Type 1 diabetes occurs when the pancreas makes very little or no insulin. People with type 1 diabetes must take insulin every day to replace the insulin their bodies are not making. This form of the disease is most often seen in children. It used to be called or juvenile diabetes, but it can occur at any age.
Type 2 diabetes is the most common form of the disease, affecting 90–95% of people with diabetes. In type 2 diabetes, the body is resistant to the action of insulin, meaning it cannot use insulin properly, so it cannot carry sugar into the cells. Although the body makes some insulin, it is not enough to overcome this resistance. You are more likely to develop type 2 diabetes if you are overweight, have a family history of diabetes, or have a history of diabetes during pregnancy. Other groups more likely to have the disease are people over age 45 and non-Caucasians. A simple blood test can tell you if you have diabetes. Gestational Diabetes is a temporary form of diabetes that can occur when a woman is pregnant. Gestational diabetes often has no symptoms, so most women are tested for blood sugar problems at some point in their pregnancy. If a woman has high blood sugar, she will have to follow a special diet for the rest of the pregnancy. In some cases, she may also need to take insulin. About 3–5% of pregnant women develop gestational diabetes.
Gestational diabetesoccurs more often in African Americans, Native Americans, Hispanic Americans, Asian Americans, women with a family history of diabetes, and those who are overweight. Although this form of diabetes usually disappears after the baby is born, more than half of women with gestational diabetes develop type 2 diabetes later in life.
Monogenic diabetes is a less common form of diabetes in which diabetes is inherited. Prediabetes occurs when blood glucose levels are higher than normal, but not high enough for a diabetes diagnosis. Over time, this can increase your risk of heart disease and stroke, as well as your risk of developing type 2 diabetes. Unfortunately, prediabetes symptoms are hard to spot, so many people have the condition and do not know it.
What Tests to Expect Why is screening for diabetes important? People can have prediabetes or type 2 diabetes for years and not have any obvious signs or symptoms. Type 2 diabetes is often not diagnosed until health problems appear as a result of high blood glucose. These can include vision problems, kidney disease, or nerve damage. If left untreated, diabetes can cause more serious problems like blindness, kidney failure, leg amputation, heart attacks, and stroke. It’s important to know if you have prediabetes or diabetes, so you can make lifestyle changes or take medication to manage your condition. People at risk should be screened (tested) for diabetes and prediabetes.
How do you get screened for diabetes? There are three blood tests that can be used to check the levels of glucose in your blood and diagnose prediabetes or diabetes: Fasting blood glucose test (FBG). Blood is drawn in the morning after you go without food overnight or for at least 8 hours. Oral glucose tolerance test (OGTT). This test is also done in the morning after going without food overnight or for at least 8 hours. Blood is drawn before you drink 8 ounces of a sugar solution and 2 hours after. This test is more precise but less convenient than the FBG test. Hemoglobin A1C test (A1C).This test shows what your average blood glucose levels have been over the past 2–3 months. You can eat and drink normally before the test.
What is an A1C test?
The A1C test is a blood test used to diagnose diabetes and to aid in its management. Current guidelines recommend an A1C level below 7 in healthy adults and below 7.5 in children with certain medical conditions. The test measures your average blood glucose over the past two to three months and shows how well your treatment plan is working overall. It does not take the place of daily blood glucose measurements, which show the level of glucose in your blood at that moment. Blood glucose levels change throughout the day depending on what and when you eat, whether or not you exercise, and which medications you may be taking. You can also use continuous glucose monitoring (CGM), which measures glucose levels in the fluid between body cells every few minutes throughout the day and night. When there is too much glucose in the blood, the extra glucose enters red blood cells and attaches to hemoglobin—a protein that carries oxygen to the cells of the body—creating glycated hemoglobin. The A1C test works by measuring the percentage of glycated hemoglobin in the blood. A higher A1C indicates that you should do your best to bring your blood glucose as close to your target to help reduce risk of developing complications.
What should your A1C level be?
Most people with diabetes should keep their A1C result below 7% (about 170 mg/dL or less). Studies have shown that people who keep their A1C below 7% greatly reduce their risks of developing long-term complications of diabetes. An average A1C for a person without diabetes is 4–6% Experts recommend that you have your A1C measured at least twice a year.
What can I do?
Whether or not you need diabetes medications or insulin, adopting a healthy lifestyle that includes eating well, losing weight if needed, exercising, limiting alcoholic beverages, and not smoking will help you better manage your diabetes.
Questions to ask your doctor
What was my latest A1C result?
What does the result mean?
What can I do to keep my blood glucose level on target?
How often should I get the A1C test?
Should I see a diabetes educator?
Should I see an endocrinologist for my care?
Over time, uncontrolled diabetes may cause serious complications including heart disease, stroke, kidney failure, blindness, and nerve damage. Keeping blood glucose levels close to normal is the key to preventing these health problems. You should monitor your glucose levels regularly and get familiar with your pattern of glucose readings at different times of the day. Regular self-monitoring provides valuable information that your health care team can use to make decisions about medication and insulin, and improve control of your diabetes. Checking your blood glucose also helps prevent immediate problems that can result from glucose levels that are too high (hyperglycemia) or too low (hypoglycemia). Both problems can be serious, if not treated right away.
Medications of Diabetes
It's very important to take diabetes medications as directed by your doctor. Left untreated, diabetes can lead to serious, even life-threatening complications—other diseases or conditions that are related to diabetes. Complications can lead to loss of vital functions (such as with your kidneys), blindness, amputation of lower limbs, and even death (especially from cardiovascular disease). By taking your medications as directed, you greatly reduce your risk of getting complications. Treatment depends on the type of diabetes you have. There are three main types of diabetes:
Type 1 diabetes occurs when the pancreas stops making insulin. It is usually seen in children and teens, but may occur later in life. People with type 1 diabetes need insulin to survive.
Type 2 diabetes is the most common type of diabetes. With type 2 diabetes, the body does not produce enough insulin and it becomes resistant to insulin’s effects. It occurs in adults and elderly patients, many of whom are overweight. Younger people can also develop type 2 diabetes.
Gestational diabetes is a type of diabetes that occurs only during pregnancy. It usually goes away after the baby is born. Women who have had gestational diabetes are more likely to develop type 2 diabetes later in life, however
Changing Your Lifestyle
If you are living with diabetes, lifestyle is an important part of your care. It is very important that you eat a good balance of foods every day and exercise regularly. Managing your diabetes also means taking medicine, if needed, and testing your blood sugar levels each day.
Diabetes does not require special foods. A healthy, balanced diet can come from everyday foods. If you have diabetes, you should: Choose foods that are low in fat and salt Choose foods that are high in fiber (such as beans, vegetables, and fruit) Eat foods from all food groups. The U.S. Department of Agriculture has plenty of information about choosing a balanced diet Lose weight if you need to by cutting down on how much you eat. Your doctor can refer you to a dietitian who can help you plan meals that taste great and are good for you.
If your diabetes is under control and you do not have high blood pressure, your doctor may allow you to drink alcohol in moderation. Keep in mind that if you drink alcohol while taking insulin or other diabetes medication, your risk of having low blood sugar may increase. If you drink alcohol, limit yourself to one drink a day if you are a woman and two drinks a day if you are a man. Avoid sugary mixed drinks. Never drink alcohol on an empty stomach.
Smoking greatly increases your risk of heart disease, eye disease, and blood vessel disease, which are major complications of diabetes. Stopping smoking is the single best thing you can do to lower your chances of developing heart and blood vessel disease.
Exercise and Physical Activity
Always see a doctor before starting an exercise program. Your doctor may have good ideas about types of exercise that would be best for you. Exercise is important for people with diabetes because it: Helps insulin work better to lower blood sugar Helps keep weight down Is good for the heart, blood vessels, and lungs Gives you more energy Exercise affects your body's need for sugar. When you exercise, be sure to: Have a snack with you in case you get low blood sugar. Wear a tag or carry a card that says you have diabetes. Eat a snack, such as milk or an apple, before exercising if your blood glucose is less than 100 mg/dL. Avoid exercising if your blood sugar is over 300 mg/dL. Do not take insulin to lower your blood sugar before exercising. This may result in severe low blood sugar. If you have heart disease or risk factors for heart disease, such as high cholesterol, high blood pressure, or poor diabetes control, check with your doctor about whether or not you need a stress test before beginning an exercise program. If you have nerve damage to your feet, be careful to wear well-fitting shoes and socks to avoid blisters. Talk with your physician and/or podiatrist about your exercise program.
a) Diabetes Complications a) Diabetes Complications
What is diabetic neuropathy?
Diabetic neuropathy is nerve damage from high blood glucose (sugar) levels in people with diabetes. Nerves throughout the body can suffer damage. People with poor glucose control and who have had diabetes for a long time are at highest risk for nerve damage. Smokers are especially at risk. About 60–70% of people who have had diabetes for many years have some form of nerve damage, but not everyone has symptoms.
What are the types and symptoms of diabetic neuropathy? The most common types of diabetic neuropathy are those that affect the limbs and those that affect organs and muscles inside the body.
The first type (called peripheral neuropathy or distal polyneuropathy or DPN) affects the sensitivity of your feet, legs, hands, and arms. It also can affect the movement of your limbs. Symptoms of DPN include:
Pain, tingling, and burning Numbness and loss of feeling
Skin ulcers (open sores)
About half of people who have DPN might not have symptoms, except for losing feeling in their feet. Because of this feeling loss, they could injure their feet and not know it. Untreated foot injuries can lead to ulcers and infection and, sometimes, amputation.
The second type (called autonomic neuropathy) affects your urinary tract, digestive system, sex organs, sweat glands, eyes, and heart. Symptoms of autonomic neuropathy include:
Bladder problems (loss of bladder control, not being able to fully empty the bladder, frequent urinary tract infections)
Digestive system problems (bloating, nausea, vomiting, diarrhea, constipation)
Erectile dysfunction in men and sexual problems in women
Too much or too little sweating
Dizziness when you stand up, from sudden drops in your blood pressure
When to see your doctor
See your doctor as soon as possible if you have:
Frequent numbness or pain in your feet, legs, hands, or arms An ulcer (sore) on your foot or leg that isn’t healing
A swollen foot or a leg infection
Digestive problems such as bloating, nausea, vomiting or constipation
Problems with urination or sexual function
Dizziness when you stand
How is diabetic neuropathy diagnosed? Your doctor will do a physical exam and ask about your symptoms. You should be checked once a year for DPN, or more often if you have foot problems. The doctor will check for loss of feeling in your feet by seeing whether you can feel light touch, pinpricks, vibrations from a tuning fork, , and the touch of a thin piece of nylon fiber against your foot The doctor may also check the reflexes in your ankles and the position of your toes. You might have tests to see how well your nerves are working. Your doctor will also make sure you don’t have other conditions, such as blood flow problems or a vitamin deficiency.
What treatments are available for diabetic neuropathy?
Good blood glucose control (keeping blood glucose from being too high or too low) may prevent further nerve damage but usually can’t reverse damage that’s already happened. Your doctor may prescribe medicines for pain that occurs with some types of nerve damage, and suggest certain vitamins if needed.
How can you prevent problems associated with diabetic neuropathy?
The most effective way to prevent damage is to keep your blood glucose level under good control. You can do so by eating a healthy diet, exercising regularly, and reaching a healthy weight. Avoiding smoking and limiting alcoholic beverages can also help. Your doctor or diabetes educator can help you plan your healthy lifestyle. You also can do a lot to prevent leg ulcers and amputations. Protect your feet by:
Questions to ask your doctor
Do I have nerve damage from diabetes?
What kind of nerve damage do I have?
Is the nerve damage permanent or temporary?
Do I need treatment for my nerve damage?
What are the risks and benefits of each of my treatment options?
Should I see a podiatrist?
Should I see a diabetes educator?
Diabetic heart disease
What is dyslipidemia? Cholesterol and triglycerides, known as lipids, are fatty substances that the body normally produces. Dyslipidemia means that lipid levels in the blood are too high or low. The most common types of dyslipidemia are:
High levels of low-density lipoprotein (LDL or “bad”) cholesterol
Low levels of high-density lipoprotein (HDL or “good”) cholesterol
High levels of triglycerides (fats in the blood) Dyslipidemia contributes to atherosclerosis (“hardening” of the arteries), a disease in which fatty deposits called plaque buildup in the arteries over time. The arteries are blood vessels that carry blood from the heart to the rest of the body. If plaque narrows your arteries, you are more likely to have heart disease, heart attack, peripheral artery disease (reduced blood flow in the limbs, most often the legs), and stroke.
Why is dyslipidemia a concern for people with diabetes?
People with diabetes are more likely to develop atherosclerosis, heart disease, poor circulation, and stroke than people who do not have diabetes. Many people with diabetes have several risk factors that contribute to atherosclerosis and its complications. These include high blood pressure, excess weight, and high blood glucose (sugar) levels. Dyslipidemia further raises the risk of atherosclerosis in people with diabetes. The most common dyslipidemia in diabetes is a combination of high triglycerides and low HDL cholesterol levels. People with diabetes may also have high LDL cholesterol.
How will you know if you have dyslipidemia? Dyslipidemia has no symptoms (what you feel). Health care providers detect it by a blood test called a lipid profile. This test measures the amount of cholesterol, triglycerides, and other fats in your blood. People usually have a lipid profile after fasting overnight.
Many things can affect your lipid levels. They include: Age, sex, and family history of heart disease Lifestyle factors such as what you eat, level of physical activity, alcohol use, and smoking High blood pressure High blood glucose levels Some medications
What should your lipid levels be?
Target values (desired levels of lipids) depend on your risk factors for heart disease. The more risk factors you have, the lower your target LDL level should be. Experts recommend the following target values:
Below 100 mg/dL (milligrams per deciliter), or below 70 mg/dL for people with diabetes, heart disease or atherosclerosis Below 130 mg/dL for people who don’t have diabetes and have few risk factors for heart disease HDL cholesterol: above 40 mg/dL for men and above 50 mg/dL for women Triglycerides: below 150 mg/dL Your doctor will work with you to set your target goals.
What can you do to improve lipid levels and keep your heart healthy?
You can improve your lipid levels with a heart-healthy diet and weight loss, increased physical activity, and good blood pressure and blood glucose control. By limiting fat intake, especially animal fats and trans fats artificial fats found in some foods), you can lower LDL cholesterol. Adding more fruits, vegetables, and fiber to your diet also helps reduce lipid levels. You may also need medication. Your doctor will decide what type of drug is right for you based on your lipid profile. Follow your doctor’s advice about diet, exercise, and medications. Routine checkups and a yearly blood test to check your lipid levels will help you manage dyslipidemia and reach your goals.
Questions to ask your doctor What is my lipid profile? What are my lipid target values? What are my treatment options for abnormal lipids? What are the risks and benefits of each of these treatments? Should I see an endocrinologist?
Remove waste and excess water from your body
Maintain the body’s chemical balance
Produce hormones that regulate red blood cell production and blood pressure, and contribute to bone health
What causes kidney disease? Diabetes is the most common cause of kidney failure in the United States. If your kidneys stop working, you will need special treatment such as dialysis (a method of filtering waste from the blood) or a kidney transplant to stay alive. A frequent complication of diabetes is high blood pressure (hypertension). Constant high blood pressure also leads to gradual kidney damage and adds to the effects of diabetes. Advanced kidney disease is often permanent. For this reason, high blood pressure and diabetes should be identified and treated early. Anyone can develop diabetes, high blood pressure, or kidney disease. However, people who are obese and people with a family history of any of these conditions have a higher risk. How are diabetes and hypertension diagnosed? Diabetes is diagnosed by measuring blood sugar (glucose) levels. People who have glucose levels of 126 mg/dL or above have diabetes. A blood glucose level between 100 and 125 mg/dL is higher than normal and increases the risk of developing diabetes. Over time, uncontrolled blood glucose levels can lead to complications such as blindness, nerve damage, heart attacks, reduced blood circulation in the limbs, and kidney failure. Hypertension is diagnosed by measuring blood pressure. People whose blood pressure is consistently 140/90 mm Hg or higher have high blood pressure,
How is kidney disease diagnosed?
Kidney damage is diagnosed with urine and blood tests. The earliest sign of kidney problems in people with diabetes is the presence of small amounts of protein in the urine. If not treated, this condition leads to more protein in the urine, then to gradual loss of kidney function, and finally to chronic (permanent) kidney disease. A urine test can detect these conditions. Several blood tests can test the kidney’s ability to filter and detoxify (clean) the blood. These include creatinine and blood urea nitrogen (BUN) tests.
How do you protect your kidneys?
Protecting your kidneys begins by knowing if you have any of the risk factors for kidney disease—obesity, high blood pressure, and/or diabetes. Therefore, periodic check-ups of body weight, blood pressure, and blood glucose can help spot problems early. Doctors use different types of medications to treat high blood glucose levels in people with diabetes, including oral medications (pills) and insulin. It is important to keep glucose levels as close to normal as possible. Recommended glucose levels are below 130 mg/dL in the morning and 180 mg/dL after meals. The hemoglobin A1C blood test evaluates how well you are controlling your blood glucose levels over time. This is done usually every three to six months. A test result below 7% shows good glucose control. In people with diabetes and hypertension, blood pressure should be less than 130/80 mm Hg. Several types of medications are used to lower blood pressure and protect kidney function.
How can you protect your kidneys?
If you have risk factors for diabetes, high blood pressure, and/or kidney disease, talks with your doctor. Preventing and treating kidney disease will depend on your particular condition. For example, if you have diabetes your doctor may recommend a urine test at least once a year to check for protein in your urine, and blood tests to check your kidney function. You can also protect your health by eating a healthy diet, exercising most days of the week, not smoking, and avoiding abuse of alcohol and other drugs. These include over-the-counter medications such as aspirin, acetaminophen, and ibuprofen. If you have high blood pressure, you should limit your intake of salt. If you have diabetes, you should limit carbohydrates. People with weakened kidney function may need to adjust their diets to also limit protein, cholesterol, and potassium.
Thyroid disordersThe thyroid is a small butterfly-shaped gland inside the neck, located in front of the trachea (wind pipe) and below the larynx (voice box). It produces two thyroid hormones triiodothyronine (T3) and thyroxine (T4)—that travel through the blood to all tissues of the body. Thyroid hormones regulate how the body breaks down food and either uses that energy immediately or stores it for the future. In other words, our thyroid hormones regulate our body's metabolism. Another gland, called the pituitary gland, actually controls how well the thyroid works. The pituitary gland is located at the base of the brain and produces thyroid-stimulating hormone (TSH). The bloodstream carries TSH to the thyroid gland, where it tells the thyroid to produce more thyroid hormones, as needed. Thyroid hormones influence virtually every organ system in the body. They tell organs how fast or slow they should work. Thyroid hormones also regulate the consumption of oxygen and the production of heat. Endocrinologists—physicians and scientists who study and care for patients with endocrine gland and hormone problems—study and treat several major disorders of the thyroid gland. The following is a list of some common thyroid disorders.
Pregnancy and thyroid disorders
What is hypothyroidism?
Hypothyroidism means you have too little thyroid hormone. Another term is an “underactive thyroid.” Hypothyroidism is the most common thyroid disorder. It occurs more often in women and people over age 60. Hypothyroidism tends to run in families.
Weight gain (only 5–10 pounds or 2–4 kg)
Dry skin and hair
These symptoms are not unique to hypothyroidism. A simple blood test can tell whether the symptoms are due to hypothyroidism or some other cause. People with mild hypothyroidism may not have any symptoms at all.
What causes hypothyroidism?
In adults, hashimoto’s disease is the most common cause of hypothyroidism. In this condition, your immune system attacks and damages your thyroid, so it can't make enough thyroid hormone. Hypothyroidism can also be caused by radioactive iodine treatment or surgery on the thyroid gland, which are used to treat other types of thyroid disorders. A problem with the pituitary gland is another rare cause. Congenital hypothyroidism is present from birth and occurs when the thyroid gland does not develop properly. How can hypothyroidism affect your health? In adults, untreated hypothyroidism leads to poor mental and physical performance. It also can cause high blood cholesterol levels that can lead to heart disease. A life-threatening condition called myxedema coma can develop if severe hypothyroidism is left untreated. Diagnosis of hypothyroidism is especially important in pregnancy. Untreated hypothyroidism in the mother may affect the baby's growth and brain development. All babies are tested at birth for hypothyroidism. If not treated promptly, a child with hypothyroidism could have an intellectual disability or fail to grow normally. How is hypothyroidism diagnosed?
Blood tests can measure your levels of thyroid-stimulating hormone (TSH) and thyroid hormone (T4). You have hypothyroidism when you have high TSH and low T4 levels in your blood. In very early or mild hypothyroidism, TSH will be high but T4 may be normal. In this case, your doctor may measure the thyroid levels more frequently to determine if hypothyroidism develops over time. When the cause of hypothyroidism is Hashimoto disease, blood tests can detect anti-thyroid antibodies that attack the thyroid.
How is hypothyroidism treated?
Hypothyroidism is treated with thyroid hormone medication, taken as a pill. Levothyroxine is the drug of choice. It is a synthetic (laboratory-made) form of T4 that is identical to the T4 the thyroid naturally makes. Levothyroxine comes in brand-name and generic versions. Most people need thyroid hormone replacement for life. If the brand or dosage needs to be changed, you should have blood tests for TSH done again. Your dose will be adjusted based on your TSH tests. Over time, doses of thyroid hormone that are too high can lead to bone loss, abnormal heart function, and abnormal heart rhythms. Doses that are too low may not relieve your symptoms. Dose adjustment may be necessary over your lifetime, including during pregnancy. You can discuss dose changes during your regular check-ups with your doctor.
How will you know if you should get tested?
If you have one or more of the symptoms of hypothyroidism, or if thyroid disease runs in your family, ask your doctor if you should have a blood test. Doctors may also recommend testing in women over the age of 60, even if they don't have symptoms. If you are diagnosed with hypothyroidism, you will need treatment to avoid serious health problems.
Questions to ask your doctor
Do I have hypothyroidism?
What treatment do I need for it?
What are the risks and benefits of each of my treatment options?
How often should I be retested?
Should I see an endocrinologist
What is hyperthyroidism?
Hyperthyroidism is a condition in which the thyroid gland is overactive and produces too much thyroid hormone. If left untreated, hyperthyroidism can lead to other health problems. Some of the most serious involve the heart (rapid or irregular heartbeat, congestive heart failure) and the bones (osteoporosis). People with mild hyperthyroidism or the elderly may not have any symptoms at all.
What causes hyperthyroidism? 'Graves' disease is the most common cause of hyperthyroidism. It occurs when the immune system attacks the thyroid gland, causing it to enlarge and make too much thyroid hormone. It is chronic (long-term) and typically runs in families with a history of thyroid disease or other autoimmune conditions. Some people with Graves' disease also develop swelling behind the eyes that causes the eyes to bulge outward. Less common causes of hyperthyroidism include: Thyroid nodules: Lumps on the thyroid gland that may secrete too much thyroid hormone Subacute thyroiditis: A painful inflammation of the thyroid typically caused by a virus Lymphocytic thyroiditis: A painless inflammation caused by lymphocytes (a type of white blood cell) inside the thyroid Postpartum thyroiditis: Thyroiditis that develops shortly after pregnancy
How is hyperthyroidism diagnosed?
Your doctor will perform a physical examination and order blood tests to measure your hormone levels. You have hyperthyroidism when the levels of T4 and T3 are higher than normal and the level of TSH is lower than normal. To determine the type of hyperthyroidism you have, your doctor may do a radioactive iodine uptake test to measure how much iodine your thyroid collects from the bloodstream. The thyroid uses iodine to make T3 and T4. Your doctor may also take a picture of your thyroid (a thyroid scan) to see its shape and size, and to see whether there are any nodules present.
What are the signs and symptoms of hyperthyroidism? Feeling too hot Increased sweating Muscle weakness Trembling hands Rapid heartbeat Tiredness/fatigue Weight loss Diarrhea or frequent bowel movements Irritability and anxiety Eye problems, such as irritation or discomfort Menstrual irregularities Infertility
How is hyperthyroidism treated? Treatment for hyperthyroidism will depend on its cause, your age and physical condition, and how serious your thyroid problem is. Available treatments include: Antithyroid medications. These drugs lower the amount of hormone the thyroid gland makes. The preferred drug is methimazole/carbimazole. For pregnant or breastfeeding women, propylthiouracil (PTU) may be preferred. Because PTU has been linked to greater side effects, it is not used routinely outside of pregnancy. Both of these drugs control, but may not cure, hyperthyroidism. Radioactive iodine. This treatment will cure the thyroid problem, but usually leads to permanent destruction of the thyroid. You will likely need to take thyroid hormone pills for the rest of your life to provide normal hormone levels. Surgery. Surgical removal of the thyroid gland (thyroidectomy) is a permanent solution, but not usually preferred, because of the risk of damage to the nearby parathyroid glands (which control calcium levels in the body) and to the nerves to the larynx (voicebox). Doctors may recommend surgery when either antithyroid medication or radioactive iodine therapy would not be appropriate. Beta blockers. These drugs (such as atenolol) do not lower thyroid hormone levels, but can control many troubling symptoms, especially rapid heart rate, trembling, and anxiety. All of these therapies have risks. Your doctor will work with you to decide which treatment option is best for you.
What should you do if you think you might have thyroid problems? Many of the signs and symptoms of hyperthyroidism may occur in other conditions. An endocrinologist, a specialist in hormone-related conditions, can help diagnose and treat hyperthyroidism. If you have ever been treated for hyperthyroidism, or are currently being treated, see your doctor regularly so that your condition can be monitored. It is important to ensure that your thyroid hormone levels are normal and that you're getting enough calcium to keep your bones strong.
Questions to ask your doctor
Do I have hyperthyroidism?
What treatment do I need for it?
What are the risks and benefits of each of my treatment options?
What else can I do to stay healthy?
Should I see an endocrinologist?
For how long will I need to be treated?
c) Pregnancy and thyroid disorders
Pregnancy and hypothyroidism
Pregnancy causes major changes in the levels of hormones made by the thyroid gland. For that reason, thyroid problems sometimes can start or get worse during pregnancy or after childbirth. If left untreated, maternal hypothyroidism poses a risk for both mother and baby. A pregnant woman’s thyroid hormones are vital not only for her but also for the development of her baby. Pregnant women with uncontrolled hypothyroidism can get high blood pressure, anemia (low red blood cell count), and muscle pain and weakness. There is also an increased risk of miscarriage, premature birth (before 37 weeks of pregnancy), or even stillbirth.
Hypothyroidism Risk Factors
Women are at increased risk of an underactive thyroid during or after pregnancy if they are over age 30 or have:
Past infertility or preterm delivery
A family history of thyroid or autoimmune disease
Type 1 diabetes or other autoimmune disease
Prior radiation treatment of the head or neck
Past thyroid surgery
Thyroid antibodies, mainly thyroid peroxidase (TPO) antibodies, which are often present in Hashimoto’s disease
A goiter (swelling of the thyroid gland) Current treatment with levothyroxine, a thyroid hormone drug, unless the dose is adjusted before or soon after conception
What causes maternal hypothyroidism? A common cause of underactive thyroid in pregnant women is Hashimoto disease, sometimes called Hashimoto thyroiditis. This autoimmune disease occurs when your immune system forms antibodies (immune proteins) that attack the thyroid. This, in turn, causes the gland to make too little thyroid hormone. People with this disease may have symptoms of hypothyroidism (see the next section), or they may notice no effects. Other causes of hypothyroidism include prior treatment for hyperthyroidism (when the thyroid makes too much thyroid hormone) and surgery to remove thyroid tumors.
The thyroid also can become underactive after childbirth. About 7% of women get postpartum thyroiditis (inflammation of the thyroid) in the first year after giving birth.
Should pregnant women be screened for hypothyroidism?
Pregnant women at high risk of thyroid problems (see box on page one) should have a thyroid function test even if they do not have symptoms of an underactive thyroid. Ideally, this screening blood test should take place by the ninth week of pregnancy or at the first prenatal visit. Because of the dangers of untreated thyroid disease, some experts advise screening all newly pregnant women for abnormal thyroid function. You should ask your health care provider early in your pregnancy whether you need thyroid function blood tests. Women who have known high levels of TPO antibodies need extra thyroid function screening. They are at increased risk of hypothyroidism and pregnancy problems such as miscarriage. Therefore, they should get a TSH blood test before they try to become pregnant, and again during the first and second trimesters of pregnancy (first six months).
What is the treatment for maternal hypothyroidism? The treatment for hypothyroidism is thyroid hormone replacement with a synthetic (man-made) form of T4 called levothyroxine. This drug is the same as the T4 your body makes and is safe for pregnant women. Before pregnancy. It is important that thyroid hormone levels are normal both before and during pregnancy. If you are already receiving levothyroxine to treat hypothyroidism, you should have your thyroid hormone levels checked before you try to conceive. If your TSH levels are too high, you may need an increase in your dose of levothyroxine. You should delay pregnancy until your disease is well controlled. During pregnancy. Once a hypothyroid woman becomes pregnant, the levothyroxine dose often must increase. Possibly the dose must go up by as much as 30% or more in the first 4 to 6 weeks of pregnancy. Contact your doctor soon after you know you are pregnant, so you can get a thyroid function blood test and discuss your treatment plan.
What can you do to help have a healthy baby? You can help ensure your baby’s health and your own health. Work with your pregnancy care provider and your endocrinologist, a specialist who treats hormone-related conditions, to receive proper medical care before, during, and after pregnancy. Take your medication as prescribed, and tell your doctor about any side effects. To make sure you get enough iodine, take daily prenatal vitamins that include 150 to 250 micrograms (mcg) of potassium iodide or iodate. Breast-feeding mothers should supplement with 250 mcg per day of iodine, to make sure their breast milk provides the iodine that their nursing babies need. Do not take thyroid medicine at the same time as prenatal vitamins or supplements containing calcium and iron. These nutrients can interfere with the absorption of thyroid hormone. Take these vitamins at least 2 or 3 hours before or after taking your levothyroxine.
Pregnancy and hyperthyroidism It most often affects women ages 20 to 40, in their childbearing years. Fortunately, hyperthyroidism during pregnancy is not common. However, the symptoms may be overlooked because some can mimic the hormonal changes a woman has in a normal pregnancy: for instance, feeling too warm, tired, or anxious. If left untreated, maternal hyperthyroidism poses a risk for both mother and baby. Pregnant women with uncontrolled hyperthyroidism can develop high blood pressure. There is also an increased risk of miscarriage, premature birth, and having a baby with a low birth weight.
What causes maternal hyperthyroidism? A common cause of overactive thyroid in pregnant women is Graves’ disease. This disease occurs when your immune system becomes overactive and forms antibodies (immune proteins) that attack the thyroid. This causes the gland to enlarge and make too much thyroid hormone. Most women with Graves’ disease find out they have it and get treatment before they become pregnant. Women with severe nausea and vomiting or those expecting twins may develop temporary hyperthyroidism. Called transient gestational thyrotoxicosis, this hyperthyroidism is due to high levels of a pregnancy hormone called human chorionic gonadotropin or hCG. Because it resolves by week 14 to 18 of pregnancy, women do not need antithyroid drugs to treat this condition. Sometimes, hyperthyroidism starts during pregnancy because of nodules (small lumps) in the thyroid. These nodules make too much thyroid hormone. The thyroid also can become overactive after childbirth. In the first year after giving birth, about 7% of women get postpartum thyroiditis (inflammation of the thyroid). This problem starts with hyperthyroidism. Most often, it clears up without treatment in a few weeks or months. But sometimes the inflammation leads to hypothyroidism, the opposite condition in which the thyroid gland doesn’t make enough thyroid hormone. In most cases, this hypothyroidism goes away on its own.
What is the treatment for maternal hyperthyroidism? During pregnancy, the preferred treatment for pregnant women with hyperthyroidism due to Graves’ disease is antithyroid medication. These drugs prevent the thyroid from making too much thyroid hormone. Temporary (gestational) hyperthyroidism does not need this treatment. Antithyroid medication can treat most cases of Graves disease in pregnancy. Rarely, some women may need surgery to remove part of the thyroid. The best time for this surgery during pregnancy is the second trimester (months 4 through 6). Women who are or may be pregnant should not receive treatment with radioactive iodine. This radioactive drug usually destroys the patient’s thyroid gland to stop it from being overactive and also can harm the unborn baby’s thyroid. While breastfeeding. Women who are breastfeeding should not get radioactive iodine treatment. They may continue antithyroid drug therapy if they take their medicine as prescribed.
Will your baby need special care? Most people with Graves disease have measurable antibodies in their blood known as thyroid stimulating immunoglobulins. In pregnant women with Graves disease, these antibodies can pass across the placenta to the baby. Though it does not occur often, this can cause thyroid disease and other medical problems for the newborn. All newborns of mothers with Graves disease who are positive for these antibodies should be checked for signs of thyroid problems and treated if necessary.
What can you do to help have a healthy baby? Your doctor can advise you on pregnancy planning. If you have active Graves disease, delay pregnancy until your disease is well controlled. Also, if you had radioactive iodine treatment, wait 6 to 12 months before trying to become pregnant.
D) Thyroid Nodule
What are thyroid nodules and who is at risk? A thyroid nodule is a growth of thyroid tissue or a fluid-filled cyst that forms a lump in the thyroid gland. Nodules are very common. The chances of developing nodules in the thyroid gland increase as you get older. Symptoms are not common, but a large nodule enough may cause pain or hoarseness, or get in the way of swallowing or breathing. Doctors are concerned about thyroid nodules, because they can sometimes be cancerous. Thyroid cancer is found in about 8 percent of nodules in men (or 8 out of 100) and in 4% of nodules in women. Thus, about 90% of all thyroid nodules are benign (non-cancerous). The cause of most benign nodules is not known, but they are often found in members of the same family. Worldwide, lack of iodine in the diet is a very common cause of nodules. How are thyroid nodules diagnosed? Most thyroid nodules are found during a routine physical exam. Sometimes the nodules are noted on an x-ray study that includes the neck. If a thyroid is found, your doctor will check a blood test to learn if the thyroid is functioning normally. Sometimes, a nodule can be associated with hyperthyroidism (producing too much thyroid hormone) or hypothyroidism (producing not enough thyroid hormone). However, the blood tests are not enough to test for thyroid cancer. To gather more information about the nodule, your doctor might recommend one or more of the following tests: Fine-needle aspiration biopsy uses a thin needle to remove cells or fluid samples from the nodule. This test may be recommended if the nodule is larger than 1.5 centimeters or if it has any concerning features on ultrasound. This test is very helpful for identifying cancerous or "suspicious" nodules. Thyroid ultrasound is used to get an exact picture of the thyroid and see if the nodule is solid or filled with fluid (cystic). Although this test cannot tell if the nodule is cancerous, it is very useful to guide the needle to remove (aspirate) cells from nodules. This procedure is called “ultrasound-guided fine needle aspiration biopsy.” Thyroid scan uses a small amount of radioactive iodine and a special camera to get a picture of the thyroid and learn if the nodule is overactive or underactive. This procedure is usually done when the blood tests show hyperthyroidism, or too much thyroid hormone. How are thyroid nodules treated? Treatment depends on the type of thyroid nodule. If the fine needle aspiration shows cancerous or suspicious cells, experts usually recommend surgery to remove the thyroid gland. After surgery, radioactive iodine therapy may be used to destroy any remaining thyroid cells. Some benign nodules may need to be removed with surgery if they are very big and are causing problems with swallowing or breathing. Most benign nodules are watched without surgery. Hyperfunctioning nodules are almost never cancerous, but they may cause hyperthyroidism, too much thyroid hormone in the body—which can lead to health problems. These nodules may be surgically removed or treated with radioactive iodine. If surgery is not recommended, your doctor needs to monitor the thyroid nodule every 6 to 12 months. This follow-up may involve a physical exam or a thyroid ultrasound or both. If the nodule gets larger, you may need to have a repeat fine needle biopsy.
What should you do if you think you have a thyroid nodule? If you think you have a thyroid nodule, see your doctor. Your doctor may refer you to an endocrinologist (a specialist in hormone-related conditions) for diagnosis and treatment. Then get the recommended treatment and follow up with your doctor as needed.
Questions to ask your doctor
What kind of nodules do I have?
Am I at risk for thyroid cancer?
What treatment do I need?
What are the risks and benefits of each of my treatment options?
Should I see an endocrinologist?
3) Adrenal DisordersLocated at the top of each kidney, the adrenal glands produce hormones that help the body control blood sugar, burn protein and fat, react to stressors like a major illness or injury, and regulate blood pressure. Two of the most important adrenal hormones are cortisol and aldosterone. The adrenal glands also produce adrenaline and small amounts of sex hormones called androgens, among other hormones. Adrenal disorders can be caused by too much or too little of a particular hormone. For example, Cushing syndrome is caused by an overproduction of cortisol, or more commonly, the use of medications called glucocorticoids—cortisol-like drugs—which are used to treat inflammatory disorders such as asthma and rheumatoid arthritis. Untreated Cushing syndrome can lead to diabetes, high blood pressure, osteoporosis, and other health issues. When the adrenal glands produce too much aldosterone, blood pressure rises. Uncontrolled high blood pressure can put you at risk for stroke, heart attack, heart failure, or kidney failure. Cushing syndrome Cushing syndrome consists of the physical and mental changes that result from having too much cortisol in the blood for a long period of time.
What causes Cushing syndrome? There are two types of Cushing syndrome: exogenous (caused by factors outside the body) and endogenous (caused by factors within the body). Exogenous Cushing syndrome: Found in people taking cortisol-like medications such as prednisone (Used to treat inflammatory disorders such as asthma and rheumatoid arthritis). Endogenous Cushing syndrome, in which the adrenal glands produce too much cortisol, is uncommon. This type of Cushing syndrome is most often caused by hormone-secreting tumours of the adrenal glands (usually non-cancerous) or the pituitary, a gland located at the base of the brain.
What are the signs and symptoms of Cushing syndrome? Weight gain, especially in the upper body Rounded face and extra fat on the upper back and above the collarbones High blood sugar (diabetes) High blood pressure (hypertension) Thin bones (osteoporosis) Muscle loss and weakness Thin, fragile skin that bruises easily Purple-red stretch marks (usually over the abdomen and under the arms) Depression and difficulties thinking clearly Too much facial hair in women.
How is Cushing syndrome diagnosed? One of the most sensitive tests measures cortisol levels in the saliva between 11:00 p.m. and midnight. Cortisol levels can also be measured in urine that has been collected over a 24-hour period. Cortisol levels measured the morning after taking a late-night dose of dexamethasone (Levels of cortisol are high).
Treatment Exogenous Cushing syndrome goes away after a patient stops taking the cortisol-like medications they were using to treat another condition. Your doctor will determine when it is appropriate for you to slowly decrease and eventually stop using the medication. For endogenous Cushing syndrome, the initial approach is a surgery to remove the tumor; some people may also need medications that lower cortisol or radiation therapy to destroy remaining tumor cells.
Adrenal insufficiency In adrenal insufficiency (AI), the cortex does not make enough steroid hormones. There are two kinds of AI:
Primary AI: Also called Addison's disease. In this rare condition, the adrenal glands do not work properly and cannot make enough cortisol, aldosterone and androgens.
Secondary AI: This results when the pituitary gland does not signal the adrenal glands to make cortisol.
Primary AI: The most common cause of primary AI is autoimmune disease. Other causes of primary AI include bleeding in the glands, infections, genetic (inherited) diseases, and surgical removal of the adrenal glands.
Secondary AI: In secondary AI, the pituitary gland does not send ACTH to the adrenal glands and so no cortisol is made. -Medicines like prednisone, hydrocortisone, or dexamethasone can cause secondary AI. -Tumors in the pituitary, surgical or radiation also may damage the pituitary.
Symptoms: They include fatigue, muscle weakness, decreased appetite, and weight loss. Some people experience nausea, vomiting, and diarrhoea. Other symptoms include:
Pain in the muscles and joints
Low blood pressure leading to dizziness upon standing
Cravings for salt (in primary AI)
Symptoms of low blood glucose, such as sweating
Darkened skin on the face, neck, and back of the hands (in primary AI)
Irregular menstrual periods in women
Diagnosis Check blood levels of cortisol, other hormones, sodium, potassium, and glucose to detect AI and help find the cause. They also look at the adrenal glands or the pituitary gland with imaging tests, such as x-rays, ultrasound, and CT or MRI scans.
What is the treatment for AI? Daily replacement of hormones for life-cortisol and aldosterone.
Primary aldosteronism Primary aldosteronism is a type of aldosterone excess. This condition occurs when your adrenals produce too much of aldosterone. Aldosterone is a hormone which helps balance the levels of sodium (salt) and potassium in your body. Having too much aldosterone causes the body to hold on to sodium, resulting in salt and water build-up and a rise in blood pressure. Uncontrolled high blood pressure can put you at risk for stroke, heart attack, heart failure, or kidney failure. When the increase of aldosterone is caused by a problem in your adrenals, the condition is called primary aldosteronism. When the problem originates outside the adrenals, it’s called secondary aldosteronism. The main causes of are:
Over activity of both adrenal glands, which occurs in about two-thirds of cases
A noncancerous growth or tumor in one adrenal gland (also called Conn’s syndrome), which occurs in about one-third of cases
An inherited disorder which affects aldosterone production, which is rare
A cancerous tumor of the adrenal gland, which is extremely rare
Risk factors for primary aldosteronism: High blood pressure that requires more than three medications to manage
High blood pressure that started at a young age (less than age 30)
Family history of stroke at a young age
Low potassium level in your blood (called hypokalemia)
Diagnosis of Primary aldosteronism Levels of aldosterone and renin in your blood. Adrenal imaging study (usually CT or MRI) to see whether you have one tumor or bilateral adrenal tumors (on both sides).
Treatment of primary aldosteronism: Treatment of PA depends on its cause and can include medication, lifestyle changes or surgery. When only one adrenal gland is overactive, medication and lifestyle changes can treat primary aldosteronism. However, doctors usually recommend surgery to remove the culprit adrenal gland. After surgery, you may still need to take medication. You should also follow a healthy lifestyle by:
Reducing sodium in your diet
Losing weight, if needed
Limiting alcohol intake
Congenital adrenal hyperplasia Congenital adrenal hyperplasia, also called CAH, is a genetic disorder in which the two adrenal glands do not function properly. Children inherit two abnormal copies of the gene from each of their parents.The genetic defect in CAH leads to abnormal enzyme (a protein that causes a chemical change in the body) activity in the adrenal glands that are needed for proper function. Without the enzyme, the adrenal glands may produce too little (or nothing) of the hormones cortisol and/or aldosterone and too much androgen. CAH can be severe (classic) or mild (nonclassic).
Diagnosis of CAH Heel prick right after birth (referred to as newborn screening). Diagnosis in infancy or later also may include:
A physical examination
Types of CAH There are two types of CAH—classic, which can be life-threatening, and nonclassic, a milder form of the disorder.
Classic CAH Classic CAH, usually first found in infancy or early childhood, is the most severe type. In one form of classic CAH, called “salt-wasting”, the adrenal glands do not make enough cortisol and aldosterone. In another form of classic CAH, called “non-salt wasting,” the enzyme shortage is less severe.
Signs and symptoms In many cases, female infants are diagnosed at birth, because they have ambiguous genitalia (external sex organs that resemble male genitals). However, they still have normal internal female organs (ovaries and uterus). A male infant with classic CAH usually appears normal at birth, although he may have an enlarged penis. After infancy, boys with classic CAH grow rapidly and show signs of early puberty. If infants are not diagnosed at birth, they may show weight loss, dehydration, diarrhea, and heart problems. They also may vomit frequently.
Treatment Individuals with classic CAH are treated with a medication called glucocorticoids to replace the cortisol their bodies can't make. Extra glucocorticoids may be needed during times of stress, such as when a patient is sick with an infection. Individuals with classic CAH, especially those with the salt-wasting form, also need medicines called mineralocorticoids. Newborns also may need sodium chloride (salt) supplements. Surgery can correct ambiguous genitalia in girls. Parents may choose to delay surgery until the child is old enough to help make the decision.
Nonclassic CAH The nonclassic form is mild and not life threatening. Signs and symptoms might not appear until childhood or adulthood.
Signs and symptoms Signs and symptoms in both males and females include: Early development of armpit and pubic hair Early or severe acne Infertility or decreased fertility Adolescent girls and adult women also may have: Masculine characteristics such as facial hair and a deep voice Infrequent or absent menstrual periods Treatment Some patients have no symptoms and require no treatment. Others need low-dose glucocorticoids (which might help with fertility), but might not need life-long treatment.
Prolactin - stimulates breast milk production after childbirth. It also affects sex hormone levels from ovaries in women and from testes (testicles) in men, as well as fertility
Growth hormone (GH) - stimulates growth in childhood and is important for maintaining a healthy body composition and well-being in adults. In adults, GH is important for maintaining muscle mass and bone mass. It also affects fat distribution in the body. Read about growth hormone excess
Adrenocorticotropin (ACTH) - stimulates the production of cortisol by the adrenal glands—small glands that sit on top of the kidneys. Cortisol, a "stress hormone," is vital to our survival. It helps maintain blood pressure and blood glucose (sugar) levels, and is produced in larger amounts when we’re under stress—especially after illness or injury. Read about having too much ACTH
Thyroid-stimulating hormone (TSH) - stimulates the thyroid gland to produce thyroid hormones, which regulate the body's metabolism, energy balance, growth, and nervous system activity
Luteinizing hormone (LH) - stimulates testosterone production in men and egg release (ovulation) in women
Follicle-stimulating hormone (FSH) - promotes sperm production in men and stimulates the ovaries to produce estrogen and develop eggs in women. LH and FSH work together to enable normal function of the ovaries and testes The following hormones are stored in the posterior (back part) of the pituitary gland:
Antidiuretic hormone (ADH) - also called vasopressin, regulates water balance in the body. It conserves body water by reducing the amount of water lost in urine
Oxytocin – causes milk to flow from the breasts in breastfeeding women, and may also help labor to progress
What is acromegaly? Acromegaly is a rare but serious condition caused by too much growth hormone (GH) in the blood. GH is released into the bloodstream by the pituitary gland, located at the base of the brain. The blood carries GH to other parts of the body where it has specific effects. In children, GH stimulates growth and development. In adults, GH affects energy levels, muscle strength, bone health, and one's sense of well-being. Too much GH in children is called gigantism and is extremely rare. Acromegaly in adults occurs mainly in middle-aged men and women. Acromegaly is a very rare condition. Each year, about three new cases of acromegaly occur for every million people.
What causes acromegaly? Acromegaly is usually caused by a non-cancerous tumor in the pituitary gland called a pituitary adenoma. The tumor produces too much GH and raises the level of GH in the blood. Too much GH also raises the level of insulin-like growth factor-1 (IGF-1), a hormone produced in the liver that also promotes growth. Rarely, acromegaly is caused by hormone-producing tumors in other parts of the body.
How is acromegaly diagnosed? If acromegaly is suspected, your doctor will do a blood test to check your level of IGF-1. High IGF-1 levels can mean that your levels of GH are also high. Another way to diagnose acromegaly is with an oral glucose tolerance test. In this test, GH levels in the blood are measured after you drink sugar water. Normally, the sugar water will make the pituitary gland stop producing GH and blood levels drop. However, a GH-producing pituitary tumor will not stop making GH, so the levels of GH in the blood will not change. What are the signs and symptoms of acromegaly? A person with acromegaly usually has large hands and feet, thick lips, coarse facial features, a jutting forehead and jaw, and widely spaced teeth. Often people with acromegaly sweat a lot. Other signs and symptoms fall into three categories, depending on the underlying causes. Symptoms can be caused by high GH levels, hypopituitarism (pituitary hormone deficiency caused by tumor damage to the pituitary), or by tumor volume effects (when the tumor is large enough to compress surrounding brain structures).
Caused by high GH levels: Numbness or burning of the hands or feet High blood glucose (sugar) Heart failure or enlarged heart High blood pressure (hypertension) Arthritis Goiter (enlarged thyroid gland) Sleep apnea (breathing repeatedly stops and starts during sleep) Tiredness Caused by hypopituitarism: Menstrual disorders (irregular bleeding; absence of periods) Lower sexual desire Tiredness Caused by tumor volume Headaches Vision problems (tunnel vision; vision loss) How is acromegaly treated? Acromegaly requires expert care. Too much GH and IGF-1 in the blood lower both your quality of life and how long you might live. The main goal of treatment is to lower GH and IGF-1 levels to normal. Treatment may be surgery, pituitary irradiation (radiation therapy on the pituitary gland), medication, or a combination of these options. If the cause of acromegaly is a pituitary tumor, surgery to remove the tumor is the first treatment. Complete removal of some tumors is difficult and other types of therapy are often needed to reach normal GH and IGF-1 levels. If your GH level isn't normal after surgery, or if you aren't a candidate for surgery, then pituitary irradiation and medication are also options. Irradiation can take a long time to bring GH levels down to normal. It may even take 10 to 20 years to be fully effective. Once the goal is reached, however, the effects of irradiation are permanent. Drugs are also available to treat acromegaly, but they are not a cure. If surgery or radiation does not lower your GH levels, you'll probably have to take medication for the rest of your life. (Rarely, when medications are stopped, control of the disease continues.) The most effective medications for acromegaly are somatostatin analogs and a GH receptor antagonist. Another type of medication (dopamine agonists) works for some but not most patients. Some patients may benefit from a combination of these medicines.
Questions to ask your doctor What are my treatment options? What are the advantages and disadvantages of each of my treatment options? Should I see an endocrinologist for my condition? How often should I have checkups? What else can I do to stay healthy? B)Cushing Disease
What Is Cushing disease? Cortisol is a hormone in the body that is directly connected to the stress response. In a healthy individual, the pituitary gland releases adrenocorticotropic hormone (ACTH), a hormone that stimulates the production and release of cortisol. When an individual faces a stressful situation, the body releases additional cortisol. Sometimes the body is not able to properly regulate the production of this hormone, leading to an overproduction of it. Cushing syndrome and Cushing disease are both conditions that occur when the body produces too much cortisol. Cushing disease and Cushing syndrome are not the same condition, but they are often confused with one another. Cushing syndrome occurs when the body produces too much cortisol. While this can happen for many reasons, it often occurs when the patient uses corticosteroid medication. Cushing disease occurs when a tumor on the pituitary gland causes the gland to produce too much ACTH, the hormone responsible for cortisol production. Too much ACTH in the system makes the adrenal glands produce cortisol in high levels. Cushing disease can also occur with excess growth of the pituitary gland. The excessive growth, known as hyperplasia, also causes the release of too much ACTH, which then leads to over-production of cortisol. Both Cushing syndrome and Cushing disease cause the same symptoms, including red lines on the abdomen, abdominal weight gain, and roundness to the face.
What causes Cushing disease? Cushing disease is a relatively rare condition, only affecting 10 to 15 people per million every year. It is more common in women and occurs most often in people between the ages of 20 and 50. Adenoma is the most common cause of Cushing disease. Adenoma is a pituitary tumor that is almost always benign. The tumors can be hard to diagnose, because they are quite small, so many people who have Cushing disease have a delayed diagnosis. Having an endocrinologist help with the diagnostic process can improve the chances of a prompt, successful diagnosis for patients who have symptoms of Cushing syndrome and Cushing disease.
What are the signs and symptoms of Cushing disease? Changes in appearance: Wide, purple stretch marks on the skin (chest, armpits, abdomen, flanks) Rapid and unexplained weight gain with a rounder face and abdomen Increased fat in the neck and above the collarbone and upper back Skin changes (bruising without injury, acne, hair growth) and red cheeks Mood and thinking: Memory loss or not being able to think clearly Depression Mood and behavior disorders Other symptoms: Fatigue Muscle weakness Menstrual cycle disorders Osteoporosis High blood glucose (diabetes) High blood pressure Blood clots in leg veins Heart attack Stroke Fracture
How is Cushing disease diagnosed? Diagnosing Cushing disease can be difficult because symptoms develop slowly, and because elevated cortisol levels can happen in cycles. As a result, cortisol levels may not be elevated at the time of testing. Testing begins with hormone blood tests to determine if blood cortisol levels are too high. This may require more than one test to establish a state of excessive blood cortisol. If the patient is not taking cortisol medications, the doctor will schedule an MRI to pinpoint the location of any tumors. If you are struggling with symptoms of elevated cortisol levels, schedule an appointment with your endocrinologist to rule out Cushing disease.
How is Cushing disease treated? The first line therapy is surgical removal of the tumor. Cure rates with an experienced pituitary surgeon are about 90% in people with small tumors. A patient will typically have transsphenoidal microsurgery through the nasal sinuses. People who are not cured usually have repeat surgery. When surgery does not work, radiation therapy may treat any remaining tumor mass. Several medications to block the adrenal glands (such as ketoconazole, metyrapone or mitotane) are often used while waiting for radiation to have an effect. In some cases, a type of drug called a dopamine agonist can reduce ACTH levels and cortisol production. Pasireotide (given by injection under the skin) can also reduce ACTH levels and cortisol production. Mifepristone is another medication that stops cortisol from working on the body. The adrenal glands are rarely removed.
C) Hyperprolactinemia What is hyperprolactinemia? Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood. The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy. Prolactin also affects the levels of sex hormones (estrogen and testosterone) in both women and men. Prolactin is made by the pituitary gland, a pea-sized organ found at the base of the brain.
What causes hyperprolactinemia? One common cause of hyperprolactinemia is a growth or tumor on the pituitary gland called a prolactinoma. The tumor produces high levels of prolactin. These tumors can be large or small and are usually benign, meaning they are not cancerous. Large tumors can also cause headaches, vision problems, or both. Prolactinomas are more common in women than in men and rarely occur in children.
Certain prescription medicines can also increase prolactin levels. These include medicines for: High blood pressure (such as calcium-channel blockers and methyldopa) Depression (tricyclic and SSRI antidepressants) Heartburn and gastroesphageal reflux disease Nausea and vomiting Pain (opiates—drugs derived from opium) Serious mental health disorders (antipsychotics such as risperdal and haloperidol) Menopausal symptoms (estrogen) Other causes include: Hypothyroidism or underactive thyroid—meaning the thyroid gland does not produce enough thyroid hormone Chest-wall injuries or other conditions that affect the chest wall, such as shingles Other tumors and diseases affecting the pituitary gland, or radiation treatment for tumors on or near the pituitary Chronic liver and kidney diseases Sometimes, no cause for hyperprolactinemia can be found. What are the signs and symptoms of hyperprolactinemia? Both men and women may have infertility, decreased sex drive, and bone loss. In addition, women may have: Vaginal dryness, leading to pain during intercourse Problems with menstruation—having no periods or irregular periods Production of breast milk when not pregnant or nursing Men may also have: Erectile dysfunction—trouble getting or keeping an erection Breast enlargement, called gynecomastia Decreased muscle mass and body hair How is hyperprolactinemia diagnosed? A blood test is used to detect excess prolactin. If prolactin levels are high, more tests are usually done to check blood levels of thyroid hormone. Normal thyroid hormone levels rule out hypothyroidism as a cause of hyperprolactinemia. Doctors will also ask about other conditions and medication use, and rule out pregnancy. If a prolactinoma is suspected, an MRI (magnetic resonance imaging) of the brain and pituitary is often the next step. Using a special machine that creates images of body tissues, an MRI can reveal a pituitary tumor and show its size. What is the treatment for hyperprolactinemia? Treatment is based on the cause. Some people with high prolactin levels, but few or no signs and symptoms, do not need any treatment. Options for treating tumors include: Prescription medicines. Bromocriptine and cabergoline decrease prolactin production. Medicines work well for most people with prolactinomas. Surgery to remove a tumor. Surgery may be used if medicines have not been effective. Surgery is sometimes needed if the tumor is affecting vision. Radiation. Rarely, if medicines and surgery have not been effective, radiation is used to shrink the tumor. Bromocriptine and cabergoline are also used to treat hyperprolactinemia with no known cause. Hypothyroidism is treated with synthetic thyroid hormone, which should bring prolactin levels back to normal. If high prolactin levels are caused by prescription medications, other types of medications can be explored. Questions to ask your doctor What caused my hyperprolactinemia? What tests do I need? What are my options for treatment? What are the advantages and disadvantages of each treatment option? Will I have long-term side effects from my condition?
6) Metabolic Syndrome
What is metabolic syndrome?
The term metabolic syndrome describes a cluster of risk factors that increase the chances of developing heart disease, stroke, and diabetes (high blood glucose, also called high blood sugar). The exact cause of metabolic syndrome is not known but genetic factors, too much body fat (especially in the waist area, the most dangerous type of fat), and lack of exercise add to the development of the condition. One in five Americans has metabolic syndrome.
You are diagnosed with metabolic syndrome if you have three or more risk factors:
Large amount of abdominal body fat: Waist measurement of more than 40 inches (102 cm) in men; more than 35 inches (88 cm) in women*
Low HDL (“good”) cholesterol: Less than 40 mg/dl in men; less than 50 mg/dl in women
High triglycerides (levels of fat in the blood): 150 mg/dl or higher
High blood pressure: 135/85 mmHg or higher, or use of blood pressure medications
High blood glucose: Fasting glucose of 100 mg/dl or higher
Having three or more risk factors is a sign that the body is resistant to insulin, an important hormone produced by the pancreas. This resistance to insulin means that more insulin than normal is needed to keep the body working.
Who is at risk for metabolic syndrome?
The syndrome runs in families and is more common among African Americans, Hispanics, Asians, and Native Americans. For all people, the chances of developing the syndrome rises as people get older. You might be at risk for the syndrome if you don’t get much exercise and have:
Gained weight, especially around the waist
Parent or sibling with type 2 diabetes
High levels of fat or glucose in your blood
High blood pressure
Most people who have metabolic syndrome feel healthy and may not have any signs or symptoms, especially if they are not obese. However, they are at risk of developing life-threatening diseases like diabetes and heart disease in the future.
How is metabolic syndrome treated? Increasing physical activity and losing weight are the best ways to begin to manage your condition. Medications can also be used to treat risk factors such as high blood pressure or high blood glucose (e.g., metformin) If you think you have risk factors for metabolic syndrome, talk with your doctor. Your doctor can run blood tests and measure your waist circumference to see if you have metabolic syndrome, and determine the best treatment option for you. Finding out if you have metabolic syndrome can give you a peek into your future health and see if you are headed down the path to heart disease. It will also give you time to make important lifestyle changes before serious complications develop.
Who is at risk for osteoporosis? Menopause. Other factors that can lead to osteoporosis include: Hormonal conditions (such as hyperparathyroidism, hyperthyroidism, diabetes, hypercortisolism, or hyperprolactinemia) Anorexia nervosa (a condition associated with very poor nutrition and abnormal ovarian function) Too much exercise or stress that leads to loss of menstrual periods If you have gone through menopause (even if you have been taking hormone therapy for a long time), have had a fracture (bone break), or are considering treatment for osteoporosis, a bone density test (DXA scan) can help determine your risk of fracture. If you are over 65 and do not have any of these risk factors for osteoporosis, you should still have a bone density test. Osteoporosis risk factors Family history Postmenopausal Premenopausal with irregular or no menstrual periods (amenorrhea) Thin or small frame Caucasian or Asian Diet low in calcium and vitamin D Little or no exercise Cigarette smoking Drinking too much alcohol Therapy with a steroid (such as prednisone) for any significant length of time Too much bone loss (osteoporosis) can lead to fractures, which can cause serious health risks, including disability and premature death. How is osteoporosis prevented and treated? You can take these steps to prevent bone loss: Get enough calcium and vitamin D, either through diet or supplements (at least 1,000–1,200 mg of calcium; 400–800 IU of vitamin D daily under age 50 or 800–1,000 IU after age 50) Do weight-bearing exercises and stay physically fit Avoid smoking Don’t drink too much alcohol Even with a healthy lifestyle, however, you may still need additional therapy to protect against bone loss and fractures. Your doctor may need to prescribe medications such as: Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid) Raloxifene Teriparatide Estrogen (when also prescribed for the relief of menopausal symptoms) Calcitonin All of these treatment options are effective, but may have side effects. Talk with your doctor to determine whether you need treatment, and which option is best for you. Questions to ask your doctor Am I at risk for osteoporosis? How often should I have a bone density test? Should I take calcium and vitamin D supplements? How much do I need? What else can I do to keep my bones strong? Should I see an endocrinologist?
8) Polycystic Ovarian Disease
What causes PCOS? Doctors aren’t exactly sure what causes PCOS. For most women, it’s probably a combination of factors, including the genes you inherit from your family. For example, women with PCOS are more likely to have a mother or sister with PCOS. What are the signs and symptoms of PCOS?
The signs and symptoms include having: Irregular menstrual periods, which means having your period more than once a month or every few months, or never having your period Periods that are very heavy or very light Unwanted hair growth on your face, chest, back, hands, upper arms and legs, or around your nipples Acne Thinner hair on your head Patches of dark, thickened skin on your neck, armpits, or between your breasts Weight problems Teens and women with PCOS also are at higher risk for type 2 diabetes, high blood pressure, and/or high cholesterol.
How does a doctor check for PCOS? Your doctor will do a physical exam and ask you about your health, your medicines, and your menstrual cycle. The doctor will also want to know whether there’s a family history of PCOS (in your mother, an aunt, or a sister). In a physical exam, your doctor will check your blood pressure, your height, and your weight. Your doctor will also look at hair growth on your body and will check for patches of darkened skin. Your doctor might order blood tests to check hormone levels, blood glucose (sugar), or cholesterol. Sometimes, doctors might do a pelvic exam or order an ultrasound (imaging) test of the ovaries and uterus. This kind of test can show whether you have ovarian cysts, which are fluid-filled bubbles in or on the ovaries. Your doctor will make sure there are no other causes of irregular periods or altered hormone levels.
What’s the treatment for PCOS? Treatments include one or more of the following: Changes in your lifestyle such as having fewer sugary drinks and high-calorie desserts to help control your weight, exercising each day, and avoiding smoking Counseling with a registered dietitian to help you choose healthy foods and lose weight if you need to Medicines that contain the female hormones estrogen and progesterone (or just progesterone), such as birth control pills, a vaginal ring, or a skin patch; medicines to help your body use insulin better, such as metformin (for pre-diabetes or diabetes); and/or acne medicine Treatment for unwanted body and facial hair, such as bleach, wax, medicines, shaving, electrolysis, or laser treatment Will PCOS affect whether I can have a baby in the future? PCOS may or may not affect whether you can have a baby. When the time comes, your doctor can help you with fertility problems. What can I do to cope with PCOS? Seeing a doctor who knows about PCOS is the first step. Choose a doctor who specializes in hormone problems (an endocrinologist) or a doctor who specializes in women’s health (a gynecologist or a family doctor). Remember that the sooner you get help for your PCOS, the sooner you could lower your risk for related health problems such as diabetes. Your doctor can help you find ways to feel better about your appearance. For example, you can ask your doctor about the best way to remove unwanted facial hair. If you feel worried or depressed, ask your parents or your doctor where to go for counseling. You can also go to a support group to talk with others who have PCOS. It’s braver to get counseling than to suffer in silence.
Questions to ask your doctor Do I have PCOS? What are my options for treatment? What are the risks and benefits of each treatment option? How long will I need treatment? Should I see an endocrinologist? Should I see a registered dietitian?
10) Ambiguous Genitalia
What factors should you consider in making a sex assignment for your child? You may be faced with a choice of whether to raise your child as a boy or a girl. You and your doctor will consider: The cause of your child’s condition (if the cause can be found) and likely gender identity The appearance of your child’s genitals Options for surgery How well your child’s gonads are likely to function in the future Whether your child will be fertile Your family’s preferences and cultural beliefs How is ambiguous genitalia managed? The goals of management are to ensure your child’s long-term emotional well-being, future sexual function and potential for fertility, and stable gender identity. Treatment can include hormone therapy (most often at puberty). Another treatment option is surgery to improve sexual function or for cosmetic reasons. Doctors may suggest surgery for some patients when they are infants. Parents also may choose not to pursue surgery or to delay it until the child is old enough to help make the decision. The choice to forego surgery is more commonly accepted today. All surgery carries risks, so talk with your child’s doctor if you are considering this option. To help you make decisions about managing your child’s condition, you and your child should see a team of health care providers. This health care team may include specialists in newborn health, genetics, endocrinology (hormones), pediatric surgery or urology, and psychology or psychiatry. Questions to ask your doctor What is my baby’s sex? Does my child need treatment now or later? Are there support groups for people dealing with this condition? Should my child see a pediatric endocrinologist?
What is gynecomastia?
Gynecomastia is breast enlargement in boys or men due to a benign (non-cancerous) increase in breast tissue. This condition results from an imbalance between testosterone (a male hormone) and estrogen (a female hormone). All males have some estrogen. But too much estrogen can cause breasts to grow. Although gynecomastia doesn’t cause health problems, it can make breasts tender. It can also be embarrassing.
Who develops gynecomastia?
Gynecomastia is common in newborn boys due to exposure to their mother’s estrogen. It also can occur in boys going through puberty. In both cases, it usually goes away on its own. In adults, it’s most common in men over the age of 50 years.
What causes gynecomastia in adults?
A number of factors can cause enlarged breasts in men, however, sometimes no cause is found:
The hormonal changes of aging (having less testosterone and more estrogen)
Increased body fat, which can increase estrogen levels
Medicines and other substances:
Medicines that prevent the production or block the action of male sex hormones, such as treatment for prostate cancer
Some antibiotics Some anti-ulcer medicines
Some cancer treatments (chemotherapy)
Some medicines for heart and blood vessel disease
Some medicines for psychiatric conditions, such as anxiety, depression, and psychotic disorders
Alcoholic beverages (drinking too much)
Illegal drugs: amphetamines, anabolic steroids and androgens (used by some bodybuilders or athletes to improve performance),
heroin, and marijuana
Some over-the-counter drugs, herbal supplements with phytoestrogens (plant substances that are like estrogen),
and lotions, such as those containing lavender or tea tree oil
Some health problems:
Conditions that result in low testosterone levels (called hypogonadism), such as Klinefelter syndrome or pituitary gland problems
Overactive thyroid gland (hyperthyroidism)
Kidney disease and kidney failure
Tumors of the testicles, adrenal glands, or pituitary gland
How is gynecomastia diagnosed? Your doctor will ask questions about your medical conditions and usual medicines, including over-the-counter medicines. In a physical exam, your doctor will check your breast tissue to see if the enlargement is gynecomastia or another condition. Other causes of enlarged breasts include fat deposits, benign tumors, and fluid-filled pouches (cysts). The doctor will look for signs of breast cancer, a rare condition in men. Your doctor also will check your testicles for size and for the presence of a tumor. Your doctor may recommend other tests: Blood tests to check hormone levels Tests to see whether the liver, kidneys, and thyroid are working properly Imaging tests, such as ultrasound or a CT scan to look for tumors A mammogram to rule out breast cancer.
What is the treatment for gynecomastia? In some cases, no treatment is needed. In other cases, the treatment depends on the factors causing the enlargement. If a medicine or other substance is the cause, your doctor may recommend you stop using it, or switch you to a different medicine. If a disease is the cause, you will be treated for the disease as needed.
Other treatments include: Medicines that block the effect of estrogen in breast tissue (especially for men who have had gynecomastia for a short time) Surgery to remove breast tissue (especially for men who have a lot of breast tissue or who have had gynecomastia for a long time). However, surgery usually isn’t done until the cause of the enlargement has been treated What should you do if you’re worried about enlarged breasts? It’s best to talk it over with your doctor. Tests can identify the cause of the enlarged breasts. If the enlargement is temporary, your doctor can offer reassurance. If treatment is needed, your doctor can discuss the options with you. Questions to ask your doctor Why are my breasts enlarged? What are my options for treatment? What are risks and benefits of each treatment option?
12) Low Testosterone
What is the role of testosterone in men’s health?
Testosterone is the most important sex hormone that men have. It is responsible for the typical male characteristics, such as facial, pubic, and body hair as well as muscle. This hormone also helps maintain sex drive, sperm production, and bone health. The brain and pituitary gland (a small gland at the base of the brain) control the production of testosterone by the testes.
In the short term, low testosterone (also called hypogonadism) can cause:
A drop in sex drive
Low sperm count
Over time, low testosterone may cause a man to lose body hair, muscle bulk, and strength and to gain body fat. Chronic (long-term) low testosterone may also cause weak bones (osteoporosis), mood changes, less energy, and smaller testes. Signs and symptoms (what you see and feel) vary from person to person.
What causes low testosterone? Low testosterone can result from: Testicular injury (trauma, castration) or infection Radiation or chemotherapy treatment for cancer Some medications, such as opiate painkillers Hormone disorders (pituitary tumors or diseases, high levels of prolactin) Chronic diseases, such as liver and kidney disease, obesity, type 2 diabetes, and HIV/AIDS A genetic condition (Klinefelter syndrome, hemochromatosis, Kallmann syndrome, Prader-Willi syndrome, myatonic dystrophy) Low testosterone is common in older men. In many cases, the cause is not known. How is low testosterone diagnosed? During a physical exam, your doctor will examine your body hair, size of your breasts and penis, and the size and consistency of the testes and scrotum. Your doctor may check for loss of side vision, which could indicate a pituitary tumor, a rare cause of low testosterone. Your doctor will also use blood tests to see if your total testosterone level is low. The normal range is generally 300 to 1,000 ng/dL, but this depends on the lab that conducts the test. To get a diagnosis of low testosterone, you may need more than one early morning (7–10 AM) blood test and, sometimes, tests of pituitary gland hormones. If you have symptoms of low testosterone, your doctor may suggest that you talk with an endocrinologist. This expert in hormones can help find the cause. Be open with your doctor about your medical history, all prescription and nonprescription drugs you are now taking, sexual problems, and any major changes in your life. How is low testosterone treated? Testosterone replacement therapy can improve sexual interest, erections, mood and energy, body hair growth, bone density, and muscle mass. There are several ways to replace testosterone:
Gel or patches that you put on your skin Injections (shots)
Tablets that stick to the gums
Pellets inserted under the skin or pills (in some countries outside the United States)
The best method will depend on your preference and tolerance, and the cost.
There are risks with long-term use of testosterone. The most serious possible risk is prostate cancer.
Other possible risks of testosterone treatment include:
A high red blood cell count
An increase in prostate enlargement
Sleep apnea—the occasional stopping of breathing during sleep (rarely)
Fluid buildup (edema) in ankles, feet and legs (rarely)
Questions to ask your doctor
What is the cause of my low testosterone?
Is testosterone replacement an option for me?
When should I get my testosterone level retested?
Should I see an endocrinologist?