• Diabetes mellitus (Type 1, Type 2 and Gestational)
• Obesity
• Thyroid related disorders
• Pituitary disorders (Acromegaly, Cushing syndrome, hyperprolactinemia etc.)
• Adrenal disorders
• PCOS, hirsuitism (excessive unwanted hairs) & menstrual disorders in females
• Menopause
• Growth disorders (short or tall child)
• Puberty disorders (delayed/early puberty)
• Ambiguous genitalia in newborn
• Metabolic bone disorders, osteoporosis and rickets
• High cholesterol & lipid disorders
• High blood pressure due to endocrine disorders

1. DIABETES MELLITUS:

What is Diabetes?

• Diabetes means you have too much sugar in your blood.
• High blood sugar problems start when either body no longer produce enough of hormone – Insulin or the insulin cannot act properly in body.
• Your body changes much of the food. You eat into a type of sugar called glucose. Body cells need sugar for their energy supply. Insulin helps move sugar from your blood into your cells and by doing this insulin keeps your blood sugar level normal.

Know the signs and symptoms

• Tiredness or sleepiness
• Need to urinate often
• Always thirsty
• Hungry all the time
• Sudden Weight loss
• Numb or tingling in the hand and feet
• Blurred vision or frequent changes of glasses
• Wounds that don’t heal easily
• Frequent vaginal and skin infections

Risk factors for diabetes (who should be screened)

• Age > 45 years
• Sedentary lifestyle
• Family history of diabetes mellitus
• Obesity
• Women who have history of diabetes mellitus during pregnancy or history of having a large baby
• Hypertension
• Lipid abnormality( high cholesterol)
• History of CVD
• Consult if you have any symptoms or risk factors for diabetes mellitus and have your blood sugar checked.

Comprehensive Diabetes Management:

• Management of all types of diabetes mellitus (type 1, type 2, diabetes in pregnancy & other types)
• Screening for complications of diabetes mellitus & its management
• Patient education regarding diabetes, diet, exercise and foot care

2. Thyroid gland disorders

It is a butterfly shaped endocrine gland located in front of neck. The main job of the gland is to produce thyroid hormone. The main function of thyroid hormone is mental development and growth in children, regulation of body temperature and assistance of other body organs in their normal function.

Hypothyroidism

It is a condition in which thyroid gland cannot produce enough thyroid hormone.

Signs and Symptoms:

• Unexplained weight loss
• Tiredness/ Lethargy
• Excessive sleepiness
• Hair loss
• Dry skin
• Depression
• Menstrual irregularities
• Difficulty in conception
• Growth Failure (not gaining adequate height)in children

Hyperthyroidism

It is a condition in which body produces excessive amount of thyroid hormone.

Signs and Symptoms:

• Weight loss
• Increased appetite
• Increased bowel movement
• Shaking hands (tremors)
• Excessive sweating
• Decreased sleep
• Feeling your heart beats
• Warm and moist palms

3. Pituitary disorders

Your pituitary gland is a pea-sized gland at the base of your brain. The pituitary is the “master gland” – it makes or stores different hormones that control many functions of the body.

• Growth (Growth hormone)
• Thyroid function (Thyroid-stimulating hormone)
• Reproductive function (Luteinizing hormone and Follicle-stimulating hormone)
• Breast feeding (Prolactin)
• Adrenal function (Adrenocorticotropin)
• Water balance (Antidiuretic hormone)
• Parturition (Oxytocin)

With pituitary disorders, one often have either too much or too little of one of your hormones. Some common disorders of pituitary gland are: Hypopituitarism, Hyperprolactinemia, Acromegaly, Non-functioning pituitary mass

The most frequent type of pituitary disorder is a pituitary tumor. These tumors are fairly common in adults. They are not brain tumors and are almost always benign (that is, not cancer). In fact, cancerous tumors of this sort are extremely rare.

There are two types of tumors—Functioning and non-functioning. Functioning tumors produce too much of a hormone normally made by the pituitary. Both types of tumors can cause problems if they are large and interfere with normal function of the pituitary gland and/or nearby structures in the brain.

The problems caused by pituitary tumors fall into three general categories:

• Hypersecretion: Too much of any hormone in the body is caused by a secretory pituitary tumor.
• Hyposecretion: Too little of any hormone in the body can be caused by a large pituitary tumor, which interferes with the pituitary gland’s ability to produce hormones. Hyposecretion can also result from surgery or radiation of a tumor.
• Tumor mass effects: As a pituitary tumor grows and presses against the pituitary gland or other areas in the brain, it may cause headaches, vision problems, or other health effects.

Injuries, certain medications, bleeding inside or close to the pituitary, and other conditions can also affect the pituitary gland. Loss of normal pituitary function also can occur after major head trauma.

4. Adrenal disorders

Adrenal glands are located at the top of each kidney. They produce hormones that help the body control blood sugar, burn protein and fat, react to stressors like a major illness, injury or surgery, 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.

Adrenal insufficiency occurs when the adrenal glands don’t make enough cortisol, and sometimes, aldosterone. Symptoms include fatigue, muscle weakness, decreased appetite, and weight loss. Some people experience nausea, vomiting, and diarrhea. Adrenal insufficiency is treated with hormones that replace the hormones your body is lacking.

5. POLYCYSTIC OVARIAN SYNDROME (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a condition that causes irregular menstrual periods and elevated levels of male hormones (androgens) in women. PCOS is very common in India. It is estimated that 1 in every 10 women in India has PCOS but because of lack of awareness it is not detected on time and many women keep suffering. The incidence of PCOS is higher in urban cities and is growing among adolescents and young girls.

Problems related to PCOS include irregular menstrual cycles, excessive facial and body hairs, acne, difficulty in conception (pregnancy) and high risk of developing diabetes mellitus and hypertension.

Mainstay of treatment of PCOS are lifestyle modifications, weight reduction, medicines to normalize menstrual cycles and drugs to reduce effects of male hormone. Patient may require medical assistance for pregnancy.

6. Menopause

Menopause, also known as the climacteric, is the time in women’s lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause typically occurs between 49 and 52 years of age.

It may also be defined by a decrease in hormone production by the ovaries. Menopause is a natural biological process. Although it ends fertility, you can stay healthy, vital and sexual.

7. Growth Disorders

A growth disorder means that a kid has abnormal growth — for example, growing a lot slower or a lot faster than other kids the same age.

The cause of a growth problem depends on the type of growth disorder in question. Some growth problems are genetic, while others may be caused by hormonal disorders or poor absorption of food. It is important to know that with proper evaluation and diagnosis, majority of the growth problems are easily treatable and child can have normal height.

Causes for growth problems usually fall into the following categories:

• Familial short stature: Familial short stature is a tendency to follow the family’s inherited short stature (shortness).
• Constitutional growth delay with delayed adolescence or delayed maturation: A child who tends to be shorter than average and who enters puberty later than average, but is growing at a normal rate may have a growth delay.
• Illnesses that affect the whole body (also called systemic diseases). Constant malnutrition, digestive tract diseases, kidney disease, heart disease, lung disease, diabetes, and severe stress can cause growth problems.
• Endocrine (hormone) diseases: Adequate production of the thyroid hormone is necessary for normal bone growth. Cushing’s syndrome, a rare condition, can be caused by a myriad of abnormalities that result in hypersecretion of corticosteroids by the adrenal gland. Growth hormone deficiency involves a problem with the pituitary gland (small gland at the base of the brain). The pituitary gland secretes several hormones, including growth hormone.
• Congenital (present at birth) problems in the tissues where growth occurs: With a condition called intrauterine growth restriction (IUGR), slow growth within the uterus occurs during a pregnancy. This can be caused by many factors, including smoking during pregnancy. The baby is born smaller in weight and length than normal, although proportionate to his/her short stature.

Having too many or too few chromosomes can result in health problems, including problems with growth. A common chromosome abnormality that results from too few chromosomes is the following:

• Turner syndrome is a genetic disorder seen in girls that causes them to be shorter than others and fail to develop during puberty. The severity of these problems varies among affected individuals. Other health problems may also be present involving the heart or renal system (kidneys, etc.). Many conditions can be managed or corrected by medical treatment. Turner syndrome occurs in one in 2,500 females born. The features of Turner syndrome result from having a missing X chromosome in each of the body’s cells.
• There are different bone diseases that affect height and growth, many of which are genetic. The most common is achondroplasia, a type of dwarfism in which the child’s arms and legs are short in proportion to his or her body length. Further, the head is often large and the trunk is normal size.
• Tall stature. Some girls may have an abnormally tall stature for their age if their parents are tall. In addition, a growth disorder called precocious puberty is characterized by an early onset of adolescence in which a child is tall for his or her age initially, but, due to rapid bone maturity, growth stops at an early age and they may be short as adults. There are a few genetic conditions that result in tall stature with other health problems also present. There are several growth disorders that are idiopathic with no known cause for the growth problem.

8. PUBERTY DISORDERS (DELAYED/EARLY PUBERTY)

Puberty is the process a child’s body goes through as it develops into an adult’s body. Normal puberty begins between 8 and 14 years of age in girls and between 9 and 14 years of age in boys. Pubic hair distribution is used to stage puberty, along with breast size and contour in girls and testicular volume in boys.

• Precocious puberty
  • Precocious puberty is when there are signs of secondary sexual maturation before 8 years of age in girls, or before 9 years of age in boys. In addition, there may be a growth spurt in height, but with early bone maturity that can lead to shorter than normal adult height.
  • Signs seen in girls include breast growth and a first period. Boys may have enlarged testicles and penis, facial hair and a deepening voice. Boys and girls both may have pubic or underarm hair growth, acne and body odor.

• Delayed puberty
  • The onset of puberty can also be delayed. Generally, this is defined as the lack of any signs of puberty by age 14 in either sex.
  • Most often, it’s simply a pattern of growth and development in a family. If the parents, uncle, aunt, siblings or cousins developed later than usual, this is called constitutional delay. It may just be that your child is a late bloomer and won’t require any treatment.
  • Medical problems are a frequent reason for delays in puberty. Chronic illnesses such as diabetes, cystic fibrosis, kidney disease or asthma can cause puberty later, just because the illness makes it hard for the body to develop.
  • Nutritional concerns may also contribute. A child who is malnourished either because of a lack of food or because of an eating disorder may lose so much weight that his or her body can’t develop properly. Girls who are otherwise well nourished but extremely active in sports may not have the proper amount of fat in their bodies to start puberty.
  • Puberty can also be delayed if certain glands are not functioning correctly. The pituitary and thyroid glands produce hormones critical for body growth and development.

9. AMBIGUOUS GENITALIA IN NEWBORN

An 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. The external sex organs may not match the internal sex organs or genetic sex. An ambiguous genitalia is not a disease rather than a sign of a condition that affects sexual development

Usually, an ambiguous genitalia is obvious at or shortly after birth, and it can be very distressing for families. Your medical team will determine the cause of ambiguous genitalia and provide information and counselling that can help guide decisions about your baby’s gender and any necessary treatment.

10. Metabolic bone disorders and Osteoporosis

Metabolic bone disease is an umbrella term referring to abnormalities of bones caused by a broad spectrum of disorders.

Most commonly, these disorders are caused by abnormalities of minerals such as calcium, phosphorus, magnesium or Vitamin D leading to dramatic clinical disorders that are commonly reversible once the underlying defect has been treated. These disorders are to be differentiated from a larger group of genetic bone disorders where there is a defect in a specific signaling system or cell type that causes the bone disorder. There may be an overlap. For example, genetic or hereditary hypophosphatemia may cause the metabolic bone disorder osteomalacia. Although there is currently no treatment for the genetic condition, replacement of phosphate often corrects or improves the metabolic bone disorder.

Conditions considered to be metabolic bone disorders are:

• Osteoporosis
• Osteomalacia (adults) & rickets (children)
• Osteitis fibrosa cystica
• Paget’s disease of bone

11. High cholesterol & 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.

If you have high LDL cholesterol or high triglycerides, you probably have an increased risk for developing heart disease.

Cholesterol

The two major forms of cholesterol found in your body are high-density lipoprotein (HDL) and low-density lipoprotein (LDL).

HDL, or “good cholesterol”, has a protective effect on your heart. HDL transports harmful cholesterol out of your arteries. Doctors usually recommend that you have a high level of HDL cholesterol.

LDL, or “bad cholesterol”, is made by your body and also absorbed from cholesterol-rich foods such as red meat and dairy. LDL can combine with other fats and substances, creating blockages in your arteries. This can reduce your blood flow and cause serious health problems.

Triglycerides

A triglyceride is a type of fat you get from the food you eat. Your body also produces it when it converts excess calories to fat for storage. Some triglycerides are necessary for the proper cell functions, but too much is unhealthy. People with high cholesterol often have a raised level of triglycerides.

Causes

Medical conditions or bad dietary habits can cause high blood cholesterol and high triglycerides.

Food

Foods that contain saturated fat or trans fat can cause an increase in cholesterol. Saturated fat is mostly found in animal-based food products such as cheese, milk, butter, and steak. Some plant-based foods, such as palm oil and coconut oil, also contain saturated fats.

Transfats, or trans-fatty acids, have undergone a hydrogenation process. Some transfats are found in animal products. These fats are often found in peanut butter, margarine, and potato chips.

Foods high in these two fats lower HDL levels and increase LDL levels. This decreases your defenses against heart disease and stroke, increasing your risk of developing these conditions.

Medical Conditions

High levels of cholesterol, heart disease, and diabetes cause high triglycerides. High blood cholesterol levels can result from:

• Diabetes
• Hypothyroidism
• Metabolic syndrome
• Medication side effects
• Cushing’s syndrome
• Polycystic ovary syndrome (PCOS)
• Kidney diseases

12. High blood pressure due to endocrine disorders

Like primary hypertension, secondary hypertension usually has no specific signs or symptoms, even if your blood pressure has reached dangerously high levels.

If you’ve been diagnosed with high blood pressure, having any of these signs may mean your condition is secondary hypertension:

• High blood pressure that doesn’t respond to blood pressure medications (resistant hypertension)
• Very high blood pressure — systolic blood pressure over 180 millimeters of mercury (mm Hg) or diastolic blood pressure over 120 mm Hg
• A blood pressure medication or medications that previously controlled your blood pressure no longer works
• Sudden-onset of high blood pressure before age 30 or after age 55
• No family history of high blood pressure
• No obesity

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