Endocrinology & Diabetes

The most common misconception is that sugar causes diabetes. Watching out sugar intake becomes important only if you've been diagnosed with diabetes. However, if you do not have diabetes, sugar intake will not cause diabetes. Diabetes is an illness which occurs as a result of problems with the production and supply of insulin in the body. Most of the food we eat is turned into glucose, a form of sugar. We use glucose as a source of energy to provide power to the muscles and other tissues. If left untreated, diabetes can lead to serious heart problems such as cardiovascular disease (CVD), or heart disease, including peripheral artery disease (PAD) and stroke.

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Diabetes insipidus is a disorder that affects the body's ability to regulate fluid levels. Unlike diabetes mellitus, which affects blood sugar levels, diabetes insipidus causes excessive thirst and urination, leading to dehydration and other complications. Speciality Endocrinology Associated Anatomy Kidneys Symptoms of Diabetes Insipidus The primary symptoms of diabetes insipidus include: - Excessive thirst and urination - Dehydration - Fatigue - Dry mouth - Constipation. Causes of Diabetes Insipidus Vasopressin is a hormone which regulates the amount of water in the body. A deficiency of vasopressin or the inability of the kidney to process vasopressin is the cause of diabetes insipidus. If there is not enough vasopressin or the kidneys are not sensitive enough to it, excess amounts of dilute urine are produced, leading to dehydration and other symptoms. Risk Factors of Diabetes Insipidus Risk factors for diabetes insipidus include: Family history of the condition Genetic conditions Head injury Brain surgery Some medications. Types of Diabetes Insipidus There are four kinds of diabetes insipidus:  Central diabetes insipidus is caused by a problem with the production or release of ADH. Damage or disease of the hypothalamus or pituitary gland due to medications or surgery can cause this. Nephrogenic diabetes insipidus occurs when kidneys do not respond to ADH properly. This can be due to genetic mutations, medications, or other medical conditions. Transient diabetes insipidus of pregnancy is a rare form of DI that occurs during pregnancy. It is thought to be caused by the increased metabolism and secretion of ADH-degrading enzymes in the placenta. Transient diabetes insipidus of pregnancy usually resolves after delivery, but in some cases, it may persist and become chronic. Primary polydipsia refers to an abnormal increase in thirst, leading to excessive fluid intake. Excessive fluid intake can overwhelm the body's ability to produce enough ADH, leading to high volumes of dilute urine. Diagnosis of Diabetes Insipidus Diabetes insipidus is typically diagnosed through: Blood and urine tests that measure hormone levels and kidney function. Imaging tests like MRI scans to examine the hypothalamus and pituitary gland. Treatment of Diabetes Insipidus Treatment for diabetes insipidus typically involves addressing the underlying cause and replacing fluid and electrolytes to prevent dehydration. Medications may be used to regulate fluid balance and reduce urine output. In severe cases, intravenous fluids or hormone replacement therapy may be necessary. Complications of Diabetes Insipidus Complications of diabetes insipidus can include: Dehydration Electrolyte imbalances Kidney damage Urinary tract infections. Prevention of Diabetes Insipidus - Diabetes insipidus is usually not preventable as it is often caused by genetic or developmental factors. - There is no known way to prevent diabetes insipidus, but early diagnosis and treatment can help prevent complications. - Maintaining a healthy lifestyle, exercising regularly and consuming a balanced diet can also help prevent other conditions that contribute to diabetes insipidus. Prognosis of Diabetes Insipidus With proper treatment, most people with diabetes insipidus are able to manage their symptoms and live normal lives. However, if it is left untreated, the condition may lead to serious complications and even death. FAQs about Diabetes Insipidus What fluids do you give for diabetes insipidus? The treatment for diabetes insipidus involves increasing fluid intake to replace the lost fluids due to excessive urination. Typically, patients with diabetes insipidus are advised to drink plenty of water, and in some cases, electrolyte solutions may also be recommended to maintain the balance of minerals in the body. How much water does a person with diabetes insipidus drink? The amount of water a person with diabetes insipidus drinks depends on the severity of their condition and the recommendations of their doctor. What happens if diabetes insipidus is left untreated? If left untreated, diabetes insipidus can lead to dehydration, electrolyte imbalances, and other complications. Chronic dehydration can cause fatigue, weakness, and confusion, while electrolyte imbalances can cause muscle cramps, irregular heartbeat, and seizures. In severe cases, untreated diabetes insipidus can be life-threatening. Can blood be donated with diabetes insipidus? In general, having diabetes insipidus does not prevent a person from donating blood. However, eligibility criteria for blood donation may vary by country and depend on factors like the severity of the condition and the medications being used to treat it. Consult with a healthcare provider or blood donation centre to determine eligibility. Review Reviewed by Dr Saket Kant, Senior Consultant - Endocrinology & Diabetes on 5 June 2024.

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A diabetic foot ulcer is one of the health complications caused due to uncontrolled diabetes. High blood glucose levels can cause nerve damage. In addition, people with diabetes may also suffer from lower extremity arterial disease, which is a condition that leads to reduced blood flow. These problems make the feet vulnerable to skin sores, also known as ulcers. They usually occur under the big toes and surrounding areas. As per researchers, about 25 percent of people who have diabetes can develop foot ulcers during their lifetime. In some cases, these foot ulcers can cause severe infections. If untreated, this may require partial or total amputation.

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Gestational diabetes is a condition that develops during pregnancy. It occurs when the hormone produced by the placenta prevents the body from using insulin effectively (insulin resistance), as a result of which glucose accumulates in the blood instead of being absorbed by the cells. Unlike other types of diabetes, in gestational diabetes blood glucose goes back to normal after childbirth. It usually appears during the middle phase of pregnancy, between 24 and 28 weeks. Gestational diabetes can affect the mother as well as the health of the baby. Pregnant mothers can manage gestational diabetes by consuming healthy foods, doing regular activity, regular blood glucose monitoring, and if required by injecting insulin.

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Graves' disease is an autoimmune disease that affects the thyroid. The condition occurs when the body's immune system mistakes the healthy cells for foreign particles and attacks them. The condition makes the hyperactive and is the leading cause of a thyroid condition known as hyperthyroidism. In this condition, the thyroid provides too many hormones. The thyroid gland is a butterfly-shaped gland that produces two hormones, thyroxine (also called T4) and triiodothyronine (also known as T3). These hormones are of great importance in maintaining bodily functions.  In Graves' disease, the immune system creates antibodies, known as thyroid-stimulating immunoglobulins, that attach to the thyroid cells. This causes the thyroid gland to produce higher than normal hormones, which results in hyperthyroidism. The condition may also lead to an enlarged thyroid, also known as goiter. The disease gets its name from Sir Robert Graves, an Irish doctor who first discovered the condition around 150 years ago. 

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Hirsutism is a condition in which coarse or coloured hair develops on women's faces and bodies. A medical problem also can occasionally cause it. On the body and face, usually, women have thin, light, hardly noticeable hair, although this hair can occasionally be denser and much more prominent. There is a rise in androgen in around half of all patients with Hirsutism. These hormones frequently trigger male sexual and physical growth. Females' androgen levels are typically low, although they can fluctuate for various reasons.  An increase can overstimulate hair follicles, resulting in excess hair growth. Hirsutism can affect anywhere from 5% to 10% of women. With age, the prevalence rise, particularly after menopause.

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Hyperthyroidism is a condition where the thyroid gland produces excessive thyroid hormones, leading to an accelerated metabolism. Treatments may involve anti-thyroid medications, radioactive iodine, or surgery to remove part of the thyroid gland. Proper management is crucial to preventing complications such as heart issues and bone loss. Difference Between Hyperthyroidism and Hypothyroidism Hyperthyroidism and hypothyroidism are both thyroid disorders, but they have opposite effects. Hyperthyroidism involves an overactive thyroid gland, resulting in increased hormone production. This speeds up metabolism, causing symptoms like weight loss and rapid heartbeat.  Hypothyroidism is when the thyroid gland is underactive and produces insufficient hormones. This slows metabolism, leading to weight gain, fatigue, and cold intolerance. Both conditions require different treatment approaches and management strategies. Symptoms of Hyperthyroidism Hyperthyroidism manifests through several physical and emotional symptoms due to an overactive thyroid gland. Weight loss: Even with a regular or heightened appetite, people might observe significant weight loss due to an accelerated metabolism. Rapid heartbeat: Rapid heart rate or palpitations can be observed, even during periods of rest, indicating hyperthyroidism. Nervousness: Feelings of anxiety or irritability, often accompanied by restlessness, can be a sign of hyperthyroidism. Tremors: Shaking or trembling, usually in the hands or fingers, can indicate excess thyroid hormone. Heat intolerance: Discomfort or excessive sweating in warm environments may occur due to the body's heightened sensitivity to heat. What Causes Hyperthyroidism? Graves' disease: The thyroid gland is attacked by the immune system in this autoimmune condition, causing an excess of hormone production. Thyroiditis: Inflammation of the thyroid gland, often leading to a temporary increase in hormone levels. Thyroid nodules: The thyroid gland may develop abnormal growths that result in the overproduction of hormones. Excess iodine: High levels of iodine intake from diet or medications can trigger hyperthyroidism. How is Hyperthyroidism Diagnosed? Hyperthyroidism can be diagnosed in several ways: Blood tests: Evaluate thyroid function by measuring the thyroid hormones and thyroid-stimulating hormone (TSH) levels. Imaging tests: Include ultrasound or radioactive iodine scans to identify thyroid nodules or inflammation. Physical exam: A healthcare provider examines the thyroid gland for enlargement or lumps. How is Hyperthyroidism Treated? Treatment for hyperthyroidism aims to normalise thyroid hormone levels through various methods. Medications: Antithyroid drugs work by reducing the production of thyroid hormones. Radioactive iodine: This treatment destroys overactive thyroid cells, thereby lowering hormone levels. Surgery: In severe cases, part or all of the thyroid gland is surgically removed to control hormone production. Risk Factors for Hyperthyroidism Hyperthyroidism can be influenced by various factors, increasing the likelihood of developing the condition. Family history: A family history of thyroid disease increases the risk of developing hyperthyroidism. Gender: Hyperthyroidism is more common in women than in men. Age: The risk of hyperthyroidism increases with age, particularly in individuals over 60. Autoimmune disorders: Conditions such as type 1 diabetes and rheumatoid arthritis are often linked to an increased likelihood of developing hyperthyroidism. Excessive iodine intake: Excessive consumption of iodine through food or medication may elevate the likelihood of hyperthyroidism in individuals who are vulnerable to this condition. Conclusion Hyperthyroidism is a manageable condition with the right diagnosis and treatment. Understanding the symptoms, causes, and treatment options can help you manage the condition effectively and improve your quality of life. Frequently Asked Questions Is hyperthyroidism life-threatening? While hyperthyroidism can cause serious complications, it is typically manageable with appropriate treatment. Can I live a normal life with hyperthyroidism? Yes, with proper treatment and management, most people with hyperthyroidism can live normal, healthy lives. What to avoid in hyperthyroidism? Avoid excessive iodine intake and stimulants like caffeine, which can worsen symptoms. What foods reduce hyperthyroidism? Consuming foods rich in calcium and magnesium, like leafy greens and nuts, could potentially assist in symptom management. Can we drink milk in hyperthyroidism? Moderate milk consumption is generally safe; however, consult with a healthcare provider for personalised advice. Review  Reviewed By Dr Aishwarya Krishnamurthy - Consultant Endocrinology & Diabetes on 28 Aug 2024.

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In general terms, Obesity refers to the excess amount of fat stored in the body. It is also known as overweight which means weighing too much. A person may be overweight from extra muscle, bone, or water, as well as from having too much fat. Obesity is generally not a disease but is known to be a major cause for the onset of various other diseases. Consuming more food means consuming more calories which then leads to obesity because our body stores unused calories as fat. Not only a major cause of other diseases, obesity sometimes makes it really difficult for the people to carry out their daily activities like washing, walking, bathing, running, lifting etc. Therefore, it should be treated at the earliest to ensure minimal damage. Being overweight puts strain on your heart and can lead to serious health problems. These problems include: Heart disease High blood pressure Sleep apnea Type 2 diabetes Varicose veins

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A neuroendocrine tumour originating from chromaffin cells is called pheochromocytoma. The chromaffin cells produce hormones of the adrenal gland - adrenaline and noradrenaline. Adrenal glands are small endocrine glands placed above the kidneys. About 80-85% of pheochromocytomas arise from the adrenal medulla, while 15-20% grow extra-adrenally and are termed paragangliomas. The majority of tumours are benign and don't spread to other parts of the body. However, the tumour releases hormones that may increase blood pressure and cause headaches, sweating, and symptoms similar to a panic attack. If a pheochromocytoma is left untreated, it can be fatal. Most pheochromocytomas affect people aged 20 to 50 years. With the surgical removal of pheochromocytomas, the symptoms also disappear. Symptoms of Pheochromocytoma Some symptoms of pheochromocytoma are: High blood pressure or hypertension Headache Tremours Paleness in the face Shortness of breath Heavy sweating Rapid heartbeat Constipation Panic attack-like symptoms Anxiety Weight loss Causes of Pheochromocytoma The exact cause of pheochromocytoma is not known. However, the tumour develops in chromaffin cells situated at the center of the adrenal gland. Chromaffin cells release adrenaline and noradrenaline, hormones controlling heart rate, blood pressure, and blood sugar. Diagnosis of Pheochromocytoma The doctors perform a physical exam and ask about medical history and symptoms. The tests they may advise include: Abdominal CT scan Catecholamines blood test (serum catecholamines) Glucose test 24-hour urine test for catecholamines and metanephrines. Metanephrine blood test (serum metanephrine) An imaging test called an MIBG scintiscan MRI of the abdomen PET scan of the abdomen Genetic tests: Doctors sometimes recommend genetic testing to assess if the pheochromocytoma is associated with an inherited disorder. Genetic testing can be useful because: Some inherited disorders can cause multiple conditions, indicating the need to evaluate and test for other medical disorders. Some diseases are more likely to be recurrent or cancerous. The test results may impact treatment decisions or long-term plans to monitor health. The tests may encourage other family members to get checked for pheochromocytoma or other conditions. Treatment of Pheochromocytoma The first line of treatment for pheochromocytoma is the surgical removal of the tumour. However, before the surgery, doctors try controlling blood pressure with medications that obstruct the actions of the high-adrenaline hormones. This reduces the risk of developing dangerously high blood pressure during the surgery. Preoperative preparation Doctors recommend taking two drugs for seven to ten days before the surgery to control blood pressure, such as alpha-blockers and beta-blockers. Additionally, by increasing the intake of salt, the blood pressure will not drop to life-threatening levels post-operatively. Alpha-blockers- These drugs relax the blood vessels, improve blood flow and thus lower blood pressure. Side effects may include dizziness, fatigue, irregular heartbeat, vision problems, sexual dysfunction in men, and swelling in the limbs. Beta-blockers- These drugs lower heart rate and slow the pumping of the heart by relaxing the heart muscles. Additionally, they help relax the blood vessels. This drug is prescribed about seven to ten days before the scheduled date of surgery. The side effects of these drugs are fatigue, dizziness, constipation, diarrhoea, upset stomach, headache, irregular heartbeat, difficulty breathing, and swelling in the limbs. High-salt diet: Alpha and beta-blockers broaden the blood vessels, lowering the amount of fluid within the blood vessels. This may lead to a drop in blood pressure to dangerous levels. Salt has a tendency to attract fluids. Hence, a high-salt diet will draw in more fluid within the blood vessels. This prevents the lowering of blood pressure to dangerous levels during and after surgery. Surgery In the majority of cases, the surgeons remove the entire adrenal gland with pheochromocytoma. This can be achieved with minimally invasive surgery, depending on the tumour size. The other adrenal gland, or any remaining adrenal gland, is left to perform its usual functions. As a result, the blood pressure returns to normal within a few weeks of surgery. Cancer treatments Only a handful of pheochromocytomas are malignant. The studies about the treatment of malignant pheochromocytomas are thus limited. Treatment options for malignant tumours and metastasized (spread to other body parts) related to a pheochromocytoma are: MIBG: This is a form of radiation therapy that combines MIBG, a compound that attaches to adrenal tumours, with a type of radioactive iodine. The therapy aims to provide radiation therapy to a specific site and eliminate malignant cells. Peptide receptor radionuclide therapy (PRRT): This therapy combines a drug that targets cancer cells and a small amount of a radioactive substance. Radiation is delivered directly to the abnormal cancer cells. Chemotherapy: Chemotherapy is the most efficient type of treatment. Administration of potent drugs during chemotherapy kills the rapidly proliferating cancer cells. Radiation therapy: Radiation therapy helps with the symptomatic treatment of tumours that have spread to other organs. Targeted cancer therapies: These medicines hamper the function of innately occurring molecules that stimulate the growth and spread of cancerous cells. Complications of Pheochromocytoma Hypertension caused by pheochromocytoma can damage multiple organs, such as the cardiovascular system, brain, and kidneys. This damage can cause numerous critical conditions, such as: Stroke Heart disease Renal failure Problems with the nerves of the eye Risk Factors of Pheochromocytoma People with rare inherited disorders carry an increased possibility of having pheochromocytoma or paraganglioma. Tumours associated with these disorders have a high chance of being cancerous. These genetic disorders may include: Multiple endocrine neoplasias, type 2 (MEN 2) Von Hippel-Lindau disease Neurofibromatosis 1 (NF1) Hereditary paraganglioma syndromes Prognosis of Pheochromocytoma Most people with benign tumours removed with surgery can live for about five years. However, recurrence has been seen in some cases. After the tumour is surgically removed, the levels of hormones return to normal. Blood pressure may remain high even after the surgery. However, this can be controlled with medicines and making certain lifestyle changes. People successfully treated for pheochromocytoma should get regularly tested to ensure that the tumour has not recurred. Family members can also benefit from testing because some cases may show prominent inheritance. Review Reviewed by Dr. Anshu Alok , Senior Consultant - Endocrinology & Diabetes.

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Pituitary adenomas are a type of tumour that are noncancerous and occur in the pituitary gland. These types of noncancerous tumours are generally divided into three categories on the basis of their biological functioning - benign adenoma, invasive adenoma or carcinomas, with carcinomas accounting for 0.1% to 0.2%, approximately 35% being invasive adenomas and most being benign adenomas. The pituitary gland is a pea-sized, reddish-grey gland, located in the centre of the brain, just above the back of the nose.

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Prediabetes is a health condition in which blood glucose is higher than normal but not high enough to diagnose diabetes. Without lifestyle measures or medical intervention, prediabetes can turn into type 2 diabetes. People with prediabetes are at a higher risk of health problems such as heart disease and stroke. Progression from Prediabetes to type 2 diabetes isn’t inevitable.

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The thyroid is a small gland, similar to a butterfly, situated in the lower part of the neck. The primary objective of this gland is to secrete hormones such as tri-iodothyronine, abbreviated as T3, and thyroxin, abbreviated as T4. These thyroid hormones provide energy to cells of the body and are one of the most important hormones to control the body’s metabolism. The most common thyroid problems include Hypothyroidism, Hyperthyroidism. The hypothalamus in our brain releases a thyrotropin-releasing hormone or (TRH). The release of thyrotropin-releasing hormone tells the pituitary gland to release thyroid-stimulating hormone (TSH). This thyroid-stimulating hormone, circulating in your bloodstream, is what tells the thyroid gland to make thyroid hormones and release them into the bloodstream. The main hormones that are released by the thyroid gland are triiodothyronine (abbreviated as T3) and thyroxine (abbreviated as T4). These are responsible for delivering energy to the cells of our body and are one of the main hormones to control the body's metabolism. The Most Common Thyroid Problems Include: Hypothyroidism - An underactive thyroid Hyperthyroidism - An overactive thyroid Goitre - An enlarged thyroid Thyroid nodules - Lumps in the thyroid gland Thyroid cancer - Malignant thyroid nodules or tissue Thyroiditis - Inflammation of the thyroid

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