Dr. Meranda Nakhla

Dr. Meranda Nakhla diagnoses and treats a wide range of hormonal and metabolic disorders, including:

Pediatric Endocrinology & Diabetes (Children & Adolescents)

• Congenital Adrenal Hyperplasia (CAH) & Other Pediatric Adrenal Disorders: A group of inherited genetic disorders affecting the adrenal glands' ability to produce certain hormones, requiring lifelong hormone replacement and monitoring. Other adrenal issues include adrenal insufficiency or tumors.
• Pediatric Type 1 Diabetes Mellitus: An autoimmune condition typically diagnosed in childhood or adolescence where the pancreas produces little or no insulin, requiring lifelong insulin management and glucose monitoring.

Thyroid & Parathyroid Gland Disorders

• Hypoparathyroidism: A rare condition in which the parathyroid glands produce too little PTH, resulting in low blood calcium levels (hypocalcemia) and high phosphorus levels.
• Thyroiditis (e.g., Subacute/De Quervain's, Postpartum, Silent/Painless): Inflammation of the thyroid gland, which can cause temporary hyperthyroidism followed by hypothyroidism, or persistent thyroid dysfunction, depending on the type.
• Thyroid Cancer (Differentiated - Papillary, Follicular; Medullary - follow-up care): Malignant tumors of the thyroid gland. Endocrinologists are involved in post-operative management, hormone suppression, and long-term surveillance.

Pituitary, Adrenal & Gonadal Axis Disorders

• Cushing's Syndrome & Cushing's Disease (Hypercortisolism): A hormonal disorder caused by prolonged exposure of the body's tissues to high levels of cortisol, either from medication (exogenous) or due to overproduction by the body (endogenous - e.g., pituitary or adrenal tumor).
• Adrenal Nodules (Incidentalomas) & Adrenal Tumors (e.g., Pheochromocytoma, Aldosteronoma): Masses found on the adrenal glands, often discovered incidentally. Evaluation is needed to determine if they are hormonally active or potentially malignant.

This list is not exhaustive. For personalized advice regarding your specific endocrine condition, please consult with Dr. Meranda Nakhla.

• Genetic Counseling Coordination & Testing for Hereditary Endocrine Neoplasia Syndromes & Familial Disorders: Risk assessment and coordination of genetic testing and counseling for individuals and families with suspected hereditary endocrine tumor syndromes (e.g., Multiple Endocrine Neoplasia - MEN1, MEN2; Von Hippel-Lindau), familial thyroid cancer, or other inherited endocrine conditions.
• Interpretation of Complex Hormonal Assays, Dynamic Endocrine Function Tests & Genetic Markers: Expert analysis and clinical correlation of specialized blood, urine, and saliva tests measuring various hormone levels. Includes interpretation of dynamic stimulation and suppression tests (e.g., ACTH stimulation, dexamethasone suppression, oral glucose tolerance test for acromegaly) to precisely evaluate endocrine gland function and identify genetic predispositions.
• Transitional Care for Young Adults with Chronic Endocrine Conditions: Facilitating the smooth transition of adolescents and young adults with lifelong endocrine disorders (e.g., Type 1 diabetes, congenital adrenal hyperplasia, hypopituitarism) from pediatric to adult endocrine care services.
• Inpatient & Outpatient Management of Endocrine Emergencies & Crises: Acute diagnosis and management of potentially life-threatening hormonal imbalances such as diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), thyroid storm, myxedema coma, adrenal crisis, severe hypoglycemia, and acute hyper/hypocalcemia, typically initiated in an emergency or hospital setting with ongoing outpatient follow-up.
• Comprehensive Endocrine System Consultation & Hormonal Health Evaluation: In-depth clinical assessment of potential hormonal imbalances and disorders affecting the endocrine glands (e.g., thyroid, pituitary, adrenal, pancreas, parathyroid, gonads). Includes detailed medical history, family history review, targeted physical examination, analysis of symptoms, and formulation of a personalized diagnostic and management plan.
• Expert Second Opinion Consultations for Complex or Rare Endocrine Disorders: Providing specialized second opinions on challenging endocrine diagnoses, interpretation of ambiguous hormone test results, or evaluation of complex or multi-faceted treatment plans.

Note: This list provides a general overview. Specific tests and treatments are determined after a thorough evaluation. Discuss with Dr. Nakhla for care relevant to your specific condition.

All medical services are provided in accordance with the standards of practice set by the Collège des médecins du Québec (CMQ) and relevant endocrinological care guidelines. Contact the clinic or your referring physician regarding new patient intake and referral processes.

Located within the MUHC - Montreal Children's Hospital in Montréal's Notre-Dame-de-Grâce (NDG) Central neighborhood, the practice is situated in a vibrant medical hub. The facility serves as a specialized unit within the hospital, offering expert endocrine care for children and adolescents. It is easily accessible via public transit, including the Société de transport de Montréal (STM) (Métro, Bus) systems, with the nearest Metro station being Mont-Royal. The hospital campus is wheelchair accessible, ensuring inclusive access for all patients. Paid parking options are conveniently located nearby, providing ease of visitations for families and caregivers. The location is ideally situated near Mont-Royal Metro Station Area and Plateau Mont-Royal Shopping & Dining, making it a central point for comprehensive pediatric endocrine services in Montréal.

Are consultations, hormone tests, and treatments with Dr. Nakhla, an Pediatric Endocrinologist, covered by Régie de l'assurance maladie du Québec (RAMQ) in QC?

Medically necessary consultations with a licensed Pediatric Endocrinologist like Dr. Nakhla, most standard diagnostic hormone blood tests, dynamic endocrine function tests when indicated, and treatments for provincially insured endocrine conditions (e.g., diabetes, thyroid disorders, adrenal insufficiency, osteoporosis management as per guidelines) are generally covered by Régie de l'assurance maladie du Québec (RAMQ) in QC when a referral from a family doctor or another specialist is in place. Some newer or specialized medications (e.g., certain advanced diabetes drugs, some growth hormone therapies, specific osteoporosis agents), medical devices (like some insulin pumps or continuous glucose monitors and their supplies), or treatments considered primarily for lifestyle or cosmetic reasons may have different coverage criteria or require special authorization. It's crucial to discuss coverage specifics for any proposed investigation or treatment with Dr. Nakhla's office, the hospital/clinic, or Régie de l'assurance maladie du Québec (RAMQ) directly.

Is a referral required to see Dr. Nakhla, an Pediatric Endocrinologist?

Yes, for services covered by the provincial health plan, a referral from your family physician or another specialist (e.g., an internist, pediatrician, or gynecologist) is almost always required to schedule an appointment with an Pediatric Endocrinologist such as Dr. Nakhla. Endocrine system disorders often involve complex interactions and can have wide-ranging effects, so an initial assessment by your primary care provider helps determine if specialist care is needed and ensures that relevant preliminary tests and medical history are available to the endocrinologist. This facilitates a more focused and efficient consultation.

What symptoms might lead my doctor to refer me to an Endocrinologist like Dr. Nakhla?

Your doctor might refer you to an Endocrinologist like Dr. Nakhla if you have symptoms or test results suggestive of a hormone imbalance or endocrine gland problem. This could include: unexplained significant weight gain or loss; persistent fatigue or lethargy; changes in mood or energy levels; excessive thirst or urination; new or worsening high blood sugar; symptoms of an overactive or underactive thyroid (e.g., palpitations, heat/cold intolerance, changes in hair/skin); bone density loss (osteoporosis); recurrent kidney stones; menstrual irregularities or fertility issues; unexplained high blood pressure; or physical changes like excessive hair growth, acromegaly features, or signs of Cushing's syndrome.

Dr. Nakhla mentioned 'dynamic endocrine testing'. What does that mean?

Dynamic endocrine testing involves tests that assess how your endocrine glands respond when stimulated or suppressed by specific substances. Unlike simple blood tests that measure baseline hormone levels, these tests evaluate the gland's functional reserve or its responsiveness to normal control mechanisms. For example, an ACTH stimulation test checks how well your adrenal glands produce cortisol when stimulated. A dexamethasone suppression test helps diagnose Cushing's syndrome by seeing if cortisol production can be suppressed. An oral glucose tolerance test can be used to diagnose diabetes or acromegaly. These tests usually involve taking a baseline blood sample, then administering a medication or substance, followed by one or more timed blood samples to measure hormone changes. Dr. Nakhla uses these tests for more precise diagnosis of certain complex endocrine conditions.

What treatment options for osteoporosis might Dr. Nakhla discuss?

If you are diagnosed with osteoporosis, Dr. Nakhla will discuss a management plan aimed at reducing your risk of fractures. This starts with lifestyle modifications, including ensuring adequate intake of calcium and vitamin D (through diet and/or supplements), engaging in regular weight-bearing and muscle-strengthening exercises, smoking cessation, and limiting alcohol intake. Fall prevention strategies are also important. If medication is indicated based on your bone density (DXA scan) and fracture risk assessment (e.g., using FRAX or CAROC tools), options include antiresorptive medications that slow bone loss (like bisphosphonates or denosumab) or anabolic agents that stimulate new bone formation (like teriparatide or romosozumab). She will help choose the most appropriate therapy based on your individual circumstances, potential side effects, and treatment goals.

I have a thyroid nodule. What can I expect during an evaluation with an Endocrinologist like Dr. Nakhla?

When evaluating a thyroid nodule, an Endocrinologist like Dr. Nakhla will conduct a thorough assessment. This typically involves reviewing your medical history (including any symptoms of thyroid dysfunction or family history of thyroid disease), performing a physical examination of your neck and thyroid gland, and ordering blood tests to check your thyroid function (TSH, and possibly free T4, T3, and thyroid antibodies). A thyroid ultrasound is almost always performed to precisely characterize the nodule's size, number, and sonographic features (e.g., solid, cystic, calcifications, irregular margins). Based on these ultrasound characteristics and the nodule's size, Dr. Nakhla will determine if a fine-needle aspiration (FNA) biopsy is needed to obtain cells for microscopic examination to rule out thyroid cancer. Most thyroid nodules are benign.

MUHC - Montreal Children's Hospital
1001 boul Décarie
Montréal, QC H4A 3J1

Phone: (514) 412-4400

The facility is wheelchair accessible.

Dr. Nakhla is a licensed Pediatric Endocrinologist regulated by the Collège des médecins du Québec (CMQ) under the Medical Act in QC. A referral from a family physician or pediatrician is typically required for consultations with Dr. Nakhla for pediatric endocrinology services covered by the provincial health plan.

Verify registration with the Collège des médecins du Québec (CMQ): https://www.cmq.org/en/directory/physicians?number=10615