Endocrinology

Each person has two adrenal glands, with each sitting on top of each kidney. Disease of the adrenal glands are divided into two categories:

1. Functional or secretory: and this depends on type of hormone being secreted from the adrenal gland. There are several disorders that can occur. These disorders are extremely rare, but can lead to other medical conditions. For example diabetes, obesity, hypertension, excess hair growth and electrolyte imbalance. Hormones that can be secreted include but are not limited to cortisol, aldosterone, testosterone and DHEA-s (Dehydroepiandrosterone sulfate).
2. Structural or anatomical: and this depends on type and size of the growth. Most commonly there are benign growths on the adrenal gland named adrenal adenomas. If they are large enough or co-secrete hormones then surgery is indicated.

Endocrinologists will work with your primary care provider to establish a treatment plan.

Calcium is an important component of the body and is necessary for both the skeleton and a variety of functions.

These include:

• Muscle contraction
• Nerve transmission
• Platelet function
• Hormone excretion
• and many others

The calcium level in the body is regulated by parathyroid hormone and vitamin D. Parathyroid hormone is produced by the parathyroid glands that are located behind the thyroid in the neck. Disorders of calcium, vitamin D and parathyroid hormone are typically diagnosed and managed by endocrinologists in conjunction with your primary doctor.

Cholesterol is a fat-like, waxy substance that can be found in all parts of your body. It aids in the production of cell membranes, many hormones, and vitamin D. The cholesterol in your blood comes from two sources: the foods you eat and your liver. However, your liver makes all of the cholesterol your body needs.

Cholesterol and other fats are transported in your blood stream in the form of spherical particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

Find out all about the Diabetes Learning Center.

Type 1 diabetes mellitus is a chronic condition in which the pancreas produces little or no insulin (the hormone that controls sugar or glucose levels in the blood and allows us to use sugar for energy). While this disorder is typically diagnosed in children and teenagers, it can occur at any age.  People who have type-1 diabetes are at increased risk for a variety of serious conditions.  These include heart disease and stroke, blindness, kidney failure and nerve damage (resulting in loss of limbs).  We know through medical research that good control of a person's blood glucose level can greatly reduced the risk of these complications.  In the dept of Endocrinology, we use a team consisting of physicians, diabetes educators, dietitians and nurses to provide a comprehensive and individualized approach to diabetes care.

Type 2 diabetes mellitus is a condition of abnormally high blood sugars caused by the body’s inability to make enough, or to properly use, insulin.  Insulin is a hormone which moves blood sugar into the body’s cells and keeps blood sugar levels normal.  Type 2 diabetes is the most common form of diabetes and used to be called non-insulin-dependent diabetes (NIDDM).

What is pre-diabetes?
Type 2 diabetes is commonly preceded by pre-diabetes.  In pre-diabetes, blood sugar levels are higher than normal but not high enough to be defined as diabetes.  Many people with pre-diabetes develop type 2 diabetes.  Much like type 2 diabetes, pre-diabetes increases the risk of developing heart disease and stroke.  With modest weight loss and moderate physical activity, people with pre-diabetes can delay or prevent type 2 diabetes.

What are some risk factors for type 2 diabetes?

• Age (people over age 45 are at higher risk for type 2 diabetes)
• Family history of diabetes
• Being overweight or obese
• Not exercising regularly
• Race and ethnicity (African-Americans, Hispanic Americans, and Native Americans are at increased risk for developing type 2 diabetes
• History of gestational diabetes or giving birth to a baby that weighed more than 9 pounds
• A low HDL cholesterol level (high-density lipoprotein – the “good” cholesterol)
• A high triglyceride level

How is type 2 diabetes managed?

• Proper diet
• Regular physical exercise
• Maintaining a normal body weight—every pound a person is above his or her ideal body weight increases the risk for type 2 diabetes
• Oral medications—help the body to make more insulin or improve how the body responds to its own insulin
• Insulin—Most people with type 2 diabetes eventually get to the point when they are not able to make enough insulin.  The need for insulin therapy is not a sign of failure—this is simply the natural progression of the disease in many people.
• Regular monitoring of blood sugar

Appropriate growth is important for both normal physical and psychological development. A growth rate that is too rapid or too slow can sometimes indicate a significant underlying medical illness. 

Growth evaluations usually begin with a careful medical history review.  We are especially interested in the patient's growth history, as well as the heights, weights, and growth patterns of close relatives  A complete physical exam can often offer clues as to the nature of the growth issue.  A simple x-ray known as a "bone age" can give us information as to how a person's actual age matches their stage of development.  These x-rays can also give us clues concerning a person's growth potential.  We typically perform blood and urine testing to rule out various medical and endocrine illnesses. 

Some patients need more complex studies of growth hormone production to see if they would benefit from growth hormone treatment.

Osteoporosis is a disease of the bones. It makes your bones less dense and weak. This can lead to fractures that can affect your life. The most devastating osteoporotic fracture can affect your hip which may limit your mobility. It also can lead to fractures of other bony parts of your body and can lead to pain and limit your activity. 30-50% of women and 15-30% of men will suffer a fracture related to osteoporosis in their lifetime.

However, osteoporosis can be prevented through proper diet and activity and the use of certain medications.

If you have osteoporosis, it is not too late to manage it, and a fracture can be prevented. Endocrinologists can help you prepare for a plan to prevent or to manage established osteoporosis.

Parathyroid glands produce parathyroid hormone, which plays a role in the regulation of calcium levels in the blood. Precise calcium levels are important in the human body, since small deviations can cause muscle and nerve impairment.

The parathyroid hormone stimulates the following functions:

• release of calcium by bones into the bloodstream
• absorption of calcium from food by the intestines
• conservation of calcium by the kidneys

The following are a few articles related to parathyroid disorders.  The individual articles can also provide you with access to other useful health information about this an a wide range of health issues.

Our pediatric endocrinologist specializes in the evaluation and treatment of patients under the age of 18 with a range of hormonal conditions, gland disorders, juvenile diabetes or other issues, including:

• Diabetes mellitus
• Diabetes insipidus
• Growth problems, such as short stature
• Early or delayed puberty
• Enlarged thyroid gland (goiter)
• Underactive or overactive thyroid gland
• Pituitary gland problems
• Adrenal gland excess or insufficiency
• Low blood sugar (hypoglycemia)
• Problems with vitamin D or calcium (rickets, high or low calcium)

The pituitary gland is sometimes called the "master" gland of the endocrine system because it controls the functions of the other endocrine glands. The pituitary gland is no larger than a pea, and is located at the base of the brain. The gland is attached to the hypothalamus (a part of the brain that affects the pituitary gland) by nerve fibers.

The functions of the pituitary gland include:

• Growth hormone
• Prolactin (to stimulate milk production after giving birth)
• ACTH (adrenocorticotropic hormone stimulates the adrenal glands)
• TSH (thyroid-stimulating hormone stimulates the thyroid gland)
• FSH (follicle-stimulating hormone stimulates the ovaries and testes)
• LH (luteinizing hormone stimulates the ovaries or testes)

What is testosterone?

Testosterone is a hormone made by the testes which is very important in male biology. It helps to maintain sexual function and fertility, muscle mass, blood counts, and normal bone density.

What are some conditions associated with abnormally low testosterone levels?

Type 2 diabetes mellitus

Obesity

Sleep apnea

What are some signs and symptoms of low testosterone levels?

Low testosterone levels can result in many different symptoms. Fatigue and loss of muscle mass or strength can be noted. Sexual problems such as erectile dysfunction or inability to achieve orgasm can develop. Other physical symptoms can include breast tenderness or enlargement. Your health care provider will perform a thorough evaluation and laboratory profile to determine if you may be a candidate for testosterone replacement therapy.

What methods of testosterone replacement are available?

• Testosterone patches
• Testosterone gels or creams
• Testosterone intramuscular injections

What are the risks of testosterone replacement therapy?

Testosterone replacement therapy is generally safe and well tolerated. Potential adverse effects include enlargement of the prostate or problems with urination. Testosterone replacement may also cause elevation in certain blood counts or lowering of HDL (high-density lipoprotein – the “good” cholesterol) levels. Your health care provider will need to periodically perform blood work as well as physical examinations to monitor how well you are responding to therapy.

The thyroid gland is located in the anterior part of the neck. It moves up or down with swallowing, but we don’t feel it. In fact it is located in front of our voice box and the soft tissue around it is our thyroid.

Thyroid disorders are divided into different categories:

1. Over secretion of thyroid hormone is called “Hyperthyroidism.” This is mainly due to Graves’ disease in which all of the thyroid gland becomes overactive. It can be associated with other features; the main one affects the eyes and is called Graves’ ophthalmopathy (eye disease) in which the eyes can become dry and itchy, the eye lids can swell up, the white section of the eyes can become red due to the inflammation. In severe cases, the eyes can bulge out of the eye sockets and rarely it can lead to blindness.  Hyperthyroidism can lead to serious health effects if not treated properly.
2. Under secretion of thyroid hormone “Hypothyroidism.” This occurs usually due to Hashimoto thyroiditis.  It is more common in women and on occasions can affect several members of the same family.
3. Anatomical: In which the thyroid gland shape can change due to a benign growth (adenoma or cyst) or a malignant growth.

Endocrinologists utilize different radiological methods and lab evaluation and if needed biopsies to differentiate between the above disorders. We work with your primary care provider and if needed would refer you to the proper surgery expert.