Endocrinology, Diabetes,
and Metabolism

What is excessive hair growth, or hirsutism?

Hirsutism is excess hair growth on the body or face. For women, the hair may grow in areas uncommon for them. This includes the upper lip, chin, chest, and back. It is due to an excess of hormones called androgens. Although all women naturally produce some androgen, high amounts can cause hair growth. It’s caused by an excess of male hormones called androgens. All women naturally produce small amounts of androgens. But high levels of this hormone can lead to hirsutism. 

Risk factors

• Disorders of the adrenal gland, pituitary gland, or thyroid gland
• Genetics
• Hormone changes from menopause
• Insulin resistance
• Medicine to treat endometriosis or other medicines
• Polycystic ovary syndrome
• Steroid use, including anabolic steroids or corticosteroids
• Tumor on the ovary

What are the symptoms of hirsutism?

Symptoms can occur a bit differently in each person. They include darker or thicker hairs growing on parts of the body such as: 

• Upper lip
• Chin
• Jawline
• Chest
• Back
• Buttocks

The symptoms of hirsutism can look like other health conditions. See your healthcare provider for a diagnosis. 

How is hirsutism diagnosed?

Your healthcare provider will ask about your symptoms and health history. They will give you a physical exam. You may also have blood tests to check for increased androgen levels. These tests can also check for other problems that may cause excess hair growth. 

How is hirsutism treated?

Treatment depends on personal preference. Hair growth causes no physical harm. The decision to remove or reduce hair varies from person to person. 

Methods to remove or reduce unwanted hair include:

• This is a way to remove hair with thin blades moved across the skin. Hair will start growing back right away, so shaving needs to be repeated often. 
• Depilatory lotion. This is a type of hair removal done with chemicals put on the skin. It softens hair above the skin so it can be wiped away. 
• Hot or cold wax can be used to pull out hair from the root. This treatment needs to be done every 2 to 3 weeks. 
• Chemicals can lighten the color of the hair and make it less easy to see. 
• A very thin needle is put into a hair follicle. Electricity is sent through the needle. This damages the hair follicle. This method is done over several sessions. This can reduce and remove hair for months or longer.
• Laser hair removal. A special laser is pointed at the skin. The light from the laser is absorbed by color (pigment) in the hair and destroys the hair. This works best on people with dark hair and light skin. This method is done over several sessions. This can reduce and remove hair for months or longer. 
• Medicated cream. Skin cream with eflornithine can slow hair growth. Results show up in 6 to 8 weeks. The hair will regrow in about 8 weeks if you stop using the cream. 

Other medicines can reduce the hormones that cause hair growth. It can take 6 months or longer for you to see results from these medicines. This is because hair grows, rests falls out, and regrows in cycles that last for months. And not all hairs are in the same part of the cycle at the same time. Because of this, treatments that affect the hair you have now may need to be repeated over time. Medicines that can change hormones to affect hair growth include: 

• Birth control pills. These are different kinds of hormone pills that prevent pregnancy. They can reduce the number of androgens in your body. Most women will notice a change in body hair growth when taking birth control pills. 
• Antiandrogen medicine.This type of medicine can reduce your body’s androgen levels. Or it may stop the effects of androgens on hair follicles. The most common type is spironolactone. The medicines can cause birth defects, so a woman must use birth control while taking them. 

Other factors that can lessen excess hair growth include:

• Treating another condition. Treating disorders of the pituitary gland, adrenal gland, or thyroid gland can lessen excess hair growth. 
• Weight loss. In some women, losing weight can reduce androgen levels and cause hair growth to slow.
• Aging. Women age 30 and older have decreasing androgen levels. Hair growth may lessen over time. 

What is a fertility disorder?

Fertility disorders are those conditions that cause a female to be unable to become pregnant, usually after one year of trying. Many times ovulation is disrupted or absent and monthly menstruation is irregular.

During ovulation, hormones are released from the hypothalamus and the pituitary gland in the brain, which signals an egg to develop and be released from the ovary. A disorder will disrupt this process.

Risk factors

• Diabetes
• Early menopause
• Hypothalamus being injured or an issue affecting it
• Overactive or underactive thyroid
• Pituitary tumor
• Polycystic ovarian syndrome
• Stress
• Weight or body is too thin or heavy

Cushing syndrome may also cause infertility, which is a disorder where very high levels of cortisol are being released in the body. Causes could be certain medications or other external factors. Symptoms might include weight gain, diabetes, high blood pressure, osteoporosis, muscle loss, fragile skin, extra facial hair in women, colored stretch marks on the torso, depression, confusion, or extra far on the upper body or a rounded face.

There are other factors impacting fertility, including drug use, sexually transmitted diseases, medications, certain chronic conditions, endometriosis, or other problems with the reproductive system.

Diagnosis

• Blood tests
• Pelvic exam

Treatment

• Drugs or medication, such as hormone injections
• Reproductive assistance technology
• Surgery

What is hypertension?

Blood pressure is the force of blood traveling through an artery. With each heartbeat, blood is pumped from the heart and into the blood vessels. Every time the heart beats, pressure is created inside arteries as the heart contracts and relaxes.

High blood pressure occurs when the force inside the arteries is too high during the contraction or relaxation.

Complications of high blood pressure include

• Death
• Heart attack
• Heart failure
• Kidney failure
• Loss of eyesight
• Stroke

Risk Factors

• Diabetes
• Excessive alcohol consumption
• Family history
• High sodium
• Kidney disease
• Lack of physical activity
• Sleep
• Smoking
• Stimulant drugs
• Stress
• Weight

Symptoms

Very high blood pressure may exhibit:

• Changes in vision
• Chest pain
• Headache

Diagnosis

• Check blood pressure
  • Systolic pressure – top number is the pressure inside the artery when the heart contracts
  • Diastolic pressure- the bottom number is the pressure inside the artery when the heart is at rest

There are four ratings of blood pressure:

• Normal – 120/80 or less
• Elevated – Systolic 120-129 and diastolic less than 80
• Stage 1 high blood pressure – Systolic is 130-139 or diastolic is 80-89
• Stage 2 high blood pressure – Systolic is 140 or higher or diastolic is 90 or higher

Treatment

Lifestyle changes

• Exercise
• High fiber foods
• Limit calories and fat in food
• Limit salt (sodium) in food
• Limit serving sizes in food
• Quit smoking
• Reduce alcohol consumption
• Reduce stress
• Sleep
• Weight

Medicine

• Alpha-blockers
• Angiotensin-converting enzyme inhibitors
• Angiotensin II receptor blockers
• Beta-blockers
• Calcium channel blockers
• Diuretics

What is hypoglycemia?

Hypoglycemia is when the blood sugar, or blood glucose, the level is too low. Glucose is the main source of fuel for the body with carbohydrates being the primary source of glucose. Hypoglycemia can be a complication of diabetes or another disorder or a sole condition within the body, but it is closely associated with diabetes.

Causes

• Diabetes medication
• Irregular food intake

Other causes of hypoglycemia are rare, but it could occur in early pregnancy, alcohol or substance abuse, after extreme exercise, during prolonged food fasting, or from a tumor.

Symptoms

• Behavior changes
• Blurry vision
• Confusion
• Disorientation
• Dizziness
• Headache
• Irritability
• Nausea
• Rapid heartbeat
• Shakiness
• Sweating

Hypoglycemia can also occur during sleep. Some signs include:

• Confusion or fatigue after waking
• Nightmares
• Seizures
• Wet clothing

Diagnosis

The ideal range of fasting morning blood sugar is 70 to 99 mg/dL (milligrams per deciliter). Blood sugar levels lower than 70 mg/dL are too low.

Blood tests will determine blood sugar levels. It may be a complication of diabetes or an insulin reaction.

Treatment

To treat low blood sugar immediately, an item with concentrated sugar needs to be consumed:

• Candy
• Glucagon injection
• Glucose tablet
• Orange
• Raisins

It may also be recommended to:

• Avoid foods high in carbohydrates
• Eating small meals more often
• Exercise
• Frequent snacks
• Variety of healthy foods

Untreated hypoglycemia can cause fainting, and, in severe instances, can lead to a coma, seizures, or death.

Prevention

A diet of rice, potatoes, bread, cereal, fruit, and sweets will help prevent blood sugar levels to get too low, but there are a variety of ways:

• Diabetes medication
• Meal plans

What is a metabolic disorder?

Metabolic disorders are disorders that impact the distribution and absorption of certain nutrients like carbohydrates, fats, proteins in the body as a reaction following the regular metabolic process.

Symptoms

• Fatigue
• Seizures
• Skin color changing, such as jaundice
• Weight loss

Symptoms are usually characterized as acute, progressive, late-onset, and permanent.

Risk factors

• Genetic transmission
• Abnormal function of the liver or pancreas

Types of disorders:

• Acid-base imbalance
• Metabolic brain diseases
• Disorders of calcium metabolism
• DNA repair-deficiency disorders
• Glucose metabolism disorders
• Hyperlactatemia
• Iron metabolism disorders
• Lipid metabolism disorders
• Malabsorption syndromes
• Metabolic syndrome X
• Inborn error of metabolism
• Mitochondrial diseases
• Phosphorus metabolism disorders
• Porphyrias
• Proteostasis deficiencies
• Metabolic skin diseases
• Wasting syndrome
• Water-electrolyte imbalance

What is a pituitary gland disorder?

The pituitary gland is a gland at the base of the brain that produces a variety of hormones that impact different organs and parts of the body. This gland is often referred to as the master gland because it has control over most of the endocrine glands. When the pituitary gland is not functioning properly, various health conditions can arise.

When not enough growth hormone is created, for example, stature is stunted in a child, while if not enough luteinizing hormone is created in women, it can cause issues with ovulation, menstruation, and fertility.

Symptoms of a pituitary gland disorder

• Dizziness
• Headaches
• Libido loss
• Muscle loss
• Skin discoloration
• Vision problems
• Weight gain

Types of pituitary gland disorders

• Acromegaly – Too much growth hormone is created, which causes abnormal growth, and can be commonly referred to as gigantism in childhood. The most common cause is a benign tumor. Symptoms include swelling of extremities, protruding jaw, large parts of the face, thick body hair, deeper voice, joint pain, arthritis, increased size of organs, headaches, vision problems, sweat and body odor, weakness, irregular menstrual cycles, larger chest, enlarged thyroid, breast discharge, impotence.
• Diabetes Insipidus – The body does not make enough antidiuretic hormone or the kidneys do not respond to the hormone. The hormone assists in balancing the amount of water in the body. Symptoms include thirst, frequent urination, or dehydration. Treatment can include medication or fluids.
• Empty Sella Syndrome – Affects the part of the skull called the sella turcica, and the pituitary gland is flattened or too small. There may be no known cause in many instances, but it can be caused by injury, surgery, or radiation therapy.
• Hypopituitarism – The pituitary gland is not active, and it does not make enough hormones. Causes can include tumors, infections or inflammation, radiation treatment, surgery, brain injury, poor blood flow, or genetic or autoimmune diseases. Treatment can include hormone replacement therapy, surgery to remove a tumor, or radiation therapy.
• Tumors

What is Polycystic ovarian syndrome?

Polycystic ovarian syndrome is a series of symptoms due to issues with women’s hormones and affects the ovaries. In polycystic ovarian syndrome cysts that can develop on ovaries create a hormone called androgen, which is mostly found in men. Though naturally found in small amounts in women, when the level is too high, it causes issues with a woman’s menstrual cycle and subsequent symptoms.

Women with polycystic ovarian syndrome could develop other serious health concerns, including diabetes, high blood pressure, and uterine cancer.

Risk factors

• Genetic factors, such as if a mother or sister has developed it
• Insulin resistance
• Obesity

Symptoms

• Abnormal or irregular period pf menstrual cycle
• Acne
• Excess bodily hair
• Infertility
• Ovaries develop cysts or are large
• Skin tags or patches of discoloration
• Thinning hair
• Weight gain

Diagnosis

• Blood test
• Ultrasound

Treatment

• Healthy diet
• Medication

Types of puberty problems

• Delayed puberty – Puberty does not begin for a child until after age 12 or 13 in girls and 13 or 14 in boys. Causes can include chromosomal problems, genetic disorders, chronic illnesses, tumors of the pituitary gland or hypothalamus, hypothyroidism, underactive pituitary gland, extreme exercise, eating disorders, and abnormal reproductive development.
• Early or precocious puberty – Puberty begins before age 8 in girls and age 9 in boys where children grow fast at first but stop growing before reaching height potential. It is due to the early release in the body of the hormone gonadotropin. It can be caused by tumors or growths on ovaries, adrenal glands, pituitary gland, or brain, as well as issues with the central nervous system, genetic syndromes, or family genetics.
• Gonadotropin-Independent early puberty – Similar to early puberty, but occurs from the early secretion of sex hormones such as estrogen in females and androgen in males. It can be caused by tumors but also from contact with or consumption of items contaminated with or containing estrogen. It is a rare condition.

What is a sex development disorder?

At birth, a child’s genitalia is present. In certain cases, the gender-specific genitalia is not clear.

Causes

There are 46 chromosomes in each cell of the human body and are grouped into 23 pairs. The 23rd pair determines gender. Females have two X chromosomes, and males have one X and one Y chromosome.

The gender of a developing baby is determined at conception. Around the 6th week of fetal development, a boy’s genitalia begin to form.

Risk factors

• Environmental factors
• Genetics

Types of disorders

• A baby girl that appears to have a small penis
• A baby boy with a penis that resembles a female clitoris

Other disorders include:

• True hermaphroditism – Has sex organs and tissue that is both male and female
• Gonadal dysgenesis – Undeveloped sex organs but have internal organs that are mostly female and external organs that vary
• Pure gonadal dysgenesis – Girls that have underdeveloped sex organs, internal and external female organs, but male chromosome
• Pseudohermaphroditism – External genitalia is in question, but internal organs are clearly of one gender
• Androgen insensitivity syndrome – Female external genitalia and male chromosomes. There is a strong family linkage.
• 5-alpha-reductase deficiency – Genitalia is unclear but has male chromosomes. The enzyme 5-alpha reductase is lacking in the body, which helps male sex organs develop and is an inherited disorder.
• Congenital adrenal hyperplasia – Girls with male sex organs due to a lack of enzymes in the adrenal gland. It is an inherited trait.
• Overproduction of male hormones before birth

What is a thyroid disorder?

The thyroid is a gland located in the upper chest or lower part of your neck and is an endocrine gland that produces hormones, which include thyroxine, triiodothyronine, and calcitonin. It helps maintain and control activity within the body, including how the body burns fat and calories. Disorders occur when the gland is not functioning properly.

Disorders include:

• Goiter or toxic nodular goiter – Enlarged thyroid gland. It can cause pain or difficulty breathing, speaking, or swallowing. A toxic nodular goiter can occur when a lump or nodule of the thyroid becomes overactive.
• Graves’ Disease – The most common form of hyperthyroidism, Graves’ disease is an autoimmune disorder involving the thyroid being overstimulated by antibodies. It can be hereditary, and it is commonly most found in young to middle-age women.
• Hashimoto's Thyroiditis – The most common type of thyroiditis, it may also be called chronic autoimmune thyroiditis. It occurs when the body creates antibodies that attack cells in the thyroid, which causes the gland to be inundated with white blood cells. It scars the thyroid, and it cannot make enough hormones. Risk factors include being female, between 30-60 years of age, heredity, and other autoimmune diseases, such as rheumatoid arthritis, or diabetes.
• Hyperthyroidism – More hormones are created by the thyroid than are needed. The body’s metabolism works at a faster rate, risk factors include over-use of medicine to treat an underactive thyroid, too much iodine in the diet, having a tumor in the pituitary gland, as well as advanced age, being female, pregnancy, past thyroid concerns, family history and other conditions such as diabetes. Symptoms include anxiety, nervousness, sweating abnormally, thinning of skin and hair, heart palpitations, hands shaking, high blood pressure, weight loss, abnormal bowel movements, insomnia confusion, and light sensitivity.
• Hypothyroidism – Not enough hormone is created by the thyroid, and it is the most common thyroid disorder. Risk factors include being female, being older than 60, family history, having past thyroid health problems, having other conditions like diabetes or arthritis, pregnancy, or an iodine deficiency. Symptoms include fatigue, sensitivity to the cold weather, voice changes, slowed speech, swelling, weight gain, dry or coarse hair, carpal tunnel in the hands, slow pulse, joint pain, confusion, and cramping.
• Thyroid Disorders in Women – As the thyroid assists in maintaining the proper bodily function, a woman’s body and health systems are adversely affected if thyroid conditions occur. These include bone health and osteoporosis, emotional and mental health patterns, pregnancy and postpartum health, reproduction, puberty, and menstruation, and menopause.
• Thyroiditis – Swelling or inflammation of the thyroid. This condition can be painless, but many times this condition does involve discomfort. It can be brought on by a virus, bacteria, radiation during treatment, after giving birth, or by drugs such as amiodarone, interferons, and lithium. Heredity can also be a factor. Symptoms include anxiety, irritability, insomnia, rapid heart rate, weight loss, fatigue, sweating or heat intolerance, increased appetite, and shaking or tremors,

Diagnosis

A medical provider will need to perform an exam, and blood tests may be needed, or ultrasound or scan.

Treatment

Treatment depends on the condition, but some may involve: 

• Medicine, including beta-blockers
• Radioactive iodine
• Steroids
• Surgery
• Thyroid hormone replacement therapy

What is thyroid cancer? 

The thyroid has two main types of cells: C cells and follicular cells. Cancer develops from the rapid growth of these cells. Tumors and nodules, or lumps, can grow. Not all are cancerous, but they can spread into nearby tissues and other parts of the body.

Nodules are usually benign, or noncancerous, and can occur at any age but mostly in older adults. They made up of cysts filled with fluid. Some don’t need to be treated, but many do as adverse symptoms develop.

Types of thyroid cancer

• Anaplastic
• Differentiated
• Medullary

Anaplastic cancer is aggressive carcinoma and is rare. It may develop from existing cancer, and it may be referred to as undifferentiated because it does not resemble other normal thyroid cells. It can spread quickly and is difficult to treat.

Differentiated cancer resembles normal thyroid tissue and usually develops from follicular cells. It is the most common type of thyroid cancer. Most differentiated cancer is papillary cancer that grows slowly and from one lobe of the thyroid gland. The lymph nodes in the neck usually are impacted if it spreads to that part of the body, and it can be treated and rarely causes death. Follicular cancer is a type of differentiated cancer that usually occurs where iodine is not found enough in someone’s diet, while Hurthle cell cancer is a difficult differentiated form of cancer to treat.

Medullary cancer occurs from c cells, which makes calcitonin, a hormone that aids in controlling calcium in the blood It can spread to various organs, including the liver and lungs, and it can be both an inherited cancer or can be sporadic and not tied to genetics.

Other types of thyroid cancers include parathyroid cancers, which affect small glands attached to the thyroid.

Risk factors

• Age (usually between 25-65 years old)
• Asian descent
• Female
• Genetics and history within the family of the disease
• Iodine deficiency
• Obesity
• Radiation treatment

Diagnosis

A medical provider can help detect swelling or lumps or nodules, particularly in the neck. Other methods include:

• Biopsy
• Blood tests to detect proper levels of certain hormones to check thyroid function, including thyroid-stimulating hormone, thyroid hormones, thyroglobulin, calcitonin, and carcinoembryonic antigen
• CT scans
• Genetic testing, such as for those with a family history of medullary thyroid cancer
• Laryngoscopy to examine the vocal cords.
• Magnetic resonance imaging, or MRI
• Positron emission tomography, or PET, scan
• Radioiodine scan
• Ultrasound
• X-ray

Stages of thyroid cancer

Thyroid cancer is usually staged based on the size of a tumor, or (T), the spread to lymph nodes, or (N), and then spread to distant tissue, which is called metastasis, or (M).

A table of the different stages along with other detailed information can be found here.

Treatment

• Beam radiation therapy – high-energy rays destroy cancer cells or slow growth.
• Chemotherapy – drugs are injected into the body or taken orally and travel through the bloodstream to reach cancer cells.
• Radioactive iodine therapy – radiation can destroy cancer cells in the thyroid that absorbs iodine.
• Surgery – lobectomy, lymph node removal, thyroidectomy
• Targeted drug therapy – drugs are used to target specific changes in the body’s cells that become cancerous, which are called kinase inhibitors. These drugs block a protein inside cells from relaying signals that cause it to grow.
• Thyroid hormone therapy – drugs, including levothroxyine, are used to replace natural hormones and maintain metabolism