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|Posted By : Dr.Gagan Priya, DM Endocrinology, MD Medicine|
|Posted On : 16 Aug 2009 (Total Views : 3602)|
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Our body functions are regulated by an intricate network of glands called ENDOCINE GLANDS that secrete molecular substances called HORMONES. The endocrine system is one of the body’s main systems for coordinating the body’s work and maintains energy, reproduction, growth and development, internal balance and responses to stress and injury.
Endocrine/ hormonal disorders happen when one or more of the endocrine systems in your body are not working well. Hormones may be released in amounts that are too much or too little for the body to work normally. This hormone imbalance (or endocrine disease) can affect your health in many ways. All of us are well aware that diabetes and hypothyroidism are the most common hormonal disorders. But this is truly just the tip of the iceberg.
The thyroid is a small butterfly-shaped gland in the neck, in front of the airway and secretes thyroid hormones. Thyroid hormones influence virtually every organ system in the body, telling them how fast or slow to work.
Too much thyroid hormone speeds up the body's metabolism (hyperthyroidism). If you are experiencing unexplained weight loss, rapid heartbeat, diarrhea or frequent bowel movements, irritability and anxiety, intolerance to heat, excess sweating, trembling of hands or fatigue, you may be suffering from hyperthyroidism and need evaluation.
On the contrary, hypothyroidism (too little thyroid hormone) is a very common problem and you should get your thyroid profile tested if you have weight gain, dry skin, loss of hair, fatigue, sluggishness, depression, constipation, menstrual irregularities, difficulty in conceiving or recurrent abortions.
A third and common group of thyroid disorders is the presence of abnormal lumps or swellings, called thyroid nodules. Although most nodules are not cancerous, people who have them should seek endocrinological opinion to rule out cancer.
Growth and development is directed by pituitary (the “master gland”), which secretes Growth hormone (GH). Deficiency of this can lead to poor growth in your child, but the good news is that this a treatable condition, with the availability of Growth hormone preparations. There are several other factors that affect growth and can be diagnosed and treated. Thus, your child merits an evaluation by an endocrinologist if he/ she is not growing well.
Rarely, excess of GH can lead to excess growth in a child (gigantism) and acromegaly in adults, with the patient complaining of body aches, excess snoring, increase in shoe size, headaches, diabetes, high blood pressure, menstrual disturbances or decreased sexual drive.
The pituitary is a very tiny gland but one of the most interesting, as it secretes several hormones which affect other glands. Sometimes, tumors in this gland secrete excess of particular hormones. At other times, there may be deficiencies of the various hormones produced.
Pituitary disease is suspected if one has unexplained milk discharge from breasts, poor growth and sexual development, irregular menstrual cycles, failure to breastfeed the baby after delivery, infertility, impotence or inability to get or maintain an erection, sudden blackouts or giddiness while standing, low blood pressure, headaches, visual defects (field defects) or rare conditions like acromegaly or Cushing’s disease.
Your endocrinologist can assess these symptoms and carry out a battery of investigations to reach at the appropriate diagnosis and plan your therapy. Treatment is focussed on hormonal replacement for the particular deficient hormones and definitive treatment for the underlying cause such as surgery and radiotherapy for pituitary tumors.
PCOS is the most common hormonal disorder among women of reproductive age and is a leading cause of infertility. Obvious signs include irregular or absent menstrual cycles, abnormal facial and bodily hair growth, acne, thinning/loss of hair on the scalp, weight gain, darkening of skin at the back of the neck and axilla (acanthosis) and polycystic ovaries, although not all patients have all these features.
Because women with PCOS ovulate (release an egg monthly) infrequently, they often have difficulty getting pregnant and are often diagnosed when they cannot conceive. PCOS can lead to increased risk for problems such as diabetes, heart disease, and certain kinds of cancer. While thin women can have PCOS, weight gain is more likely.
Other disorders such as those that affect adrenal or thyroid glands may mimic PCOS. For this reason, a careful evaluation of your individual case history and laboratory tests by the endocrinologist are essential for an accurate diagnosis. While there is still no cure for PCOS, the good news is that there are many effective ways to treat these symptoms. Together with changes in diet and exercise, these treatments are empowering women with PCOS to lead healthier and more satisfying lives. Even the problem of infertility can often be corrected and conception can occur.
Osteoporosis and Metabolic Bone Disease
Most of us are well aware that osteoporosis (poor bone strength) leads to increased risk of fractures and occurs as a part of aging process, especially after menopause if you are a female. And it is also known that we need to take calcium and vitamin D to improve our bone health. Still, I have seen people complaining at BMD camps that their bone density is poor though they take regular supplements.
It is important to understand that poor bone health may result from an entire spectrum of hormonal disorders like hyperparathyroidism, defects in vitamin D action, renal failure, hypophosphatemia, hyperthyroidism, steroid abuse, Cushing’s syndrome, hypogonadism and growth hormone deficiency. Proper diagnosis and treatment of these hormonal conditions can save you from serious fractures and loss of mobility. Your endocrinologist can also guide you to choose from a range of therapies for improvement of the already lost bone mass.
Another disorder of calcium metabolism relates to low calcium levels in your blood. You may complain of numbness and tingling sensation over fingers or mouth, spasm of hands and feet, cataract at a young age or repeated convulsions.
Disorders of Sexual Development and Function
Sexual development starts in the mother’s womb and completes at the time of puberty. It is regulated by endocrine glands (including the hypothalamus, pituitary and ovaries or testis) in a complex pattern. Any hormonal abnormality can adversely affect this process and lead to disorders of sexual development.
Disorders of puberty may manifest as sexual development getting delayed or not occurring at all, occurring too early, or in a wrong direction (male features developing in a female such as excess facial hair, acne, loss of scalp hair, thickening of voice, clitoral enlargement). Hormonal problems may also arise at a later age and lead to hypogonadism. The patient may suffer from menstrual irregularities, infertility, decreased sexual interests, decreased shaving frequency, impotence, loss of muscle mass and bone mass.
Rarely a child may be born with genitalia which are not clearly male or female and this is a cause of serious psychological distress for the parents and later the child.
In a society, where discussing such issues is considered a taboo, one needs to understand that these are treatable conditions and the individual can live a life as normally as the person next door. With rapid advances in the field of endocrinology in recent times and the range of specific hormone replacement therapies available, there is a lot of hope for those with such problems.
Adrenal Disorders and Steroid Abuse
Tumors of the adrenals can lead to excess weight gain, diabetes, abnormal stretch marks, thin fragile skin, muscle weakness, osteoporosis, uncontrolled blood pressure and merits a thorough evaluation and treatment.
One of the most common, and yet often neglected, problem results from the irrelevant use of steroids (glucocorticoids) by quacks. Steroids provide instant relief in many problems and infuse a feeling of well being. But they cause long term complications, because of the high steroid levels in your body and you cannot stop them abruptly as the body becomes dependent on them. Such quack practice needs to be strongly discouraged and one should take steroids only under careful supervision of an expert, who can assess your need and titrate the doses carefully.
Obesity and Metabolic Syndrome
Last but not the least, let me just talk of the growing menace of modern society which is no longer a problem of the Western world – the Obesity epidemic. With modern lifestyle, increasing consumption of fastfood and sedentary habits, a large proportion of our population is crossing the boundary between normal and overweight. This has lead to an enormous increase in the risk of diabetes, high blood pressure, high cholesterol, cardiac disease, stroke, kidney disease, osteoarthritis, gout, polycystic ovaries, certain cancers, sleep disturbances among others.
What is most distressing is the rising trend of obesity in children, which is often misinterpreted as a sign of good health by parents. A recent survey conducted by AIIMS in school children revealed shocking results. One fourth of the school children were overweight or clearly obese.
I would agree that it is very simple to advise weight loss but really difficult to achieve and then sustain it. The specialist can help chalk out a plan tailored for your specific needs and also rule out hormonal problems which might be actually responsible for your excess weight. Ongoing research has also lead to development of specific medicines, which may help in weight reduction, but need to be taken under supervision.
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