Endocrinology is a branch medicine that deals with the endocrine system, its diseases, and its specific secretions such as hormones. It is also concerned with the integration of developmental events proliferation, growth, and differentiation, and the psychological or behavioral activities of metabolism, growth and development, tissue function, sleep, digestion, respiration, excretion, mood, stress, lactation, movement, reproduction, and sensory perception caused by hormones. The endocrine system consists of several glands, all in different parts of the body, that secrete hormones directly into the blood rather than into a duct system. Therefore, endocrine glands are regarded as ductless glands.
Diabetes mellitus is commonly known as diabetes, is a group of metabolic disorders characterized by high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced.
Cardiovascular disease: Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries.
Nephropathy: The kidneys contain millions of tiny blood vessel clusters that filter waste from the blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
Alzheimer's disease: Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
Retinopathy: Diabetes can damage the blood vessels of the retina potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
Foot damage: Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly.
Depression: Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.
Neuropathy: Excess sugar can injure the walls of the tiny blood vessels that nourish nerves, especially in legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.
Skin conditions: Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections. Once, bacterial infections were life threatening, especially for people with diabetes.
Endocrine disruptors are chemicals that can interfere with endocrine systems at certain doses. These disruptions can cause cancerous tumors, birth defects, and other developmental disorders. Any system in the body controlled by hormones can be derailed by hormone disruptors. Specifically, endocrine disruptors may be associated with the development of learning disabilities, severe attention deficit disorder, cognitive and brain development problems deformations of the body that includes breast cancer, prostate cancer, thyroid and other cancers; sexual development problems such as feminizing of males or masculinizing effects on females, etc.
Diabetic nephropathy also known as diabetic kidney disease is the chronic loss of kidney function occurring in those with diabetes mellitus. Protein loss in the urine due to damage to the glomeruli may become tremendous, and causes a low serum albumin with resulting generalized body swelling and result in the nephrotic syndrome. For some people, diabetic nephropathy can progress to chronic kidney disease and kidney failure. However, most people with diabetes do not develop kidney disease that progresses to kidney failure.
The main is to filter waste products and excess water from the bloodstream so that they can be excreted in the form of urine. This is carried out by a system of tubes and blood vessels known as nephrons. Inside the nephrons are tiny blood vessels called capillaries and tiny urine-collecting tubes. One of the major structures in the nephron is a group of blood vessels known as the glomerulus, which acts as a filter. Having high blood glucose levels can interfere with the function of the glomerulus. The filtering function of the kidneys doesn’t work properly and proteins start to leak from the blood into the urine.
Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes mellitus. It is a leading cause of blindness. Diabetic retinopathy affects up to 80% of those who have had diabetes for 20 years or more. At least 90% of new cases could be reduced with proper treatment and monitoring of the eyes. The retina is the membrane that covers the back of the eye. It is highly sensitive to light. It converts any light that hits the eye into signals that can be interpreted by the brain. This process produces visual images, and it is how sight functions in the human eye. Diabetic retinopathy damages the blood vessels within the retinal tissue, causing them to leak fluid and distort vision.
Diabetic retinopathy is the result of damage to the small blood vessels and neurons of the retina. The earliest changes leading to diabetic retinopathy include narrowing of the retinal arteries associated with reduced retinal blood flow; dysfunction of the neurons of the inner retina, followed in later stages by changes in the function of the outer retina, associated with subtle changes in visual function; dysfunction of the blood-retinal barrier, which protects the retina from many substances in the blood leading to the leaking of blood constituents into the retinal neuropile.
Track 06: Pediatric Endocrinology
Pediatric endocrinology is a medical subspecialty dealing with disorders of the endocrine glands, such as variations of physical growth and sexual development in childhood, diabetes and many more. By age, pediatric endocrinologists, depending upon the age range of the patients they treat, care for patients from infancy to late adolescence and young adulthood. The most common disease of the specialty is type 1 diabetes, which usually accounts for at least 50% of a typical clinical practice. The next most common problem is growth disorders, especially those amenable to growth hormone treatment. Pediatric endocrinologists are usually the primary physicians involved in the medical care of infants and children with intersex disorders.
The specialty also deals with hypoglycemia and other forms of hyperglycemia in childhood, variations of puberty, as well other adrenal, thyroid, and pituitary problems. Many pediatric endocrinologists have interests and expertise in bone metabolism, lipid metabolism, adolescent gynecology, or inborn errors of metabolism. Training for pediatric endocrinology consists of a 3 year fellowship following completion of a 3 year pediatrics residency. The fellowship, and the specialty, are heavily research-oriented and academically based, although less exclusively now than in past decades.
What is a Pediatric Endocrinologist?
What Kind of Training Do Pediatric Endocrinologists Have?
What Types of Treatment Do Pediatric Endocrinologists Provide?
Pediatric Endocrinologists — the Best Care For Children
Hypothalamus: The hypothalamus is located in the lower central part of the brain. This part of the brain is important in regulation of satiety, metabolism, and body temperature. In addition, it secretes hormones that stimulate or suppress the release of hormones in the pituitary gland.
Pituitary gland: The pituitary gland is located at the base of the brain beneath the hypothalamus and is no larger than a pea. It is often considered the most important part of the endocrine system because it produces hormones that control many functions of other endocrine glands
Pineal gland: The pineal body, or pineal gland, is located in the middle of the brain. It secretes a hormone called melatonin, which may help regulate the wake-sleep cycle of the body
Thyroid gland: The thyroid gland is located in the lower front part of the neck. It produces thyroid hormones that regulate the body's metabolism. It also plays a role in bone growth and development of the brain and nervous system in children. The pituitary gland controls the release of thyroid hormones. Thyroid hormones also help maintain normal blood pressure, heart rate, digestion, muscle tone, and reproductive function
Parathyroid: The parathyroid glands are two pairs of small glands embedded in the surface of the thyroid gland, one pair on each side. They release parathyroid hormone, which plays a role in regulating calcium levels in the blood and bone metabolism.
Thymus: Thymus gland makes white blood cells called T-lymphocytes that fight infection and are crucial as a child's immune system develops. The thymus starts to shrink after puberty.
Adrenal Glands: The two adrenal glands are triangular-shaped glands located on top of each kidney. The adrenal glands are made up of two parts. The outer part is called the adrenal cortex, and the inner part is called the adrenal medulla. The outer part produces hormones called corticosteroids, which regulate the body's metabolism, the balance of salt and water in the body, the immune system, and sexual function. The inner part, or adrenal medulla, produces hormones called catecholamines.
Pancreas: The pancreas is an elongated organ located toward the back of the abdomen behind the stomach. The pancreas has digestive and hormonal functions. One part of the pancreas, the exocrine pancreas, secretes digestive enzymes. The other part of the pancreas, the endocrine pancreas, secretes hormones called insulin and glucagon. These hormones regulate the level of glucose in the blood.
The reproductive glands: These glands are the main source of sex hormones. In males, the testes, located in the scrotum, secrete hormones called androgens; the most important of which is testosterone. These hormones affect many male characteristics like sexual development, growth of facial hair and pubic hair as well as sperm production. In females, the ovaries, located on both sides of the uterus, produce estrogen and progesterone as well as eggs. These hormones control the development of female characteristics such as breast growth, and they are also involved in reproductive function like menstruation, pregnancy
Bone is living, growing tissue. It is made mostly of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework. Vitamin D helps the body absorb and process calcium. Together, these two nutrients are the cornerstone of healthy bones.
Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures of the hip, spine, and wrist. There are many causes of osteoporosis. Not only do bones lose density with age, medications used to treat breast cancer, arthritis, asthma, Crohn's disease and Addison's disease can also lower bone density. Some illnesses such as hyperthyroidism, hypopituaritism and eating disorders also cause bones to lose strength.
Nutrition: Nutrition, especially calcium, plays an important role in preventing osteoporosis. In people who have healthy bones, adequate calcium intake on a daily basis is necessary to maintain bone health.
Living with the Disease: It is common to feel anxious about health or lifestyle when diagnosed with osteoporosis feelings of loneliness; depression and helplessness are all very common.
Exercises for Healthy Bones: Exercise is recommended for all people with osteoporosis, even people who have had a spine or hip fracture. Exercise is an important step towards protecting the bones, as it helps protect the spine, slows the rate of bone loss, and builds muscle strength, which can prevent falls
Calcium and Vitamin D: Calcium and Vitamin D are essential nutrients for proper bone health. Vitamin D helps to increase the absorption of calcium, ultimately building stronger bones. It also improves the function of muscles, improving your balance and decreasing the likelihood of falls, which can lead to fractures.
Multiple endocrine neoplasia is a group of disorders that affect the body's network of hormone-producing glands called the endocrine system. Hormones are chemical messengers that travel through the bloodstream and regulate the function of cells and tissues throughout the body. Multiple endocrine neoplasia typically involves tumors in at least two endocrine glands; tumors can also develop in other organs and tissues. These growths can be noncancerous or cancerous. If the tumors become cancerous, the condition can be life-threatening.
The major forms of multiple endocrine neoplasia are called type 1, type 2, and type 4. These types are distinguished by the genes involved, the types of hormones made, and the characteristic signs and symptoms. Many different types of tumors are associated with multiple endocrine neoplasia. Type 1 frequently involves tumors of the parathyroid glands, the pituitary gland, and the pancreas. Tumors in these glands can lead to the overproduction of hormones. The most common sign of multiple endocrine neoplasia type 1 is overactivity of the parathyroid glands.
The hypothalamus produces gonadotropin-releasing hormone which is released in a pulsatile fashion every 60 to 120 minutes. Its target organ, the anterior pituitary gland, responds to each pulse of gonadotropin-releasing hormone by producing a corresponding pulse of luteinizing hormone (LH) and, to a lesser degree, follicle-stimulating hormone (FSH). If the gonadotropin-releasing hormone pulses do not occur with the proper amplitude, frequency, and diurnal variation, hypogonadism may result of idiopathic hypogonadotropic hypogonadism. Continuous stimulation by gonadotropin-releasing hormone agonists actually suppresses pituitary release of LH and FSH and thus testosterone production
Testosterone is synthesized from cholesterol through several intermediate compounds, including dehydroepiandrosterone (DHEA) and androstenedione. Circulating testosterone is mostly protein bound, about 40% avidly bound to sex hormone binding globulin and 58% loosely bound to albumin. Thus, only about 2% of circulating testosterone is bioavailable as free testosterone. This bioactive component of total testosterone is responsible for male characteristics, libido, bone and muscle mass.
Testosterone, DHT, and estradiol provide negative feedback on the hypothalamic-pituitary axis. In males, estradiol is the main inhibitor of LH production, whereas both estradiol and inhibin B, a peptide produced by Sertoli cells of the testes, inhibit production of FSH. In the presence of testosterone, FSH stimulates the Sertoli cells and induces spermatogenesis. In spermatogenesis, each germinal cell located adjacent to the Sertoli cells, undergoes differentiation into 16 primary spermatocytes, each of which generates 4 spermatids. Each spermatid matures into a spermatozoon. Spermatogenesis takes 72 to 74 days and yields about 100 million new spermatozoa each day. Upon maturation, spermatozoa are released into the rete testis, where they migrate to the epididymis and eventually to the vas deferens. Migration requires an additional 14 days. During ejaculation, spermatozoa are mixed with secretions from the seminal vesicles, prostate, and bulbourethral glands.
The hypothalamic-pituitary-testicular (HPT) axis
The GH, insulin-like growth factor (IGF)-1, and PRL effects
The inhibin/activin-follistatin system
Estrogen and testicular function
Paracrine/autocrine regulation of testicular function
Aging and male endocrine function
Hormonal interaction between the hypothalamus, anterior pituitary gland, and ovaries regulates the female reproductive system. The hypothalamus secretes a small peptide, gonadotropin-releasing hormone (GnRH), also known as luteinizing hormone releasing hormone. GnRH regulates release of the gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from specialized cells (gonadotropes) in the anterior pituitary gland. These hormones are released in short bursts every 1 to 4 hours. LH and FSH promote ovulation and stimulate secretion of the sex hormones estradiol and progesterone from the ovaries.
Estrogen and progesterone circulate in the bloodstream almost entirely bound to plasma proteins. Only unbound estrogen and progesterone appear to be biologically active. They stimulate the target organs of the reproductive system. They usually inhibit but, in certain situations may stimulate gonadotropin secretion. Central influences that regulate release of GnRH include neurotransmitters and peptide. Such factors may inhibit release of GnRH during childhood, and then initiate its release to induce puberty in early adolescence. Early in puberty, hypothalamic GnRH release becomes less sensitive to inhibition by estrogen and progesterone. The resulting increased release of GnRH promotes LH and FSH secretion, which stimulates production of sex hormones, primarily estrogen. Estrogen stimulates development of secondary sexual characteristics.
Ovarian Follicular Development
Cyclic Changes in Other Reproductive Organs
Transgender is an umbrella term for a diverse group of people such as trans women (male-to-female) and trans men (female-to-male), genderqueer individuals, and many others whose gender identity or expression differs from societal expectations of how they should look, act, or identify based on the sex they were assigned at birth. Transgender and other gender minority people are often the targets of discrimination and harassment that can lead to negative health outcomes. The term “gender nonconforming” is used to describe individuals whose gender identity, role, or expression differs from what is normative for their assigned sex at birth in a given culture and historical period.
Transgender is used as an umbrella term to describe individuals whose gender identity differs from the assigned sex at birth. Transgender males are people assigned female at birth but who self-identify as male. Transgender females are people assigned male at birth, but who self-identify as female. Transgender individuals are often denied insurance coverage for appropriate medical and psychological treatment. Over the last decade, there has been considerable research on and development of evidence-based standards of care that have proven to be both safe and efficacious for the treatment of gender dysphoria/gender incongruence. There is also a growing understanding of the impact that increased access to such treatments can have on the mental health of these individuals.
Obesity is a condition in which a person has excess body fat. Obesity can increase a person's risk of diseases and health problems, including high blood pressure, diabetes and heart disease. It is a complex problem and a major public health concern, both in the United States and worldwide. Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity, and genetic susceptibility. A few cases are caused primarily by genes, endocrine disorders, medications, or mental disorder. The view that obese people eat little yet gain weight due to a slow metabolism is not medically supported. On average, obese people have greater energy expenditure than their normal counterparts due to the energy required to maintain an increased body mass.
A metabolic disorder occurs when the metabolism process fails and causes the body to have either too much or too little of the essential substances needed to stay healthy. Metabolic disorders can take many forms a missing enzyme or vitamin that’s necessary for an important chemical reaction, abnormal chemical reactions that hinder metabolic processes and disease in the liver, pancreas, endocrine glands, or other organs involved in metabolism. Metabolic disorders can be present at birth, and many can be identified by routine screening. If a metabolic disorder is not identified early, then it may be diagnosed later in life, when symptoms appear. Specific blood and DNA tests can be done to diagnose genetic metabolic disorders. The gut microbiota, which is a population of microorganisms that live in the human digestive system, also has an important part in metabolism and generally has a positive function for its host.
Classification of body fat and fat distribution
Diagnostic criteria of metabolic syndrome
Aloe vera: Aloe vera is a common plant with many different uses. Many people are aware of its benefits for skin care, but it may also have other benefits, including slowing the progress of type 2 diabetes.
Cinnamon: Cinnamon is a fragrant spice that comes from the bark of a tree. It has a taste that can add sweetness without any additional sugar. It is popular with people with type 2 diabetes for this reason alone, but it may also offer other benefits.
Bitter melon: Bitter melon is a medicinal fruit. There is some evidence that bitter melon may help with the symptoms of diabetes. One review has noted that people have used many parts of the plant to help treat diabetes.
Milk thistle: People have used milk thistle since ancient times for many different ailments, and especially as a tonic for the liver. The extract from milk thistle that has received the most attention from scientists, is a compound with antioxidant and anti-inflammatory properties. These are the properties that may make milk thistle a useful herb for people with diabetes.
Fenugreek: Fenugreek is another seed that may help lower blood sugar levels.The seeds contain fibers and chemicals that help to slow down the digestion of carbohydrates and sugar. There is also some evidence that the seeds may help delay or prevent the onset of type 2 diabetes.
Gymnema: Gymnema sylvestre is a herb that comes from India. A 2013 review noted that people with both type 1 and type 2 diabetes who took gymnema showed signs of improvement. In people with type 1 diabetes who took the leaf extract for 18 months, fasting blood sugar levels fell significantly, compared with a group who received only insulin.
Ginger: Ginger is another herb that people have used for thousands of years in traditional medicine systems. However, in 2015, a review suggested that it may also help treat diabetes. The results showed that ginger lowered blood sugar levels, but did not lower blood insulin levels.
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Scientists are conducting research to learn more about diabetes, including the following studies
The Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study is following more than 5,000 people across the country who have type 2 diabetes to find out which combination of two diabetes medicines is best for blood glucose, also called blood sugar, management; has the fewest side effects; and is the most helpful for overall health in long-term diabetes treatment.
Trial Net: It is conducting research studies around the world, including risk screening for relatives of people with type 1 diabetes, monitoring for people at risk, and innovative clinical trials aimed at slowing down or stopping the disease
Ablation remedy is a type of minimally invasive procedure croakers use to destroy abnormal towels that can be present in numerous conditions. Ablation remedy is a type of minimally invasive procedure croakers use to destroy abnormal towels that can be present in numerous conditions. For illustration, a croaker might use an ablation procedure to destroy (ablate) a small quantum of heart towel that is causing abnormal heart measures or to treat excrescences in the lung, bone, thyroid, liver, or other areas of the body.
Croakers trained in imaging (radiologists), heart specialists (cardiologists), and other specialists perform ablation remedies. They may use examinations fitted through the skin, flexible tubes fitted through a roadway (catheters), or energy shafts. Imaging ways are used to guide the ablation. The abnormal towel can be bloodied or destroyed in colorful ways, including heat (radiofrequency ablation), extreme deep freeze (cryoablation), spotlights, or chemicals.