC five days a week. Each fellow evaluates six to eight patients per clinic while the remaining 30-40 patients are seen by housestaff and medical students rotating through the Endocrine-Diabetes Service. Each fellow is assigned to one of these three clinics for the duration of the fellowship to facilitate continuity of patient care. A full-time faculty member provides supervision. The primary purpose of these clinics is to provide consultation for the evaluation and development of treatment plans for patients referred with endocrine and diabetes problems. The eventual goal is to return the patients to their primary physicians for long-term follow-up care. In certain instances, the fellow may choose to continue to follow selected patients for educational purposes. Support services (e.g., diabetes education, podiatry, dietary, ophthalmology, and radiology) are available at each of these facilities. On occasion, referral of patients back to the Thyroid-Endocrine Clinics at the LAC+USC Medical Center may be required to provide more intensive outpatient management.

Roybal Diabetes Managed Care Program: In brief, the program is based in a recently remodeled, purpose-built diabetes center in the Roybal Comprehensive Health Center of the LAC Northeast Cluster Healthcare Network. The center provides comprehensive diabetes preventative care (prevention of complications) under the co-leadership of Drs. Michael Roybal and Anne Peters. Dr. Ruchi Mathur provides patient care along with fellows from the training program. The center includes a digitized eye camera, a clinical laboratory, a phlebotomy room and an education center. Primary care physicians and endocrinologists see patients together in this center where the patient care plan is established by use of written, case-based protocols. This care is implemented by diabetes nurses in a case-based manner. The majority of the patients are Latino and the majority of the doctors and nursing staff at the center are Spanish-speaking.

LAC+USC Medical Center Thyroid Clinic: This clinic provides outpatient care for patients with all types of thyroid disease. The clinic meets once weekly under the direct supervision of full-time faculty members with special interest and training in thyroid disorders. The clinic and its pre-clinic conference provide in-depth training in thyroid disease, including hypo- and hyperthyroidism, thyroid neoplasia, goiter, thyroiditis, thyroid manifestations of systemic illness and inborn errors of thyroid hormone metabolism.

Diabetes in Pregnancy Clinic: This clinic provides antenatal care for pregnant women with pre-gestational and gestational diabetes mellitus. Fellows learn methods for diagnosis and management of diabetes during pregnancy.

Private Practice

Faculty members in the Division of Endocrinology and Diabetes provide clinical care for private patients in two locations: the Healthcare Consultation Center II and University Hospital on the USC Health Sciences Campus and at the USC Westside Center for Diabetes.

Health Sciences Campus: The USC Division of Endocrinology and Diabetes provides assessment and management services for patients with a variety of endocrine disorders, especially in the areas of diabetes, pituitary diseases, adrenal disorders and disorders of calcium and bone metabolism. The endocrine faculty has extensive experience in the management of such disorders and, where necessary, utilize the state-of-the-art USC Endocrine Laboratory to assist in diagnostic assessment. In addition, the most advanced imaging modalities are available for diagnosis. For patients who require surgery, there are a number of renowned USC surgeons who specialize in endocrine surgery, especially of the pituitary gland, thyroid and parathyroid glands and adrenal glands. The latest in medical management is available where surgery is not indicated. Clinical care is provided by Drs. Jorge Mestman, Peter Singer, Jonathan LoPresti, Robert Rude, Stephan Bughi, Mariola Ficinski and Nurse Practitioner Evelyne Fleury-Milfort. The USC Center for Diabetes and Metabolic Disorders, directed by Dr. Jorge Mestman, is an integral part of the Division’s private clinical practice on the Health Sciences Campus. The Center offers a comprehensive program that includes state-of-the-art medical care and a diabetes self-management program that has achieved American Diabetes Association recognition. Care is provided by a multi-disciplinary team of endocrinologists, nurse practitioners, certified diabetes educators (CDE), dietitians and specialty physicians, such as nephrologists, cardiologists, neurologists, ophthalmologists and orthopedic surgeons. Services include intensive diabetes management for individuals with type 1 and type 2 diabetes, early diagnosis and treatment of type 2 diabetes, prevention of type 2 diabetes, gestational diabetes care, pre-conception care, diabetes and pregnancy management and insulin pump therapy. In addition to providing patients with the opportunity to participate in clinical trials, the center also offers two community programs: a monthly support group for patients on intensive therapy with multiple injections or insulin pump, and an annual half-day educational seminar.

USC Westside Center for Diabetes: The USC Westside Center for Diabetes is located in the Carthay Center section of Los Angeles’ West Side. The Center is directed by Dr. Anne Harmel, an internationally recognized specialist in diabetes care. Dr. Ruchi Mathur also sees patients with diabetes and other endocrinologic disorders at the Center. The Westside Center is a full-service center specializing in the prevention and treatment of diabetes in children and adults. The Center also treats all disorders of metabolism and endocrinology, (such as thyroid, cholesterol, pituitary and adrenal disorders). The Center is staffed by an expert team consisting of diabetologists, endocrinologists, pediatricians, internists, diabetes nurse educators, a nutritionist, nurse practitioner, and dermatologist. Staff members are certified diabetes educators and the Center’s diabetes education program is certified by the American Diabetes Association, in conjunction with the USC Diabetes Program located on the USC Health Sciences Campus. The Westside Center also has a clinical research program to perform research studies designed to advance the treatment of diabetes.

Specialized Services available at the Westside Center for Diabetes :

1. Diabetes screening and prevention
2. Nutritional, weight loss, and exercise therapies
3. Treatment of prediabetes, and type 1 and 2 diabetes
4. Individual education on use of glucose meters, insulin and other tools for the treatment of diabetes
5. Intensive insulin therapy
6. Use of insulin pumps
7. Treatment of hypertension and abnormal cholesterol levels
8. Management of gestational (pregnancy-induced) diabetes
9. Support groups
10. Downloading and analysis of blood glucose meters
11. Continuous blood glucose monitoring and interpretation of blood sugar trends
12. Full hormonal testing

USC Thyroid Diagnostic Center: This program has brought together a group of highly experienced, nationally recognized endocrinologists who specialize in thyroid disease to work with experts in cyto-pathology, nuclear medicine and the surgical sub-specialties in an integrated team approach in the diagnosis and management of thyroid diseases. This group also has available to it one of the finest endocrine laboratories in the U.S. that specializes in thyroid testing. Diagnosis and management of recurrent thyroid cancers is one area where the team of physicians in the USC Thyroid Diagnostic Center has particular expertise. Working with their colleagues in surgery, oncology, radiology and nuclear medicine, they have developed protocols to manage even the most difficult cases.

USC Endocrine Services Laboratory: The USC Endocrine Services Laboratory is a fully licensed, CAP-accredited clinical laboratory. Our mission is to offer research-quality endocrine tests at competitive prices to physicians both at USC and throughout the U.S. We are committed to integrating new research methods and insights into clinical medicine. Our laboratory is widely recognized as a quality thyroid reference laboratory and has been singled out at recent American Thyroid Association and Endocrine Society meetings for playing an important role in transferring TSH and thyroglobulin methodologies from the research environment to clinical practice. Under the leadership of Dr. Carole Spencer, the Endocrine Services Laboratory has become nationally and internationally known for its quality thyroglobulin measurements that are used in the management of patients with thyroid cancer. The dual RIA/IMA strategy, pioneered by Dr. Spencer, is now being recognized as optimal for thyroglobulin autoantibody-positive patients and is being adopted by other laboratories.