Endocrine diagnoses and diabetes explained for patients
 

Dr Asjid Qureshi
MB ChB (Edin), MD (Lon), MRCP (Edin)
London Diabetes and Endocrinology
Consultant
Wellington Hospital and Clementine Churchill Hospital

 
 

London, UK

English / русский / العربية

 

   
 
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D  I  S  O  R  D  E  R  S

P  O  L  Y  C  Y  S  T  I  C      O  V  A  R  Y      S  Y  N  D  R  O  M  E

Who it affects

Polycystic ovary syndrome is a common disorder affecting 10 to 20% of women.

 

What gland is involved

The ovaries

 

Symptoms

Not all women have all the features polycystic ovary syndrome. Symptoms that may occur individually or in combination include an irregular menstrual cycle, excess hair growth and problems with weight and conception.

 

Diagnosis

There is no single diagnostic test for this syndrome. Investigations that patient may undergo include blood tests (e.g. serum testosterone, LH, FSH) and ultrasound scans (transvaginal or transabdominal scan of the ovaries).

 

Treatment

Treatment is tailored to individual patients and is dependent on which symptom(s) is experienced. A healthy lifestyle with weight control is helpful in almost all patients.

 

Specific treatments may include the oral contraceptive pill for menstrual irregularity, Dianette or Vaniqua cream for excess hair growth. Treatments such as spironolactone, flutamide and finasteride are sometimes used in the treatment of hirsuitism. Medication used in this area are often used off licence, i.e. used for a reason not detailed in the drug`s licence.

 

Not all patients have difficulty with conception. Those that do, may require specialist treatment in a fertility unit.

 

Outlook

Patient with polycystic ovary syndrome have this disorder lifelong. The severity of symptoms may vary with time and the focus of treatment is likely to vary at different stages of the patient`s life. Treatment is therefore likely to vary with time.

 

 

 

H  Y  P  E  R  T  H  Y  R  O  I  D  S  I  M

Who it affects

Hyperthyroidism is also known as thyrotoxicosis or an over active thyroid is a common disorder. An over active thyroid may result from various causes. Patients with Graves` disease are usually younger, female and may have a history or family history of diseases such as rheumatoid arthritis, pernicious anaemia or Addison`s disease. Multiple benign overactive thyroid nodules is another course. This is called a toxic multi-nodular goitre. More rarely an overactive thyroid can be due to drugs such as Amiodarone or a single hyperactive thyroid nodule (toxic nodule). Postpartum thyroiditis refers to abnormal thyroid function following the delivery of a child.

 

What gland is involved

The thyroid gland lies in the front part of the neck just under skin and below the thyroid cartilage (Adam`s apple).

 

Symptoms

Hyperthyroidism may cause symptoms such as weight loss, increased appetite, tremor of the hands, palpitations, loose motions or menstrual irregularity.

 

Diagnosis

The blood tests used to diagnose an overactive thyroid are Thyroid Stimulating Hormone (TSH), free T4 and sometimes free T3. Free T4 is produced by the thyroid in response to TSH stimulation. Free T4 is converted to free T3, the more active form of the hormone. TSH is produced by the pituitary and because of thyroid hormone feedback, levels are low or undetectable in hyperthyroidism. The tests used to determine what caused thyroid over activity may include blood tests (thyroid anti-bodies), ultrasound scans or thyroid isotopes scans.

 

Treatment

The treatment of an overactive thyroid is dependent on the cause. Graves` disease is typically treated with anti-thyroid medication (Carbimazole or Propylthiouracil) for 6-18 months. Once discontinued, about 50% of patients may remain off medication. In those whom an over active thyroid re-occurs (relapse), treatment with radioiodine or surgery may be considered.

Anti-thyroid medication may be titrated to control thyroid function or used in a "block and replace" fashion. Block and replace therapy entails using anti-thyroid medication to block thyroid hormone production and levothyroxine replacement to normalise TFTs.

Hyperthyroidism due to a multinodular goitre is usually treated with radioiodine or surgery, although medication is usually prescribed initially.

 

Outlook

About half of patients with Graves` disease are able to successfully discontinue all medication after a closely monitored course of anti-thyroid medication. 

Patients treated with surgery (total thyroidectomy) or radioiodine (ablative doses) usually become hypothyroid and require lifelong thyroxine therapy. 

Thyroid surgery is arranged by referring to a surgeon.  

Surgical removal of the entire thyroid gland will result in hypothyroidism and require lifelong levothyroxine therapy. The parathyroid glands lie behind the thyroid and although efforts are made to avoid it, these may also be removed during total thyroidectomy surgery. Such patients may require lifelong vitamin D therapy.

Some surgeons aim to achieve normal thyroid function off medication by removing part of the thyroid gland. With this approach, there is however a chance that the thyroid remains overactive or becomes overactive at a later time.  

Radioiodine is a popular alternative to surgery. It involves the administration of the isotope I131 that is administered in the form of a liquid or tablet. Patient will be advised to take certain precautions e.g. avoiding contact with young children and pregnant women for a period of time after treatment. The main side-effect of radioiodine therapy (ablative dose) is to render the patient`s thyroid under active. Life-long levothyroxine therapy is required in this case. It is important that if you are considering radioiodine therapy, you mention to your endocrinology specialist if:

  1. you come into contact with children or pregnant women

  2. you suffer from urinary incontinence

  3. plan to conceive

  4. you are a carer for someone

 

 

 

H  Y  P  O  T  H  Y  R  O  I  D  I  S  M

Who it affects

Hypothyroidism is a common disorder affecting 5% of the general population.

 

What gland is involved

The thyroid gland lies in the front part of the neck just under skin and below the thyroid cartilage (Adam`s apple).

 

Symptoms

Patients with hypothyroidism may experience symptoms such as tiredness, lethargy, weight gain, constipation, dry skin and hair loss.

 

Diagnosis

Hypothyroidism is diagnosed with blood tests including TSH, free T4 +/- free T3.

 

Treatment

Treatment is with levothyroxine tablets. The dose is usually titrated over many months whilst monitoring blood tests.

 

Prognosis

An under active thyroid is usually a lifelong disorder. Blood test are performed at intervals to ensure the correct dose of levothyroxine is taken. Patients with hypothyroidism are entitled to free prescriptions in the NHS.

 

 

 

H  Y  P  E  R  P  A  R  A  T  H  Y  R  O  I  D  I  S  M

Who it affects

Hyperparathyroidism is an uncommon disorder affecting 1 in 500 people.

 

What gland is involved

There are usually 4 parathyroid gland that lie just behind the thyroid gland (see above). There is a lower and upper gland on the left, and similarly on the right. In this disorder, one gland may be affected in isolation (parathyroid adenoma) or less commonly, all four glands (parathyroid hyperplasia).

 

Symptoms

Hyperparathyroidism is now commonly discovered following routine blood tests. Patients frequently do not complain of any specific symptoms. Patients may have a history of kidney stones or osteoporosis.

 

Diagnosis

Hyperparathyroidism is diagnosed with blood tests including a blood calcium and parathyroid hormone level. Other investigations you may undergo include 24hr urine collections, bone mineral density scans and ultrasound and isotopes scans of the neck.

 

Treatment

Treatment of this disorder is depend on the severity of complications of hyperparathyroidism. The treatment is tailored to individual patients and may include observation and medication alone or surgical removal of any abnormal parathyroid gland(s). Surgical removal is more likely in young patient, those with kidney stones or osteoporosis.

 

Prognosis

In older patients managed conservatively, hyperparathyroidism usually has no adverse effect on a patient`s life. The outlook for patient`s undergoing surgical removal of abnormal parathyroid glands is good. Patients are usually observed to ensure that the calcium levels and parathyroid hormone levels return to normal. Osteoporosis may also improve following surgery.

 

 

 

A  D  D  I  S  O  N  `  S      D  I  S  E  A  S  E

Who it affects

Addison`s disease is a rare disorder affecting 1 in every 100,000 people. It may be due to antibody destruction of cells in the adrenal gland, surgical removal of the adrenal glands, infections or inherited conditions.

 

What gland is involved

The adrenal glands are affected in this disorder. There are 2 adrenal glands. They are small star shaped glands that lie above each kidney.

 

Symptoms

Patients with Addison`s disease may experience symptoms such as tiredness, weight loss, lethargy and skin discoloration.

 

Diagnosis

This disorder is diagnosed using blood tests. Tests involving the administration of a drug followed by a series of blood tests (short synacthen test) is usually required. Other tests that patients may undergo include other blood tests (e.g. ACTH, adrenal anti-bodies) and a CT or MRI scan of the adrenal glands.

 

Treatment

Treatment is with steroid replacement. This is usually in the form of hydrocortisone in split doses. It is important that the first doses of the day is taken first thing each morning and the evening dose around 6pm and not less than 4hrs before sleeping. Addison`s disease also requires treatment with Fludrocortisone. In addition to an assessment of symptoms, blood and urine tests may be used to adjust doses of replacement hormones.

 

Prognosis

Addison`s disease is a life long disorder requiring long-term replacement therapy. The prognosis is good. It is important that patients carry a steroid card and increase their steroid replacement temporarily around times of serious illness. 

 

 

 

C  U  S  H  I  N  G  `  S      S  Y  N  D  R  O  M  E

What is it

This disorder is characterised by an excess of glucocorticoids or steroid production in the body.

 

Who it affects

Cushing`s syndrome is a rare disorder affecting 1 per 500,000 people.

 

What gland is involved

Cushing`s syndrome may result from excessive ACTH release from the pituitary gland (Cushing`s disease) or excess cortisol production by the adrenal gland. It may also arise from steroid use in other medical conditions and rarely by unusual sources of ACTH production.

 

Symptoms

Patients may experience symptoms such as facial fullness, weight gain, changes in fat and muscle distribution, lilac coloured stretch marks, excess fat tissue around the upper back, diabetes and osteoporosis.

 

Diagnosis

Initial investigations that may be performed in Cushing`s syndrome include a series of blood tests and 24hr urine collections. Some of the tests performed will involve the administration of steroid tablets and blood tests carried out over a number of days (see low dose Dexamethasone suppression test). Hospital admission during this time is sometimes required.

 

Once, a diagnosis of Cushing`s syndrome is confirmed doctors will investigate further to clarify the cause of the excess steroids. These investigations may include further blood tests (see high dose Dexamethasone suppression test), CT or MRI scans of the relevant parts of the body.

 

Treatment

This depends on the cause of Cushing`s syndrome. Pituitary and adrenal causes are usually due to discrete benign tumours that are over-secreting hormones and these are usually amenable to surgery. Pituitary radiotherapy may also play a role in the management of patient with Cushing`s disease.

 

Frequently, medication such as Ketoconazole and or Metyrapone will be used to control Cushing`s syndrome prior to surgery. This not only improves a patient`s symptoms, but also helps to improve tissue healing that is so important in surgery.

 

Outlook

The majority of patients notice a significant improvement in quality of life with treatment. The longer-term outlook in a patient with Cushing`s disease is dependent on the underlying cause, duration of the disease and how well cortisol levels are controlled using the above treatments.

 

 

 

O  S  T  E  O  P  O  R  O  S  I  S

What is it

Osteoporosis is characterised by a weakening of bones such that patients are at an increased risk of fractures (broking a bone)

 

Who it affects

Osteoporosis is a common disorder affecting 10 % of the general population. It is more common in woman, Caucasians and Asians. Other risk factors include smoking, alcohol excess and steroid use. Certain endocrine disorders such as hypogonadism (male/female hormone deficiency), hyperparathyroidism, hyperthyroidism, and Cushing`s syndrome may be associated with osteoporosis.

 

What gland is involved

Osteoporosis is a disorder of bones. Its cause however, may arise in a number of glands as detailed above. 

Symptoms

Patient with osteoporosis may have no symptoms. A fracture or broken bone as a result of osteoporosis will cause pain and affect mobility.

 

Diagnosis

Osteoporosis is diagnosed using imaging techniques; commonly a bone mineral density scan. Investigating the cause of osteoporosis is dependent on what medical conditions are suspected, but may include blood tests, urine tests, or various scans.

 

Treatment

Patients with osteoporosis should avoid smoking and limit alcohol intake. Exercise is beneficial for bone strength, but needs to be tailored individually. Patients should always take adequate precautions to avoid injuries that may result in fractures.

 

Specific treatments you may be prescribed for osteoporosis may include vitamin D supplements, bisphosphonates or Strontium Renalate. Additional endocrine treatments may include replacement hormones for deficiencies, e.g. HRT in premature ovarian failure.

 

Prognosis

The outlook of osteoporosis is dependent on the cause and degree of osteoporosis. For example, mild osteoporosis with a treatable cause, will respond better. Newer drugs in the treatment of osteoporosis are continually being developed.

 

A priority for patients with osteoporosis should be to maintain a good quality of life. To achieve this it is important to avoid fractures and therefore to develop safe practises when mobilising.

 

 

 

H  Y  P  O  P  I  T  U  T  A  R  I  S  M

Who it affects

Hypopituitarism is an uncommon disorder affecting 45 per 100,000 people. Its causes include: surgical removal of a pituitary tumour, radiation of the pituitary, infections and tumours (usually benign).

 

What gland is involved

The pituitary gland is situated just below the brain and behind the nose. It is a small gland that has two lobes; anterior and posterior. The anterior lobe secretes hormones including TSH, ACTH, LH, FSH, GH and prolactin. Patients with hypopituitarism lack one or more of these hormones. Patients with panhypopituitarism lack all the hormones secreted by the pituitary gland. The posterior lobe secretes vassopressin.

 

Symptoms

The symptoms a particular patient may experience is dependent on which hormone(s) is lacking.  

Symptoms associated with a lack of ACTH may include tiredness, lethargy, weight loss and dizziness. 

Symptoms associated with a lack of  LH and FSH may result in absence or irregularity of the menstrual cycle, loss of libido, or infertility. 

Symptoms associated with a lack of TSH may be associated with tiredness, weight gain, constipation and dry skin. 

Symptoms associated with a lack of  prolactin is usually not associated with specific symptoms. 

Symptoms associated with a lack of  growth hormone in adults may be associated with reduced muscle mass, bone mass, quality of life and cardiac function.

Symptoms associated with a lack of vassopressin include excess urination and subsequent thirst and excessive drinking of fluids.
 

Diagnosis

Hypopituitarism is diagnosed with blood tests. These may include the administration drugs such as insulin, glucagon or tetracosactrin, followed by a series of blood tests.

 

Treatment

Treatment is dependent on which hormone(s) is deficient. Replacement is often with the end hormone rather than the pituitary hormone itself. For example, TSH is produced by the pituitary and stimulates the thyroid to produce thyroxine. A deficiency in TSH is therefore treated with levothyroxine therapy. Similarly ACTH deficiency is treated with oral steroids, usually hydrocortisone in split doses.

 

Prognosis

Patients with hypopituitarism usually require life long replacement therapy. Once patients are on the correct replacement therapy, the majority of patients have a good quality of life and the outlook is very good. 

 

 

 

H  y  p  e  r  p  r  o  l  a  c  t  i  n  a  e  m  i  a

Who it affects

A high blood prolactin level is detected in less than 1% of the general population.

 

What gland is involved

Prolactin is released from the pituitary gland, a small gland just below the brain and behind the nose. This hormone may be elevated due to a lesion within the gland itself or due to drugs such as Metoclopramide or anti-psychotic medication. Lesions within the pituitary gland that may associated with hyperprolactinaemia, may be sub-classified into a small benign tumour (microadenoma; <1cm) or a larger benign tumour (macroadenoma; >1cm).

 

Symptoms

Patients may have no symptoms and the results may be detected coincidently. Symptoms that patients may experience include infrequent or absent menstruation (oligoamenorrhoea), milk production from the breast (galactorrhoea), headaches and visual problems. Men may complain of a reduced libido and erectile problems.

 

Diagnosis

Hyperprolactinaemia is diagnosed with a blood test. To investigate for an underlying cause, a pituitary CT or MRI scan is performed.

 

Treatment

In some cases, no treatment is required. In some situations, causative medication may be discontinued and in other cases medication such as Bromocriptine, Cabergoline or Quinagolide are used to control prolactin levels. Pituitary surgery is needed in some cases where vision is disturbed by a large pituitary tumour and medication is ineffective.

 

Prognosis

The prognosis in this disorder is very good as medical treatment is usually very effective. In a significant number of patients, particularly those with microprolactinomas, medical therapy can be withdrawn successfully. This should only be done under clinical guidance.

 

 

 

B  e  n  i  g  n     t  h  y  r  o  i  d     n  o  d  u  l  e     o  r     c  y  s  t

Who it affects

Thyroid nodules and cysts are very common and usually benign. They are increasingly being detected because of the widespread availability of ultrasound and CT scanning.

 

What gland is involved

The thyroid gland lies in the front part of the neck just under skin and below the thyroid cartilage (Adam`s apple).
 

Symptoms

Thyroid nodules or cysts are detected increasingly commonly during routine scanning for other reasons. These may cause no symptoms. In other patients a visible swelling below the skin may be seen and may change in size over time.
 

 Diagnosis

A thyroid nodule or cyst can be detected on examination or using an ultrasound scan. To clarify whether such a lesion is benign or malignant requires further investigation; tests that are used to help clarify include fine needle aspiration, ultrasound and isotope scanning. 
 

Treatment

Treatment depends upon the nature of the suspected thyroid nodule or cyst. Benign lesions are generally observed. Malignant lesions are removed surgically. Indeterminate lesions are also generally removed surgically. Large lesions, whether benign on FNA or not, are often removed surgically. It is important to inform your doctor if you feel the lesion is changing in appearance. 
 

Prognosis

Benign thyroid lesions are of little consequence and do not adversely affect a patients long-term health.

 

 

 

T  h  y  r  o  i  d      C  a  n  c  e  r

Who it affects

Thyroid cancer is very rare and accounts for less than 1% of cancer related deaths. There are various types of thyroid cancer, e.g. follicular, papillary, Hurthle cell, medullary and anaplastic.

 

What gland is involved

The thyroid gland lies in the front part of the neck just under skin and below the thyroid cartilage (Adam`s apple).
 

Symptoms

Thyroid cancer may present as a visible swelling below the skin in the thyroid. This swelling generally enlarges over time. In other patients thyroid cancer may be detected by chance, e.g. during a scan for another reason or when the thyroid is removed surgically for another medical reason.
 

 Diagnosis

To confirm a diagnosis of thyroid cancer, it is necessary obtain a sample of tissue. This may be obtained through a fine needle aspiration. Ultrasound and isotope scans may provide helpful information, but are not usually diagnostic. 
 

Treatment

Malignant lesions are removed surgically. The extent of surgery is dependent on the type of thyroid cancer and degree of spread (if at all). Most patients will also receive radioiodine therapy to ablate any remaining thyroid tissue and eliminate any residual cancer. Triiodothyronine or levothyroxine therapy is often used after surgery to suppress TSH production from the pitutary gland. TSH stimulates the growth of certain thyroid cells and therefore potentially the growth of certain thyroid tumours. The measurement of thyroglobulin (a protein produced solely by the thyroid) is frequently used as a means to monitor recurrence of thyroid cancer.
 

Outlook

This is dependent on factors such as the type of thyroid cancer, the degree of spread (if any) and the success of surgery.

 

 

 

P H A E O C H R O M O C Y T O M A

Who it affects

This is a rare condition that affects about 5 in 1 million people.

 

What gland is involved

Phaeochromocytomas usually arise in the adrenal glands. They secrete catecholamine hormones, usually adrenaline or noradrenaline.
 

Symptoms

Patients with a phaeochromocytoma may experience symptoms such as  palpitations, headaches, sweating and anxiety. Their blood pressure may also be high.

 Diagnosis

To diagnose this condition, 24 hour urine collections are required, blood tests and scans of the adrenal glands (CT, MRI and isotope scans).
 

Treatment

Most cases are due to a discrete benign lesion in one adrenal gland. Treatment in such instances is by surgery. This is increasingly performed laproscopically. Certain drugs, including some used for anaesthesia, may precipitate a medical emergency in patients with a phaeochromocytoma. It is therefore important to discuss any changes to your medication with an endocrinology specialist, before these are made.

In preparation for surgery, good communication is essential between your surgeon and endocrinology specialist to ensure that the appropriate medications are commenced. It is important that alpha-blockers are introduced before beta-blockers in the treatment of high blood pressure in patients with a phaeochromocytoma.
 

Outlook

The outlook for benign phaeochromocytoma is very good, although high blood pressure may persist. Recurrence rates are less than 10%.

Malignant phaeochromocytomas are rare and the outlook should be discussed on an individual basis with your endocrinology specialist.

 

 

 

C O N N ` S    S Y N D R O M E

Who it affects

Conn`s syndrome or primary hyperaldosteronism occurs in 2% of patients with high blood pressure.

 

What gland is involved

The adrenal glands are affected in this disorder. There are 2 adrenal glands. They are small star shaped glands that lie above each kidney. In Conn`s syndrome, there may be a discrete benign adrenal lesion that secretes aldosterone. More rarely, both adrenal glands may be enlarged and over-secrete aldosterone.
 

Symptoms

Patients with this disorder usually have high blood pressure. Patients may also have a low potassium level on blood tests.

 Diagnosis

To diagnose this illness, blood tests for aldosterone and renin are required. In addition patients will require a CT or MRI scan of the adrenal glands.
 

Treatment

In most cases, Conn`s syndrome is due to a single benign lesion in one adrenal gland and therefore curable with surgery. This is increasingly performed laproscopically. In rarer cases where both adrenal glands appear to be a fault with no discrete lesion, surgery is usually avoided and medication such as Spironolactone is used long-term to control aldosterone effects and blood pressure.
 

Outlook

The outlook is very good for patients with Conns`s syndrome, although high blood pressure may persist.
 

 

 

 

T  Y  P  E      1      D  I  A  B  E  T  E  S

Who it affects

Type 1 diabetes, is an illness that predominantly affects young patients. It affects 3-5% of the general population.

 

What gland is involved

The pancreas produces little or no insulin in response to glucose. The pancreas is an organ near the liver that produces various enzymes that are used to help digest food and hormones that circulate in the blood.

 

Symptoms

Patient with type 1 diabetes not uncommonly present very unwell and require hospital admission. Symptoms that these patients may have experienced prior to admission typically include thirst, passing large amounts of urine and weight loss. There may be a family history of type 1 diabetes, autoimmune conditions such as autoimmune hypothyroidism, rheumatoid arthritis or Addison`s disease.

 

Diagnosis

Diagnosis is usually made with blood tests and urine tests.
 

Treatment

Treatment is with insulin replacement. Insulin may be injected 2 or more times a day. Precise regimes are tailored individually. Patient in whom it is indicated, insulin may also be administered through an insulin pump.  

As with all patients with diabetes, it is important that patients with type 1 diabetes maintain a healthy lifestyle.

 

Prognosis

In patients with type 1 diabetes, the omission of insulin may be associated with serious ill-health and diabetic ketoacidosis requiring emergency admission to hospital.

 

Poorly controlled diabetes in the longer term may be associated with disorders affecting the eyes, kidneys, nerves and brain. It is therefore important that patients with diabetes attend regular appointments to ensure good control is being achieved and that any complications are being detected and managed appropriately.

 

 

 

T  Y  P  E      2      D  I  A  B  E  T  E  S

Who it affects

Type 2 diabetes is an increasingly common disorder and typically affects older patients than type 1 diabetes. The risk of developing type 2 diabetes is increased in overweight and obese patients and there is often a family history of type 2 diabetes.

 

What gland is involved

In type 2 diabetes the pancreas produces insufficient insulin to control glucose levels adequately.

 

Symptoms

Although patients may present as an emergency and very unwell, increasingly patient`s are being diagnosed whilst relatively well in the community. This may reflect a greater awareness of diabetes and screening in people at increased risk.

 

Diagnosis

Diagnosis of type 2 diabetes is made with blood tests. Urine tests may also be performed.

 

Treatment

The basis for treatment of type 2 diabetes is a healthy lifestyle. Your dietician will advise you of the dietary changes required. Patients with this disorder, not uncommonly require treatment with medicines such as Metformin and sulphonylureas. Newer agents are continually being developed and being incorporated into treatment algorithms. 

Patients with type 2 diabetes that are not adequately controlled on oral medication, may also require treatment with insulin. This may be administered once or more times per day. Precise insulin regimes are tailored individually. Some newer agents such as Exenatide are also administered through injections. Exenatide can aid weight loss and is not a form of insulin.
 

Prognosis

Well controlled diabetes has a good prognosis. Poorly controlled diabetes in the longer term may be associated with disorders affecting the eyes, kidneys, nerves and brain. Poorly controlled diabetes may thus reduce the quality of life as well as survival. It is therefore important that patients with diabetes attend regular appointments to ensure good control is being achieved and that any complications are being detected and managed appropriately.

 

 

 

O  B  E  S  I  T  Y

Who it affects

Obesity is an increasingly common disorder. It is estimated that obesity will affect 40% of the population by 2020.

BMI (Body Mass Index) is used to classify patients as overweight or obese. BMI is calculated by dividing the weight (kg) by the height (m) squared. Categorising BMI into different ranges helps healthcare professionals to tailor treatment.

 

What gland is involved

Although fat cells are actively secreting hormones and receiving signals, obesity is not usually caused by an abnormality of these cells, but rather relates to a combination of factors including diet and exercise, medical health, psychosocial well-being and genetics. Depending on the symptoms experienced, doctors may investigate to establish whether any hormonal abnormality is contributing to a patient’s weight gain.

 

Symptoms

Symptoms of obesity apart from excess weight may include, tiredness, lethargy and restricted mobilising. Obesity may be associated with various disorders which in turn may cause other symptoms. These include diabetes, high blood pressure, gallstones and obstructive sleep apnoea.

 

Diagnosis

Diagnosis is made after taking a history and examining the patient and where necessary excluding disorders that may be contributing to the patient`s symptoms.

 

Treatment

Treatment is tailored to each patient. The basis of treatment in all patient`s is a healthy lifestyle, calorie control and exercise.  

Medications that help limit the amount of calories absorbed from food or reduce appetite are available and used in selected patients.

Obesity surgery is generally available for patients with a BMI>40kg/m2 or those with a BMI>35kg/m2 who have an associated medical condition. Surgical techniques that have been used may be broadly classified into three groups. Restrictive, malabsorptive and a combination of these two. Specific techniques include gastric balloon insertion, gastric banding and various types of bypass surgery.

 

Outlook

It is important to remember that a 5% weight loss in some patients is associated with marked medical benefit, e.g. a 50% reduction in the incidence of diabetes at 4yrs. In this regard most patients will achieve a medically beneficial effect, but desire greater weight reduction. 

There is an average weight loss of 10% with medication. This is not always maintained however.  

The prognosis in patients in whom surgery is indicated, depends on the surgical procedure performed. In very obese patients, surgery is the treatment most likely to be successful. Surgery may help to not only reduce weight, but also blood pressure, cholesterol and the risk of diabetes or treatment required to control diabetes. A rapid reduction in weight following surgery may be associated with symptoms such as feeling tired, aches, feeling cold and mood changes.

 

 

 
 

DISCLAIMER: The information contained in the Endocrinology Specialist website is general information and not specific endocrine or diabetes advice. Patients should always consultant their physician or an endocrinology specialist. For further details please read the full disclaimer.

 
 

 
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