Endocrine Conditions & Disorders

The domain of endocrinology covers a wide range of hormonal conditions. The cause of these conditions is due to the increased or decreased production of a specific hormone. If there is a hormonal deficiency in the body, it may trigger symptoms. However, diagnosing of the condition may be difficult as patients may feel unwell in unconventional ways. You should consult your general physician if you are able to comprehend some of these peculiar signs. If the symptoms persist and your general physician feels it is due to hormonal imbalance, he may refer you to a specialist, an endocrinologist to be precise. The Department of Endocrinology at Fortis Hospital, Mumbai has well-accomplished endocrinologists who are adept at handling complicated cases of endocrine disorders. Endocrine disorders can be categorised into the following:
 

  • Pituitary Disorders:
    Although manageable by medical treatments, pituitary gland disorders usually require surgical therapy to remove the tumour. In order to chalk out the best possible treatment plan, Fortis specialists will first determine if the tumour is functional or non-functional by examining clinical symptoms, vision status, size, make-up, shape and location of the growth along with taking into account the patient’s age and if he or she has undergone any previous surgeries. With an individualised treatment plan in place, Fortis’ neuro-endocrinologist are able to provide therapy for the following types of pituitary disorders including:
     

    • Acromegaly, Cushing’s Disease and Prolactinomas that falls under functional pituitary tumours
    • Thyroid, the adrenal glands, water balance, reproductive organs, and growth hormone (GH) secretion falls under pituitary hormone deficiencies

 

  • Bone and Mineral Disorders:

In order to maintain one’s overall health, the endocrine system generates, breaks down and controls the functions of the hormones and minerals in the body. Calcium, iron, salt, vitamins and other important substances are natural minerals that are regulated within the body. If the normal processing of hormones and minerals are disrupted, it can result in bone and mineral disorders such as:
 

  • Osteoporosis:

This is a condition where small holes in the bones that are naturally present begin to grow. This results in changing the natural structure of the bones in the body. Symptoms include severe pain, possibly leading to bone fractures and breaks. This condition is common in ageing women and men.
 

  • Osteomalacia:

Bones are often softened in this condition particularly due to Vitamin D deficiency in the body. Symptoms such as bone pain and muscle weakness in this condition is a common occurrence. This may also result in fractures.
 

  • Hyperparathyroidism:

The neck region has the parathyroid glands that generates the parathyroid hormones. These hormones help in controlling the levels of calcium in the body. However, if the calcium levels in the blood stream increase drastically, it may lead to kidney stones, problems of the nervous system, pancreatitis or stomach ulcers.  

  • Paget’s Disease of the Bone:

Old bones are broken by a healthy bone metabolism which is a natural process in the body. This helps in the construction of new bones. Paget’s disease of the bone can occur if this natural process of new bone development is disturbed or stops working. Symptoms of this conditions includes bone and joint pain and may lead to the bones becoming more fragile.
 

  • Kidney Stones:

Recurring kidney stones may develop if the calcium levels increase in the body. The stones are basically hard deposits of minerals and acid salts. The stones may pass through the urinary tract but may also cause pain.
 

  • Adrenal Disorders:

Located just above the kidneys, the adrenal glands generate three important hormones. Two of these hormones, cortisol and aldosterone, are produced from the outer adrenal cortex. The third hormone, epinephrine, originates from the inner adrenal medulla. Patients suffering from adrenal disorders encounter an increase or decrease in any of these three hormones. A more detailed probe may be required if the nodules or masses start developing in the adrenal gland. The main types of adrenal disorders include:
 

  • Adrenal Insufficiency:

If the hormones reduce their secretion from the adrenal gland, it may cause a deficiency in all three of the adrenal hormones. Adrenal insufficiency may also be the result of autoimmune destruction of the adrenal gland more popularly referred to as Addison’s disease. It may also occur if the adrenal glands start bleeding, or develop infections like tuberculosis. Patients may experience weight loss, weakness, dizziness and possibly stomach pain, nausea and vomiting when suffering from adrenal insufficiency. In case the glands are damaged severely, recovery is usually not an option and a replacement of the hormone may be required. Other forms of treatment may include cortisol-like medications and aldosterone-like medications.
 

  • Hypercortisolism:

If there is an overproduction of the adrenal hormone, in this instance, cortisol, the condition is known as hypercortisolism. It may also be a result of over-stimulation from the pituitary gland or may directly be the result of a problem within the adrenal gland, either from a single cortisol-secreting adrenal mass or from a nodular adrenal disease.
 

  • Hyperaldosteronism:

If the aldosterone hormone goes into overproduction in the body, it may cause the potassium in the blood to decrease. This may lead to high blood pressure. Usual treatment may not be effective at this point of time. A single adrenal mass or a nodular adrenal disease may also be one of the causes for this condition.
 

  • Adrenal Masses:

Lumps or masses may develop in adrenal glands. However, in most cases, these lumps are generally not malignant and do not result in any additional complications. At times, some of these lumps may produce adrenal hormones in excess. Ultrasounds, CT Scans and MRI Scans are able to detect adrenal masses. However, detailed examination may be required to confirm that the lump is not producing hormones in excess that is not malignant. If further investigation finds that the mass is indeed cancerous, it can be removed through a surgical procedure. For benign masses, clinical monitoring is the best course of treatment.
 

  • Thyroid Disorders:

Located in front of the neck region, thyroid glands create the thyroid hormone which assists in controlling the metabolism of the body. If the thyroid hormone is produced in excess, it may result in hyperthyroidism. If the hormone production decreases significantly, it can cause hypothyroidism or thyroiditis which is an inflammation of the thyroid gland. Reduced production may also result in the development of lumps in the thyroid gland or thyroid cancer.  Here are the major types of thyroid disorders in detail:
 

  • Hyperthyroidism:

If there is a significant increase in the production of the thyroid hormone in the blood, the rate of metabolism in the body also rises. Signs of the disorder mainly comprise of increased sweating, rise in heart palpitations, feeling unusually warm, sudden weight and hair loss, trembling, fatigue and weakness. The condition can be diagnosed through blood tests or a thyroid scan. There are several caused of hyperthyroidism. Inflammation of the thyroid gland is the cause of the condition. However, the most common cause is an autoimmune disorder known as Graves’ disease, where antibodies in the blood triggers the thyroid gland to increase its production of the thyroid hormone. Medical treatment is required immediately to slow down the production and initiate the diseases to go into remission. But it may reappear after a period of time. Radioactive iodine therapy or hormone replacement are more permanent forms of treatment that may be required if the disease does not go into remission.
 

  • Hypothyroidism:

If the thyroid gland produces less than the required amounts of the thyroid hormone, it slows down the metabolism rate in the body. Hashimoto’s thyroiditis is a condition where the immunity of the gland is destroyed. This is the most common cause of hypothyroidism. Usage of radioactive iodine treatment, surgical removal of the thyroid gland, radiation treatments of the head and neck and certain medications may also result in hypothyroidism. Feeling tired and cold, experiencing weight gain, dry skin, constipation, and swelling of the ankles or face are some of the symptoms of hypothyroidism. The symptoms usually become more pronounced with the passage of time. TSH, T4 and T3 which are blood tests can be used to detect the condition. The condition in general is permanent and needs treatment throughout one’s lifespan. Oral medications in most cases are sufficient forms of treatment which can be effective.
 

  • Thyroiditis:

When there is an inflammation of the thyroid gland, it results in thyroiditis which may cause a temporary rise in the production of the thyroid hormone in the blood. However, there are long-term impacts which causes destruction to the thyroid gland that ultimately causes the thyroid gland to decrease hormonal production. Hashimoto’s thyroiditis is the most common form of thyroiditis. This is an auto-immune condition which can affect the patient throughout their life-span. The damage is gradual and permanent resulting in lowering hormonal production even further.  Detection can be done through TPO screening. If hormonal levels fall below normal, then hormonal replacement is the only long-term medical solution available today. There are rare forms of thyroiditis such as “Painless” (Silent), “Post-partum” or “Painful” (Subacute). Most of these thyroiditis forms causes a temporary increase in the production of the thyroid hormone lasting over a span of several months. Eventually, the thryroid function returns to normal. In case of severe damage, normalcy in thyroid function cannot be achieved and a hormone replacement becomes a necessity.
 

  • Thyroid Lumps:

Lumps or nodules may often develop within the thyroid glands. The probability of this happening increases with the age of the patient. In the majority of cases, these nodules are non-cancerous and do not cause any further complications. However, approximately 5% to 10% of such lumps may turn malignant. These cancerous lumps are large enough to be felt and may be detected through an Ultrasound Scan. To examine the nature of the nodule, if it is larger than 1.0 cm -1.5 cm in diameter, a fine-needle aspiration biopsy can be done to check if it has turned cancerous. Surgery is required if the nodule is cancerous in order to remove it. For benign lumps, no treatment is usually required. If the lump grows larger, certain symptoms such as pressure in the neck region, hoarseness of the voice, experiencing difficulty in swallowing or breathing can become more pronounced. Surgical therapy may be required in order to remove the lump in such a situation as there are no treatments available to shrink the thyroid nodule.
 

  • Thyroid Cancer:

For women and men, thyroid cancer is the 5th and 16th most common type of cancer affecting them respectively. Thyroid cancers are treatable and is rarely fatal. Papillary and follicular cancers are the most prevalent forms of thyroid cancer. The malignant cells are usually low grade and generally do not penetrate in the surrounding organs in the body. However, some rare forms like medullary, anaplastic, or thyroid lymphoma are more aggressive in nature. Fine-needle aspiration biopsy is generally used to diagnose thyroid cancer. Surgical therapy is needed to remove the thyroid cancer with a combination of radioactive iodine therapy in certain cases.
 

  • Gonadal Disorders:

Testes or gonads in men and the ovaries in women, may be affected by certain endocrinal conditions. These are known as gonadal disorders which may cause complications such as infertility, sexual dysfunction or low production of the testosterone hormone. The ovaries in women are the reproductive organ that creates ovum which in turn secrets hormones such as oestrogen and progesterone. If an abnormality is detected in the functioning of the ovaries due to these deficiencies, it may result in the following:
 

  • Ammenorrhoea:
    This basically causes an absence of menstrual blood during the reproductive age of the woman. This can be further sub-categorised into two types:
     

    • Primary Ammenorrhoea which occurs if there is a congenital absence of the uterus or the ovary fails to receive the eggs.
    • Secondary Ammenorrhoea develops due to hormonal imbalances in the pituitary and hypothalamus.

 

  • Hypogonadism:

This condition develops if the levels of the oestrogen hormones run really low.
 

  • Polycystic Ovarian Symptom:

This condition develops in 5% to 10% of women who fall under the reproductive age group. PCOS has strong relations with other health complications such as obesity, diabetes and insulin resistance. In this condition, the woman’s ovaries produce follicles. However, the eggs rarely mature and leave the ovaries. This in turn transforms the immature follicles in fluid filled sacs known as cysts.   Gonadal disorders may also result in abnormalities of the functioning of the testis in men. Complications arising out of that include:
 

  • Hypogonadism:

This condition develops in men when there is a deficiency in the production of the testosterone hormone. The pituitary glands can send chemical message to the testicles to produce testosterone. If the problem originates from there, it can cause primary hypogonadism.
 

  • Testicular Cancer:

Abnormal cells present in the testicles can start to divide and expand uncontrollably. This is the primary cause of testicular cancer that affects younger boys in general. The foremost symptom of this condition is the presence of a lump or irregularity in the testis. In general, symptoms for endocrine disorders are either absent or mild. However, the symptoms that do manifest primarily develop due to the excessive production of a hormone deficiency. The usual treatment is to correct this hormonal imbalance if the symptoms become troublesome. A synthetic hormone is administered to rectify the imbalance in the body. If the symptoms are being caused by a benign tumour such as prolactinoma, radiation therapy along with surgery may be required as a means of treatment. With accurate diagnosis and treatment, symptoms of endocrine disorders can be smoothly resolved.