Centres of Excellence

Endocrinology refers to study of endocrine glands that produce hormones. It deals with disorders of hormones and metabolism.

• Diabetes
• Thyroid disorders
• Growth and sexual development disorders
• Osteoporosis, Osteomalacia, Calcium and parathyroid gland disorders.
• Hyperandrogenic disorders like Hirsutism, polycystic ovaries.
• Obesity
• Infertility (ovulatory defects, Disorders of pituitary)
• Disorders of pituitary, adrenal and other Hormonal disorders.

Diabetes Mellitus is the commonest endocrine disorders. It is due to absolute or relative deficiency of Insulin and insulin action.

Diabetes Mellitus is of two principal varieties. Type 1 is due to destruction of pancreas resulting in insulin deficiency and diabetes mellitus. Type 1 diabetes subject need insulin for survival.
Type 2 diabetes is much more common constituting 95% of total diabetic subjects. It is due to relative insulin deficiency combined with decrease in its effectiveness in regulating glucose ant other metabolic processes. Type 2 diabetes is more common in subjects with family history of diabetes.



 

Diabetes may present with loss of weight, increased thirst, increased frequency of urination, genitourinary infections etc. Many patients are asymptomatic. Therefore not only patients with symptoms but subjects at high risk such as overweight, family history of diabetes should undergo blood test for diagnosis.

India has the largest number of Diabetic subjects in the world. Diabetes is more common in cities. Type 2 Diabetes is much more common constituting 95% of total diabetic subjects. It is due to relative insulin deficiency combined with decrease in its effectiveness in regulating glucose ant other metabolic processes. Type 2 diabetes is more common in subjects who are overweight, have sedentary lifestyle, consume high fat, high calorie diet with low fiber. Recent increase in T2DM is due changed lifestyle over last few decades. Indians are also genetically predisposed to develop Diabetes Mellitus.

Type 2 diabetes Mellitus subjects can be managed by diet and lifestyle modification, oral tablets and insulin. Diet and Lifestyle modifications  are cornerstone of diabetic management but drugs are mostly required. Type 1 diabetes need insulin for survival.

Acute complications of Diabetes are Diabetic ketoacidosis and hyperosmolar Coma. Chronic complications of Diabetes are related to heart (Coronary artery disease), Brain (stroke), Kidney (renal failure), eyes (blindness), Nerves (neuropathy, chronic foot ulcer). Optimum treatment can control diabetes and prevent complications related to eye, nerves, kidneys, feet and heart etc.

There are incretin based based treatment for type 2 Diabetes, These agents increase insulin secretion depending on ambient glucose levels.Incretin mimetic Exenatide and Liraglutide are injectable preparations for treatment of hyperglycemia in type 2 Diabetes.These drugs also lead to some weight loss.DPP IV iinhibitors are oral drugs that increase incretin levels and help to control hyperglycemia in Type 2 diabetes.

Type 1 Diabetes patients have access to newer insulin analogues such as ultra short acting insulins (Insulin aspart, insulin lispro and insulin glulisine) and long acting insulin analogues such as (insulin Glargine and insulin Detemir). These insulin analogues are expensive but are good at achieving better glycemic control without hypoglycemia. Research is still on in field of stem cell therapy, immunomodulation, beta cell replacement for treatment of type1 diabetes patients.




 

Thyroid disorders are also very common. Patients may present with neck swelling due to thyroid enlargement (Goiter), symptoms of hyperthyroidism (weight loss with normal or increased appetite, palpitations, tremors etc) or symptoms of hypothyroidism (lethargy, weight gain etc). Thyroid swelling can be malignant also.
 

Earlier iodine deficiency was most common cause of goiter. However iodination of salt has reduced this problem. Auto immunity is principal cause of thyroid disorders these days.

A proper diagnosis can be made by blood tests, radio isotope studies, fine needle aspiration for cytology etc.

Thyroid disorders can be managed by drugs, radio iodine therapy or surgery.

Most of thyroid disorders require long term treatment. For subjects with hypothyroidism therapy can be life-long. One should not stop or change treatment without doctor’s advice.

A child who is shorter than his peers and is not growing as per his/her age should be evaluated by the doctor.

Hypothyroidism, Growth hormone deficiency, Cushing syndrome are common hormonal causes of short stature.

Defects of sexual development can be genetic,Hypothalamic- Pituitary or gonadal disorders.

Ovulatory dysfunction and oligo-azoospermia because of hypothalamus pituitary disorders are hormonal causes of Infertility.

Osteomalacia/ Rickets, Osteoporosis, disorders of parathyroids are common metabolic bone disorders.

Patients with metabolic bone disorders may present with bone pains, deformity and fragility fractures.

Patients of pituitary disorders may present with pituitary hyperfunction (acromegaly/ Gigantism, Cushing’s syndrome, hyper prolactinemia), pituitary hypofunction (hypo pituitarism) or visual problems due to pituitary tumour.

Patients with pituitary disorders can be managed by drugs, surgery or radiation therapy.

Patients with adrenal disorders may present with hypertension, weight changes, skin changes.

Obesity could be due to genetic disorders, hormonal disorders and flawed lifestyle.

Obesity can be managed by treatment of underlying hormonal disorder if any. For common obesity lifestyle modification is must. Drugs can be given to select patients. For patients with extreme obesity, surgery is advised.