There are several reasons why an endocrinologist may use diagnostic screenings, namely:
- The levels of hormones in a patient’s body need to be measured
- To examine if the endocrine glands are functioning normally
- To detect the source of the endocrinological issues
- To ensure that any previous diagnosis made was accurate
A number of tests may be recommended by the specialist to arrive at a conclusive diagnosis of the patient’s condition. The common ones are:
- Fine Needle Aspiration or FNA Biopsy:
The abnormal cells from the thyroid nodule or the area under observation is collected by inserting a thin needle. The sample is later examined by a cytopathologist in order to detect the presence of any malignant cells.
- Sestamibi Scan:
A radioactive dye is injected into the blood stream followed by a nuclear medicine scan. The dye can detect enlarged parathyroid glands. The scan may have to be repeated a few times throughout the day as it can locate the presence of any benign tumours up to 80% of the time.
- SPECT Imaging Scan:
This scan is more accurate as the radioisotope used is immediately absorbed by the thyroid gland and the enlarged parathyroid adenoma. The thyroid gland is washed out by the isotope but is retained by the parathyroid adenoma. This screening is especially useful to have an accurate understanding if the patient can undergo a minimally invasive parathyroidectomy procedure.
Using sound waves, an ultrasound scan is able to detect masses of fluid or soft tissues. It is predominantly helpful in assessing thyroid nodules, lymph nodes in the neck. It can also identify the presence of enlarged parathyroid glands.
- Endoscopic Ultrasound:
A gastroenterologist performs the endoscopic ultrasound by inserting an ultrasound probe in to the abdomen and duodenum. It is able to check the pancreas and its surrounding areas for the presence of localized, small pancreatic neuroendocrine tumorous growths, particularly insulinomas, which is a rare, insulin producing lump in the pancreas.
- Computerized Tomography (CT):
X-rays are used to check cross-sectional images in a CT Scan. Detailed visuals are produced of regions such as the neck, chest and stomach. The CT Scan also assesses if a goiter has spread to the chest area. It is additionally useful in examining the presence of parathyroid gland if it is not in its usual location. Further evaluation can also be done of the pancreas, liver and adrenal masses with the help of a CT Scan.
A non-contrast CT Scan may be recommended by the specialist, if he suspects a case of thyroid cancer.
- 4D CT Scan:
This is a more advanced form of the existing CT Scan where visuals produced are able to check for abnormal parathyroid glands, particularly, if the parathyroid surgery has failed. By using a special type of dye that uptakes and washes out the parathyroid glands and makes them easily distinguishable from similar structures in the neck such as the lymph nodes.
- Magnetic Resonance Imaging (MRI):
Cross sectional images of the body are produced by using a magnetic field that is especially useful in separating various types of soft tissue masses present in the body. It can also be used to determine the presence of parathyroid glands, adrenal and liver masses.
- Positron Emission Test (PET):
If there is a spike in the metabolism of glucose which is found in most cancers, a PET Scan will be able to detect the same. Additionally, if there are unknown areas of cancer growths, the PET Scan detect that too. If the specialist suspects thyroid cancer, he may recommend a PET Scan if radioactive iodine cannot be used.
- Radioactive Iodine Scan (RAI):
This is a very sensitive test where the entire body may be scanned by administering radioactively labelled iodine. Thyroid cells have the capability to absorb the iodine, thereby helping to detect the presence of normal and most types of cancerous thyroid cells both in the neck region and throughout the rest of the body.
The somatostatin receptors on many neuroendocrine tumours are connected by a hormone known an octreotide that is present in a synthetic form. The Octreoscan is used to detect the presence of carcinoid tumours and pancreatic NETs. It also assesses if the octreotide will able to bind with the tumour throughout the treatment phase.
- Meta Iodo Benzo Guanidine (MIBG) Scan:
This is again a radioactive iodine compound that the cells can absorb and synthesize catacholamines. Pheochromocytomas, paragangliomas, metastatic and bilateral diseases can be easily detected via MIGB imaging.
- Venous Sampling:
This is an invasive procedure performed by interventional radiology. A catheter is inserted into the vein to draw blood samples that are later examined for their hormone levels from particular spots. The concept of performing this screening is to narrow down the origin of the abnormal hormone secretion. The test may also be used before a reoperative parathyroid surgery and in insulinomas or gastrinomas.
- Bone Density Test
If there is a risk of osteoporosis, a bone density test may be recommended, even if there are no visible symptoms in the body. By using an X-ray, it displays the patient’s bones and if it has undergone any loss of tissue and minerals.
- ACTH Stimulation Test:
The pituitary gland produces the hormone ACTH that can command the outer portion of the adrenal gland to generate another hormone known as a cortisol. With the help of an ACTH Stimulation test, it can measure the levels of cortisol in the blood stream of the patient. It can also detect if the pituitary glands are functioning normally.
- CRH stimulation test:
If there is a decrease in the patient’s adrenal hormone, a CRH Stimulation test can detect it easily. CRH or corticotropin-releasing hormone is a naturally developing hormone which may set a triggering reaction to the pituitary glands to secrete the ACTH hormone.
- Dexamethasone Suppression Test
If the specialist needs to find out the source of why the patient has increased levels of the cortisol hormone, he may recommend a dexamethasone suppression test. During the test, the patient is administered with a synthetic form of the cortisol hormone known as dexamethasone. The patient’s urine is then checked to see how the patient’s body has responded to it. The test is generally used if the specialist suspects too many adrenal hormones present in the patient’s body.
- Five-day glucose sensor test:
This test uses a tiny sensor along with an electronic recorder to monitor the glucose levels in the patient’s body. Through this test, the doctor will be able to detect patterns in the patient’s glucose levels and determine methods to prevent the possibility of the patient developing low blood sugar.
In many cases, treating endocrine disorder can be quite complicated. Changes in one hormone does possess the potential to throw another hormone in the body completely off-balance. Through a series of diagnostic testing, your specialist doctor at Fortis Hospital, Mumbai will be able to find the route cause of the type of endocrine disorder affecting you and determine the individualised treatment plan accordingly.
Endocrinologists at Fortis Hospital, Mumbai have several years of expertise and are prone to adapting to newer and more cutting-edge medical technologies making the patient experience as non-invasive and smooth as possible. Through multiple consultations, your endocrinologist will talk you through the probable ways of treating your condition and help you choose the one that suits your health condition the best.