Endocrinology and Paediatric Endocrinology Hospital in India

Causes

In a condition called primary adrenal insufficiency, damage occurs to the outer layer of the Adrenal Gland which affects the production of hormones. This occurs due to Autoimmune Disease in which the antibodies that usually fight against diseases, mistakenly attack Adrenal Glands instead and destroy them.

The other causes for failure of the Adrenal Gland are infections affecting the Adrenal Glands, Tuberculosis, Cancer of the Adrenal Glands, Fungal Infections, HIV, Haemorrhage, Tumours, use of blood thinning drugs (anticoagulants) and bleeding in the Adrenal Glands.

In another condition known as secondary adrenal insufficiency, due to the disease of the Pituitary Gland, the Adrenal Glands do not produce enough hormones. Pituitary Glands are present near the Brain, and they stimulate Adrenal Glands to produce hormones.

When you stop medications suddenly that have corticosteroid hormones in them, you develop temporary adrenal insufficiency.

If Addison’s Disease is left untreated then you can develop an Addisonian crisis that occurs because of illness, infection or injury.

Symptoms

The person suffering from Addison’s Disease has the following symptoms;

• Fatigue
• Muscle weakness
• Decreased appetite
• Weight loss
• Darkening of skin
• Low blood sugar
• Craving for salty foods
• Nausea
• Vomiting
• Diarrhea
• Dizziness
• Joint pains
• Depression
• Irritability
• Pain in the lower back that radiates to the abdomen and legs
• Blood Pressure falls below normal and may faint
• Dehydration

The levels of potassium increase in the body leading to a condition known as Hyperkalemia.

Diagnosis

Addison’s Disease diagnosis is as follows:

To measure the levels of potassium, sodium, cortisol, and ACTH (Adrenocorticotropic Hormone) and to check the presence of antibodies, blood tests are conducted by the doctor.

In a test called an ACTH Stimulation Test, synthetic ACTH is injected into the blood. This ACTH provokes Adrenal Glands to produce cortisol hormone. If the Adrenal Glands do not respond, then it confirms that they are damaged.

If the doctor suspects Pituitary disease as the cause for the symptoms, then a test known as the Insulin-induced Hypoglycemia Test is done which involves checking levels of cortisol hormone and blood sugar. In a healthy individual, the cortisol levels increase while the blood sugar levels fall.

Imaging tests like CT Scans and MRIs are done to check for any abnormalities in the Adrenal Glands.

Treatment

The Addison’s Disease treatment mainly involves correcting the steroid hormonal imbalance. Oral corticosteroids may be prescribed and include fludrocortisone (Florinef), prednisone, and hydrocortisone (cortef) or cortisone acetate.

In case you are unable to take oral medications, corticosteroid injections may be given.

In Androgen Replacement Therapy, which involves treating androgen hormone (sex hormone) deficiency in women, dehydroepiandrosterone is given to improve the overall sex life of the individual.

In a life-threatening condition called Addisonian crisis, which is characterised by low blood sugar levels, low Blood Pressure and high potassium levels in the blood, emergency medical care is given in which intravenous injections of saline, hydrocortisone and sugar (dextrose) are given.

Preparing for a medical emergency

You must be prepared to handle a medical emergency. It is advised that you always carry extra oral medication with you.

Keep an injectable form of corticosteroid with you after consulting your doctor for emergency use.

Wear a bracelet and carry a medical alert card with you that indicates your problem to the emergency medical team.

Discoverer of Addison’s Disease

Addison’s Disease was discovered by the well-known British physician and scientist, Dr Thomas Addison. A son of a grocer and flower seller, Addison became a renowned physician at the Guy’s Hospital where he dedicated his life to teaching students and curing his patients. He first described Addison’s Disease in the year 1855 AD in his paper publication. He made many more significant discoveries in the field of medicine. However, due to overwork, he was affected by depression which led him to commit suicide by jumping to his death in 1860 AD. Dr Thomas Addison will always be remembered for his contribution and service to the field of medicine.

Signs and Symptoms

The growth of the Tumours can cause pressure on the surrounding organs that lead to severe pain. The symptoms vary depending on the hormone produced by the functioning Tumours and include the following:

• Excess production of the aldosterone hormone may cause Conn's Syndrome. The symptoms include High Blood Pressure, weakness, muscle spasms, tingling sensations, and excessive urination.
• Increased secretion of cortisol may lead to Cushing’s Syndrome. The symptoms include rapid weight gain, growth of fat pads on the back of the neck, and excess sweating.
• Excess release of androgens can cause hair growth, acne, increased muscle mass and abnormal menstruation in the women.
• Excess estrogen levels in men may cause the growth of breast tissue and impotence.

The symptoms of pheochromocytoma are High Blood Pressure, Headaches, Heart Palpitations, and Panic Attacks. Cortical Carcinoma or Adrenal Cancer may cause pain, a lump in the abdomen, feeling of fullness, and weight loss.

Causes and Risk Factors

The causes of Adrenal Gland Tumour are unclear and, in most cases, there are no identifiable risk factors.

In general, the risk factors for Adrenal Gland Tumour are listed below:

• Age: Pheochromocytoma is a rare form of Adrenal Gland Tumour that most likely occurs in middle-aged adults.
• Genetic Syndrome: Certain hereditary conditions also increase the risk of Adrenal Gland Tumours and those include:
• Li-Fraumeni Syndrome
• Von Hippel-Lindau Disease
• Multiple Endocrine Neoplasia Type 1 and 2
• Beckwith-Wiedemann Syndrome
• Lifestyle: Use of tobacco may increase the risk of developing Adrenal Gland Tumours.

Diagnosis

The diagnosis of Adrenal Gland Tumour begins with the physical examination and medical history. Your doctor may recommend certain blood and urine tests to determine the levels of adrenal hormones. In addition to blood and urine tests, your doctor may recommend the following tests:

• Biopsy: A small sample of tissue is removed from the Adrenal Gland to examine under the microscope. The sample is analyzed for the signs of Cancer.
• Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) Scan: The CT and MRI Scans are recommended to determine the presence of any abnormalities or Tumours and measure the size of the Tumour.
• Dexamethasone Suppression Test: A test in which dexamethasone is given, and the levels of cortisol are determined to assess the function of the Adrenal Gland.

Treatment

The Adrenal Gland adenomas of small size require no treatment. The treatment depends on the type of the Tumour and your general health. Your doctor may recommend one or more of the following therapies to help relieve the symptoms.

Surgery: The surgery is usually the first choice of treatment for Adrenal Gland Tumour to prevent the spread of Cancer cells. Your doctor may suggest surgery that involves the removal of the part that is affected.

Chemotherapy: Chemotherapy is suggested depending on the stage of Cancer and involves the use of Anti-cancer drugs. The primary goal of Cancer Therapy is to stop the growth of the Tumour cells and shrink the cells to reduce the excess production of adrenal hormones. A Chemotherapy regimen usually consists of a specific number of cycles during a particular period.

Radiotherapy: Radiation Therapy uses high-energy X-rays to destroy the Tumour cells or to stop the cells from growing.

Symptoms

Most of these Tumours are clinically silent, or the symptoms may appear late in the disease. The symptoms are mainly due to the excess serotonin levels and differ based on the location of the Tumour.

If the Carcinoid Tumours are restricted to the Digestive Tract, then you will have the below symptoms:

• Nausea, vomiting, Diarrhoea
• Abdominal pain
• Difficulty passing stools due to Intestinal obstruction
• Rectal bleeding and pain
• Flushing and blushing of the face

If the Carcinoid Tumours have spread to the Lungs, then you will have the below symptoms:

• Chest pain
• Shortness of breath
• Wheezing
• Weight gain at the back and in the mid-section
• Pink to purple coloured marks on the skin
• Flushing and blushing of the face

Causes

In general, Tumours originate due to some genetic disorders. Mutations in the DNA of the cells cause abnormalities in the cell cycle causing uncontrolled division. This results in the formation of the mass called Tumours.

Risk factors

Family history: A family history of Type I Multiple Endocrine Neoplasia (MEN I) increases the risk of Carcinoid Cancer.

Gender: Compared to men, women are more prone to develop this condition.

Older age: As you age, your risk for the Carcinoid Tumours increases. It is more common in people aged 60 and above.

Diagnosis

The below tests are performed to confirm if you have Carcinoid Tumours:

Treatment

Usually, treatment is based on the size of the Tumour. Several treatment options are available for the treatment of Carcinoid Tumours. They are:

Surgery: Surgical Resection to remove the Tumour is the treatment of choice. It is preferably done in patients where the Tumour has spread to the Liver.

Radiation Therapy: This treatment is used to kill Cancer cells. External beam Radiotherapy helps to relieve bone pain from the spread of the Tumour to the bone.

Biological Therapy: Drugs to enhance the Immune System to attack the Tumour cells help in delaying the growth of the Tumour and prevent the symptoms. For example, interferon-alpha.

Medications: Drugs which inhibit the secretion of the hormone by the Tumour cells can help to reduce the signs and symptoms. For example, octreotide and lanreotide.

Other techniques such as the killing of Cancer cells with Radiofrequency Ablations (heat) or Cryoablation (freezing) are also employed.

Complications

• Gastrointestinal Carcinoid Tumours can cause Bowel Obstruction or Perforation, Appendicitis, or Intussusceptions.
• The risk of metastasis (spread of Cancer) increases with the increase in the size of the Tumour.
• Carcinoid crisis excessively worsens the symptoms and can be life-threatening.
• The Lung Carcinoid Tumour produces an excess of the cortisol hormone which causes a condition called Cushing’s Syndrome.
• Carcinoid Heart Disease can occur in some patients due to the excess secretion of serotonin. In this condition, the lining of the Heart chambers and the valves may leak resulting in Heart Failure.

Self-management

People with Cancer need strategies for coping with the condition. Following are some of the helpful strategies:

• Enquiring in detail about your condition and making decisions about healthcare
• Talking to others with Cancers
• Eating healthy foods such as fruits and vegetables
• Adding a little exercise to your daily routine
• Getting adequate sleep at night
• Cutting down the stress

Types of early puberty

There are two types of Precocious Puberty.

• Central Precocious Puberty: It is the most common and identical to normal puberty and it starts too early. The early signs of Precocious Puberty in girls are the development of Breasts. Tumours or injuries in the Brain and Spinal Cord, excessive fluid buildup in the Brain, and Radiation treatments to the Brain or Spinal Cord are some of the causes of Central Precocious Puberty. McCune-Albright Syndrome, Congenital Adrenal Hyperplasia and Hypothyroidism also cause central precocious puberty.
• Peripheral Precocious Puberty: It is also called Precocious Pseudo-puberty and is observed in very rare cases. It is involved with hormones like estrogen or testosterone. It can be due to problems associated with Ovaries, Testicles, Adrenal Gland, Pituitary Gland, and an Underactive Thyroid Gland.

There are some conditions that resemble early puberty, but actually, they are not. Premature Thelarche is the development of Breasts in girls at a very young age. It does not require treatment. Premature Pubarche is the development of pubic or underarm hair at an early age. It is due to the abnormal or excessive release of adrenal hormones.

Signs and Symptoms

In girls: Precocious puberty symptoms in girls are breast development, menstruation, development of pubic or underarm hair, rapid height growth, mature body odour, and acne.

In boys: Precocious puberty symptoms in boys are enlargement of testicles and penis, growth of facial hair and upper lip hair, deepening of the voice, rapid height growth, mature body odour, and acne.

Complications

Precocious puberty causes physical, emotional, and behavioural problems in individuals. The rapid growth of height stops at a certain period and there will be no further development in height leading to short stature. It can also lead to stress and increased risk for Breast Cancer in girls.

Diagnosis

The diagnosis of early puberty includes the following tests:

• Physical Examination: A complete physical examination will be performed to evaluate the changes in the body.
• Blood Tests: Blood tests will be performed to check hormone levels and Thyroid levels in the body.
• Urine Tests: Urine tests will be performed to check the levels of sex hormones in the body.
• X-ray: It is for the assessment of the bone age to determine the level of growth. It is usually performed on the wrist or hand.
• Magnetic Resonance Imaging (MRI): MRI of the Brain is performed to check for the presence of Tumours in the Brain.
• Ultrasound: An ultrasound of the ovaries is helpful to determine the growth rate of ovaries, and Tumours in the ovaries.
• Computerized Tomography Scan: It is performed to identify Tumours in the body and identify the underlying cause of physical changes in the body.

Treatment of Early Puberty

On diagnosis of early puberty, the doctor would treat your child based on the causes of Precocious Puberty, mainly to stop the rapid growth. If it is due to a Tumour or disease, the treatment would be to reduce the Tumour or the disease condition. If it is due to increased sexual hormones, then medications will be given to lower the levels of hormones.

The approved treatment to reduce the level of hormones is LHRH (Luteinizing Hormone-releasing Hormone) analogues. Synthetic hormones are used to block the production of the sex hormones that cause early puberty. This treatment can reduce the breast size in girls or stop further development. In boys, the size of the penis and testicles may shrink back to the expected for their age. The height growth will also slow down to an expected rate.

Causes

Goitre occurs when the Thyroid Gland does not produce enough hormones to meet the requirements in the body for driving the chemical process of energy production and utilization. To meet the increased needs, the Thyroid enlarges.

Types of Goiter

Simple Goiter is of two types, Endemic (Colloid) and Sporadic (nontoxic) Goiter.

Colloid Goiter occurs in people living in areas with iodine-deficient soil. Since iodine is a mineral necessary for Thyroid hormone production, these people are not able to make enough hormones and this causes the Thyroid to enlarge. Another factor for iodine deficiency Goiter is the consumption of hormone-inhibiting foods like cabbage, broccoli and cauliflower. The exact cause of Sporadic Goiter is not known.

In another type of Goiter seen in Grave’s Disease, there is an autoimmune cause for Goiter. Goitre occurs because the defence system, called the Immune System usually attacks invading germs to destroy them, aberrantly attacks the Thyroid stimulates it to produce more hormones and causes it to enlarge.

In another autoimmune condition called Hashimoto’s Disease, there is an underproduction of hormones and this causes the Thyroid to enlarge as it attempts to produce more hormones in an attempt to compensate for the deficiency.

In another type of Goiter called the Nodular Goiter, one or more nodules may cause growth and hence enlargement of the Thyroid Gland. In most cases, these nodules are not a Cancer. Hormonal changes in pregnancy can cause the Thyroid to enlarge. Cancer of the Thyroid and inflammation are other causes of Goiter. Some medicines like lithium or aminoglutethimide can cause a nontoxic Goiter.

Symptoms

Below is a list of symptoms of Thyroid problems:

• The main symptom of Goiter is an Enlarged Thyroid. This may be a localized swelling in the form of a nodule or a generalized enlargement that is evidently visible. As the Thyroid Gland enlarges in the neck, it can press upon the surrounding structures in the neck and upper chest.
• Pressure upon the windpipe can cause cough and hoarseness.
• Breathing may get difficult with large Goiters.
• Pressure upon the food pipe causes difficulty swallowing.
• Upon raising the arm above the head, there may be swelling of superficial blood vessels in the neck causing dizziness.

Thyroid enlargement can have complications due to the over or under function of the gland. Excessive production of Thyroid hormones called Hyperthyroidism can cause an increase in:

• Heartbeat
• Diarrhea
• Tremors
• Agitation
• Sleep problems
• Anxiety
• weight loss despite increased or normal appetite
• Excessive sweating
• Heat intolerance

An underactivity of the Thyroid is called Hypothyroidism. Hypothyroidism symptoms can lead to

• Tiredness
• Weight gain
• Constipation
• Dry rough skin
• Loss of hair
• Menstrual irregularities

Diagnosis

Goiter is diagnosed by clinical examination and a few tests. The patient may be asked to swallow while the doctor palpates the gland. An enlarged gland can be felt as a prominence that moves with the act of swallowing.

A blood test may be done to assess the Thyroid function. This involves laboratory measurement of the hormones T3 and T4. In addition, Thyroid Stimulating Hormone (TSH) may be measured. This is a hormone produced by the Pituitary Gland, a small pea-shaped gland situated at the base of the Brain.

TSH regulates the hormone production by the Thyroid. The blood may also be tested for antibodies if an autoimmune cause is suspected.

An ultrasound may reveal the size, nodules, and any possible compressions.

A Thyroid scan may be done by injecting a radioactive material into the superficial blood vessel and then taking images to study its uptake by the Thyroid Gland. This uptake is suggestive of the activity of the gland.

The size and extent of Goiter can be studied by doing a CT Scan or Magnetic Resonance Imaging (MRI).

Treatment

Here are a few points for the treatment for Hyper and Hypothyroidism:

• A Goiter that is too small and causes no distressing symptoms may be just advised a watchful waiting.
• If Goiter occurs due to iodine deficiency, a solution of potassium iodide or Lugol’s iodine may be taken.
• Radioactive iodine treatment may help to shrink an overactive gland that is producing excess hormones.
• A part or whole gland may be removed surgically if it is causing disabling symptoms.
• In Hypothyroidism, Thyroid hormones may be supplemented as tablets containing a medicine called levothyroxine.
• If the Goiter is due to inflammation, medicines like aspirin or corticosteroids can help.

Causes

Hashimoto’s Disease is an autoimmune disease, where one’s own body produces antibodies against Thyroid cells and damages them, also disrupting their normal function. Production of low Thyroid hormone for a long time results in Hypothyroidism.

The exact reason why the Immune System acts against the Thyroid Gland is not yet known. However, researchers believe that some bacteria or viral infection might trigger the autoimmune reaction and some say that it is because of genetic flaws that run through families. Hashimoto’s Disease can affect anyone but it is more common in women than in men.

Risk factors

The risk of developing Hashimoto’s Disease increases in women seven times more than in men; it is also found that people between the age group of 40-60 years are at higher risk. The condition runs in families where if one is affected, then the risk of the closest relative being affected increases.

People suffering from other disease conditions like Grave’s Disease (Thyroid Gland making too much of Thyroid hormone), Vitiligo ( a disease that destroys the cells responsible for skin colour), Rheumatoid Arthritis, Addison’s Disease (disease of the Adrenal Gland), Diabetes Type - 1, and Pernicious Anaemia (Anaemia due to inadequate absorption of vitamin B12) are more prone to develop Hashimoto’s Disease. In addition, consuming high amounts of iodine also results in Hashimoto’s Disease.

Symptoms

Many people suffering from Hashimoto’s Disease do not exhibit any symptoms. As the disease progresses over time, they show few symptoms that are similar to the symptoms exhibited by Hypothyroidism. A few symptoms of Hashimoto’s Disease are

• Weight gain
• Fatigue
• Difficulty swallowing
• Slow Heart rate
• Enlarged Thyroid Gland that is visible
• Constipation
• Depression
• Hair loss
• Ache, cramp, tenderness, or stiffness of the muscles
• Increase sensitivity to cold
• Skin turning pale and dry
• Pain, stiffness, and swelling of the joints
• Puffy face
• Hoarse voice
• Excess menstrual bleeding
• Difficulty conceiving
• High level of blood cholesterol
• Forgetfulness

Diagnosis

Diagnosis begins with a simple physical examination looking for the enlarged Thyroid Gland.

• In a person with no symptoms, the doctor may perform routine Thyroid Function Tests.
• A simple blood test will be done to check the levels of TSH (Thyroid Stimulating Hormone) and T4 (Thyroid Hormone).
• When the Thyroid Gland fails in its function the Pituitary Gland produces an excess amount of TSH, to stimulate the production of Thyroid Hormone (T4) by the Thyroid Gland. Therefore initially the level of TSH will be slightly increased and the level of T4 will be normal, a condition called Clinical Hypothyroidism. But over time, the Thyroid Gland can’t keep going any longer the level of T4 drops below normal and the level of TSH remains high indicating Hypothyroidism.
• People who have Hashimoto’s Hypothyroidism have a specific kind of autoantibodies in their blood, which is not found in other people who have Hypothyroidism due to other causes. A blood test showing the presence of these antibodies confirms Hashimoto’s Disease.

Treatment

There is no cure for Hashimoto’s Disease. Treatment for Hashimoto’s Thyroiditis Disease depends on how damaged the Thyroid Gland is.

• If there is no hormone deficiency and your Thyroid function is normal, then the doctor may go for the wait-and-watch approach or choose to treat for reducing the size of the gland in case of Goiter.
• If a lack of Thyroid Hormone and elevated TSH level is detected, then treatment begins with Thyroid Hormone Replacement Therapy (levothyroxine).
• A daily pill may restore the normal Thyroid function and bring back the T4 and TSH levels to normal.
• The dosage of the medicine depends on the age, weight, and severity of Hypothyroidism.
• A routine blood test is done frequently to check the level of Thyroid Hormone and the dosage of the medicine is adjusted accordingly.

Causes

Hirsutism is caused by an excess of male hormones called androgens. These hormones are normally produced in small quantities by the ovaries, the sex glands, and Adrenal Glands, the sex hormone-producing glands present above the Kidneys. When androgens become excessive due to dysregulation, it causes Hirsutism.

• Hirsutism may run in your family. In this case, it is believed to be genetic.
• Hirsutism can be caused by an adverse effect produced due to the intake of some medicines like steroids, danazol, phenytoin, etc.
• Hirsutism can be caused by conditions that lead to an excess of androgens in women. One such condition is Polycystic Ovarian Disease, in which there are fluid-filled cysts in the ovaries that lead to increased production of androgens.
• Women are often obese, maybe Diabetic, and also complain of menstrual irregularities and acne. Another medical condition that can cause Hirsutism is Cushing syndrome, where the Adrenal Glands produce an excess of a steroid called cortisol.
• Such women may be obese and have other features like a round moon face, fat belly, thin limbs, fragile skin with easy bruising, menstrual problems, and even infertility.
• Hirusitism can be caused by some Cancers in the ovaries and Adrenal Glands, where excess androgens may be produced by the erratically dividing cells.
• Most of the time, there is no evident cause of Hirsutism. The hair follicles just become sensitive to androgens. The cause of this is not known.
• You should see the doctor when you have other accompanying complaints like excessive and coarse hair that may suddenly increase, or you may develop irregular menstruation and face problems controlling your weight.

Getting rid of excess hair

• You can shave off the excess hair or depilate it.
• Waxing and plucking are other means to remove unwanted hair. None of these is permanent and you may need to repeat them at frequent intervals as the stubble grows back.
• If you develop redness or pricking sensation after any of these, you can apply a soothing moisturizer or astringent.
• You can use any of the hair-removing creams.
• You can camouflage the hair by using bleach to make it match your skin colour.
• Before you use a hair-removing cream or bleach, apply a small amount of it on the forearm and leave it for a few minutes. Wait for a day to watch if you develop any irritations or other local or generalized reactions.
• If not, you are not sensitive to them and can safely use them. It is desirable to repeat this every time you repeat the application, no matter with the same cream or bleach.
• You may resort to one of the permanent hair-removing measures like electrolysis. In this, a small electric current passes through a needle placed into the hair roots which destroys them. This is expensive, time-consuming, and needs expertise. Do not use any of the home electrolysis products without seeking medical advice.
• Some women use laser hair removal in which laser, a type of radiation, that is used to destroy hair. It should be done by an expert, needs multiple sessions, and results may not be permanent. Side effects are changes in the colour of the skin and irritation.
• You should lose excess weight. Excess weight in itself is the cause of an imbalance of hormones.
• Menstrual irregularities may be corrected with exercise.
• You should undergo investigation and treatment of Hirsutism for any underlying medical disorders.

Medications

You may be prescribed medicines to control Hirsutism. Birth control pills can decrease the amount of androgens and can be used in women who do not plan a pregnancy in the near future.

• You may need an anti-androgen medication. This class of drugs antagonises the effects of androgens.
• Common anti-androgens are finasteride and spironolactone.
• Without altering the already existing hair, these decrease the growth of new hair.
• These should be consumed for at least 3 to 6 months before any appreciable effects. These can adversely affect your baby so you should not get pregnant when on treatment.
• There are some medicines that can be applied to the face to control facial hair. One such cream contains a medicine called eflornithine. This may need a consistent application for 1-2 months for appreciable results.
• Potential side effects with such creams are skin irritation and rash. All medicines are not equally effective in all women.

Functions of Cortisol

The Adrenal Glands in your body produce cortisol. Production of cortisol hormone increases during stress. This hormone helps balance the effects of insulin on the body and reduces the Immune System’s inflammatory response. It also helps in regulating Blood Pressure and converting fats, carbohydrates, and proteins into simple molecules.

Causes

Your body produces and releases high levels of cortisol for numerous reasons. Some of these are depression, inheritance, malnutrition, athletic training, emotional stress, and alcohol consumption. History of a Pituitary Gland or Adrenal Gland Tumour, overuse of corticosteroids, and stress due to surgery, acute illness, pregnancy, injuries, etc. also cause Hypercortisolism.

Symptoms

The most common Cushing’s Syndrome symptoms include:

• Obesity
• Backache
• Impotence
• Facial hair growth
• Moon-shaped face
• Generalized weakness
• Changes in the mental condition
• Purple-coloured stretch marks on arms, thighs, and breasts
• Increased urination
• Increased thirst
• Superficial skin infections
• Hunch formation

In men, other symptoms such as erectile dysfunction, loss of sexual drive, and decreased fertility are also observed.

Diagnosis

Your doctor would recommend blood and urine examinations for determining cortisol levels. A dexamethasone suppression test is also performed to assess Adrenal Gland function.

To determine the cause, your doctor may suggest the following tests:

• Adrenocortical Tropic Hormone (ACTH) Level
• Glucose Test
• Potassium Test
• Abdominal CT Scan
• White Blood Cell Count
• Cranial MRI or Cranial CT Scan

Treatment

Your doctor would choose an appropriate treatment option based on the cause of the disorder. If the cause is drug-induced (mainly due to corticosteroids), then the drug dose must be reduced under medical supervision.

If the cause of Hypercortisolism is due to any Pituitary Tumour, then your doctor would recommend surgery. At times Radiation Therapy is also needed. After the surgery, your doctor would prescribe a Hydrocortisone Replacement Therapy. Cortisol Replacement Therapy may be prescribed for a lifetime in certain instances.

If the cause of Cushing’s Syndrome is an Adrenal Tumour, then surgery is required for the removal of the Tumour. If it is not possible to remove the Tumour, your doctor will prescribe certain medications that help in the suppression of cortisol secretion.

Adrenalectomy is a surgical intervention that removes the Adrenal Glands. This intervention is reserved for the patients for whom medications do not work well. After the surgery, the patient must start a lifelong daily therapy of Glucocorticoid and Mineral Corticoid Replacement Therapy.

Complications

Diabetes Mellitus, High Blood Pressure, severe infections, Kidney Stones, bone loss, and muscle loss are some of the complications associated with Cushing’s Syndrome.

Prevention

Hypercortisolism or Cushing’s Syndrome can be prevented by creating an awareness of the associated symptoms; this helps in early detection and early treatment.

Causes

High levels of stress, frequent infections, reduced physical activity, a carbohydrate-rich diet, and insufficient doses of glucose-lowering agents are the major factors that can contribute to Hyperglycemia.

Symptoms

The common short-term Hyperglycemia symptoms include:

• Fatigue
• Nocturia
• Blurred vision
• Excessive thirst
• Excessive urination
• Sores that do not heal

If any of the above symptoms of Hyperglycemia are found, then it is advisable to check your blood glucose levels. If Hyperglycemia is left untreated, it may lead to severe complications such as eye, Heart, nerve, and Kidney damage.

Diagnosis

Your doctor would ask you to go for different types of diagnostic tests for diagnosing Hyperglycemia, these tests include:

Random blood sugar (RBS): This test reflects the blood glucose levels at a given point in time. Usually, the normal values lie between 70 – 125mg/dL

Fasting blood glucose: The blood glucose levels are measured in the early morning before you eat or drink anything. Normal levels are less than 100mg/dL. Levels those are above 100mg/dL to 125mg/dl, are the evidence of pre-diabetes, while levels above 126mg/dl are indicative of Diabetes.

Oral glucose tolerance test: This test is performed after a dose of sugar is consumed. This test is most commonly used for the diagnosis of gestational Diabetes (Diabetes during pregnancy).

Glycohemoglobin A1c: This test measures the amount of glucose that is bound to the red blood cells and provides the status of the blood glucose levels over the past 2 to 3 months.

Treatment

There are various ways by which you can manage blood glucose levels easily. Some of the Hyperglycemia treatment options are:

Monitor your glucose levels: You must regularly check your glucose levels and track if there are fluctuations in your glucose levels. This helps you to know and control the rising blood glucose levels and can be able to prevent the complications associated with Hyperglycemia.

Workout: Reduced physical activity can be one of the reasons for Hyperglycemia; you must, therefore, plan a perfect exercise program that is suitable for you and before doing so, talk to your doctor. Exercise can stand as the best and most effective way to keep your blood glucose levels in control.

Plan good eating habits: Carbohydrates are the main culprits that may increase your blood glucose levels. So, work with a Dietician to construct a healthy, diet plan that has fewer carbohydrates. The doctor will take up your medical history and ask for your symptoms of Hyperglycemia and then proceed with the best suitable treatment regimen. Your doctor may change the time, dose and type of Diabetic medication or just adjust the dose based on your blood glucose levels.

What happens if Hyperglycemia is untreated?

If Hyperglycemia in Diabetes is left untreated, it can lead to a life-threatening condition called Ketoacidosis (Diabetic Coma). This condition is developed when there is less amount of insulin in the body. When there is low insulin in the body, fats are used for energy production which may release ketones, too much of ketones are toxic to the body, they pile up and after some of them are excreted, cause Ketoacidosis.

The symptoms of Ketoacidosis include:

• Dry mouth
• Nausea and vomiting
• Difficulty in breathing
• Fruity smell while breathing

When you notice any of these symptoms, you must immediately call your doctor as it requires immediate treatment.

Symptoms

The Hyperthyroidism symptoms are mainly related to the increased metabolic rate, producing the common symptoms like:

• Weight loss
• Weakness
• Difficulty sleeping
• Irregularities in the Heart rhythm, especially an increase in the Heart rate
• Increased Blood Pressure
• Excessive sweating
• Hand tremors

Hyperthyroidism can also cause frequent bowel movements, exophthalmos (prominent eyeballs), nervousness, restlessness, an increase in appetite, inability to concentrate, etc. In women, irregularities in the menstrual cycle are also seen.

If you have symptoms such as dizziness, shortness of breath, increased Heartbeat, or loss of consciousness, immediate medical help is required.

Causes

Grave’s Disease is the most common cause of Hyperthyroidism. It is a genetic disorder. In this condition, the antibodies are produced to stimulate the Thyroid Gland to secrete more hormones than normal.

The other causes of Hyperthyroidism include:

• Excess iodine intake, which is the key ingredient for the synthesis of the two hormones
• Excess intake of tetraiodothyronine, either through medicines diet or supplements
• Inflammation of the Thyroid Gland, which causes leakage of the hormones out of the gland
• Tumours of the Thyroid Gland or Pituitary Gland
• Ovarian and Testicular Tumours
• Imaging tests which use contrast dye that has iodine (this is a rare cause)

Risk factors

Hyperthyroidism is more prevalent in women than in men. It runs in families, i.e. it is inherited from parents.

Complications

Hyperthyroidism causes Atrial Fibrillation, which is a dangerously increased Heartbeat that can lead to Stroke or Congestive Heart Failure.

Osteoporosis, which involves the thinning of the bones which become very brittle and can easily break can also occur.

A Thyroid Crisis (storm) can occur which causes the worsening of the symptoms and requires immediate medical help. Abdominal pain, fever, and decreased alertness are some signs.

The other complications related to the surgery include:

• Hypothyroidism (Underactive Thyroid)
• Scarring of the neck
• Hoarseness to the voice box
• Low calcium levels of the Parathyroid Glands (glands present adjacent to the Thyroid Glands), lead to damage to the glands

Diagnosis

When you present the symptoms of Hyperthyroidism, your doctor performs a physical examination which shows an increase in the size of the Thyroid Gland. The other tests include:

Treatment

Based on the cause and the severity of the symptoms, your doctor will choose the appropriate treatment for Hyperthyroidism. The treatment options include:

• Antithyroid medicines primarily, propylthiouracil or methimazole. These medicines interfere with the production of Thyroid hormones.
• Use of radioactive iodine to destroy the Thyroid Gland, thereby controlling the production of the Thyroid hormones.
• Surgical removal of the Thyroid Gland.

You will need Thyroid hormone replacement pills for your whole life if you undergo surgery or radioactive iodine therapy.

Additionally, symptomatic relief for fast Heart rate, anxiety, tremors, and sweating till Hyperthyroidism is controlled may be provided with beta-blockers. High-dose glucocorticoids may be given for vision-threatening eye problems while mild cases of vision problems are managed with saline eye drops and sunglasses.

Self-management

If you follow the below suggestions, it will be beneficial during your treatment:

Seek dietary information: If you had a great weight loss, then you may need additional calories and proteins in your diet. Additionally, the amount of salt and calcium intake also needs to be checked with your doctor.

Calcium and vitamin D: Due to the risk of bone thinning in patients with Hyperthyroidism, adequate calcium and vitamin D intake are essential.

Management of Grave’s Disease: You may use sunglasses, lubricating eye drops and raise your head above the level of the rest of your body to reduce swelling and pressure. Use OTC (over-the-counter) drugs such as hydrocortisone to relieve redness and swelling of the skin. Applying a cool compress provides extra moisture and relief to your eyes.

Causes

The main causes of Hypoparathyroidism include:

• Genetics
• Autoimmune diseases
• Exposure to Radiation Therapy
• Low magnesium levels in the body
• Surgical removal of Parathyroid Gland
• Genetic disorders such as DiGeorge Syndrome

Risk factors

The factors that increase the risk of developing Hypoparathyroidism include:

• Family history of Hypoparathyroidism
• Neck surgery in which Thyroid was involved
• Autoimmune diseases or Endocrine conditions such as Addison’s Disease

Symptoms

In Hypoparathyroidism, there is calcium depletion, so the symptoms are usually related to calcium deficiency:

• You may have muscle cramps
• Your skin would be dry and scaly
• You may be anxious or feel depressed
• There may be pain during the menstrual period
• Your nails would break easily due to brittleness
• You may experience muscle spasms, especially around the mouth

Children with Hypoparathyroidism experience symptoms like headache, vomiting dental problems, poor tooth development, and weakened tooth enamel.

Complications

There can be numerous complications that are associated with Hypoparathyroidism. Certain complications that are caused by low calcium levels can be reversible and can be treated with adequate treatment, and they include, tetany, paresthesias, seizures, dental defects, compromised Kidney function, and Heart Failure.

A few complications caused by Hypoparathyroidism cannot be improved with the treatment. So early diagnosis and appropriate treatment would be helpful.

Diagnosis

Your doctor would initially review your medical history and perform a physical examination to check the symptoms such as scaly or dry skin, hair loss, muscle spasms, etc.

Your doctor would then order certain related tests to understand the levels of calcium, phosphorous, magnesium and Parathyroid Hormone in the blood.

Urine analysis is also required to evaluate the level of calcium excreted in the urine. Your doctor would also order an ECG (electrocardiogram), which helps in determining the electrical activity of your Heart and to check any abnormalities in your Heart’s rhythm that can be a result of calcium deficiency.

Your doctor would order bone density tests and X-rays, which help to evaluate the effect of calcium deficiency on your bones.

Treatment

The goal of the treatment is to alleviate the symptoms and to set the normal levels of calcium and phosphorous in your body. The treatment options include:

Calcium supplementation: Your doctor would prescribe oral calcium supplements such as calcium gluconate, which helps in increasing the levels of calcium in your blood. But, an overdose of calcium in the body may lead to side effects such as constipation in some people.

Vitamin D: Your doctor would prescribe doses of vitamin D which helps in better absorption of calcium and elimination of phosphorous.

Dietary changes: If you have Hypoparathyroidism, your doctor would advise you to take foods rich in calcium and low in phosphorous. You must take the following foods:

• Beans
• Apricots
• Almonds
• Prunes and oats
• Green leafy vegetables

You must avoid the following foods that are rich in phosphorous and may reduce the levels of calcium in your body.

• Alcohol
• Tobacco
• Baked foods
• Tea and coffee
• Eggs and red meat
• White bread and pasta

Pituitary hormones and their functions

The various hormones produced by the Pituitary Gland and their functions are described below:

Causes

The major cause of Hypopituitarism is the presence of a Tumour in the Pituitary Gland. Pituitary Tumour squeezes the tiny Pituitary Gland and damages it; it also puts pressure on the optic nerve causing visual difficulties

Other causes of Hypopituitarism are

• Tumour in Brain
• Brain Surgery
• Meningitis infection
• Injury in the head region
• Radiation treatment
• Inadequate blood supply to Pituitary Gland
• Tuberculosis
• Surgical removal of Pituitary tissues
• Stroke
• Hemochromatosis (too much iron is absorbed from the Gastrointestinal Tract)
• Histiocytosis (increases in immune cells)
• Disease of the hypothalamus (a small part of the Brain just above the Pituitary, that controls the Pituitary function)
• Sarcoidosis (inflammation in the Lymph Nodes, Lungs, Liver, eyes, skin, or other tissues)
• In many the cause of Hypopituitarism is unknown

Symptoms

Symptoms of Hypopituitarism develop either suddenly or gradually. A few symptoms of Hypopituitarism are

• Constipation
• Abdominal discomfort
• Weakness/fatigue
• Nausea
• Muscle weakness
• Puffed face
• Hoarse voice
• Headache
• Reduced Blood Pressure
• No appetite
• Weight gain or weight loss
• Loss of underarm and pubic hair
• Sensitive to cold/difficulty staying warm
• Joint stiffness
• Feeling thirsty and excess urination
• Visual difficulties
• Erectile dysfunction in men
• Loss of facial and body hair in men
• Loss of sexual interest in men
• Infertility in women
• Inability to produce breast milk in women
• Irregular or no menstrual bleeding
• Shout stature in children
• Development of sexual characters is slowed

If the patient experiences sudden symptoms like headache, visual problems, confusion or low Blood Pressure, the doctor should be consulted immediately, as this could be warning us against a condition called Pituitary Apoplexy (Pituitary bleeding).

Diagnosis

If the patient’s symptoms, medical history, and complete medical check-up signal towards deficiency of Pituitary hormone then the doctor may perform several tests to check the levels of various hormones.

Blood tests can reveal the amount of various hormones in the body. If the result shows low levels of one or more hormones then depending on the levels of these hormones it can be associated with inadequate Pituitary hormone production. An Endocrinologist (a physician who deals with the Endocrine System & hormones) will check the amount of hormone secreted by the patient after giving him/her medicines that stimulate hormone production. This is called a stimulation test. Scanning of the Brain using Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) shows any damage injury or structural deformity in the Pituitary Gland. A vision test is done to determine if any Pituitary Tumour exists and how much it has damaged the vision of a person. In children, X-ray study helps to check whether the bones of hands and legs are growing normally.

Treatment

Treating Hypopituitarism starts with treating the cause of the disease. If Hypopituitarism is caused due to the presence of a Tumour, then the person might undergo surgery to remove the Tumour or he might be subjected to Radiation Therapy to shrink the Tumour. If the condition doesn’t seem to return to normal even after treating the underlying condition, the doctor may move on to Hormone Replacement Therapy. In case of ACTH deficiency, the doctor may prescribe corticosteroids such as prednisone & hydrocortisone, to replace the missing cortisol hormone. In the case of anti-diuretic hormone deficiency, desmopressin is prescribed to replace the missing ACTH. This also helps to regain the body’s loss of water through excess urination. If the growth hormone is deficient, growth hormone medications are given to promote growth in children. Levothyroxine is prescribed to replace the missing Thyroid hormone if the patient is deficient in TSH. Sex hormone medications are prescribed to replace testosterone (in men), estrogen (in women) or estrogen/progesterone combination in women in case of missing LH and FSH. Hormone Replacement Therapy requires regular monitoring of the hormone levels in the patient to make sure that the medication given is working effectively. Any side effects like becoming sick, gaining weight or going through stressful situations should be reported to the doctor as an adjustment in the dosage might be required. A dose adjustment is very much essential if the patient becomes pregnant.

Symptoms

The Hypothyroidism symptoms depend on the degree of deficiency of the Thyroid hormone, the common symptoms are:

• Fatigue
• Constipation
• increased cholesterol levels
• Dry and rough skin
• Hair loss
• Memory loss
• Depression

In severe stages of the condition, it can cause symptoms such as a drop in body temperature, puffiness around the eyes, a slowing Heart rate, and Heart Failure.

Causes

• Thyroid destruction during therapies with radioactive iodine or surgery
• Severe iodine deficiency
• Inflammation of the Thyroid Gland: A history of or current inflammation of the gland can cause damage to a large number of cells, making them incapable of producing adequate amounts of Thyroid hormones.

Risk factors

Anyone of you may develop Hypothyroidism. However, there are a few factors that increase your risk of developing the condition such as:

• Age: The incidence of Hypothyroidism increases with age.
• Gender: Hypothyroidism is more common in women compared to men.
• Family history of Thyroid Disease
• If you have had Thyroid Surgery.
• If you have been pregnant.

Complications

Severe Hypothyroidism can lead to a life-threatening condition called myxedema coma. Other complications include Goiter, Heart problems, mental health issues, Peripheral Neuropathy, infertility, and birth defects.

Diagnosis

Hypothyroidism is common in older women; therefore doctors recommend that older women should be screened for the disorder during routine annual physical examinations. Pregnant women and women who are planning for pregnancy must also have regular screenings for Hypothyroidism

Your doctor would review your symptoms which are suggestive underactive Thyroid. The symptoms include; feeling increasingly tired, dry skin, constipation and weight gain, or your doctor may ask you if you have had a past history of Thyroid problems or a Goiter Disorder.

Blood tests: Your doctor would order blood tests that measure the Thyroid levels which include, TSH levels (Thyroid Stimulating Hormone) and thyroxine. If there is any evidence of high levels of TSH and low levels of thyroxine, then your doctor may suspect an underactive Thyroid Gland.

TSH test is the best screening test; your doctor will likely check TSH first and follow with a Thyroid hormone test if needed. TSH tests also play a vital role in the management of Hypothyroidism. It helps your doctor to prescribe you the exact dose of medication.

Treatment

Hypothyroidism treatment in the majority of cases includes lifetime medications.

Supplemental Thyroxine: Your doctor would prescribe the exact dose of the drug based on your history, symptoms and TSH levels. Thyroxine is similar to T4 hormone which is deficient in Hypothyroidism. So this drug would enhance your levels of thyroxine in the body. Your doctor would regularly monitor you to adjust the required dosage of the drug.

Iodine: Iodine is very important for the functioning of the Thyroid Gland. People with Autoimmune Thyroid Disease can be sensitive to iodine, which can worsen Hypothyroidism. Your body’s iodine requirement will increase during the pregnancy. So you must ensure that you are taking enough iodine.

Nutrition: Dietary modifications affect the way your body absorbs Thyroid drugs. Therefore, you must discuss with your doctor before performing any dietary changes, which include eating too much soy products or cruciferous vegetables such as cauliflower.