Endocrinology is the field of medicine involving the body's chemical messengers, or hormones and its biochemical control mechanisms, or metabolism. Endocrinologists care for patients with complex hormonal disorders and metabolic conditions. Common endocrine problems include Type I and Type II diabetes, thyroid disorders, metabolic bone disease, pituitary and adrenal gland conditions, growth and gonadal disorders, and lipid and nutritional disorders.
The American Board of Internal Medicine and American Board of Pediatrics have programs leading to board certification in endocrinology as a subspecialty in their field. The American Board of Obstetrics and Gynecology also certifies reproductive endocrinology as a subspecialty. The American College of Physicians, the American Medical Association, and other physician organizations will acknowledge specialists in endocrinology as physicians with expertise, specialized training and research endeavors in hormonal disorders.
Endocrinologists are called upon to treat patients with complex medical conditions. They tend to treat those persons who are most seriously ill with diabetes and its complications. For example, people with diabetes frequently develop blindness, kidney failure and severe artherosclerosis if not properly treated. Diabetes Mellitus is a leading cause of death in the elderly who develop heart, eye, kidney and nervous system complications from long-standing blood sugar elevation. There are many patients, most notably those with chronic endocrine conditions, for whom an Endocrinologist should severe as the primary care physician. There is abundant evidence that patients with diabetes benefit from a treatment team supervised by an Endocrinologist. Such a team can help patients achieve the kind of close control which has been demonstrated to reduce complications. In those cases where the Endocrinologist is not the primary care physician referral to an Endocrinologist is appropriate for:
Diabetes
a. Refer to an Endocrinologist for routine follow-up visits: every 3 - 4 months for IDDM once stabilized and every 3 - 6 months for NIDDM once stabilized.
b. Initiation of insulin therapy.
c. Hgb A1C or a glycosylated hemoglobin >2% above the upper limit of normal.
d. Unstable glycemia control characterized by frequent or severe hypoglycemia and or hyperglycemia.
e. Diabetic ketoacidosis.
f. Diabetic hyperosmolaritiy state.
g. Development of complications of diabetes including the presence of microalbuminuria, painful neuropathy, autonomic neuropathy, and/or retinopathy.
h. Diabetic patients who are pregnant or are considering pregnancy.
i. Pregnant patients who develop gestational diabetes.
j. Patients who desire intensive insulin therapy or those whom it is clinically indicated.
k. Patients who are candidates for insulin pump therapy should be evaluated and such care initiated and managed by an Endocrinologist.
l. Preoperative care for patients with difficult to manage diabetes.
m. Diabetic patients are best managed by a team approach, headed by an endocrinologist, including the use of educational services of a nurse educator and registered dietician (RD) who are Certified Diabetes Educators (CDE), if available.
Thyroid Disease
a. In hyperthyroidism, refer to an Endocrinologist for assessment, treatment plan, including radio-active iodine if appropriate, and management until stabilization has occurred.
b. Assessment, treatment and management of hypothyroidism which is unusually complicated or with difficult to interpret thyroid function tests.
c. Refer to an Endocrinologist and Ophthalmologist for evaluation and treatment of ophthalmopathy related to thyroid disease.
d. Evaluation, biopsy and management of thyroid nodules.
e. Patients with an unexplained abnormal thyroid exam or thyroid function test.
f. Patients with thyroid cancer should be referred to an Endocrinologist for evaluation and therapy and then seen at least yearly.
g. Patients with subacute thyroiditis or tender, painful or enlarged thyroid.
h. Infants with abnormal neonatal thyroid screening test, children under the age of three with hypothyroid or questionable thyroid function, or thyroglossal duct cyst.
Osteoporosis and Metabolic Bone Disease
a. Referral of patients for evaluation and treatment of osteoporosis including osteoporosis of disease and steroid induced osteopenia.
b. Disorders of calcium metabolism, including hyper and hypoparathyroidism and renal stone.
c. Disorders of Vitamin D metabolism including Rickets and osteomalacia.
d. Paget's Disease.
e. Other metabolic bone disorders.
Pituitary and Adrenal Conditions
a. Pituitary and hypothalamic tumors.
b. Cushing's disease, acromegaly, hyperprolactinemia and other disorders of pituitary and hypothalamic function.
c. Hypopituitarism.
d. Diabetes insipidus and SIADH
e. Electrolyte disorders.
f. Adrenal tumors including pheochromocytomas, adenomas, carcinomas and Cushing's syndrome.
g. Addison's disease
h. Adrenal suppression due to prolonged steroid use, including preoperative management.
i. Endocrine Hypertension.
j. Ectopic hormone secretion.
Growth and Gonadal disorders including impotence and infertility
a. Accelerated or abnormal growth velocity, growing failure or failure to thrive.
b. Delayed or precocious puberty.
c. Precocious thelarche and pubarche
d. Under - virilization.
e. Sexual ambiguity (ambiguous genitalia).
f. Cryptorchidism.
g. Amenorrhea.
h. Galactorrhea.
i. Menstrual disorders.
j. Congenital adrenal hyperplasia, hirsutism and virilization.
k. Gynecomastia.
l. Menopausal disorders.
Lipid and Nutritional Disorders
a. Cases of hyperlipidemia not responding to first line treatment modalities.
b. Morbid and Metabolic Obesity.
c. Hormonal complications associated with eating and nutritional disorders.
d. Diagnosis and evaluation of hypoglycemia, and its treatment.
e. Inborn errors of metabolism.
