Endocrinology

Endocrinology is a medical specialty that studies the endocrine glands in the human body, the diseases associated with them and the methods for their diagnosis and treatment. The glands, along with the hormones they make up the endocrine system.

What are hormones?

Hormones are molecules that are produced by the endocrine glands, including the hypothalamus, pituitary, adrenal, gonads, thyroid, parathyroid and pancreas. The term "endocrine" means that in response to specific stimuli, the products of these glands are released into the bloodstream. The hormones are then transported through the blood to their target cells. Some hormones have only a few specific target cells, while other hormones affect multiple cell types in the body. The target cells for each hormone are characterized by the presence of certain docking molecules (i.e. receptors) for the hormone, which are located either on the cell surface or inside the cell. The interaction between the hormone and its receptor triggers a cascade of biochemical reactions within the target cell that ultimately alter the function or activity of the cell.

Mechanisms of action

There are several classes of hormones, including steroids, amino acid derivatives and polypeptides, and proteins. These hormone classes differ in their overall molecular structure (e.g. size and chemical properties). As a result of the structural differences, their mechanisms of action (e.g. whether they can enter their target cells and how they modulate the activity of these cells) also differ. Steroids that are produced by the gonads and by the adrenal cortex have a molecular structure similar to that of cholesterol. The molecules can enter their target cells and interact with receptors in the fluid that fills the cell (i.e., the cytoplasm) or in the cell nucleus. Hormone-receptor complexes then bind to specific regions of the cell's genetic material, thereby regulating the activity of specific hormone-responsive genes. Amino acid derivatives are modified versions of some of the building blocks of proteins. The thyroid gland and adrenal medulla produce this type of hormone. Like steroids, amino acid derivatives can enter the cell where they interact with receptor proteins that are already bound to specific regions of DNA. The interaction modifies the activity of the affected genes. Polypeptide and protein hormones are chains of amino acids of different lengths (from three to several hundred amino acids). These hormones are mainly found in the hypothalamus, pituitary gland and pancreas. In some cases, they are derived from inactive precursors or prohormones that can be cleaved into one or more active hormones. Because of their chemical structure, polypeptide and protein hormones cannot enter cells. Instead, they interact with receptors on the cell surface. The interaction initiates biochemical changes in the membrane or interior of the cell, ultimately modifying the activity or function of the cell.

Regulation of hormonal activity

In order to maintain body homeostasis and respond adequately to environmental changes, hormone production and secretion must be tightly controlled. To achieve this control, many bodily functions are regulated not by a single hormone but by several hormones that regulate each other. For example, for many hormone systems, the hypothalamus secretes so-called releasing hormones that are transported through the blood to the pituitary gland. There, the releasing hormones induce the production and secretion of pituitary hormones, which are in turn transported by the blood to their target glands (e.g., the adrenal glands, gonads, or thyroid). In these glands, the interaction of pituitary hormones with their respective target cells results in the release of hormones that ultimately influence the organs targeted by the hormonal cascade.

Constant feedback from the target glands to the hypothalamus and pituitary gland ensures that the activity of the hormonal system involved remains within appropriate limits. Thus, in most cases there are negative feedback mechanisms by which hormones released from the target glands affect the pituitary gland and/or hypothalamus. When certain predetermined levels of these hormones are reached in the blood, the hypothalamus and/or pituitary gland stop releasing hormones, thus shutting down the cascade. In some cases, a so-called short-circuit feedback occurs, in which the pituitary hormones act directly on the hypothalamus. The sensitivity with which these negative feedback systems operate (i.e., the target hormone levels that are required to turn off the release of hypothalamic or pituitary hormones) may change with different physiological conditions or life stages. For example, the progressive decrease in hypothalamic and pituitary sensitivity to negative feedback from gonadal steroid hormones plays an important role in sexual maturation. Although negative feedback is more common, some hormonal systems are controlled by positive feedback mechanisms in which the target gland hormone acts back on the hypothalamus and/or pituitary to increase the release of hormones that stimulate the secretion of the target gland hormone. One such mechanism occurs during a woman's menstrual cycle: the increase in estrogen levels in the blood temporarily stimulates rather than inhibits hormone release from the pituitary and hypothalamus, thereby further increasing estrogen levels and ultimately leading to ovulation. However, such a mechanism requires a certain threshold level at which positive feedback is turned off in order to maintain a stable system.

The hypothalamus and its hormones

The hypothalamus is a small area located in the brain that controls many bodily functions, including eating and drinking, sexual function and behavior, blood pressure and heart rate, maintenance of body temperature, the sleep-wake cycle, and emotional states (e.g., fear, pain, anger, and pleasure). Hypothalamic hormones play a major role in regulating many of these functions. Because the hypothalamus is part of the central nervous system, hypothalamic hormones are actually produced by nerve cells. In addition, because signals from other neurons can modulate the release of hypothalamic hormones, the hypothalamus serves as a major link between the nervous and endocrine systems. For example, the hypothalamus receives information from higher brain centers that respond to various environmental signals. Therefore, hypothalamic function is influenced by both the external and internal environment, as well as hormonal feedback. Stimuli from the external environment that indirectly influence hypothalamic function include the light-dark cycle; temperature; signals from other members of the same species; and a wide variety of visual, auditory, olfactory, and sensory stimuli. Communication between other areas of the brain and the hypothalamus, which conveys information about the internal environment, involves electrochemical signal transmission via molecules called neurotransmitters (e.g., aspartate, dopamine, gamma-aminobutyric acid, glutamate, norepinephrine, and serotonin). The complex interplay of the actions of different neurotransmitters regulates the production and release of hormones from the hypothalamus.

Hypothalamic hormones are released into the blood vessels that connect the hypothalamus and pituitary gland. Because they usually promote or inhibit the release of hormones from the pituitary gland, hypothalamic hormones are commonly called releasing or inhibiting hormones. The main releasing and inhibiting hormones include:

• Corticotropin - releasing hormone (CRH), which is part of the hormone system that regulates carbohydrate, protein and fat metabolism, as well as sodium and water balance in the body.
• Gonadotropin - releasing hormone (GnRH), which helps control sexual and reproductive functions, including pregnancy and breastfeeding.
• Thyrotropin - releasing hormone (TRH), which is part of the hormonal system controlling the metabolic processes of all cells and which contributes to the hormonal regulation of lactation.
• Growth Hormone - releasing hormone (GHRH), which is an essential component of the body's growth-promoting system.
• Somatostatinwhich also affects bone and muscle growth, but has the opposite effect of growth hormone.
• Dopamine - a substance that functions primarily as a neurotransmitter but also has some hormonal effects, such as suppressing lactation until it becomes necessary after birth.

The pituitary gland and its main hormones

The pituitary gland is small in size and located in the brain just below the hypothalamus. The pituitary gland consists of two parts: the anterior pituitary and the posterior pituitary.

The anterior pituitary gland produces several important hormones that either stimulate target glands (e.g., the adrenal glands, gonads, or thyroid) to produce hormones or directly affect target organs. Anterior pituitary hormones include:

• Adrenocorticotropic hormone (ACTH) - stimulates the adrenal cortex to produce corticosteroid hormones - mainly cortisol - as well as small amounts of female and male sex hormones.
• Gonadotropins - Gonadotropins consist of two molecules, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These two hormones regulate the production of female and male sex hormones in the ovaries and testes, as well as the production of germ cells - that is, eggs and sperm.
• Thyroid-stimulating hormone (TSH), also called thyrotropin- stimulates the thyroid gland to produce and secrete thyroid hormone
• Growth Hormone (GH) - directly affects the target organs. GH is the most common of the pituitary hormones. As the name implies, it plays a major role in controlling growth and development of the body. For example, it stimulates linear bone growth; promotes the growth of internal organs, adipose tissue, connective tissue, endocrine glands, and muscle; and controls the development of reproductive organs. Accordingly, blood GH levels are highest during early childhood and puberty and decline thereafter. However, even relatively low GH levels can still be important later in life, and GH deficiency can contribute to some symptoms of aging.

In addition to its growth-promoting role, GH influences carbohydrate, protein, and fat metabolism. GH also improves the uptake of amino acids from the blood into cells, as well as their incorporation into proteins, and stimulates the breakdown of lipids in adipose tissue.To produce these various effects, GH modulates the activities of multiple target organs, including the liver, kidneys, bones, cartilage, skeletal muscle, and fat cells.

• Prolactin - directly affects the target organs

Along with other hormones, prolactin plays a central role in the development of the female breast and in the initiation and maintenance of lactation after birth. However, the function of prolactin in men is not well understood, although excessive prolactin release can lead to decreased sexual desire (i.e., libido) and impotence. Several factors control the release of prolactin from the anterior pituitary. For example, prolactin is released in increasing amounts in response to the rise in blood estrogen levels that occurs during pregnancy. In lactating women, prolactin is secreted in response to suckling by the baby. Several releasing and inhibiting factors from the hypothalamus also control the release of prolactin. The most important of these factors is dopamine, which has an inhibitory effect.

Alcohol consumption by lactating women can affect lactation both through its effects on prolactin and oxytocin release and through its effects on the mammary glands and milk composition.

The posterior pituitary does not produce its own hormones; instead, it stores two hormones - vasopressin and oxytocin - that are produced by neurons in the hypothalamus. Both of these hormones collect at the ends of neurons that are located in the hypothalamus and extend to the back of the pituitary. Vasopressin, also called arginine vasopressin (AVP), plays an important role in the body's water and electrolyte economy. Thus, the release of vasopressin promotes the reabsorption of water from urine in the kidneys. Through this mechanism, the body reduces urine volume and conserves water. The release of vasopressin from the pituitary gland is controlled by the concentration of sodium in the blood, as well as blood volume and blood pressure. For example, high blood pressure or increased blood volume results in inhibition of AVP release. Consequently, more water is excreted in the urine and both blood pressure and blood volume are reduced. Alcohol has also been shown to inhibit the release of AVP. Conversely, certain other drugs (e.g., nicotine and morphine) increase AVP release, as does severe pain, fear, nausea, and general anesthesia, resulting in lower urine production and water retention. Oxytocin, the second hormone stored in the posterior pituitary gland, stimulates uterine contractions during childbirth. In lactating women, the hormone activates the ejection of milk in response to suckling by the baby (the so-called relaxation reflex).

The adrenal glands and their hormones

The adrenal glands are small structures located at the top of the kidneys. Structurally, they consist of an outer layer (i.e., the cortex) and an inner layer (i.e., the medulla). The adrenal cortex produces numerous hormones, primarily corticosteroids. The cortex is also the source of small amounts of sex hormones; however, these amounts are negligible compared to the amounts normally produced by the ovaries and testes. The medulla of the adrenal gland generates two substances - adrenaline and noradrenaline - which are released as part of the fight or flight response to various stressors. The main glucocorticoid in humans is Cortisol (also called hydrocortisone), which helps control carbohydrate, protein and lipid metabolism. For example, cortisol increases blood glucose levels by stimulating gluconeogenesis in the liver and promoting the formation of glycogen (i.e., a molecule that serves as a storage form of glucose) in the liver. Cortisol also decreases glucose uptake in muscle and adipose tissue, thereby opposing the effects of insulin. Furthermore, in various tissues, cortisol promotes the breakdown of proteins and lipids to products (amino acids and glycerol) that can be used for gluconeogenesis. In addition to these metabolic activities, cortisol protects the body from the harmful effects of various stressors, including acute trauma, major surgery, severe infections, pain, blood loss, hypoglycemia, and emotional stress. All of these stressors lead to a dramatic increase in blood cortisol levels. For people whose cortisol levels cannot rise (for example, because they have had their adrenal glands removed), even mild stress can be fatal. Finally, high doses of cortisol and other corticosteroids can be used medically to suppress tissue inflammation in response to injury and to reduce the immune response to foreign molecules.

The main mineralocorticoid in humans is Aldosteronewhich also helps regulate the body's water and electrolyte balance. Its main functions are to store sodium and excrete potassium from the body. For example, aldosterone promotes the reabsorption of sodium in the kidneys, thereby reducing water excretion and increasing blood volume. Similarly, aldosterone reduces the ratio of sodium to potassium concentrations in sweat and saliva, thereby preventing sodium loss through these pathways. The effect can be very useful in hot climates where a lot of sweating occurs. Unlike glucocorticoids, pituitary or hypothalamic hormones do not regulate the release of aldosterone. Instead, it is mainly controlled by another hormone system, the reninangiotensin system, which also controls kidney function.

The sex glands and their hormones

The gonads (ovaries and testes) perform two main functions. First, they produce germ cells (eggs in the ovaries and sperm in the testes). Second, the gonads synthesize steroid sex hormones that are necessary for the development and functioning of both female and male reproductive organs and secondary sex characteristics as well as for pregnancy, childbirth, and lactation. There are three types of sex hormones; each with different functions. Estrogens (e.g., estradiol) that exert feminizing effects; (2) progestogens (e.g. progesterone) that affect the uterus in preparation for and during pregnancy; and (3) androgens (e.g. testosterone) that exert masculinising effects. In addition to reproductive functions, sex hormones play multiple essential roles in the body. For example, they affect carbohydrate and lipid metabolism, the cardiovascular system, and bone growth and development.

• Estrogens - The main estrogen is estradiol, which, in addition to small amounts of estrone and estriol, is produced mainly in the ovaries. Other sites of estrogen production include the corpus luteum, placenta, and adrenal glands. In men and postmenopausal women, most estrogens present in the circulation are derived from the conversion of testicular, adrenal, and ovarian androgens. Conversion occurs in peripheral tissues, primarily adipose tissue and skin. The primary role of estrogens is to coordinate the normal development and functioning of the female genitalia and breasts. During puberty, estrogens promote the growth of the uterus, breasts, and vagina; determine the pattern of body fat deposition and distribution that results in the typical female form; regulate pubertal growth and growth arrest at adult stature; and control the development of secondary sex characteristics. In adult women, the major functions of estrogens include regulating the menstrual cycle, contributing to the hormonal regulation of pregnancy and lactation, and maintaining female libido.

During menopause, estrogen production in the ovaries stops. The resulting decrease in estrogen levels leads to symptoms such as hot flashes, sweating, heart palpitations (i.e. palpitations), increased irritability, anxiety, depression, and brittle bones (i.e. osteoporosis). Administration of estrogens (i.e., hormone replacement therapy) can relieve these symptoms and reduce the risk of osteoporosis and coronary heart disease in postmenopausal women. At the same time, however, hormone replacement therapy may increase the risk of certain cancers (e.g., breast and uterine cancers). Alcohol consumption has been shown to increase estrogen levels in the blood and urine, even in premenopausal women who drink two or fewer drinks per day. These findings suggest that moderate alcohol consumption may help prevent osteoporosis and coronary heart disease in postmenopausal women. However, other studies have found no consistent association between alcohol consumption and elevated estrogen levels.

• Gestagens - The ovaries produce progestogens during a particular phase of the menstrual cycle and in the placenta throughout most of pregnancy. Gestagens cause changes in the uterine lining in preparation for pregnancy and, together with estrogens, stimulate mammary gland development in the breasts in preparation for lactation. The primary progestogen is progesterone.
• Androgens - The main androgenic steroid is testosterone, which is secreted mainly by the testes but also, in small amounts, by the adrenal glands (in both men and women) and by the ovaries. Its main function is to stimulate the development and growth of the male reproductive tract. In addition, testosterone has strong protein anabolic activity - that is, it promotes the generation of protein, which leads to an increase in muscle mass. The specific functions of testosterone vary during different developmental stages as follows:

In the fetus, testosterone mainly ensures the development of the internal and external male genitalia. During puberty, testosterone promotes the growth of the male genitalia and is responsible for other features of male development, such as the pubertal growth spurt and eventual growth arrest at adult stature; deepening of the voice; growth of facial, pubic, axillary, and body hair; and increase in muscularity and strength In adult males, testosterone primarily serves to maintain virility, libido, and sexual potency, as well as to regulate sperm production. Testosterone levels decline slightly with age, although the decline is not as drastic as the decrease in estrogen levels in women during menopause.

The thyroid gland and its hormones

The thyroid gland, which consists of two lobes, is located in front of the trachea, just below the larynx. The gland produces two structurally related hormones, thyroxine (T4) and triiodothyronine (T3), which are iodine derivatives of the amino acid tyrosine. Both hormones are collectively called "thyroid hormone". T4 accounts for approximately 90 percent of the hormone produced in the thyroid gland. However, T3 is a much more active hormone, and most of the T4 produced by the thyroid is converted to T3 in the liver and kidneys. Thyroid hormone in general serves to increase the metabolism of almost all body tissues. For example, thyroid hormone stimulates the production of certain proteins involved in the generation of body heat, a function that is essential for maintaining body temperature in cold climates. In addition, thyroid hormone promotes several other metabolic processes involving carbohydrates, proteins, and lipids that help generate the energy needed for body functions. In addition to these metabolic effects, thyroid hormone plays an essential role in the development of the central nervous system during the late fetal and early postnatal stages of development. Furthermore, thyroid hormone has an effect similar to that of GH on normal bone growth and maturation. Finally, thyroid hormone is necessary for the normal development of teeth, skin, and hair follicles, as well as for the functioning of the nervous, cardiovascular, and gastrointestinal systems.

In addition to thyroid hormone, certain cells (parafollicular C cells) in the thyroid gland produce calcitonin, a hormone that helps maintain normal blood calcium levels. Specifically, calcitonin lowers blood calcium levels by reducing the release of calcium from bones; inhibiting permanent bone erosion (bone resorption), which also releases calcium; and inhibiting calcium reabsorption in the kidneys. These effects are opposite to those of parathyroid hormone (PTH), which is discussed in the next section.

Parathyroid glands and their hormones

The parathyroid glands are four pea-sized bodies located behind the thyroid gland that produce parathyroid hormone (PTH). This hormone increases blood calcium levels, helping to maintain bone quality and an adequate supply of calcium, which is needed for multiple functions in the body (for example, muscle movement and signal transmission in cells). Specifically, PTH causes reabsorption of calcium by and excretion of phosphate in the urine. PTH also promotes the release of accumulated calcium from bone as well as bone resorption, both of which increase blood calcium levels. Finally, PTH stimulates the absorption of calcium from food in the gastrointestinal tract. Consistent with the central role of PTH in calcium metabolism, the release of this hormone is not controlled by pituitary hormones but by blood calcium levels. Thus, low calcium levels stimulate PTH release, whereas high calcium levels suppress it. Many of the functions of PTH require or are facilitated by a substance called 1,25-dihydroxycholecalciferol, a vitamin D derivative. In addition, many other hormones are involved in regulating calcium levels in the body and bone metabolism, including estrogens, glucocorticoids, and growth hormone.

The pancreas and its hormones

The pancreas is located in the abdomen, behind the stomach, and performs two distinctly different functions. First, it acts as an exocrine organ, as most of the cells of the pancreas produce various digestive enzymes that are secreted into the intestine and which are essential for the efficient digestion of food. Second, the pancreas serves as an endocrine organ because certain cell clusters (the islets of Langerhans) produce two hormones - insulin and glucagon - that are secreted into the blood and play a major role in blood sugar regulation.

• Insulin

Insulin is produced in the beta cells of the langerhans islands. Its main purpose is to lower blood sugar levels; in fact, insulin is the only blood sugar-lowering hormone in the body. To this end, insulin promotes the formation of stored forms of energy (e.g. glycogen, proteins and lipids) and inhibits the breakdown of these stored nutrients. Accordingly, the target organs of insulin are primarily those that are specialized for energy storage, such as the liver, muscle, and adipose tissue. Specifically, insulin has the following metabolic effects: Promotes glucose uptake into cells and conversion to glycogen, stimulates glucose breakdown, and inhibits gluconeogenesis Stimulates amino acid transport into cells and protein synthesis in muscle cells, thereby lowering the levels of amino acids available for gluconeogenesis in the liver Increases fat synthesis in the liver and adipose tissue, thereby lowering the levels of glycerol, which may also serve as a starting material for gluconeogenesis. Insulin release is controlled by a variety of factors, including blood glucose levels; other islet hormones (e.g., glucagon); and indirectly other hormones that alter blood glucose levels (e.g., GH, glucocorticoids, and thyroid hormones).

• Glucagon

The second pancreatic hormone regulating blood sugar is glucagon, which is produced in the alpha cells of the islets of langerhans. Glucagon raises blood sugar levels; accordingly, its main actions are generally opposite to those of insulin. For example, glucagon increases glycogen breakdown and gluconeogenesis in the liver, as well as lipid and protein breakdown. Glucagon release is regulated by many of the same factors as insulin release, but sometimes with opposite effects. Thus, an increase in blood glucose levels stimulates insulin release but inhibits glucagon release. A finely tuned balance between insulin and glucagon activity is essential for maintaining blood sugar levels. Accordingly, disturbances of this balance, such as insulin deficiency or the body's inability to respond adequately to insulin, lead to serious disorders such as diabetes mellitus.

Hormonal imbalance is a major cause of numerous medical conditions.

There are 3 main groups of disorders that are considered by Endocrinology specialists:

• When the glands do not produce enough hormones. This condition is called hypofunction of the gland.
• When the glands produce an excessive amount of hormones - hyperfunction of the gland.
• Tumors that develop in the endocrine glands.

The change in the function of the endocrine glands, as well as their physical change, leads to a change in the whole organism.

What are the most common endocrine diseases?

DIABETES

Diabetes mellitus is a chronic, socially significant disease in which the level of glucose in the blood is elevated. Glucose is needed for energy production, which occurs in every cell of the body. Glucose from the blood can only enter the cells in the presence of sufficient amounts of insulin. Insulin has the property of reducing the elevated blood sugar after food intake by helping it enter the cell. Insulin is the key that unlocks the cell door to allow glucose to enter the cell and produce energy. So it is in people who do not have diabetes.

In diabetics, there is a complete or partial lack of insulin production by the pancreas, as well as impaired action of the insulin produced.

DIABETES TYPE 1

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin. Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce energy.

Various factors, including genetics and certain viruses, can contribute to type 1 diabetes. Although type 1 diabetes usually appears in childhood or adolescence, it can also develop in adults.

Despite active research, type 1 diabetes still has no cure. Treatment focuses on managing blood sugar levels with insulin, diet and lifestyle to prevent complications.

Symptoms

Signs and symptoms of type 1 diabetes can appear relatively suddenly and may include:

• Increased thirst
• Frequent urination
• Bed wetting in children who have not previously wet the bed at night
• Extreme hunger
• Unwanted weight loss
• Irritability and other mood swings
• Fatigue and weakness
• Blurred vision

Reasons

The exact cause of type 1 diabetes is unknown. Normally, the body's own immune system - which normally fights harmful bacteria and viruses - mistakenly destroys the insulin-producing cells (islets of Langerhans) in the pancreas. Other possible causes include:

• Genetics
• Exposure to viruses and other environmental factors

The role of insulin

• Once a significant number of islet cells are destroyed the pancreas will produce little or no insulin.
• The pancreas secretes insulin into the bloodstream.
• Insulin circulates, allowing sugar to enter the cells.
• Insulin lowers the amount of sugar in the blood.
• As the blood glucose level decreases, the secretion of insulin by the pancreas also decreases.

The role of glucose

Glucose - sugar - is a major source of energy for the cells that make up muscle and other tissues.

Glucose comes from two main sources: food and liver.

Sugar is absorbed into the bloodstream, where it enters the cells with the help of insulin.

The liver stores glucose as glycogen.

When glucose levels are low, for example when no food has been taken for some time, the liver breaks down stored glycogen into glucose to keep glucose levels within normal limits.

In type 1 diabetes, there is no insulin to release glucose into the cells, so sugar builds up in the bloodstream. This can cause life-threatening complications.

Risk factors

Some known risk factors for type 1 diabetes include:

• Family History. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition.
• Genetics. The presence of certain genes indicates an increased risk of developing type 1 diabetes.
• Geography. The incidence of type 1 diabetes tends to increase as you move away from the equator.
• Age. Although type 1 diabetes can occur at any age, it appears at two noticeable peaks. The first peak is seen in children between the ages of 4 and 7, and the second is in children between the ages of 10 and 14.

Complications

Over time, complications from type 1 diabetes can affect major organs in the body, including the heart, blood vessels, nerves, eyes and kidneys. Maintaining a normal blood sugar level can dramatically reduce the risk of many complications.

Ultimately, complications from diabetes can be debilitating or even life-threatening:

• Disease of the heart and blood vessels. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the small blood vessels (capillaries) that feed the nerves, especially in the legs. This can cause numbness, tingling, burning, or pain that usually starts at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar can eventually lead to complete loss of all sensation in the affected limbs.
• Damage to the nerves that affect the gastrointestinal tract can cause problems with nausea, vomiting, diarrhea, or constipation. For men, erectile dysfunction can be a problem.
• Kidney damage (nephropathy). The kidneys contain millions of tiny clusters of blood vessels that filter waste from the blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage renal disease that requires dialysis or a kidney transplant.
• Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), which can potentially cause blindness. Diabetes also increases the risk of other serious vision diseases, such as cataracts and glaucoma.
• Damage to the foot. Nerve damage in the feet or poor blood flow to the feet increase the risk of various foot complications. If left untreated, cuts and blisters can develop into serious infections that may eventually require amputation of the toe, foot or leg.
• Skin and mouth condition. Diabetes can make sufferers more susceptible to skin and mouth infections, including bacterial and fungal infections. Gum disease and dry mouth are also more likely.
• Complications during pregnancy. High blood sugar levels can be dangerous for both mother and baby. The risk of miscarriage, stillbirth and birth defects increases when diabetes is not well controlled. For the mother, diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high blood pressure and pre-eclampsia.

Prevention

There is no known way to prevent type 1 diabetes. But researchers are working on preventing the disease or further destroying islet cells in people who are newly diagnosed. One such method is the administration of stem cells. You can read more here: https://www.medikara.bg/directions/regenerative-medicine

DIABETES TYPE 2

Type 2 diabetes is a disorder in the way the body regulates and uses sugar (glucose) as fuel. This long-term (chronic) condition results in too much sugar circulating in the bloodstream. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems.

In type 2 diabetes, there are primarily two interrelated problems in the body's functioning. The pancreas does not produce enough insulin - a hormone that regulates the movement of sugar in cells - and the cells respond poorly to insulin and take up less sugar.

Type 2 diabetes used to be known as adult-onset diabetes, but it can also start in childhood and adulthood. Type 2 diabetes is more common in adults, but the increase in the number of obese children has led to more cases of type 2 diabetes in younger people.

There is no cure for type 2 diabetes, but weight loss, proper diet and exercise can help manage the disease. If diet and exercise are not enough to manage blood sugar, insulin therapy may be needed.

Symptoms

The signs and symptoms of type 2 diabetes often develop slowly. In fact, a patient can live with type 2 diabetes for years and not know it. When signs and symptoms are present, they may include:

• Increased thirst
• Frequent urination
• Increased hunger
• Unwanted weight loss
• Fatigue
• Blurred vision
• Slow healing wounds
• Common infections
• Numbness or tingling of the hands or feet
• Areas of darkened skin, usually in the armpits and neck

Reasons

Type 2 diabetes is primarily the result of two interrelated problems:

• Cells in muscle, fat and liver become resistant to insulin. Because these cells do not interact normally with insulin, they do not take in enough sugar.
• The pancreas is unable to produce enough insulin to manage blood sugar levels.
• Exactly why this happens is unknown, but being overweight and inactive are key contributing factors.

Risk factors

Factors that can increase the risk of type 2 diabetes include:

• Weight. Being overweight or obese is a major risk.
• Fat distribution. Storing fat primarily in the abdomen - rather than the thighs- indicates greater risk.
• Lack of motor activity. The less activity, the greater the risk. Physical activity helps control weight, uses glucose as energy and makes cells more sensitive to insulin.
• Family History. The risk of type 2 diabetes increases if a parent, brother or sister has type 2 diabetes.
• Race and ethnicity. Although it is not clear why, people of certain races and ethnicities - including blacks, Hispanics, American Indians and Asians, and Pacific Islanders - are more likely to develop type 2 diabetes than white people.
• Blood lipid levels. Increased risk is associated with low levels of high-density lipoprotein (HDL) cholesterol - the "good" cholesterol - and high levels of triglycerides.
• Age. The risk of type 2 diabetes increases with age, especially after age 45.
• Prediabetes. Prediabetes is a condition in which the blood sugar level is higher than normal but not high enough to be classified as diabetes. If left untreated, prediabetes often progresses to type 2 diabetes.
• Risks associated with pregnancy. The risk of developing type 2 diabetes increases if gestational diabetes develops during pregnancy or when a baby weighing more than 4 kg is born.
• Polycystic ovary syndrome. Having polycystic ovary syndrome - a common condition characterised by irregular menstrual cycles, excessive hair growth and obesity - increases the risk of diabetes
• Areas of darkened skin, usually in the armpits and neck. This condition often indicates insulin resistance.

Complications

Type 2 diabetes affects many major organs, including the heart, blood vessels, nerves, eyes and kidneys. Also, factors that increase the risk of diabetes are risk factors for other serious chronic diseases. Managing diabetes and controlling blood sugar can reduce the risk of these complications or comorbid conditions.

Potential complications of diabetes and common comorbidities include:

• Disease of the heart and blood vessels. Diabetes is associated with an increased risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis).
• Nerve damage (neuropathy) in the extremities. High blood sugar over time can damage or destroy nerves, leading to numbness, tingling, burning, pain, or eventual loss of feeling, which usually starts at the tips of the toes or fingers and gradually spreads upward.
• Other nerve damage. Damage to the nerves of the heart can contribute to an irregular heart rhythm. Nerve damage in the digestive system can cause problems with nausea, vomiting, diarrhea, or constipation. In men, nerve damage can cause erectile dysfunction.
• Kidney disease. Diabetes can lead to chronic kidney disease or irreversible end-stage renal disease who are overweight and unable to reduce blood sugar levels with lifestyle changes.

An important modern method of treatment for Type 2 Diabetes is matabolic surgery. Read more about this method here: https://www.medikara.bg/directions/bariatrichna-hirurgiya

HYPERTHYROIDISM

Hyperthyroidism (overactive thyroid) occurs when the thyroid gland produces too much of the hormone thyroxine. Hyperthyroidism can speed up the body's metabolism, causing involuntary weight loss and a rapid or irregular heartbeat.

Several treatments are available for hyperthyroidism. Doctors use antithyroid drugs and radioactive iodine to slow the production of thyroid hormones. Sometimes treatment for hyperthyroidism involves surgery to remove all or part of the thyroid gland.

Although hyperthyroidism can be serious if ignored, most people respond well once hyperthyroidism is diagnosed and treated.

Symptoms

Hyperthyroidism can mimic other health problems, which can make diagnosis difficult. It can also cause a wide variety of signs and symptoms, including:

• Involuntary weight loss, even when appetite and food intake remain the same or increase
• Frequent heartbeat (tachycardia) - usually more than 100 beats per minute
• Irregular heart rhythm (arrhythmia)
• Heart palpitations (palpitations)
• Increased appetite
• Nervousness, anxiety and irritability
• Tremor - usually subtle trembling in the hands and fingers
• Sweating
• Changes in the menstrual cycle
• Increased sensitivity to heat
• Changes in bowel function, especially more frequent bowel movements
• Enlarged thyroid gland (goiter), which may appear as swelling at the base of the neck
• Fatigue, muscle weakness
• Difficulties with sleep
• Thinning of the skin
• Fine, brittle hair

Older people are more likely to have no signs or symptoms or have mild ones, such as increased heart rate, heat intolerance, and a tendency to fatigue during usual activities.

Reasons

Normally, the thyroid gland releases just the right amount of hormones, but sometimes it produces too much T4. This can happen for a number of reasons, including:

• Graves' disease. Graves' disease is an autoimmune disorder in which antibodies produced by the immune system stimulate the thyroid gland to produce too much T4. It is the most common cause of hyperthyroidism.
• Hyperfunctioning thyroid nodules (toxic adenoma, toxic multinodular goiter or Plummer's disease). This form of hyperthyroidism occurs when one or more thyroid adenomas produce too much T4. An adenoma is a part of the gland that has separated from the rest of the gland, forming noncancerous (benign) lumps that can cause the thyroid to enlarge.
• Thyroiditis. Sometimes the thyroid gland may become inflamed after pregnancy, due to an autoimmune condition or for unknown reasons. Inflammation can cause excess thyroid hormone stored in the gland to leak into the blood. Some types of thyroiditis can cause pain, while others are painless.

Risk factors

Risk factors for hyperthyroidism include:

• Family history, especially of Graves' disease
• Gender - occurs more often in women
• Personal history of certain chronic diseases, such as type 1 diabetes, pernicious anemia, and primary adrenal insufficiency

Complications

Hyperthyroidism can lead to a number of complications:

• Heart problems. Some of the most serious complications of hyperthyroidism involve the heart. These include rapid heart rate, a heart rhythm disorder called atrial fibrillation that increases the risk of stroke, and congestive heart failure, a condition in which the heart cannot circulate enough blood to meet the body's needs.
• Brittle Bones. Untreated hyperthyroidism can also lead to weak, brittle bones (osteoporosis). The strength of bones depends in part on the amount of calcium and other minerals they contain. Too much thyroid hormone interferes with the body's ability to incorporate calcium into bones.
• Eye problems. People with Graves' ophthalmopathy develop eye problems including bulging, red or swollen eyes, sensitivity to light and blurring or double vision. Left untreated, severe eye problems can lead to vision loss.
• Red, swollen skin. In rare cases, people with Graves' disease develop Graves' dermopathy. This affects the skin, causing redness and swelling, often on the shins and feet.
• Thyrotoxic crisis. Hyperthyroidism puts patients at risk for thyrotoxic crisis - a sudden increase in symptoms that leads to fever, rapid pulse and even delirium. If this happens, medical help should be sought immediately.

HYPOTHYROIDISM

Hypothyroidism (inactive thyroid) is a condition in which the thyroid gland does not produce enough of certain important hormones.

Hypothyroidism may not cause noticeable symptoms in the early stages. Over time, untreated hypothyroidism can cause a range of health problems, such as obesity, joint pain, infertility and heart disease.

Accurate thyroid function tests are available to diagnose hypothyroidism. Treatment with synthetic thyroid hormone is usually simple, safe and effective once the correct dose is found.

Symptoms

The signs and symptoms of hypothyroidism vary depending on the severity of the hormone deficiency. Problems tend to develop slowly, often over several years.

In the beginning, symptoms of hypothyroidism such as fatigue and weight gain may not be noticed. Or they may simply be attributed to aging. But as metabolism continues to slow, more obvious problems may develop.

Signs and symptoms of hypothyroidism may include:

• Fatigue
• Increased sensitivity to cold
• Constipation
• Dry skin
• Weight gain
• Puffy face
• Snoring
• Muscle weakness
• Elevated blood cholesterol level
• Muscle pain, tenderness and stiffness
• Pain, stiffness or swelling of the joints
• Heavier than normal or irregular menstrual periods
• Thinning hair
• Funny heartbeat
• Depression
• Impaired memory
• Enlarged thyroid gland (goiter)

Although hypothyroidism most commonly affects middle-aged and older women, anyone can develop the condition, including infants. Initially, babies born without a thyroid gland or with a gland that is not working properly may have few signs and symptoms.

When newborns have problems with hypothyroidism, problems may include:

• Yellowing of the skin and whites of the eyes (jaundice). In most cases, this occurs when the baby's liver cannot metabolize a substance called bilirubin, which is normally formed when the body recycles old or damaged red blood cells.
• Large, protruding tongue
• Difficulty breathing
• Hoarse cry
• Umbilical hernia

As the disease progresses, babies are likely to have feeding problems and may fail to grow and develop normally. They may also have:

• Constipation
• Poor muscle tone
• Excessive sleepiness

When hypothyroidism in infants is left untreated, even mild cases can lead to severe physical and mental retardation.

Hypothyroidism in children and teenagers

In general, children and teens who develop hypothyroidism have the same signs and symptoms as adults, but may also experience:

• Weak growth leading to low growth
• Delayed development of permanent teeth
• Fun puberty
• Poor mental development

Reasons

Hypothyroidism can be due to a number of factors, including:

• Autoimmune disease. The most common cause of hypothyroidism is an autoimmune disease known as Hashimoto's thyroiditis. Autoimmune diseases occur when the immune system produces antibodies that attack its own tissues. Sometimes this process involves the thyroid gland. Scientists are not sure why this happens, but it is probably a combination of factors, such as the body's own genes and environmental triggers.
• Excessive response to treatment of hyperthyroidism. People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or antithyroid drugs. The goal of these treatments is to return thyroid function to normal. But sometimes correcting hyperthyroidism can cause the thyroid hormone production to drop too much, leading to permanent hypothyroidism.
• Thyroid surgery. Removing all or much of the thyroid gland can reduce or stop hormone production. In this case, you will need to take thyroid hormones for life.
• Radiotherapy. Radiation used to treat head and neck cancer can affect the thyroid gland and can lead to hypothyroidism.
• Medication. A number of medications can contribute to hypothyroidism. One such drug is lithium, which is used to treat certain mental disorders.
• Less commonly, hypothyroidism can result from one of the following:
• Congenital disease. Some babies are born with a defective thyroid gland or without a thyroid gland. In most cases, the thyroid does not develop normally for unknown reasons, but some children have an inherited form of the disease. Often babies with congenital hypothyroidism appear normal at birth.
• Disorder of the pituitary gland. A relatively rare cause of hypothyroidism is the inability of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) - usually due to a benign pituitary tumor.
• Pregnancy. Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid. If left untreated, hypothyroidism increases a woman's risk of miscarriage, premature birth, and pre-eclampsia, a condition that causes a woman's blood pressure to rise significantly during the last three months of pregnancy. It can also seriously affect the developing fetus.
• Iodine deficiency. Trace minerals of iodine - found primarily in seafood, algae, plants grown in iodine-rich soil and iodized salt - are essential for thyroid hormone production. Too little iodine can lead to hypothyroidism, and too much iodine can worsen hypothyroidism in people who already have this disease. Iodine deficiency is common in some parts of the world, but adding iodine to table salt virtually eliminates this problem.

Complications

Untreated hypothyroidism can lead to a number of health problems:

• Goose. Constantly stimulating the thyroid to release more hormones can cause the gland to increase in size, a condition known as goiter. Although not usually uncomfortable, a large goiter can affect your appearance and may interfere with swallowing or breathing.
• Heart problems. Hypothyroidism may also be associated with an increased risk of heart disease and heart failure, mainly because high levels of low-density lipoprotein (LDL) cholesterol - the "bad" cholesterol - can occur in people with an underactive thyroid.
• Mental health issues. Depression can occur early in hypothyroidism and become more severe over time. Hypothyroidism can also cause delayed mental functioning.
• Peripheral neuropathy. Long-term uncontrolled hypothyroidism can cause peripheral nerve damage. Peripheral neuropathy can cause pain, numbness and tingling in the affected areas.
• Mixed. This rare, life-threatening condition results from long-term, undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness, followed by profound lethargy and unconsciousness. Myxedema coma can be induced by sedatives, infection or other stress on the body . If there are signs or symptoms of myxedema immediate emergency medical attention should be sought.
• Infertility. Low thyroid hormone levels can interfere with ovulation, which impairs fertility. In addition, some causes of hypothyroidism - such as an autoimmune disorder - can also impair fertility.
• Birth Defects. Babies born to women with untreated thyroid disease may have a higher risk of birth defects than babies born to healthy mothers. These children are also more prone to serious intellectual and developmental problems.
• Babies with untreated hypothyroidism present at birth are at risk for serious problems with both physical and mental development. But if this condition is diagnosed in the first few months of life, the chances of normal development are excellent.

HASHIMOTO

Hashimoto's disease is a condition in which the immune system attacks the thyroid gland. Inflammation from Hashimoto's disease, also known as chronic lymphocytic thyroiditis, often results in an underactive thyroid gland (hypothyroidism). Hashimoto's disease is the most common cause of hypothyroidism. It primarily affects middle-aged women, but can also occur in men and women of any age and in children. Treatment of Hashimoto's disease with thyroid hormone replacement is usually simple and effective.

Symptoms

At first, no signs or symptoms of Hashimoto's disease may be noticed, or swelling may appear in the front of the neck (goiter). Hashimoto's disease usually progresses slowly over years and causes chronic damage to the thyroid gland, leading to a drop in thyroid hormone levels in the blood. The signs and symptoms are primarily those of an underactive thyroid (hypothyroidism).

Reasons

The reason that causes the immune system to attack the thyroid is unknown. Some scientists think a virus or bacteria may trigger the reaction, while others think there may be a genetic problem.

A combination of factors - including heredity, gender and age - can determine the likelihood of developing the disease.

Risk factors

These factors may contribute to the risk of developing Hashimoto's disease:

• Gender. Women are much more likely to develop Hashimoto's disease.
• Age. Hashimoto's disease can occur at any age, but is more common in middle age.
• Heredity. If others in the family have thyroid disease or other autoimmune diseases you are more likely to develop Hashimoto's disease.
• Another autoimmune disease. Having another autoimmune disease - such as rheumatoid arthritis, type 1 diabetes or lupus - increases the risk of developing Hashimoto's disease.
• Exposure to radiation. People exposed to excessive levels of radiation from the environment are more susceptible to Hashimoto's disease.

Complications

If left untreated, an underactive thyroid (hypothyroidism) caused by Hashimoto's disease can lead to a number of health problems:

• Goose. Constant stimulation of the thyroid to release more hormones can cause the gland to enlarge, a condition known as goiter. Hypothyroidism is one of the most common causes of goiter. It's generally not uncomfortable, but a large goiter can affect appearance and can interfere with swallowing or breathing.
• Heart problems. Hashimoto's disease may also be associated with an increased risk of heart disease, mainly because high levels of low-density lipoprotein (LDL) cholesterol - the "bad" cholesterol - can occur in people with an underactive thyroid (hypothyroidism). If left untreated, hypothyroidism can lead to enlargement of the heart and possibly heart failure.
• Mental health issues. Depression can occur early in Hashimoto's disease and can become more severe over time. Hashimoto's disease can also cause a decrease in sexual desire (libido) in both men and women and can lead to a slowing of mental functioning.
• Myxedema - This rare, life-threatening condition can develop due to long-term severe hypothyroidism resulting from untreated Hashimoto's disease. Its signs and symptoms include drowsiness followed by profound lethargy and unconsciousness.
• A myxedema coma can be induced by exposure to cold, sedatives, infection, or other stress on the body. Myxedema requires immediate emergency medical treatment.
• Birth Defects. Babies born to women with untreated hypothyroidism due to Hashimoto's disease may have a higher risk of birth defects than babies born to healthy mothers. Doctors have long known that these children are more susceptible to intellectual and developmental problems. There may be a link between hypothyroid pregnancy and birth defects, such as cleft palate.
• There is also a link between hypothyroid pregnancy and heart, brain and kidney problems in infants. If you are planning to become pregnant or if you are in early pregnancy, be sure to have your thyroid level checked.

ADDISON'S DISEASE

Addison's disease, also called adrenal insufficiency, is a rare disease that occurs when the body does not produce enough of certain hormones. In Addison's disease, the adrenal glands produce too little cortisol and often too little aldosterone.

Addison's disease occurs in all age groups in both sexes and can be life-threatening. Treatment involves taking hormones to replace those that are lacking.

Symptoms

Symptoms of Addison's disease usually develop slowly, often over several months. Often the disease progresses so slowly that symptoms are ignored until a stress, such as an illness or injury, occurs that worsens the symptoms. Signs and symptoms may include:

• Extreme fatigue
• Weight loss and reduced appetite
• Darkening of the skin (hyperpigmentation)
• Low blood pressure
• Desire for salt intake
• Low blood sugar (hypoglycemia)
• Nausea, diarrhea, or vomiting (gastrointestinal symptoms)
• Pain in the abdomen
• Muscle or joint pain
• Irritability
• Depression or other behavioural symptoms
• Body hair loss or sexual dysfunction in women
• Acute adrenal insufficiency (Addisonian crisis)

Sometimes the signs and symptoms of Addison's disease can appear suddenly. Acute adrenal failure (Addisonian crisis) can lead to life-threatening shock. Emergency medical help should be sought if the following signs and symptoms are present:

• Strong weakness
• Confusion
• Pain in the lower back or legs
• Severe abdominal pain, vomiting and diarrhea leading to dehydration
• Decreased consciousness or delirium
• In an Addisonian crisis there is also:
• Low blood pressure
• High potassium (hyperkalemia) and low sodium (hyponatremia)

Primary adrenal insufficiency

When the cortex is damaged and does not produce enough adrenocortical hormones, the condition is called primary adrenal insufficiency. This is most often the result of an attack on the body (autoimmune disease). For unknown reasons, the immune system views the adrenal cortex as foreign, something to attack and destroy. People with Addison's disease are more likely than others to have another autoimmune disease.

Other causes of adrenal insufficiency may include:

• Tuberculosis
• Other adrenal gland infections
• Prevalence of cancer in the adrenal glands
• Bleeding in the adrenal glands. In this case, you may have an Addisonian crisis without any previous symptoms.

Secondary adrenal insufficiency

The pituitary gland produces a hormone called adrenocorticotropic hormone (ACTH). ACTH in turn stimulates the adrenal cortex to produce its hormones. Benign pituitary tumors, inflammation, and previous pituitary surgery are common causes of insufficient pituitary hormone production.

Too little ACTH can result in too little of the glucocorticoids and androgens normally produced by the adrenal glands, even though the adrenal glands themselves are not damaged. This is called secondary adrenal insufficiency. Mineralocorticoid production is not affected by too little ACTH.

Most symptoms of secondary adrenal insufficiency are similar to those of primary adrenal insufficiency. However, people with secondary adrenal insufficiency do not have hyperpigmentation and are less likely to have severe dehydration or low blood pressure. They are more likely to have low blood sugar.

A temporary cause of secondary adrenal insufficiency occurs when people taking corticosteroids (for example, prednisone) to treat chronic conditions, such as asthma or arthritis, stop taking the corticosteroids suddenly instead of reducing the dose gradually.

Complications

Addisonian crisis

If Addison's disease is left untreated an Addisonian crisis can develop as a result of physical stress, such as injury, infection or illness. Normally, the adrenal glands produce two to three times the usual amount of cortisol in response to physical stress. In adrenal insufficiency, failure to increase cortisol production under stress can lead to an Addisonian crisis.

Addisonian crisis is a life-threatening situation that leads to low blood pressure, low blood sugar levels and high potassium levels in the blood. In such cases, there is a need for immediate medical attention.

People with Addison's disease usually have associated autoimmune diseases.

Prevention

Addison's disease cannot be prevented, but there are steps that can be taken to avoid an Addisonian crisis. If the patient is always feeling tired, weak and losing weight a specialist endocrinologist should be consulted. Treatment with corticosteroids is prescribed. They can cause serious side effects in other cases, but in Addison's disease the side effects of high doses of glucocorticoids should not occur, as the dose that is prescribed replaces the missing amount. However, mandatory follow-up by a physician is needed so that too high a dose is not taken.

CUSHING'S DISEASE

Cushing's syndrome occurs when the body has too much of the hormone cortisol. This can result from taking oral corticosteroid medications. Or the body may produce too much cortisol.

Too much cortisol can cause some of the hallmarks of Cushing's syndrome - a fatty hump between your shoulder blades, a rounded face and pink or purple stretch marks on your skin. Cushing's syndrome can also lead to high blood pressure, bone loss and sometimes type 2 diabetes.

Treatment for Cushing's syndrome can return cortisol levels in the body to normal and symptoms improve. The earlier treatment begins, the better the chances of recovery.

Symptoms

The signs and symptoms of Cushing's syndrome can vary depending on the levels of excess cortisol.

Common signs and symptoms of Cushing's syndrome:

• Weight gain and fat deposits, especially around the middle and upper back, in the face (moon face) and between the shoulder blades (buffalo hump)
• Pink or purple stretch marks on the skin of the abdomen, thighs, chest and arms
• Thin, fragile skin that is easily injured
• Slow healing of cuts, insect bites and infections
• Acne

Signs and symptoms that women with Cushing's syndrome may experience:

• Thicker or more visible body and facial hair (hirsutism)
• Irregular or absent menstruation
• Signs and symptoms that men with Cushing's syndrome may experience:
• Decreased sexual desire
• Reduced fertility
• Erectile dysfunction
• Other possible signs and symptoms of Cushing's syndrome:
• Severe fatigue
• Muscle weakness
• Depression, anxiety and irritability
• Loss of emotional control
• Cognitive difficulties
• New or worsened high blood pressure
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• Infections
• Darkening of the skin
• Loss of bone tissue leading to fractures over time
• In children, impaired growth

Reasons

Cushing's syndrome can develop when taking oral corticosteroid drugs, such as prednisone, in high doses over time.

Oral corticosteroids may be needed to treat inflammatory diseases such as rheumatoid arthritis, lupus and asthma. They may also be used to prevent rejection of a transplanted organ.

It is also possible to develop Cushing's syndrome from injectable corticosteroids - for example, repeated injections for joint pain, bursitis and back pain. Inhaled steroid medicines for asthma and steroid skin creams used for skin conditions such as eczema are usually less likely to cause Cushing's syndrome than oral corticosteroids. But in some people, these drugs can cause Cushing's syndrome, especially if taken in high doses.

The body's own overproduction (endogenous Cushing's syndrome)

The condition may be due to the body producing either too much cortisol or too much adrenocorticotropic hormone (ACTH), which regulates cortisol production.

In these cases, Cushing's syndrome may be associated with:

• Tumor of the pituitary gland (pituitary adenoma). A non-cancerous (benign) pituitary gland tumor located at the base of the brain produces an excess amount of ACTH, which in turn stimulates the adrenal glands to produce more cortisol. When this form of the syndrome develops, it is called Cushing's disease. It occurs much more often in women and is the most common form of endogenous Cushing's syndrome.
• ACTH-secreting tumor. Rarely, a tumor that develops in an organ that does not normally produce ACTH begins to secrete this hormone in excess. These tumors, which may be noncancerous (benign) or cancerous (malignant), are usually found in the lungs, pancreas, thyroid, or thymus.
• Primary adrenal gland disease. Disorders of the adrenal glands can cause them to produce too much cortisol. The most common is a noncancerous tumor of the adrenal cortex called an adrenal adenoma, but only a small proportion of adenomas produce too much cortisol.
• Cancerous tumors of the adrenal cortex are rare, but can also cause Cushing's syndrome. Sometimes benign, nodular enlargement of both adrenal glands can lead to Cushing's syndrome.
• Family history of Cushing's. Rarely, people inherit a tendency to develop tumors of one or more of the endocrine glands, which affects cortisol levels and causes Cushing's syndrome.

Complications

Without treatment, complications of Cushing's syndrome can include:

• Loss of bone tissue (osteoporosis), which can lead to abnormal bone fractures, such as rib fractures and leg bone fractures
• High blood pressure (hypertension)
• Type 2 diabetes
• Frequent or unusual infections
• Loss of muscle mass and strength

ACROMEGAL

Acromegaly is a hormonal disorder that develops when the pituitary gland produces too much growth hormone in adulthood.

When there is too much growth hormone, the bones increase in size. In childhood, this leads to an increase in height and is called gigantism. But in adulthood, a change in height does not occur. Instead, the increase in bone size is limited to the bones of the hands, feet and face and is called acromegaly.

Because acromegaly is uncommon and physical changes occur slowly over many years, the condition sometimes takes a long time to recognize. Left untreated, high growth hormone levels can affect other parts of the body in addition to the bones. This can lead to serious - sometimes even life-threatening - health problems. But treatment can reduce the risk of complications and significantly improve symptoms, including enlargement of the features.

Symptoms

• A common sign of acromegaly is enlarged hands and feet. For example, rings that used to fit cannot be put on, and the size of shoes has gradually increased.
• Acromegaly can also cause gradual changes in facial shape, such as a prominent lower jaw and brow bone, an enlarged nose, thickened lips and wider spacing between teeth.
• Because acromegaly tends to progress slowly, early signs may not be apparent for years. Sometimes people only notice the physical changes by comparing old photos with newer ones.
• In general, the signs and symptoms of acromegaly tend to vary from person to person and may include some of the following:
• Enlarged hands and feet
• Enlarged facial features including facial bones, lips, nose and tongue
• Rough, oily, thickened skin
• Excessive sweating and body odour
• Small growths of skin tissue (skin tags)
• Fatigue and weakness of the joints or muscles
• Pain and limited joint mobility
• Deep, hoarse voice due to enlarged vocal cords and sinuses
• Loud snoring due to upper airway obstruction
• Vision problems
• Headache, which may be prolonged or severe
• Menstrual cycle disorders in women
• Erectile dysfunction in men
• Loss of interest in sex

Reasons

Acromegaly occurs when the pituitary gland produces too much growth hormone (GH) over a long period of time.

When the pituitary gland releases GH into the blood, it triggers the liver to produce a hormone called insulin-like growth factor-1 (IGF-1) - sometimes also called insulin-like growth factor-I or IGF-I. IGF-1 is what makes bones and other tissues grow. Too much GH leads to too much IGF-1, which can cause the signs, symptoms, and complications of acromegaly.

In adults, a tumor is the most common cause of too much GH production:

• Pituitary tumors. Most cases of acromegaly are caused by a noncancerous (benign) tumor (adenoma) of the pituitary gland. The tumor produces excessive amounts of growth hormone, which causes many of the signs and symptoms of acromegaly. Some of the symptoms of acromegaly, such as headaches and impaired vision, are due to the tumor pressing on nearby brain tissue.
• Non-pituitary tumors. In some people with acromegaly, tumors in other parts of the body, such as the lungs or pancreas, cause the disorder. Sometimes these tumors secrete GH. In other cases, the tumors produce a hormone called growth hormone-releasing hormone (GH-RH), which signals the pituitary gland to produce more GH.

Complications

If left untreated, acromegaly can lead to serious health problems. Complications can include:

• High blood pressure (hypertension)
• High cholesterol
• Heart problems, especially enlargement of the heart (cardiomyopathy)
• Osteoarthritis
• Type 2 diabetes
• Enlargement of the thyroid gland (goiter)
• Pre-cancerous growths (polyps) on the lining of the colon
• Sleep apnea- a condition in which breathing repeatedly stops and starts during sleep
• Carpal tunnel syndrome
• Increased risk of cancerous growths
• Compression or fractures of the spinal cord
• Changes in vision or loss of vision

Early treatment of acromegaly can prevent the development or worsening of these complications. Untreated acromegaly and its complications can lead to premature death.

NANISM

A dwarfism is short stature that results from a genetic or medical condition. A dwarfism is usually defined as a condition where an adult has a height of up to 147 cm. The average adult height among people with dwarfism is 122 cm.

Many different medical conditions cause dwarfism. In general, disorders are divided into two broad categories:

Disproportionate dwarfism. If body size is disproportionate, some body parts are small and others are of average or above average size. Disorders causing disproportionate dwarfism inhibit bone development.

Proportional dwarfism. A body is proportionately small if all parts of the body are small in equal degree and appear proportionate like a body of average height. Medical conditions that occur at birth or appear in infancy limit overall growth and development.

Some people prefer the term "short stature" or "little people" rather than "midget". Therefore, it is important to be sensitive to the preferences of someone who has this disorder.

Symptoms

Signs and symptoms - other than short stature - vary widely across the spectrum of disorders.

Disproportionate dwarfism

Most people with dwarfism have disorders that cause disproportionately short stature. Usually this means that a person has an average torso size and very short limbs, but some people may have a very short torso and shortened (but disproportionately large) limbs. In these disorders, the head is disproportionately large compared to the body.

Almost all people with disproportionate dwarfism have normal intellectual abilities. The rare exceptions are usually the result of a secondary factor, such as excess fluid around the brain (hydrocephalus).

The most common cause of dwarfism is a condition called achondroplasia, which causes disproportionately short stature. This disorder usually results in the following:

• Medium sized torso
• Short arms and legs, with particularly short upper arms and upper legs
• Short fingers, often with a wide space between the middle and ring fingers
• Limited mobility in the elbow
• Disproportionately large head, with prominent forehead and flattened bridge of nose
• Progressive development of shrunken legs
• Progressive development of waist sway
• Another cause of disproportionate dwarfism is a rare disease called spondyloepiphyseal congenital dysplasia (SEDC). Symptoms can include:
• Very short torso
• Short neck
• Short arms and legs
• Wide, rounded breasts
• Slightly flattened cheekbones
• An opening in the palate of the mouth (cleft palate)
• Hip deformities that lead to inward rotation of the hips
• Instability of the bones of the neck
• Progressive curvature of the upper spine
• Progressive development of waist sway
• Vision and hearing problems
• Arthritis and joint movement problems
• Adult height ranges from 91 cm to just over 122 cm

Proportional dwarfism

Proportional dwarfism results from medical conditions present at birth or occurring in infancy that limit overall growth and development. So the head, body, and limbs are small but proportional to each other. Because these disorders affect overall growth, many result in poor development of one or more body systems.

Growth hormone deficiency is a relatively common cause of proportional dwarfism. It occurs when the pituitary gland fails to produce a sufficient amount of growth hormone, which is essential for normal growth in childhood. Signs include:

• Height below the third percentile in standard pediatric growth charts
• Growth rate slower than expected for age
• Delayed or no sexual development during the teenage years

Reasons

Most disorders associated with dwarfism are genetic diseases, but the causes of some conditions are unknown. Most cases of dwarfism result from a random genetic mutation in either the father's sperm or the mother's egg, rather than the full genetic makeup of either parent.

TURNER SYNDROME

Turner syndrome, a condition that affects only women, occurs when one of the X chromosomes (sex chromosomes) is missing or partially missing. Turner syndrome can cause a variety of medical and developmental problems, including short stature, failure of ovarian development and heart defects.

Turner syndrome can be diagnosed before birth (prenatally) or in infancy. Sometimes, in women with mild signs and symptoms of Turner syndrome, the diagnosis is delayed until teenage or young adulthood.

Girls and women with Turner syndrome need ongoing medical care from a variety of specialists. Regular check-ups and appropriate care can help most girls and women lead healthy, independent lives.

Symptoms

The signs and symptoms of Turner syndrome can vary in girls and women with this disorder. In some girls the presence of Turner syndrome may not be obvious, but in other girls a number of physical characteristics and poor growth are evident very early. Signs and symptoms may be minor, developing slowly over time, or significant, such as heart defects for example.

Before birth

• Turner syndrome can be suspected prenatally based on prenatal cell-free DNA screening - a method of screening for certain chromosomal abnormalities in the developing baby using a blood sample from the mother - or prenatal ultrasound. A prenatal ultrasound of a baby with Turner syndrome may show:
• Large fluid collection in the back of the neck or other abnormal fluid collections (edema)
• Heart abnormalities
• Abnormal kidneys

At birth or during infancy

• Signs of Turner syndrome at birth or during infancy may include:
• Wide or net-like neck
• Low-set ears
• Wide chest
• High, narrow palate
• Arms that turn outward at the elbows
• Fingernails and toenails that are narrow and turned up
• Swelling of the arms and legs, especially in childbirth
• Slightly smaller than average height at birth
• Fun growth
• Heart defects
• Low hairline at the back of the head
• Small lower jaw
• Short fingers and toes

In childhood, teenage and adulthood

The most common signs in almost all girls, teenagers and young women with Turner syndrome are short stature and ovarian insufficiency due to ovarian failure, which may have occurred at birth or gradually during childhood, the teenage years or young adulthood. Signs and symptoms of this include:

• Fun growth
• No growth spurts at expected moments in childhood
• Adult height is significantly less than might be expected for a female family member
• Failure to initiate sexual changes expected during puberty
• Sexual development that "stuck" in the teenage years
• Early end of menstrual cycle not due to pregnancy
• For most women with Turner syndrome, it is impossible to conceive a child without fertility treatment.

Reasons

Most people are born with two sex chromosomes. Boys inherit the X chromosome from their mothers and the Y chromosome from their fathers. Girls inherit one X chromosome from each parent. In girls who have Turner syndrome, one copy of the X chromosome is missing, partially missing, or altered.

The genetic changes of Turner syndrome may be one of the following:

• Monosomy. The complete absence of the X chromosome is usually due to an error in the father's sperm or in the mother's egg. This results in each cell in the body having only one X chromosome.
• Mosaicism. In some cases, an error in cell division occurs during the early stages of fetal development. This results in some cells in the body having two complete copies of the X chromosome. Other cells have only one copy of the X chromosome.
• X chromosome abnormalities. Abnormal or missing parts of one of the X chromosomes may occur. Cells have one complete and one altered copy. This error can occur in the sperm or egg, with all cells having one complete and one altered copy. Or the error can occur in cell division in early fetal development, so that only some cells contain the abnormal or missing parts of one of the X chromosomes (mosaicism).
• Y chromosome material. In a small percentage of cases of Turner syndrome, some cells have one copy of the X chromosome and other cells have one copy of the X chromosome and little Y chromosomal material. These individuals develop biologically as women, but the presence of Y chromosome material increases the risk of developing a type of cancer called gonadoblastoma.
• Effect of chromosomal errors. The missing or altered X chromosome of Turner syndrome causes errors during fetal development and other developmental problems after birth - for example, short stature, ovarian failure and heart defects. The physical characteristics and health complications that arise from the chromosomal defect vary widely.

Risk factors

The loss or alteration of the X chromosome occurs randomly. Sometimes it is due to a problem with the sperm or egg, and other times the loss or change of the X chromosome occurs early in fetal development.

Family history does not appear to be a risk factor, so it is unlikely that parents of one child with Turner syndrome will have another child with this disorder.

Complications

Turner syndrome can affect the proper development of several body systems, but varies greatly in people with the syndrome. Complications that can occur include:

• Heart problems. Many babies with Turner syndrome are born with heart defects or even mild abnormalities in the heart structure that increase the risk of serious complications. Heart defects often involve problems with the aorta, the large blood vessel that branches off from the heart and delivers oxygen-rich blood to the body.
• High blood pressure. Women with Turner syndrome have an increased risk of high blood pressure, a condition that increases the risk of developing heart and blood vessel disease.
• Hearing loss. Hearing loss is common in Turner syndrome. In some cases it is due to the gradual loss of nerve function. The increased risk of frequent middle ear infections can also lead to hearing loss.
• Vision problems. Girls with Turner syndrome have an increased risk of poor muscle control of eye movements (strabismus), nearsightedness, and other vision problems.
• Kidney problems. Girls with Turner syndrome may have some kidney malformations. Although these abnormalities usually do not cause medical problems, they can increase the risk of high blood pressure and urinary tract infections.
• Autoimmune disorders. Girls and women with Turner syndrome have an increased risk of an underactive thyroid (hypothyroidism) due to the autoimmune disease Hashimoto's thyroiditis. They also have an increased risk of diabetes. Some women with Turner syndrome have gluten intolerance (celiac disease) or inflammatory bowel disease.
• Skeletal problems. Problems with bone growth and development increase the risk of abnormal curvature of the spine (scoliosis) and forward rounding of the upper back (kyphosis). Women with Turner syndrome are also at increased risk of developing weak, brittle bones (osteoporosis).
• Learning difficulties. Girls and women with Turner syndrome usually have normal intelligence. However, there is an increased risk of learning difficulties, especially in learning that involves spatial concepts, math, memory and attention.
• Mental health issues. Girls and women with Turner syndrome may have difficulty functioning well in social situations and have an increased risk of attention-deficit/hyperactivity disorder.
• Infertility. Most women with Turner syndrome are infertile. However, a very small number of women may become pregnant spontaneously, and some may become pregnant after fertility treatment.
• Complications during pregnancy. Because women with Turner syndrome are at increased risk for complications during pregnancy, such as high blood pressure and aortic dissection, they should be monitored by a cardiologist before and during pregnancy.

HYPOGONADISM

Hypogonadism occurs when the gonads produce little, if any, sex hormones. It affects teenagers and adults of both sexes. The condition causes low sexual desire or libido.

The testes in the male reproductive system produce testosterone, the main male hormone. Hypogonadism in men results from low testosterone.

The ovaries in the female reproductive system produce estrogen, progesterone, and testosterone. Women with hypogonadism often have low estrogen and progesterone.

Two glands in the brain, the hypothalamus and the pituitary, send signals to the gonads. These signals tell the body to produce sex hormones. When hypogonadism is present, something in the brain or sex glands interferes with hormone production.

Depending on the cause, hypogonadism can be:

• Primary hypogonadism: a problem in the gonads slows or stops hormone production.
• Secondary (central) hypogonadism: a problem with brain signals affecting hormone production.

In their late 40s or 50s, every man has lower amounts of sex hormones. As a result, sexual desire decreases. These changes are expected and normal. They are not necessarily a sign of hypogonadism. Younger people who have little or no interest in sex may have hypogonadism.

Conditions and treatments that increase the risk of primary hypogonadism include:

• Endocrine (adrenal) disorders, such as diabetes or Addison's disease.
• Cancer treatment, including radiation therapy and chemotherapy.
• Genetic disorders, such as Turner syndrome (in women) or Klinefelter syndrome (in men).
• Iron excess (hemochromatosis).
• Undescended testicles.
• Liver disease or kidney disease.
• Surgery of the reproductive organs.
• Risk factors for secondary hypogonadism include:
• Use of anabolic steroids or opioids.
• Brain surgery.
• Cancer treatment.
• Genetic disorders that affect brain development, such as Prader-Willi syndrome.
• Infections, including HIV.
• Inflammatory diseases, such as sarcoidosis.
• Obesity.
• Pituitary tumors (adenomas) and disorders.

It is not clear why some people develop hypogonadism. For unknown reasons, a problem with the gonads or the brain affects the body's production of sex hormones.

Symptoms of hypogonadism vary depending on the cause and gender. Teenagers may receive a diagnosis of secondary hypogonadism when they do not start puberty on time. For example, teenage girls with hypogonadism may not get their periods or develop breasts. Boys may have no facial hair or underdeveloped testicles.

Adults may experience low sex drive (sexual dysfunction) as well as hair loss and hot flashes. Other common complaints include fatigue and difficulty concentrating.

Signs of hypogonadism in women include:

• Abnormal menstruation.
• Milky discharge from the nipples.
• Signs of hypogonadism in men include:
• Enlarged breasts (gynecomastia).
• Erectile dysfunction.
• Infertility due to low sperm count.
• Loss of muscle.

How is hypogonadism diagnosed?

The diagnosis is made after:

• In women, a gynecological examination may also be performed.
• Blood test. It can check the levels of sex hormones, thyroid hormones, prolactin and iron. This test is done in the morning when hormone levels are highest.
• Imaging tests: an MRI or CT scan can identify tumors in the pituitary gland or brain. An ultrasound can check for problems such as ovarian cysts or polycystic ovary syndrome.
• Spermogram for men.
• Hypogonadism can cause:
• Anxiety or depression.
• Infertility.
• Osteoporosis.
• Relationship problems.

How is hypogonadism managed or treated?

Treatment of hypogonadism varies depending on the cause. In primary hypogonadism, hormone replacement therapy can increase hormone levels. These treatments come in gels, implants, pills, injections, and skin patches. Female hormone therapy may slightly increase a woman's risk of uterine (endometrial) cancer, blood clots, and strokes.

If a problem with the pituitary gland such as a tumor causes secondary hypogonadism, it may require medication, radiation therapy or surgery.

What is the prognosis for people with hypogonadism?

Primary hypogonadism can be a chronic condition that requires ongoing treatment. If hormone replacement therapy is stopped, hormone levels can drop, causing symptoms to return.

If a treatable condition such as a pituitary gland tumor is causing hypogonadism, hormone levels should return to normal once treatment of the cause begins.

POLYCYSTIC OVARY SYNDROME

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excessive levels of male hormone (androgen). The ovaries may develop multiple small collections of fluid (follicles) and not release eggs regularly.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss can reduce the risk of long-term complications such as type 2 diabetes and heart disease.

Symptoms

The signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to significant weight gain.

The signs and symptoms of PCOS vary. A diagnosis of PCOS is made when at least two of these signs are present:

Irregular menstruation. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you may have fewer than nine cycles a year, more than 35 days between periods, and unusually heavy periods.

Excess androgen. Elevated levels of male hormones can lead to physical signs, such as excess facial and body hair (hirsutism), and sometimes severe acne and male pattern baldness.

Polycystic ovaries. The ovaries may be enlarged and contain follicles that surround the eggs. As a result, the ovaries may not function regularly.

The signs and symptoms of PCOS are usually more severe if one is overweight.

Reasons

The exact cause of PCOS is unknown. Factors that may play a role include:

• Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, the body's main energy . If cells become resistant to the action of insulin, then blood sugar levels can rise and the body can produce more insulin. Excess insulin can increase androgen production, causing difficulties with ovulation.
• Low-grade inflammation. This term is used to describe the white blood cells' production of substances to fight infection. Research shows that women with PCOS have a type of low-grade inflammation that stimulates the polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
• Heredity. Research shows that certain genes may be linked to PCOS.
• Excess androgen. The ovaries produce abnormally high levels of androgen, leading to hirsutism and acne.

Complications

Complications of PCOS can include:

• Infertility
• Gestational diabetes or high blood pressure caused by pregnancy
• Miscarriage or premature birth
• Nonalcoholic steatohepatitis - severe liver inflammation caused by fat accumulation in the liver
• Metabolic syndrome - a group of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase the risk of cardiovascular disease
• Type 2 diabetes or prediabetes
• Sleep apnoea
• Depression, anxiety and eating disorders
• Abnormal uterine bleeding
• Cancer of the uterine lining (endometrial cancer)
• Obesity is associated with PCOS and can worsen complications of the disease.

OSTEOPOROSIS

Osteoporosis makes bones weak and fragile - so fragile that a fall or even light exertions such as bending over or coughing can cause a fracture. Fractures associated with osteoporosis most often occur in the hip, wrist or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone is not in sync with the loss of old bone.

Osteoporosis affects men and women of all races. But white and Asian women, especially older women who have gone through menopause, are at highest risk. Medications, a healthy diet and exercise can help prevent bone loss or strengthen already weak bones.

Symptoms

There are usually no symptoms in the early stages of bone loss. But once bones are weakened by osteoporosis, signs and symptoms may appear, which include:

• Back pain caused by a broken or collapsed vertebra
• Loss of height over time
• Hunched posture
• A bone that breaks much easier than expected

Reasons

Bones are in a constant state of renewal - new bone is created and old bone is broken down. When young, the body makes new bone faster than it breaks down old bone and bone mass increases. After the early 20s, this process slows down and most people reach peak bone mass by age 30. As we age, bone mass is lost faster than it is created.

How likely it is to develop osteoporosis depends in part on how much bone mass was achieved in youth. Peak bone mass is partly inherited and also varies by ethnic group. The higher the peak bone mass, the more bone there is 'in reserve' and the less likely it is to develop osteoporosis as you get older.

Risk factors

A number of factors can increase the likelihood of developing osteoporosis - including age, race,lifestyle, medical conditions and treatment.

Immutable risks

• Gender. Women are much more likely to develop osteoporosis than men.
• Age. As you age, the risk of osteoporosis becomes greater.
• Race. People of Caucasian or Asian descent are at greatest risk for osteoporosis.
• Family History. If there is a parent or sibling with osteoporosis this suggests a greater risk of osteoporosis.
• Body Frame Size. Men and women who have small body frame sizes tend to have a higher risk because they may have less bone mass from which to draw as they age.

Hormonal levels

Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. Examples include:

Sex hormones. Decreased levels of sex hormones tend to weaken bones. Declining estrogen levels in menopausal women is one of the strongest risk factors for developing osteoporosis. Prostate cancer treatment, which reduces testosterone levels in men, and breast cancer treatment, which reduces estrogen levels in women, are likely to accelerate bone loss.

Thyroid problems. Too much thyroid hormone can cause bone loss. This can happen if the thyroid is overactive or when taking too much thyroid hormone medication to treat an underactive thyroid.

Other glands. Osteoporosis is also associated with overactivity of the parathyroid and adrenal glands.

Dietary factors

Osteoporosis is more likely to occur in people who have:

• Low calcium intake. Lack of calcium throughout life plays a role in the development of osteoporosis. Low calcium intake contributes to reduced bone density, early bone loss and increased risk of fractures.
• Eating disorders. Severe restriction of food intake and underweight weaken bones in both men and women.
• Gastrointestinal surgery. Surgery to reduce the size of the stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium.

Steroids and other drugs

Long-term use of oral or injected corticosteroid drugs, such as prednisone and cortisone, interferes with the bone repair process.

Certain bad habits can increase the risk of osteoporosis. Examples include:

• Sedentary lifestyle. People who spend a lot of time sitting have a higher risk of osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are good for bones, but walking, running, jumping, dancing and weight lifting seem to be especially beneficial.
• Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks per day increases the risk of osteoporosis.
• Tobacco use. The exact role that tobacco plays in osteoporosis is not clear, but tobacco use has been shown to contribute to bone weakness.

Complications

Bone fractures, especially in the spine or hip, are the most serious complications of osteoporosis. Hip fractures are often caused by a fall and can lead to disability and even an increased risk of death in the first year after injury.

In some cases, spinal fractures can occur, even without a blow or fall. The bones that make up the spine (vertebrae) can weaken, which can lead to back pain, loss of height and stooped posture.

Prevention

Good nutrition and regular exercise are essential for maintaining healthy bones throughout life.

• Calcium

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium per day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

• Vitamin D

Vitamin D improves the body's ability to absorb calcium and improves bone health.

Most people need at least 600 units (IU) of vitamin D per day. This recommendation increases to 800 IU per day after age 70.

• Physical activity

Physical activity can help build strong bones and slow bone loss.

Strength training helps strengthen the muscles and bones of the arms and upper spine. Weight-bearing exercises - such as walking, jogging, running, climbing stairs, jumping rope, skiing and impact sports - mainly affect the bones of the legs, hips and lower spine. Balance exercises like can reduce the risk of falling.

Diagnosis of the endocrine system

Endocrine disorders cause a wide range of symptoms. Many of these symptoms overlap with those of other conditions. This can make endocrine disorders difficult to diagnose and diagnosis may require a number of investigations and tests.

For example, endocrine disease can be diagnosed using:

• Hormone testing to determine if there are abnormally high or low levels of specific hormones
• Blood tests
• Urine tests to rule out other problems, such as infections or kidney problems
• Genetic tests to check for gene abnormalities that increase your risk of endocrine disease or affect your response to treatment

Other studies of the endocrine system:

• Fine needle aspiration - A fine needle is inserted into the area of interest (usually a thyroid nodule) and cells are removed, spread on a slide and evaluated by a cytopathologist. This process is repeated about three to six times. It is often performed under ultrasound guidance. The image shown will allow doctors to know what the diagnosis is.
• Sestamibi scan - A nuclear medicine scan that detects abnormally enlarged parathyroid glands after a radioactive dye is injected into the bloodstream. The scan is repeated several times during the day. SPECT imaging (a more sensitive and accurate type of scan) is routinely used. The radioisotope is taken up immediately by both the thyroid gland and the enlarged parathyroid adenoma. The isotope is washed out of the thyroid but remains in the parathyroid adenoma, as seen in an image taken after 2 hours. This test is useful to determine whether a patient is eligible for minimally invasive parathyroidectomy
• Ultrasound - Ultrasound uses sound waves to detect masses or fluid in soft tissue. It is particularly useful in evaluating thyroid nodules, lymph nodes of the neck and can identify enlarged parathyroid glands.
• Endoscopic ultrasound - An ultrasound probe is inserted into the stomach and duodenum by a gastroenterologist to view the pancreas and surrounding structures. This ultrasound is very useful for locating small neuroendocrine tumors of the pancreas, especially insulinoma.
• Computed tomography (CT) - CT is a cross-sectional image using X-rays. It generates very detailed images of the neck, chest and abdomen. It is sometimes used to assess whether a goiter extends into the chest or to look for a parathyroid gland that is not in its usual place. The abdomen is very useful for assessing the pancreas, liver and adrenal masses.
• 4D CT scan - This is a new test that is useful for imaging abnormal parathyroid glands, especially in cases of failed parathyroid surgery. It uses the special uptake and washing of dye from the parathyroid gland to differentiate it from other similar structures on the neck, such as lymph nodes.
• Magnetic resonance imaging (MRI) - This test uses a magnetic field to generate cross-sectional images of the body. It is particularly good at distinguishing different types of soft tissue masses. It can also be used to identify parathyroid glands and to better characterize adrenal and liver masses.
• Positron emission tomography (PET) test - PET scans can image the increased glucose metabolism found in most cancers. It is useful in finding otherwise undetected areas of cancer growth. It is also used to image thyroid cancers that do not take up radioactive iodine.
• Radioactive Iodine Imaging (RAI) Scan - Thyroid cells are designed to take up iodine and therefore a whole body scan after administration of radiolabeled iodine is a very sensitive test for detecting normal and most thyroid cancer cells in both the neck and the rest of the body.
• Octreoscan - Octreotide is a synthetic form of somatostatin-a hormone that binds to the somatostatin receptors on many neuroendocrine tumors. It is used to image carcinoid tumors and pancreatic NETs and to assess whether tumors will bind to octreotide for potential treatment with the drug.
• Venous Sampling - Venous sampling is an invasive technique performed through interventional radiology in which a catheter is inserted into a vein to draw blood samples for analysis of hormone levels from specific sites. The purpose of the test is to locate the source of abnormal hormone secretion. It is sometimes used before reoperative parathyroid surgery, in hyperaldosteronism and in insulinoma or gastrinomas.

Treatment

Treatment of endocrine diseases varies depending on the disease and the patient's medical history. For endocrine conditions that are associated with tumor growth, surgery may be a potential treatment. Other endocrine problems can be treated in the following ways:

• Suppression of hormones. Overactive glands can be managed by administering medical treatment. Patients who suffer from these types of endocrine disorders will need to be on a structured treatment plan for the rest of their lives, but can achieve a relatively good quality of life.
• Hormone replacement therapy. Endocrine disorders that cause a lack of hormone release can be managed by hormone replacement therapy. Careful, supervised treatment can help the endocrine system get back on track and release hormones in the right way.

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