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More On Endocrinology

Endocrinology is the medical specialisation on matters that concern the endocrine system, or hormones, in the human body. More specifically, it examines the human glandular system and complications arising from it.

Endocrinologists are specially trained physicians who diagnose patients with diseases related to the glands and provide effective, targeted treatment.

The Role of the Endocrinologist
An endocrinologist is a doctor who has studied the endocrine system and its diseases. These doctors know how to diagnose the diseases of the endocrine glands, and also how to treat them. Because these doctors specialize in these conditions, which are often complex and have vague / non-specific symptoms, an endocrinologist is your best advocate when dealing with hormonal issues.


a) What is the endocrine system?

The endocrine system is a series of glands that produce and secrete hormones that the body uses for a wide range of functions. These control many different bodily functions, including:

  • Respiration
  • Metabolism
  • Reproduction
  • Sensory perception
  • Movement
  • Sexual development
  • Growth

Hormones are produced by glands and sent into the bloodstream to the various tissues in the body. They send signals to those tissues to tell them what they are supposed to do. When the glands do not produce the right amount of hormones, diseases develop that can affect many aspects of life.

b) What are typical endocrine disorders?

The endocrinologist specialises in treating disorders of the endocrine system such as hyperthyroidism, hypothyroidism, diabetes, disorders of menopause, PMS, andropause, infertility, pituitary disorders such as growth hormone deficiency and adrenal disorders such as Cushing’s disease or Addison’s disease.

c) What are the different types of endocrine diseases?

a. Tumours: Tumours in the glands, whether cancerous or benign, can cause hormone imbalance.
b. Gland hypersecretion: Occurs when a gland secretes too much of the hormone it is designed to create.
c. Gland hyposecretion: Diseases caused when the body has a deficiency of a certain hormone due to the glands secreting too little of it.

d) What is the thyroid gland?

The thyroid gland is part of the endocrine system and is responsible for producing and releasing thyroid hormones into the bloodstream.

e) What does my thyroid gland do?

The thyroid gland produces hormones, which regulate the body’s metabolic rate as well as heart and digestive function, muscle control, brain development and bone maintenance. Its correct functioning depends on having a good supply of iodine from the diet.

f) What could go wrong with my thyroid gland?

The thyroid gland can become overactive (hyperthyroidism) or underactive (hypothyroidism). This may, rarely, occur from birth, or develop later on in life. Hypothyroidism is often accompanied by an enlargement of the thyroid gland known as goitre.

g) What is hypothyroidism?

Hypothyroidism, also known as an under-active thyroid, is a condition where the thyroid gland does not create enough of a thyroid hormone called thyroxine. Thyroid hormones regulate the way in which the body uses energy – metabolism – and without enough thyroxine many of the body’s functions slow down. Thyroid hormones affect multiple organ systems, meaning that the symptoms of hypothyroidism are wide-ranging and diverse, affecting different people in different ways. Symptoms and signs of hypothyroidism include:

  • Fatigue
  • Weight gain
  • Cold intolerance
  • Joint and muscle pain
  • Constipation
  • Dry skin
  • Thin, brittle hair or fingernails
  • Decreased sweating
  • Heavy periods (menorrhagia)
  • Slowed heart rate
  • Weakness
  • High cholesterol
  • Puffy face, feet and hands.
  • Decreased taste and smell
  • Hoarseness
  • Slow speech
  • Thickening of skin
  • Peripheral neuropathy
  • Mental health issues: including depression and memory impairment
  • Infertility
  • Birth defects
  • Myxedema: a rare, life-threatening condition characterized by intense cold intolerance and profound lethargy.

Hypothyroidism is a condition that develops slowly, meaning that symptoms may go unnoticed for a long period of time and can be difficult to spot.

h) What is hyperthyroidism?

Hyperthyroidism is a condition where the thyroid produces more thyroxine than is needed by the body. It is also referred to as thyrotoxicosis, or an over-active thyroid.
It can occur if you have:

  • Graves’ disease (the most common cause)
  • Toxic multinodular goitre (a goitre is an enlarged thyroid gland)
  • Solitary toxic thyroid adenoma (an adenoma is a clump of cells)
  • Thyroiditis (inflammation of the thyroid gland)

It can also occur when too much replacement thyroxine (levothyroxine) is taken as a treatment for an under-active thyroid (hypothyroidism). Hyperthyroidism is more common in women. About 8 in 100 women and 1 in 100 men develop hyperthyroidism at some stage of their lives. It can occur at any age.

If there is too much thyroid hormone, every function of the body tends to speed up. It is not surprising then that some of the symptoms of hyperthyroidism are nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of your skin, fine brittle hair and weakness in your muscles—especially in the upper arms and thighs. Symptoms of thyrotoxicosis include intolerance to heat, weight loss, increased appetite, increased bowel movements, irregular menstrual cycle, rapid and irregular heartbeat, palpitations, tiredness, irritability, tremor, hair loss and retraction of the eyelids resulting in a ‘staring’ appearance. As the hyperthyroidism continues, the body tends to break down, so being tired is very common.

The most common cause is overproduction of thyroid hormone by the entire thyroid gland. This condition is also known as Graves’ disease, and antibodies in the blood that turn on the thyroid and cause it to grow and secrete too much thyroid hormone cause it. This type of hyperthyroidism tends to run in families and it occurs more often in young women. Little is known about why specific individuals get this disease.

Hyperthyroidism usually begins slowly but in some young patients these changes can be very abrupt. At first, the symptoms may be mistaken for simple nervousness due to stress. If you have been trying to lose weight by dieting, you may be pleased with your success until the hyperthyroidism, which has quickened the weight loss, causes other problems.

i) What is a goitre?

Enlargement of the thyroid (goitre) can occur due to iodine deficiency or thyroid tumours. If you suspect that you have an enlarged thyroid, you should seek medical advice as soon as possible.

j) What are adrenal glands?

The adrenal glands are two glands that sit on top of your kidneys that are made up of two distinct parts.

      • The adrenal cortex—the outer part of the gland—produces hormones that are vital to life, such as cortisol (which helps regulate metabolism and helps your body respond to stress) and aldosterone (which helps control blood pressure).
      • The adrenal medulla—the inner part of the gland—produces essential (you need them to live) hormones, such as adrenaline and noradrenaline (which helps your body react to stress).
k) What are some of the most common disorders and diseases of the adrenal glands?
  • Addison’s disease
    This rare disorder may affect anyone at any age. It develops when the adrenal cortex fails to produce enough cortisol and aldosterone.
  • Adrenal cancer
    Adrenal cancer is an aggressive cancer, but it’s very rare. Malignant adrenal tumors are rarely confined to the adrenal glands—they tend to spread to other organs and cause adverse changes within the body because of the excess hormones they produce.
  • Cushing’s syndrome
    Cushing’s syndrome is an uncommon condition that is essentially the opposite of Addison’s disease. It is caused by overproduction of the hormone cortisol. There are a variety of causes of this disorder—a tumour in the adrenal gland or pituitary gland could be to blame.
  • Congenital adrenal hyperplasia
    This genetic disorder is characterized by low levels of cortisol. It’s common for people with congenital adrenal hyperplasia to have additional hormone problems such as low levels of aldosterone (which maintains a balance of water and salt).
l) What is the pituitary gland?

The pituitary is an important gland in the body and it is often referred to as the ‘master gland’, because it controls several of the other hormone glands (e.g. adrenals, thyroid).

It is usually about the size of a pea and consists of two parts (often called lobes) – a front part, called the anterior pituitary and a back part, called the posterior pituitary.

The pituitary gland sits in a bony hollow called the pituitary fossa. This is behind the bridge of the nose and below the base of the brain, close to the optic nerves.

m) What can go wrong with my pituitary gland?

The most common problem with the pituitary gland occurs when a benign growth (often referred to as ‘adenoma’ or ‘tumour’) develops. This can cause the gland to produce excess hormone, or it can block hormone production, or it can be ‘non functioning’ (hormone production not affected in any way).

Other rarer causes of pituitary disorders include traumatic brain injury and pituitary infarction (also known as pituitary apoplexy).

n) What is diabetes?

Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. This is because your pancreas doesn’t produce any insulin, or not enough insulin, to help glucose enter your body’s cells – or the insulin that is produced does not work properly (known as insulin resistance). Insulin is the hormone produced by the pancreas that allows glucose to enter the body’s cells, where it is used as fuel for energy so we can work, play and generally live our lives. It is vital for life.

Diabetes is very common, with an increasing number of people being affected by the condition every year. In 2011, it was estimated that around 366 million people have diabetes worldwide, with this number predicted to grow to 552 million by 2030.

There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes.

Type 1 diabetes usually develops in childhood or adolescence, but usually appears before the age of 40, particularly in childhood. Around 10% of all diabetes is type 1, but it’s the most common type of childhood diabetes. This is why it’s sometimes called juvenile diabetes or early-onset diabetes.

In type 1 diabetes, the pancreas doesn’t produce any insulin – the hormone that regulates blood glucose levels. This is why it’s also sometimes called insulin-dependent diabetes. If the amount of glucose in the blood is too high, it can, over time, seriously damage the body’s organs.

In type 2 diabetes, the body either doesn’t produce enough insulin to function properly, or the body’s cells don’t react to insulin. Around 90% of adults with diabetes have type 2, and it tends to develop later in life than type 1.

When does diabetes occur?

Diabetes develops when glucose can’t enter the body’s cells to be used as fuel. This happens when either:

                • There is no insulin to unlock the cells (Type 1)
                • There is not enough insulin or the insulin is there but not working properly (Type 2).
o) What are diabetic complications?

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

        • Cardiovascular disease.Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.
        • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
        • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
        • Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
        • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
        • Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.