| Name | Description |
| Acromegaly | This is due to a pituitary tumor that produces excess of growth hormone. In a mature adult the only parts of the body that can still grow are the hands and feet, lips nose and the lower jaw. Excess growth of these areas give rise to a typical appearance . There can be diabetes and hypertension as well. Treatment is usually surgery . Very rarely drugs or radiation are used. |
| Androgen insensitivity (complete) | . Here the person produces testosterone but none of the features associated with maleness are found. This is because of a genetic reason that testosterone has absolutely no action on the body. The parents of such a child need extensive counselling and the child is reared as a girl. Incomplete versions of the condition are also found. |
| Calcium | Both low and high calcium levels cause multiple problems. Low calcium is generally treated with vitamin D. High calcium levels can have many causes and need careful assessment and treatment. Untreated, high calcium levels can cause kidney stones pancreatitis and other problems. |
| Congenital adrenal hyperplasia | This is a rare disease which a person inherits from both parents. Excess of male hormones are produced typically from age 1 week. Sometimes there may be abnormal levels of sodium and potassium in the blood as well. Treatment is with steroids. In some girls, surgery may also be needed. |
| Craniopharyngioma | These are rare developmental tumors of the pituitary which generally presents in children. |
| Cushing Disease | Named after a famous American neurosurgeon this is a pituitary tumor which produces large amounts of a hormone called ACTH. Excess ACTH in turn produces excess of cortisol which gives rise to a typical set of problems. Treatment is usually surgery. |
| Diabetes – type 1 | Diabetes mellitus occurs when there is insufficient insulin in the body. In type 1 diabetes, about 5 % of the body’s insulin production still remains active at the time of diagnosis. The disease presents suddenly, usually after a minor illness. Here the only treatment is insulin. Patients and their families need extensive education on how to inject insulin, check blood sugars and so on. A normal life is possible including pursuing a career and having children. |
| Diabetes – type 2 | This is the common form of diabetes. There is insufficient insulin in the body, at least 50 % short of requirement. Initially the condition is managed by exercise and a meal plan. With this, tablets or insulin are added. The body weight should be kept at ideal levels, which again, depends on height, sex and body build. Blood pressure and cholesterol need to be controlled as well as the glucose and there should be no tobacco use. Targets are set for each patient. For example the target for a 30 year old healthy woman will be different from that of a 70 year old man who has had a stroke. Regular check ups are a must especially regarding the heart, kidneys and eyes. Diet charts are not as important as thought previously as the meal plan for diabetes is very similar to normal eating. |
| Diabetes and pregnancy. | Blood glucose can go up in the later part of pregnancy. Treatment is almost always insulin. The target blood glucose in pregnancy is set at a lower level. This is because a fall of blood glucose does not harm the baby while a rise in the value can cause harm. |
| Diabetes Insipidus | This is not to be confused with the more common diabetes mellitus. Here the posterior pituitary does not function as it should. The patient produces large amounts of urine and is thirsty all the time. It is often difficult to make the diagnosis. Treatment is with medicine. |
| Diabetes medicines | A large number of tablets and some injections are available. The trend is to start with medicines that do not cause the blood sugar to fall and then graduate to other more potent tablets. |
| Endocrine hypertension | Endocrine causes of high blood pressure are rare. Some causes are not so serious, but some may actually be life threatening. |
| Erectile dysfunction | . An extremely common and distressing problem. Many persons find relief in the Viagra© group of tablets. Some hormonal causes have to be looked for and treated. Has to be differentiated from loss of sexual desire or libido. |
| Gender issues | . Gender incongruence is a situation where the person feels uncomfortable in the gender in which he or she has been born. This is no longer considered a mental health issue. Treatment is complex and needs to be delivered by a multidisciplinary team. |
| Glucose meters. | Many meters are available. They are not as accurate as a lab test. The current ISO specifications for meters require that they be accurate to within 15 % either way of the actual lab value. They are very useful for patients on insulin, not so much for patients on tablets. |
| Goiter. | This is a smooth enlargement of the thyroid. If the thyroid is overactive or underactive as well, treatment is needed. Otherwise, cosmetic treatment with thyroid tablets can be offered in some situations. Sometimes the thyroid gland develops many nodules or swellings on its surface. This is a multinodular goiter. |
| Hair loss. | Hair loss is seen in several hormonal conditions for example PCOS or thyroid disease. Unfortunately in most cases an endocrinologist cannot provide satisfactory relief. |
| Hypogonadism – females | Here the ovary does not produce female hormone (called estrogen) and does not produce mature eggs. The defect can lie in the ovary due to genetic causes, cancer chemotherapy and so on. Sometimes the defect lies in the pituitary which does not properly produce the hormones FSH & LH. The pituitary problem is very challenging to treat in females. |
| Hypogonadism - males | The testis produces testosterone and sperm under the control of hormones coming from the pituitary called FSH & LH. Damage in either the testis or pituitary can cause hypogonadism. It is quite simple to replace the missing testosterone. Getting the testis to produce sperm is a complex and challenging task and may not always be possible. |
| Hypogonadotrophic hypogomadism | Here the pituitary does not produce hormones called FSH & LH. It can happen from birth due to genetic causes, or be due to pituitary tumor or surgery. The testis does not produce testosterone or sperm. FSH & LH are available as injections and often (but not always) produce a successful outcome. |
| Insulin pump. | The pump is a small battery driven device about the size of a cell phone. It is carried in the pocket and is programmed to pump insulin throughout the day and night. A tube leads to the abdomen where a tiny needle connects it to the abdomen. It is disconnected during bathing or swimming. Before the patient eats, he instructs the pump to pump in an extra dose called a bolus. The bolus dose depends on what the patient plans to eat, he will give a large bolus for a large meal and a small one for a snack. |
| Insulin. | Insulin is a protein and works only if injected into the body. Injection is almost painless and very simple. Human insulin is now produced synthetically. A large number of insulins are available which vary in their peak action and duration of action. |
| Klinefelter Syndrome | This is a genetic disease of males where the testes do not produce enough of sperm or testosterone. |
| Milk secretion | This is called galactorrhea. Usually but not always, the hormone prolactin is elevated. Drugs are the commonest cause of prolactin elevation. These are mainly medicines used for gastrointestinal and psychiatric disorders. Rarely the cause may be a prolactin producing tumor of the pituitary. |
| Obesity | Contrary to popular opinion, obesity or being overweight is rarely a hormonal problem. Treatment is often frustrating as major and permanent life style changes have to be made and these are often not possible. Most treatments work for a short while only as the body tends to go back to its original weight . Surgical treatments are now quite popular. |
| Osteoarthritis | . This is a degenerative disease, most commonly affecting the knees and hips. It is a joint disease and not a hormonal disease and is included here because it is often confused with osteoporosis |
| Osteomalacia | Severe vitamin D deficiency in an adult is called osteomalacia. There is no deformity as growth is complete. There may be weakness bone pain and other features, all completely relieved by vitamin D. |
| Osteoporosis | Here bones become brittle . Osteoporotic bones can easily break under very little stress, of a kind that which would not affect normal bones. It commonly occurs after menopause but can affect both sexes. Some drugs can affect bone health. Treatment is sometimes frustrating as the goal is to prevent a fracture. Which means that if nothing happens, the treatment has worked. |
| Parathyroid | There are usually 4 parathyroid glands in the neck. They produce a hormone called PTH. High calcium levels are seen if there is parathyroid over activity, usually due to a tumor in one of of the glands. The treatment is surgical removal of the offending gland. In some situations there can be a rise of PTH with normal levels of calcium. Surgery is not done in these cases. The most common cause is deficiency of Vitamin D. |
| Penis size | Small penis size if a common cause of worry for parents and grandparents. In most cases, the boy is overweight and a normal size penis lies buried in fat. Rarely requires treatment other than weight loss. |
| Pheochromocytoma | This is a rare tumor of the adrenal gland. Among other problems it causes sudden rise of blood pressure. Can be fatal if not diagnosed and treated. Treatment is surgical removal. |
| Pituitary | The pituitary gland is a tiny structure situated below the brain and straight behind the nose. The front part of the gland called anterior pituitary produces hormones that control, the thyroid, cortisol production, milk secretion and sexual function. Any of these functions can be lost causing disease. For example the hormone controlling cortisol production is called ACTH. ACTH in turn controls the adrenal gland which actually produces the vital hormone called cortisol. In ACTH deficiency, the patient will suffer from a lack of cortisol. If ACTH is in excess, there will be excess cortisol production. |
| Pituitary developmental tumors | These are rare. The common ones are craniopharyngioma and germ cell tumors. |
| Pituitary tumor treatment | Many small tumors are picked up by chance and do not secrete any hormone. These are often left alone but carefully followed up. One type of tumor called a prolactinoma is almost always treated with medicines. Other tumors are treated by surgery which is often done through the nose. Radiation and very rarely chemotherapy is used in selected patients. |
| Pituitary tumors. | The anterior pituitary can develop a tumor which secretes a hormone. These tumors are detected early as the effects of excess hormone secretion are noticed early. Sometimes a pituitary tumor can be silent or non secreting. These tumors as they grow can squeeze out normal hormone production. Or they may put pressure on nearby structures and damage them. The commonest damage these tumors can cause is to the visual pathway. |
| Polycystic ovaries | This is extremely common condition, typically called PCOS or polycystic ovarian syndrome. Many factors including multiple genes are implicated. Being overweight makes PCOS more prominent. Many patients have delayed or absent periods. They do not have a deficiency of the female hormone estrogen. It is very important that the patient and her family understand the situation. Almost all PCOS women can have children. Unfortunately the internet is a poor resource for finding out about PCOS. |
| Posterior pituitary. | This is the part behind the anterior pituitary. This mainly secretes a hormone called anti diuretic hormone or ADH. ADH concentrates the urine. If ADH is deficient, the patient produces large amounts of urine and can even become severely dehydrated. The posterior pituitary does not form tumors. |
| Precocious puberty | Unlike early puberty, precocious puberty is a disease. An underlying cause has to be looked for. Sometimes no cause is found. Treatment is often needed and basically consists of temporarily stopping the biological clock. |
| Prolactinoma | This is a pituitary tumor producing a hormone called prolactin, often shortened to PRL. PRL is needed only for breastfeeding but is found in men too. PRL producing tumors are almost always treated by the endocrinologist with tablets. |
| PTH | This is the hormone produced by the parathyroid glands. If Vitamin D levels are low there is a compensatory rise of PTH. Here the treatment is vitamin D. |
| Puberty delayed | If there are no signs of puberty in girls over 13 years or boys over 14 years, then there may be a problem. Often a short course of hormones is enough to ‘jump start’ puberty. Sometimes there may be a disease whereby puberty has to be started by medicines and drug treatment has to be maintained long term. |
| Puberty early | Over the years the heights and weights of children have increased. Puberty also occurs earlier than before. This is normal. There is no clear dividing line between the normal and the abnormal. Careful assessment and follow up is needed. |
| Rickets | A growing child needs vitamin D and calcium. Most children get enough calcium in their diet. If however, vitamin D is deficient, their bones get deformed. This is called rickets and is treated by vitamin D. |
| Semen related problems | Quantity or viscosity (thickness) of seminal fluid is usually not a major issue. The quantity and quality of the sperm is important in terms of fertility. Short lived problems can be due to viral illness or other diseases. Long standing problems may require specialist treatment. |
| Sheehan syndrome | Here the pituitary gland is destroyed partly or completely as a complication of childbirth. Typically if there is excessive bleeding during childbirth, the pituitary gland gets destroyed. The patient does not lactate or menstruate after childbirth and progressively gets weaker. Diagnosis is a challenge as most patients belong to disadvantaged socio-economic groups and do not usually come to an endocrinologist. |
| Short stature | The height of a child must always be considered against the heights of both biological parents. There is no fixed figure for ‘normal height’. There is a rather wide range for what is considered normal. Once we decide the height is below range, a standard set of rather expensive tests are needed. After this, and in a few situations only, Growth Hormone injections are advised. |
| Short stature – adult | Very little growth is possible once the bones around the knee mature. Please beware of internet sites that promise height increase for adults. |
| Sperm | Problems can rise due to low number or poor forward progression of sperm. Both are seen under a microscope. Modern reproductive technology has opened new avenues of treatment . |
| Thyroid – hyperthyroid. | An overactive thyroid gland causes symptoms like weight loss tremor or palpitations. Some patients get better on their own and need to be identified early on. Treatment for the rest is with tablets, radioiodine or surgery. Eventually all patients will become hypothyroid. |
| Thyroid – hypothyroid. | The hormone TSH generally goes up in hypothyroidism, when the thyroid gland is unable to produce adequate levels of thyroid hormone. The symptoms are vague and extremely common even in the absence of thyroid disease. For example, tiredness, weakness, forgetfulness poor academic performance are very common but by no means specific to the thyroid. Being overweight is a rare feature, seen only in extreme cases. The dose of thyroid hormone tablets needs to be carefully regulated. There are no side effects as we are merely replacing a deficit. |
| Thyroid cancer. | Every patient is unique, but in the vast majority, about 97%, patients live out their normal life span. The thyroid gland is removed by surgery. |
| Thyroid nodule. | Here there is a swelling of a portion of the thyroid gland. Nodules are common and increase with age. Very few, not more than 10 % are malignant. If there is more than one nodule, each one has to be considered separately. An ultrasound of the thyroid is sufficient to screen and reassure many patients. In some patients a small portion of a nodule is sucked out with an ordinary syringe and needle and examined. This is called FNAC. FNAC can clear most nodules and flag the really suspicious ones. Unfortunately there is a grey area where the FNAC cannot give a clear answer. |
| Turner Syndrome | This is a female genetic disorder where patients are short and do not have good ovarian function. Many clinical features have been described. A given patient usually does not have all the features. Various treatments are available but of course the basic gene defect cannot be corrected. |
| Vitamin D | This is a hormone produced by the body when exposed to sunlight. The amount of sun exposure needed is so high that it is impractical for a city dweller to have adequate levels. Hence vitamin D supplements are often needed. No food found in nature has vitamin D. Over enthusiastic use of vitamin D is harmful, but unfortunately quite common.. |