Endocrinology

Endocrinology

Endocrinology is a super specialty branch of medicine dealing with Hormonal problems like Diabetes, Thyroid, Obesity, Growth, PCOS, Infertility and other hormonal problems. Most of these problems are chronic requiring regular follow up and team work.


The Endocrinology and Diabetes program at Sai’s Institute of Endocrinology provides long-term care for children and teens with diabetes and other endocrine system problems, such as puberty, growth and thyroid disorders. We believe in caring for your child while helping you learn how best to manage your child’s condition. Children’s program meets national standards. Our team is experienced in caring for growing children, and includes diabetic doctors,patient counselors,Dietitian,Physiotherapist(Exercise Counselor).


Diabetes Treatments:

• Basic minimum services offered to you under this program will be control of blood sugar, blood pressure, cholesterol and weight as latest guidelines followed worldwide.

• You will also be screened for any evidence of disease of eyes, kidneys, peripheral nerves, foot, heart or blood vessel that is quite common in patients with diabetes and may be silent.

• Once your basic parameters are assessed, our doctors along with diabetes educators and nutritionist will chalk out a treatment plan tailor made to cater to your need, keeping your lifestyle and preferences in mind. Based upon your control, you will be asked to follow up once in 3 – 6 months interval. In case any complication related to diabetes is picked up in screening, you will be offered specialized treatment program.





Diabetic retinopathy

Diabetes can cause progressive damage to the retina, the light-sensitive lining at the back of the eye. It does so by damaging the blood vessels of retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. The longer the person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness. We screen the retina for retinopathy using state of the art fundus camera.

Diabetic nephropathy

Diabetic nephropathy is damage to your kidneys caused by diabetes. In severe cases, it can lead to kidney failure. The earliest sign of kidney damage is leakage of albumin in excess. This can be tested at any time on the spot. Our laboratory is capable of assaying and reporting albumin level in 30-40min.

Diabetic foot evaluation

Long standing Diabetes and foot deformities can cause multiple calluses (dry and thick skin over the soles). The nails can become hard and difficult to cut. Our Podiatrist performs small procedures to remove these high risk features and these procedures can prevent foot ulcers.

Preventive Podiatry: (foot care)

Diabetes can cause progressive damage to the retina, the light-sensitive lining at the back of the eye. It does so by damaging the blood vessels of retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. The longer the person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness. We screen the retina for retinopathy using state of the art fundus camera.


Insulin pump therapy

The feet are especially at risk in diabetes due to progressive loss of sensation. There can be narrowing of arteries supplying blood to the lower limbs. In our foot examination, we assess the sensation, blood flow and any deformities in the footInsulin pump is a boon for patients with Type1 DM who are having wide fluctuations in glucose. The device configuration may vary depending on design. It is worn externally and can be discreetly clipped to your belt, slipped into a pocket, or hidden under your clothes. It delivers precise doses of rapid-acting insulin to closely match your body’s needs.


CGM / ambulatory glucose profile

There are situations where the HbA1C does not match with the glucose recordings and patients have multiple low sugar symptoms which make treatment adjustment difficult. A coin sized probe inserted to back of arm can monitor glucose every 15min once for 14 days to give 3040 readings. This wealth of information can make a huge difference to management.


Thyroid Treatments:


Hypothyroidism

It is a common disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as poor ability to tolerate cold, a feeling of tiredness, constipation, depression, and weight gain. Occasionally there may be swelling of the front part of the neck due to goitre. Untreated hypothyroidism during pregnancy can lead to delays in growth and intellectual development in the baby.


Goitre

A goitre is a swelling of the neck or larynx resulting from enlargement of the thyroid gland (thyromegaly), associated with a thyroid gland that may not be functioning properly.




Thyroid nodules

Thyroid nodule is a localized swelling or lump within the thyroid gland. A thyroid nodule can be single or multiple in which case it is part of a multinodular goitre. Thyroid nodules are usually small and painless. They do not cause any pressure effects in the neck. Most patients do not even notice the swelling. Thyroid nodules are usually firm, smooth, and easily felt through the skin if they are large enough. Most nodules over 2 cm are palpable during a careful examination of the neck area. Smaller nodules are usually only detectable by ultrasound. The rest of the gland feels normal.


Thyroid cancer

Cancer does affect the thyroid gland. We need an ultrasound and guided FNAC do identify if a particular nodule is harbouring cancer. We have an experienced head and neck cancer surgeon who can go through the preoperative assessment and suggest appropriate treatment. We also follow up a number of thyroid cancer patients who do very well and require an annual blood test to look for recurrence Tg and antiTG.


Reproductive Endocrinology :


Polycystic ovarian syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a common endocrine system disorder among women of reproductive age affecting up to one in 10 women. Women with PCOS may have enlarged ovaries that contain small collections of fluid called follicles located in each ovary as seen during an ultrasound exam The cysts by themselves are not harmful cause hormone imbalances. Infrequent or prolonged menstrual periods, excess hair growth, acne, and obesity all occur in women with polycystic ovary syndrome. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications, such as type 2 diabetes and heart disease We have dedicated PCOS care team including a dietitian and an endocrinologist. We offer psychologic counselling for weight loss along with usual advice.


Hirsutism

Hirsutism is excessive body hair in men and women on parts of the body where hair is normally absent or minimal, such as on the chin or chest in particular, or the face or body in general. It may refer to a male pattern of hair growth that may be a sign of a more serious medical condition, especially if it develops suddenly at any time. It is due to increased levels of androgen hormones. Most Women with hirsuitism can have good improvement with treatment. Treatment is usually initiated after thorough evaluation for serious hormonal issues





Female infertility

The main symptom of infertility is the inability to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you're not ovulating. Infertility is a condition that affects approximately 1 out of every 6 couples. An infertility diagnosis is given to a couple that has been unsuccessful in efforts to conceive over the course of one full year. When the cause of infertility exists within the female partner, it is referred to as female infertility. Female infertility factors contribute to approximately 50% of all infertility cases.


Amenorrhea

Amenorrhea (uh-men-o-REE-uh) is the absence of menstruation — one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who haven't begun menstruation by age 15. Causes of amenorrhea include problems with the reproductive organs or with the glands that help regulate hormone levels. Treatment of the underlying condition often resolves amenorrhea.


Male Sexual Disorders :


Hypogonadism

Male hypogonadism is a condition in which the body doesn't produce enough testosterone the hormone that plays a key role in masculine growth and development during puberty or has an impaired ability to produce sperm or both. In boys, there can be a delay in appearance of facial hair and absence of growth in the penis. Any delay beyond 14 years needs to be investigated thoroughly with an early morning Testosterone and LH, FSH hormones. After the age of 40 years there is a gradual decline in testosterone in all men in 2-5% men this can be more acute and lead to symptoms like muscle loss, fatigue, ere


Erectile dysfunction

Erectile dysfunction (ED), also known as impotence, is a type of sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual activity in humans. A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is most often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. Occasional ED isn’t uncommon. Many men experience it during times of stress. Frequent ED can be a sign of health problems that need treatment.


Male Infertility

Male infertility refers to a male's inability to cause pregnancy in a fertile female. In humans, it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity. A man’s fertility generally relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy. Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male. In most cases, there are no obvious signs of infertility. Medical tests are needed to find out if a man is infertile.


Adernal Disorders:


Cushing’s Syndrome

Cushing’s syndrome occurs due to abnormally high levels of the hormone cortisol. It can be diagnosed through 24-hour urinary free cortisol test.


Adrenal insufficiency

Adrenal insufficiency or adrenal fatigue is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones. It is diagnosed by ACTH stimulation test. We do a stimulation test with acton prolangatum an analogue of ACTH for assessing adrenal reserve.


Pheochromocytoma

Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure. Plasma metanephrine and urine 24hr metanephrine test is done for detecting a pheochromocytoma.


Primary hyperaldosteronism

Hyperaldosteronism is a disease in which the adrenal gland(s) make too much aldosterone which leads to hypertension (high blood pressure) and low blood potassium levels. It is diagnosed by aldosterone renin test.



Adrenal cancer

Adrenal cancer is a condition that occurs when abnormal cells form in or travel to the adrenal glands. A noncancerous tumor of the adrenal gland is called a benign adenoma.at occurs when abnormal cells form in or travel to the adrenal glands. Your blood and urine will be tested to look for high levels of the hormones produced by some adrenal adenomas and carcinomas.


Metabolic Bone Diseases :


Osteoporosis

Osteoporosis is a condition of fragile bone with an increased susceptibility to fracture. Osteoporosis is a disease where increased bone weakness increases the risk of a broken bone. It is the most common reason for a broken bone among the elderly. Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. Chronic pain and a decreased ability to carry out normal activities may occur following a broken bone.


Vitamin D deficiency (Osteomalacia)

Osteomalacia is the softening of the bones caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium. The impairment of bone metabolism causes inadequate bone mineralization. Osteomalacia in children is known as rickets, and because of this, use of the term "osteomalacia" is often restricted to the milder, adult form of the disease. Signs and symptoms can include diffuse body pains, muscle weakness, and fragility of the bones.



Osteogenesis imperfecta

Osteogenesis imperfecta (OI), also known as brittle bone disease, is a group of genetic disorders that mainly affect the bones. It results in bones that break easily. The severity may be mild to severe. Other symptoms may include a blue tinge to the whites of the eye, short height, loose joints, hearing loss, breathing problems, and problems with the teeth.


Paget’s disease

Paget's disease is a chronic bone disorder. Paget's disease of bone is caused by the excessive breakdown and formation of bone, followed by disorganized bone remodeling. This causes affected bone to weaken, resulting in pain, misshapen bones, fractures and arthritis in the joints near the affected bones. Rarely, it can develop into a primary bone cancer known as Paget's sarcoma. Often Paget's disease is localized to only a few bones in the body. The pelvis, femur, and lower lumbar vertebrae are the most commonly affected bones. Paget's disease typically is localized, affecting just one or a few bones, as opposed to osteoporosis, for example, which usually affects all the bones in the body.



Endocrine Disorders :


Recurrent hypoglycemia

Diabetes can cause progressive damage to the retina, the light-sensitive lining at the back of the eye. It does so by damaging the blood vessels of retina. Diabetic retinopathy occurs when these tiny blood vessels leak blood and other fluids. The longer the person has diabetes, the more likely they will develop diabetic retinopathy. If left untreated, diabetic retinopathy can cause blindness. We screen the retina for retinopathy using state of the art fundus cameraHypoglycemia occurs when blood glucose levels fall below 4 mmol/L (72mg/dL). The symptoms are sweating, fatigue, feeling dizzy. This can be tested through blood glucose test. We perform a supervised fast to mimic conditions that trigger hypoglycemia and assay levels of glucose; insulin; cpeptide during hypoglycemia. These tests are essential for identifying cause of hypoglycemia.


Lipid disorders

A lipid disorder means that you have high levels of either low-density lipoprotein (LDL), cholesterol, or elevated levels of fats called triglycerides. This can be diagnosed by testing lipid profile such as cholesterol, triglycerides, LDL, VLDL, HDL. We perform LDL using an enzymatic assay and not by calculation like at other centers, so that an important test like LDL can be done while waiting at the office. Quick availability of result will make our treatment decision robust.






Electrolytes disturbances

The most serious electrolyte disturbances involve abnormalities in the levels of sodium, potassium or calcium. Chronic laxative abuse or severe diarrhea or vomiting (gastroenteritis) can lead to electrolyte disturbances along with dehydration. It can be diagnosed through blood test such as sodium, potassium, magnesium, calcium levels.


Kidney or urinary bladder stones disorder

Kidney stones, or renal calculi, are solid masses made of crystals. Symptoms of a kidney stone include flank pain and blood in the urine. It can be tested through ultrasound, CT scan, pyleography.




Neuroendocrine tumors

Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. They most commonly occur in the intestine, but they are also found in the pancreas, lung and the rest of the body.


Ambiguous genitalia

Ambiguous genitalia is a rare condition in which an infant's external genitals don't appear to be clearly either male or female. In a baby with ambiguous genitalia, the genitals may not be well-formed or the baby may have characteristics of both sexes.



Pediatric Endocrinology :


Short stature

Short stature refers to a height of a human being which is below typical. Whether a person is considered short depends on the context. Because of the lack of preciseness, there is often disagreement about the degree of shortness that should be called short. Longitudinal growth assessment is essential in child care. Short stature can be promptly recognized only with accurate measurements of growth and critical analysis of growth data. Short stature, optimally defined relative to the genetic endowment of the individual, is recognized by comparing an individual child’s height with that of a large population of a similar genetic background and, more particularly, using the mid-parental target height. Adult height is largely genetically predetermined although environmental factors also play a pivotal role.


Tall stature

Tall stature is defined as height beyond 97th. Percentile (i.e., over two standard deviations) of mean for age and sex. Excessive growth is defined as an abnormally rapid growth velocity, which could manifest as height acceleration across two major percentile lines on the growth chart. It means 3 out of every 100 children in a community are tall and should be evaluated. Usually occurs in a female child and the mother often remembers her unusual tall stature during her childhood. Also known as constitutional tall stature is the most common cause of tall stature. The bone as is marginally to moderately advance so that the final height prediction is not very height. Hormonal causes of tall stature include hyperthyroidism, precocious puberty and excess growth hormone.



Early puberty

Early puberty is puberty occurring at an unusually early age. In most cases, the process is normal in every aspect except the unusually early age, and simply represents a variation of normal development. Puberty starts on average in girls between ages 8 and13 and in boys between ages 9 and 14. Doctors diagnose early puberty when this normal process starts early and continues to progress through growth spurts and bone maturation, usually for reasons we don't understand. Girls who show significant signs of puberty and its progression before age 7 and boys before age 9 are considered precocious.


Delayed puberty

Puberty is described as delayed puberty with exceptions when an organism has passed the usual age of onset of puberty with no physical or hormonal signs that it is beginning. Puberty may be delayed for several years and still occur normally, in which case it is considered constitutional delay of growth and puberty, a variation of healthy physical development. Delay of puberty may also occur due to malnutrition, many forms of systemic disease, or to defects of the reproductive system (hypogonadism) or the body's responsiveness to sex hormones.




Pituatary Disorders :


Acromegaly

Acromegaly is a disorder that results from excess growth hormone (GH) after the growth plates have closed. The initial symptom is typically enlargement of the hands and feet. There may also be enlargement of the forehead, jaw, and nose. Other symptoms may include joint pain, thicker skin, deepening of the voice, headaches, and problems with vision. Complications of the disease may include type 2 diabetes, sleep apnea, and high blood pressure.


Cushing’s disease

Cushing’s syndrome occurs due to abnormally high levels of the hormone cortisol. This can happen for a variety of reasons. The most common cause is overuse of corticosteroid medications. In most cases, medication can help you manage your cortisol levels. Cushing’s syndrome is also known as Cushing syndrome or hypercortisolism. Cushing's syndrome is all about the stress hormone cortisol. Most cases of Cushing's syndrome can be cured, though it may take some time for your symptoms to ease up. The condition, also known as hypercortisolism, is more common in women than men. It's most often seen in people ages 25 to 40. You can get Cushing's syndrome when there’s too much cortisol in your body for too long.



Prolactinoma

A prolactinoma is a benign tumor (adenoma) of the pituitary gland that produces a hormone called prolactin. It is the most common type of functioning pituitary tumor. Symptoms of prolactinoma are too much prolactin in the blood (hyperprolactinemia), or those caused by pressure of the tumor on surrounding tissues. Prolactin stimulates the breast to produce milk, and has many other functions such as regulation of mood. Hence prolactin levels are usually higher during pregnancy and after childbirth. After delivery of a baby, a mother's prolactin levels come down to normal a few weeks after breastfeeding is discontinued. Each time the milk is dispensed, prolactin levels rise this process may cycle to maintain milk production. In males it is responsible for the sexual refractory period after orgasm and excess levels can lead to erectile dysfunction.


Pituitary tumors

Pituitary tumors are abnormal growths that develop in your pituitary gland. Most pituitary tumors are noncancerous (benign) growths (adenomas). Adenomas remain in your pituitary gland or surrounding tissues and don't spread to other parts of your body. For example: Prolactinoma, a tumor that overproduces prolactin. Acromegaly (adults) gigantism (child), caused by an excess growth hormone. Cushing's disease, caused by a pituitary tumor stimulating an overproduction of cortisol. Most pituitary tumors are noncancerous (benign) growths (adenomas). Adenomas remain in your pituitary gland or surrounding tissues and don't spread to other parts of your body.




Hypopituitarism

Hypopituitarism is a rare disorder in which your pituitary gland either fails to produce one or more of its hormones or doesn't produce enough of them. Despite its size, this gland secretes hormones that influence nearly every part of your body. In hypopituitarism, you have a short supply of one or more of these pituitary hormones. This deficiency can affect any number of your body's routine functions, such as growth, blood pressure and reproduction. You'll likely need medications for the rest of your life to treat hypopituitarism, but your symptoms can be controlled.




Diabetes insipidus

Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced can be nearly 20 liters per day. Reduction of fluid has little effect on the concentration of the urine. Complications may include dehydration or seizures. Extreme urination continues throughout the day and the night. In children, DI can interfere with appetite, eating, weight gain, and growth, as well. They may present with fever, vomiting, or diarrhea. Adults with untreated DI may remain healthy for decades as long as enough water is consumed to offset the urinary losses. However, there is a continuous risk of dehydration and loss of potassium that may lead to hypokalemia.




SIADH (syndrome of inappropriate ADH secretion)

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a condition in which the body makes too much antidiuretic hormone (ADH). It is characterized by excessive release of antidiuretic hormone from the posterior pituitary gland or another source. The increase in blood volume (hypervolemia) often results in true hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased. Although the sodium level is low. SIADH is brought about by an excess of water rather than a deficit of sodium. This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water. ADH is a substance produced naturally in an area of the brain called the hypothalamus. It is then released by the pituitary gland at the base of the brain.




Parathyroid Disorders :


Hyperparathyroidism

Hyperparathyroidism occurs when the parathyroid glands make too much parathyroid hormone (PTH). PTH helps regulate the levels of calcium, vitamin D, and phosphorus in your bones and blood. This condition affects bone and make it weak and also there is high calcium in the blood. Diagnosis can be made by testing calcium and iPTH at our center.


Hypoparathyroidism

Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone. This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles. Diagnosis is done by calcium phosphorus and iPTH levels.



Other Services :


Nutrition services and dietetics

Nutrition is the knowledge concerned with the diet and its effects on health, especially with the practical application of a scientific understanding of nutrition. Dietitian will help to advance an understanding of how diet affects the health and well-being of people. Dietitians provide medical nutrition therapy. They also provide health education and counsel the patients on how to lead a healthy life.

Facilities at Sai's Institute of Endocrinology