Endocrinology

Care begins with assessing the concerns and needs of each individual, with communication of information that increases understanding of the disease process, allays anxiety, and enhances coping skills.

Treatment plans are individualized and are designed to maximize safety, address the most troubling symptoms, anticipate and minimize future problems, and reflect up-to-date knowledge.

Endocrinological diseases or symptoms

Patient with endocrine disorders or metabolic disturbances are often referred by their practitioner to our unit. Frequently, patients make an appointment because of abnormal laboratory values or symptoms that may be related to endocrine disorders as listed below:

  • Thyroid diseases
    Thyroid goiter
    Thyroid carcinoma, thyroid nodules
    Hyperthyroidism (i.e. grave's disease, multiple autonomy ("hot nodules")
    Hypothyroidism (i.e. case of immune thyroiditis, Hashimoto`s thyroiditis)


  • Dysfunction parathyroid glands (hypercalcaemia or hypocalcaemia) in
    Hypoparathyreoidism or Hyperparathyreoidisms (a lack or an excess of parathyroid hormone with low or high calcium in the blood)


  • Diseases of the adrenal glands

    Cushing-Syndrom = Hypersecretion of cortisone or drug induced with symptoms of overweight, striae and sometimes infections

    Hyperaldosteronisms:
    Conn Syndrom = Hypersecretion of aldosterone with Hypopotassianemia

    Morbus Addison:
    Lack of cortisone and other adrenal hormones with feelings 
    of weakness dehydration, hypotension, or shock out of proportion to severity of current illness, Unexplained hypoglycaemia, Hyponatremia, hyperkalemia, azotemia, hypercalcemia, or eosinophilia, Hyperpigmentation or vitiligo  

    In combination with other autoimmune endocrine deficiencies, such as hypothyroidism or gonadal failure

    Adrenogenital Syndrom
    = Syndromes, simple virilizing form (presenting as genital ambiguity) and a salt-wasting form (presenting as hyponatremia, hyperkalemia, and hypotension. The deficiency may also cause sexual precocity in children. Adolescent and adult women have acne, hirsutism and menstrual irregularity that are indistinguishable from the polycystic ovary syndrome

    Pheochromozytoma
    = Excess of adrenaline with hypertension, arterial hypertension hormonally conditioned

       

      • Dysfunction of the pituitary

        Acromegaly = Gigantism

        Prognathism, Arthralgias and arthritis, Carpal tunnel syndrome, Acroparesthesia Hypertrophy of frontal bones

        Menstrual abnormalities, Galactorrhea, Decreased libido, impotence, low levels of sex hormone-binding globulin. Multiple endocrine neoplasia type 1, Hyperparathyroidism, Pancreatic islet-cell tumors

        Cushing-Syndrom
        (excess of cortisol) = Centripetal obesity, Facial plethora

        Glucose intolerance, Weakness, proximal myopathy, Hypertension, Psychological changes Easy bruisability, Hirsutism, Oligomenorrhea or amenorrhea, Impotence, Acne, oily skin, Abdominal striae, Ankle edema

        Prolactinoma 
        Hyperprolactinemia in premenopausal women causes hypogonadism, manifested by infertility, oligomenorrhea, or amenorrhea and less often by galactorrhea

        Panhypopituitarisms
         = Lack of pituitarian hormones

       

       

          • Diabetes mellitus

            Diabetes mellitus = Hyperglycemia often accompanied with hyperlipidemia 
            (metabolic syndrom)

           

           

          • Hyperlipidaemia and metabolic syndrome

            World Health Organization - A World Health Organization (WHO) diabetes group proposed a set of criteria for the metabolic syndrome in 1998 with the recognition that these criteria could be modified as more was learned about the syndrome.

            Insulin resistance, impaired glucose tolerance, or diabetes were included in this definition, which follows:

            • Hyperinsulinemia or a fasting plasma glucose (FPG) 110 mg/dL (6.1 mmol/L) or a plasma glucose two hours after an oral glucose tolerance test 200 mg/dL (11.1 mmol/L).

            • PLUS at least two of the following: Abdominal obesity, defined as a waist-to-hip ratio >0.90, a body mass index (BMI) 30 kg/m2, or a waist girth 94 cm (37 in) (see "Clinical evaluation of the overweight adult", section on Determination of degree and type of overweight) Dyslipidemia, defined as serum triglyceride 150 mg/dL (1.7 mmol/L) or high-density lipoprotein HDL cholesterol <35 mg/dL (0.9 mmol/L) Blood pressure 140/90 mmHg or the administration of antihypertensive drugs.



          • Postmenopausal syndrome

            The menopausal transition begins with variation in menstrual cycle length and an elevated serum FSH concentration and ends with the final menstrual period (not recognized until after 12 months of amenorrhea).
            Stage -2 (early) is characterized by variable cycle length (>7 days different from normal menstrual cycle length, which is 21 to 35 days). Stage -1 (late) is characterized by 2 skipped cycles and an interval of amenorrhea 60 days; women at this stage often have hot flashes as well.

            Menopause is defined by 12 months of amenorrhea after the final menstrual period. It reflects complete, or near complete, ovarian follicular depletion and absence of ovarian estrogen secretion. 

            The most common acute change during menopause is the hot flash, which occurs in up to 75 percent of women in some cultures, but only about 20 percent of these women seek medical attention for treatment of their flashes. As noted above, hot flashes are most common in the late menopausal transition and early postmenopausal periods.

           
           

          • Hirsutisms:

            Hirsutism, defined as excessive male-pattern hair growth, affects between 5 and 10 per cent of women of reproductive age. It may be the initial, and possibly only, sign of an underlying androgen disorder, the cutaneous manifestations of which may also include acne and male-pattern balding (androgenic alopecia). Depending upon the body site, hormonal regulation plays an important role in the hair growth cycle. Race and ethnicity are important determinants of body hair distribution in women. Polycystic ovary syndrome is the most common cause of hirsutism.

            The diagnosis of idiopathic hirsutism is given to women with hirsutism with normal serum androgen concentrations, no menstrual irregularity, and no identifiable cause of their hirsutism. Other causes include congenital adrenal hyperplasia, ovarian and adrenal androgen-secreting tumors, medications, and other rare disorders.


          • Excess or lack of sexual hormones

            Women: After excluding pregnancy, the most common causes of secondary amenorrhea are: Ovarian disease - 40 percent Hypothalamic dysfunction - 35 percent Pituitary disease - 19 percent Uterine disease - 5 percent

            Men: When testosterone deficiency first occurs after puberty has been completed, symptoms may include a decrease in energy and libido, erektile dysfunktion, that occur within days to weeks. However, sexual hair, muscle mass, and bone mineral density do not fall to a readily detectable degree for several years. Men may also present with infertility. Some may present with hiperlipedemia.

          • Osteoporosis:

            Reduced bone mass is the most common clinical skeletal disorder. An age-related decline in bone mass begins around age 35 years and accelerates in women after menopause. Early diagnosis and quantification of bone loss and fracture risk have become more important because of the availability of therapies that can slow or even reverse the progression of osteoporosis.
          Endocrinology Specialist (Dr. Franck, MD)
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