ENDOCRINOLOGY AND DIABETICS

Endocrinologist

Endocrinologists are specially trained physicians who diagnose diseases related to the glands. The diseases they are trained to treat often affect other parts of the body beyond glands. While primary care doctors know a lot about the human body, for diseases and conditions directly related to glands they will usually send a patient to an endocrinologist.

The glands in a person’s body release hormones. Endocrinologists treat people who suffer from hormonal imbalances, typically from glands in the endocrine system or certain types of cancers. The overall goal of treatment is to restore the normal balance of hormones found in a patient’s body. Some of the more common conditions treated by endocrinologists include:

Adrenal Disorders

Located at the top of each kidney, the adrenal glands produce hormones that help the body control blood sugar, burn protein and fat, react to stressors like a major illness or injury, and regulate blood pressure. Two of the most important adrenal hormones are cortisol and aldosterone. The adrenal glands also produce adrenaline and small amounts of sex hormones called androgens, among other hormones. Adrenal disorders can be caused by too much or too little of a particular hormone. For example, Cushing syndrome is caused by an overproduction of cortisol, or more commonly, the use of medications called glucocorticoids—cortisol-like drugs—which are used to treat inflammatory disorders such as asthma and rheumatoid arthritis. Untreated Cushing syndrome can lead to diabetes, high blood pressure, osteoporosis, and other health issues.

When the adrenal glands produce too much aldosterone, blood pressure rises. Uncontrolled high blood pressure can put you at risk for stroke, heart attack, heart failure, or kidney failure.

Adrenal Insufficiency

Adrenal insufficiency occurs when the adrenal glands don’t make enough cortisol, and sometimes, aldosterone. Symptoms include fatigue, muscle weakness, decreased appetite, and weight loss. Some people experience nausea, vomiting, and diarrhea. Adrenal insufficiency is treated with hormones that replace the hormones your body is lacking.
A genetic condition called congenital adrenal hyperplasia also causes the adrenal glands to make too little cortisol and/or aldosterone, and too much androgen.

The good news is that the conditions caused by overproduction or underproduction of adrenal hormones are treatable. Read more about adrenal disorders and treatment in this section.

Osteoporosis and Bone Health

Bone health is important for everyone. The risk of osteoporosis increases with age. However, there are steps you can take at any age to prevent osteoporosis or delay its effects. Read more about osteoporosis symptoms and treatment in this section and in our related fact sheets.

Osteoporosis and Hormones

Too much or too little of certain hormones in the body can contribute to osteopenia and osteoporosis.

  • During and after menopause, the ovaries make much less of the hormone estrogen. Estrogen loss may also occur with surgical removal of the ovaries or because of excessive dieting and exercise. Estrogen helps protect bone.
  • Men produce less testosterone as they age. Lower testosterone levels may also contribute to bone loss.

Osteoporosis Signs and Symptoms

While osteoporosis symptoms are few, the first sign is often a bone fracture. Many women and men go through life without knowing that they have lost bone mass until they break their hip, spine, or wrist.

Some people have spine fractures that lead to a curve in their upper back. The first suggestion of spinal fractures and one of the first symptoms of osteoporosis may be when you realize you are not as tall as you used to be. Other signs and symptoms are back pain and stooped posture. If you have lost more than one and a half inches from your height as a young adult, you may wish to speak with your doctor about testing for osteoporosis.

More serious problems may occur after a hip fracture, because some people lose the ability to walk normally, perform activities of daily living, or live independently.

Diabetes

For patients who are at risk for diabetes, prediabetes can be an indication that problems are coming. Understanding prediabetes and its signs and symptoms can help you get treatment early, protecting your health now and in the future.

Prediabetes occurs when blood glucose levels are higher than average, but not quite high enough to be considered diabetes. Blood glucose, also called blood sugar, is something the body creates from the foods that you consume. A hormone called insulin, produced by the pancreas, transports the glucose from your blood to the cells where it is needed for energy. When insulin is working well, blood sugar levels are at a healthy level — providing needed energy to the cells.

However, sometimes the process of insulin production is harmed. When this happens, the glucose is not metabolized and builds up in the blood, leading to high blood glucose levels. If left untreated, those levels can rise to the point where the patient is diagnosed with diabetes.

Overview of Diabetes

Diabetes occurs when the pancreas, a gland behind the stomach, does not produce enough of the hormone insulin, or the body can’t use insulin properly. Insulin helps carry sugar from the bloodstream into the cells. Once inside the cells, sugar is converted into energy for immediate use or stored for the future. That energy fuels many of our bodily functions.
There are two types of diabetes: type 1 and type 2.

Type 1 Diabetes

It occurs when the pancreas makes very little or no insulin.. People with type 1 diabetes must take insulin every day to replace the insulin their bodies are not making. This form of the disease is most often seen in children. It used to be called or juvenile diabetes, but it can occur at any age.

Type 2 Diabetes

This is the most common form of the disease, affecting 90 to 95 percent of people with diabetes. In type 2 diabetes, the body is resistant to the action of insulin, meaning it cannot use insulin properly, so it cannot carry sugar into the cells. Although the body makes some insulin, it is not enough to overcome this resistance. You are more likely to develop diabetes if you are overweight, have a family history of diabetes, or have a history of diabetes during pregnancy. Other groups more likely to have the disease are people over age 45 and non-Caucasians. A simple blood test can tell you if you have diabetes.

Diabetes During Pregnancy

A temporary form of diabetes can occur when a woman is pregnant. This is called gestational diabetes and often has no symptoms. Most women are tested for blood sugar problems at some point in their pregnancy. If a woman has high blood sugar, she will have to follow a special diet for the rest of the pregnancy. In some cases, she may also need to take insulin. About 3 to 5 percent of pregnant women develop gestational diabetes.

Gestational diabetes occurs more often in African Americans, Native Americans, Hispanic Americans, Asian Americans, in women with a family history of diabetes, and in those who are overweight. Although this form of diabetes usually disappears after the baby is born, more than half of women with gestational diabetes develop type 2 diabetes later in life.

Diabetes Symptoms

  • Increased thirst
  • Increased urination
  • Constant feelings of hunger
  • Weight loss
  • Blurred vision
  • Constantly feeling tired
  • A fruity smell on the breath

Diabetes Complications

The high blood sugar of uncontrolled diabetes can result in dangerous complications. Diabetes is the most common cause of blindness, kidney failure, and non-traumatic amputation of the toes, feet, or legs. Uncontrolled diabetes can also lead to heart disease, stroke, and the nerve damage and decreased blood flow that can lead to amputation. People with diabetes may have life-threatening reactions to extremely high blood sugar, as well as extremely low blood sugar caused by diabetes medications.

Keeping your glucose levels close to normal will greatly lower your chances of developing long-term complications. If you already have complications, keeping your glucose levels close to normal will help keep these problems from getting worse.

Diabetes Treatment

If, in spite of your best efforts at preventing the condition, you find that you are diagnosed with diabetes, the medical field has many diabetes medications to treat your condition. Both oral and injected medications can help prevent blood sugar swings and metabolize insulin more effectively. While these medications cannot be considered a diabetes cure, as they do not stop the condition and must be continued, they can help you enjoy a normal life while managing diabetes.

Lifestyle

If you are living with diabetes, lifestyle is an important part of your care. It is very important that you eat a good balance of foods every day and exercise regularly. Managing your diabetes also means taking medicine, if needed, and testing your blood sugar levels each day.

Diet

Diabetes does not require special foods. A healthy, balanced diet can come from everyday foods. If you have diabetes, you should

  • Choose foods that are low in fat and salt
  • Choose foods that are high in fiber (such as beans, vegetables, and fruit)
  • Eat foods from all food groups to have a balanced diet
  • Lose weight if you need to by cutting down on how much you eat.

Your doctor can refer you to a dietitian who can help you plan meals that taste great and are good for you.

Alcohol

If your diabetes is under control and you do not have high blood pressure, your doctor may allow you to drink alcohol in moderation. Keep in mind that if you drink alcohol while taking insulin or other diabetes medication, your risk of having low blood sugar may increase.

If you drink alcohol, limit yourself to one drink a day if you are a woman and two drinks a day if you are a man. Avoid sugary mixed drinks. Never drink alcohol on an empty stomach.

Smoking

Smoking greatly increases your risk of heart disease, eye disease, and blood vessel disease, which are major complications of diabetes. Stopping smoking is the single best thing you can do to lower your chances of developing heart and blood vessel disease.

Exercise and Activity

Always see a doctor before starting an exercise program. Your doctor may have good ideas about types of exercise that would be best for you. Exercise is important for people with diabetes because it

  • Helps insulin work better to lower blood sugar
  • Helps keep weight down
  • Is good for the heart, blood vessels, and lungs
  • Gives you more energy

Exercise affects your body’s need for sugar. When you exercise, be sure to

  • Have a snack with you in case you get low blood sugar.
  • Wear a tag or carry a card that says you have diabetes.
  • Eat a snack, such as milk or an apple, before exercising if your blood glucose is less than 100 mg/dL.
  • Avoid exercising if your blood sugar is over 300 mg/dL.
  • Do not take insulin to lower your blood sugar before exercising. This may result in severe low blood sugar.

If you have heart disease or risk factors for heart disease, such as high cholesterol, high blood pressure, or poor diabetes control, check with your doctor about whether or not you need a stress test before beginning an exercise program.

If you have nerve damage to your feet, be careful to wear well-fitting shoes and socks to avoid blisters. Talk with your physician and/or podiatrist about your exercise program.

Medications and Blood Sugar Monitoring

Taking your medicines and monitoring your blood sugar are also part of managing your diabetes.

If you need to take medicine, be sure to take it as directed. Do not change your dosage or how often you take your medicine unless your doctor tells you to. Take it as prescribed and on time every day. Be careful not to skip doses of insulin or other medicines.

Test your blood for sugar as directed by your doctor. Some people only test once a day. Those who take insulin or more than one medication may need to test four or more times a day. Talk to your doctor about how often you should test your blood sugar.

See your doctor for a hemoglobin A1c test every three to six months. This blood test gives your doctor a picture of your blood sugar levels over the past three months. Ask your doctor if you have questions about your A1c test results. You should have a normal result if most of your blood sugar levels are near 100 mg/dl.

Make a commitment to learn about your condition and make the lifestyle changes needed to maintain good health despite the challenges of diabetes. A great doctor, the right medication, a good diet, and exercise will go a long way in ensuring your well-being for many years to come.

Endocrine disorders in children (lack of growth, problems with puberty)

When many people think about hormones, they think of the male and female sex hormones testosterone and estrogen. But children as well as adults produce many other kinds of hormones that affect every aspect of their health.

Learn more about how hormones can specifically affect a child or adolescent’s growth and development, as well as their overall health, in our related fact sheets. If you are specifically interested in growth hormone disorders.

Heart problems (high cholesterol, triglycerides, high blood pressure)

The endocrine system is a network of glands and organs that produce, store, and secrete hormones. It influences many aspects of the cardiovascular system, which include the heart and blood vessels. While hormones play a necessary role in maintaining healthy cardiovascular function, very high levels of some can contribute to cardiovascular disease.

Certain hormones can increase blood pressure and raise levels of lipids (blood fats—cholesterol and triglycerides). Hypertension (high blood pressure) and dyslipidemia (abnormal lipid levels) are risk factors for heart disease and stroke.

Men's health (infertility, testosterone levels)

The endocrine system plays a critical role in human reproduction and sexuality. In men, the testes (testicles) produce testosterone, a hormone that brings about the physical changes that transform a boy into an adult male. Throughout life, testosterone helps maintain muscle and bone mass, sperm production, and sex drive. Women’s ovaries produce estrogen and progesterone, hormones responsible for female development and maintaining pregnancy.

Changes in the levels of male and female hormones can be caused by a variety of factors, and can result in erectile dysfunction (impotence) in men, and can be a cause of infertility and low sex drive in both sexes.

If you have a reproductive health problem, the first step towards resolving it is getting an accurate diagnosis. For that, you should consult a medical specialist such as an endocrinologist who is an expert in reproductive problems. After a diagnosis is made, your doctor will describe your treatment options. Many problems can be managed with the use of hormone therapy.

Male Reproductive Health Problems

Hormones are essential to reproductive health in all aspects of a man’s sexual life. The hypothalamus and pituitary gland are located at the base of the brain, and they work together to release hormones— luteinizing hormone (LH) and follicle stimulating hormone (FSH) —that stimulate the testes to produce testosterone and sperm. Testosterone, the main male hormone, helps maintain sex drive; vitality; sperm production; facial, pubic, and body hair; muscle; and bone.

In men, important health issues related to hormonal imbalances or deficiencies include:

  • Male hypogonadism—effects (symptoms) of low testosterone and consistently lower than normal levels of testosterone in the blood
  • Male infertility—inability to produce sperm adequate for reproduction
  • Sexual dysfunction
  • Erectile dysfunction—inability to get or keep an erection firm enough for sexual intercourse
  • Decreased libido—reduced sexual desire or interest.

These conditions are often, but not always, related to each other.

Pituitary Disorders

The pituitary gland is a tiny organ, the size of a pea, found at the base of the brain. As the “master gland” of the body, it produces many hormones that travel throughout the body, directing certain processes or stimulating other glands to produce other hormones.

The pituitary gland makes or stores many different hormones. The following hormones are made in the anterior (front part) of the pituitary gland:

  • Prolactin – Prolactin stimulates breast milk production after childbirth. It also affects sex hormone levels from ovaries in women and from testes (testicles) in men, as well as fertility.
  • Growth hormone (GH) – GH stimulates growth in childhood and is important for maintaining a healthy body composition and well-being in adults. In adults, GH is important for maintaining muscle mass and bone mass. It also affects fat distribution in the body. Read about growth hormone excess.
  • Adrenocorticotropin (ACTH) – ACTH stimulates the production of cortisol by the adrenal glands—small glands that sit on top of the kidneys. Cortisol, a “stress hormone,” is vital to our survival. It helps maintain blood pressure and blood glucose (sugar) levels, and is produced in larger amounts when we’re under stress—especially after illness or injury. Read about having too much ACTH.
  • Thyroid-stimulating hormone (TSH) – TSH stimulates the thyroid gland to produce thyroid hormones, which regulate the body’s metabolism, energy balance, growth, and nervous system activity. Read about TSH-secreting tumors.
  • Luteinizing hormone (LH) – LH stimulates testosterone production in men and egg release (ovulation) in women.
  • Follicle-stimulating hormone (FSH) – FSH promotes sperm production in men and stimulates the ovaries to produce estrogen and develop eggs in women. LH and FSH work together to enable normal function of the ovaries and testes.

The following hormones are stored in the posterior (back part) of the pituitary gland:

  • Antidiuretic hormone (ADH) – ADH, also called vasopressin, regulates water balance in the body. It conserves body water by reducing the amount of water lost in urine.
  • Oxytocin – Oxytocin causes milk to flow from the breasts in breastfeeding women, and may also help labor to progress.

Pituitary Tumors

The most frequent type of pituitary disorder is a pituitary gland tumor. These tumors are fairly common in adults. They are not brain tumors and are almost always benign (that is, not cancer). In fact, cancerous tumors of this sort are extremely rare.

There are two types of tumors—secretory and non-secretory. Secretory tumors produce too much of a hormone normally made by the pituitary, and non-secretory tumors do not. Both types of tumors can cause problems if they are large and interfere with normal function of the pituitary gland and/or nearby structures in the brain.

The problems caused by pituitary tumors fall into three general categories:

  • Hypersecretion: Too much of any hormone in the body is caused by a secretory pituitary tumor.
  • Hyposecretion: Too little of any hormone in the body can be caused by a large pituitary tumor, which interferes with the pituitary gland’s ability to produce hormones. Hyposecretion can also result from surgery or radiation of a tumor.
  • Tumor mass effects: As a pituitary tumor grows and presses against the pituitary gland or other areas in the brain, it may cause headaches, vision problems, or other health effects.

Injuries, certain medications, bleeding inside or close to the pituitary, and other conditions can also affect the pituitary gland. Loss of normal pituitary function also can occur after major head trauma.

Thyroid Disorders

The thyroid is a small butterfly-shaped gland inside the neck, located in front of the trachea (windpipe) and below the larynx (voicebox). It produces two thyroid hormones—triiodothyronine (T3) and thyroxine (T4)—that travel though the blood to all tissues of the body.

Thyroid hormones regulate how the body breaks down food and either uses that energy immediately or stores it for the future. In other words, our thyroid hormones regulate our body’s metabolism.

Another gland, called the pituitary gland, actually controls how well the thyroid works. The pituitary gland is located at the base of the brain and produces thyroid-stimulating hormone (TSH). The bloodstream carries TSH to the thyroid gland, where it tells the thyroid to produce more thyroid hormones, as needed.

Thyroid hormones influence virtually every organ system in the body. They tell organs how fast or slow they should work. Thyroid hormones also regulate the consumption of oxygen and the production of heat.

Endocrinologists—physicians and scientists who study and care for patients with endocrine gland and hormone problems—study and treat several major disorders of the thyroid gland. The following is a list of some common thyroid disorders.

Hyperthyroidism

Too much thyroid hormone from an overactive thyroid gland is called hyperthyroidism, because it speeds up the body’s metabolism. This hormone imbalance occurs in about 1 percent of all women, who get hyperthyroidism more often than men. One of the most common forms of hyperthyroidism is known as Graves’ disease. This autoimmune disorder (when your body’s defense system attacks your own cells) tends to run in families. Because the thyroid gland is producing too much hormone in hyperthyroidism, the body develops an increased metabolic state, with many body systems developing abnormal function.

Hypothyroidism

Too little thyroid hormone from an underactive thyroid gland is called hypothyroidism. In hypothyroidism, the body’s metabolism is slowed. Several causes for this condition exist, most of which affect the thyroid gland directly, impairing its ability to make enough hormone. More rarely, there may be a pituitary gland tumor, which blocks the pituitary from producing TSH. Whether the problem is caused by the thyroid or by the pituitary gland, the result is that the thyroid is producing too few hormones, causing many physical and mental processes to become sluggish. The body consumes less oxygen and produces less body heat.

Thyroid Nodules

A thyroid nodule is a small lump in the thyroid gland. Thyroid nodules are common. These nodules can be either a growth of thyroid tissue or a fluid-filled cyst, which forms a lump in the thyroid gland. Almost half of the population will have tiny thyroid nodules at some point in their lives but, typically, these are not noticeable until they become large and affect normal thyroid size. About 5 percent of people develop large nodules, more than a half inch across (about 1 centimeter).

Although most nodules are not cancerous, people who have them should seek medical attention to rule out cancer. Also, some thyroid nodules may produce too much thyroid hormone and cause hyperthyroidism, or become too large, interfering with breathing or swallowing or causing neck discomfort.

Other Problems

Other thyroid problems include cancer, thyroiditis (swelling of the thyroid gland), or a goiter, which is an enlargement of the thyroid gland.

Weight and Metabolism

Being either overweight or underweight can affect your health in many ways. Both can increase your risk for serious heart problems, and being overweight makes it more likely that you will develop diabetes, high blood pressure, certain cancers, and other health problems. Read more about weight issues and what you can do to stay healthy.

Women's health (menopause, infertility, some menstrual problems)

Hormones have many important effects on women’s health. The female sex hormones, estrogen and progesterone, are most well known because their influence on a woman’s reproductive health, from menstruation to pregnancy to menopause and more. But your body also makes and uses many other kinds of hormones that affect other aspects of your health—from your energy level, weight, mood and much more.

Hormones and the impact of woman’s sexuality and reproduction, the common hormonal disorder polycystic ovary syndrome (PCOS) and menopause as well as other hormone conditions that affect both women and men.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. Infertility is one of the most common PCOS symptoms. Because the symptoms of PCOS are seemingly unrelated to one another, the condition is often overlooked and undiagnosed.

Polycystic ovary syndrome causes irregular menstrual cycles, excessive body or facial hair and polycystic ovaries as its main symptoms. Polycystic means “many cysts,” and PCOS often causes clusters of small, pearl-sized cysts in the ovaries. The cysts are fluid-filled and contain immature eggs. Women with PCOS produce slightly higher amounts of male hormones known as androgens, which contribute to some of the symptoms of the condition.

The cause of PCOS is not known. Some women with PCOS are less sensitive to insulin than other women, a condition known as insulin resistance. Insulin resistance can cause the ovaries to produce too many male hormones. The resulting hormonal imbalance can cause the symptoms of PCOS. The condition appears to run in families, and sisters of those with it are twice as likely to have it. Currently, PCOS has no cure, but a variety of PCOS treatments can help alleviate the symptoms of this disease, including infertility.

PCOS Symptoms

PCOS is a syndrome disease defined by a collection of signs and symptoms. The symptoms of PCOS that one patient experiences can be very different from the symptoms of another patient. If you have two or more of the following symptoms, you need to have a thorough checkup to determine if you need PCOS treatment:

  • Irregular or missing menstrual periods
  • Infertility
  • Excess or unwanted body or facial hair growth
  • Thinning hair on the scalp
  • Weight problems, often including weight gain around the waist
  • Skin problems, including skin tags, darkening skin and acne

Complications of PCOS

The common PCOS symptoms are difficult enough for most women, but some will experience further complications, including:

  • Diabetes, elevated insulin levels or insulin resistance
  • Heart and blood vessel problems
  • Uterine cancer
  • Sleep apnea

Each of these problems can be life threatening, which is why treatment for PCOS is so important.

PCOS Treatments

Polycystic ovary syndrome treatment starts with a proper diagnosis. Treatments are then chosen based on a woman’s symptoms, age and future pregnancy plans. Treatment for PCOS may include:

  • Birth control pills to regulate menstruation
  • Insulin-sensitizing medications
  • Ovulation induction to treat infertility
  • Androgen-blocking medications
  • Topical anti-hair-growth medications
  • Other excess hair treatments
  • Treatments for hair loss
  • Acne treatments
  • Removal of other skin problems
  • Lifestyle and Prevention

One of the best treatments for PCOS is a healthy lifestyle. A healthy diet, low in refined carbohydrates, is important, as this can help regulate blood sugar levels. Exercise can also help the body regulate insulin and keep excess weight off. Losing weight is challenging with PCOS, but doing so can help reduce the male hormone levels in the body, and some women will begin to ovulate naturally. With a proper diagnosis, lifestyle changes, and PCOS treatment, women can get relief from this condition and the overwhelming health problems it can cause.

Menopause

Menopause is a natural part of a woman’s life cycle. While menopause symptoms can be frustrating and, at times, overwhelming, the process is natural. Understanding this change better will help women get through the symptoms and choose the right treatments for their needs.

Overview

Menopause is the process a woman goes through that causes her monthly periods to end. During menopause, a woman’s ovaries stop producing eggs and produce fewer female hormones. When it is over, she can no longer get pregnant naturally.

Menopause, and specifically the symptoms of menopause, can be challenging, both emotionally and physically. Yet for many women, the change of life is something they welcome, with freedom from menstrual periods and pregnancy.

As you approach mid-life, estrogen levels start to fluctuate and then drop. Most women notice that their periods stop being predictable. They may become shorter, longer, heavier or lighter than usual, and the spacing between periods may change, until a woman starts to skip her periods altogether. Eventually, they will cease.

In the United States, the average age for menopause is 51 for non-smokers and 49 for smokers. The average age range is 47 to 55 years. Those who start menopause before age 45 are considered to have early menopause, while those who begin before age 40 are said to have premature menopause.

The entire transition takes between four and five years, and during this time women can still get pregnant. Typically the process occurs gradually, but women who have lost or damaged ovaries may experience menopause more rapidly.

Menopause Symptoms

Symptoms of menopause will begin when a woman’s estrogen levels start changing. The first symptoms many women notice include:

  • Hot flashes
  • Mood swings
  • Mental fogginess

As the process progresses, women will experience additional menopause symptoms, including:

  • Problems with sex
  • Vaginal dryness
  • Low libido
  • Worsening PMS
  • Irregular periods
  • Depression, sadness or anxiety
  • Sudden or frequent urinating
  • Higher risk for bone loss and fractures
  • Higher risk of heart disease

The symptoms of menopause occur due to the changing hormones the woman experiences. As the hormone levels begin to stabilize, and estrogen levels stay consistently low, many symptoms will decrease, and many will disappear altogether. Some, such as a higher risk of heart disease or bone loss, remain a constant through middle age and beyond, as a woman’s body adjusts to her new hormone levels. Understanding these symptoms will help you choose the right treatment options as you navigate the changes menopause brings.