As a Diabetologist catering for the needs of type 1 and type 2 diabetes and also pre-diabetes and the Metabolic Syndrome, my Practice incorporates the services of a specialist Dietician, a Nurse Educator, and an Insulin Pump technologist.
I have an excellent rapport with colleagues involved in sub-specialties dealing with Diabetic complications practicing within a short distance from my consulting rooms. These include Ophthalmologists, Vascular Surgeons, Neurologists, Podiatrists, and Cardiologists. My staff arranges referral to these doctors when needed. We offer a 24-hour diabetes service and cater for both chronic and acute problems. My unit is also affiliated to the CDE Diabetes Managed Care program that is contracted to many of the larger Medical Aid Schemes in South Africa and allows for a comprehensive cover for Diabetic services on a Capitation-based manner at no extra cost to the patient. Particulars about this program may be obtained from the secretary.
Endocrine problems that I see include conditions like thyroid disorders, osteoporosis, pituitary diseases, problems of calcium and Vitamin D metabolism, adrenal disorders, problems of the aging Male with low Testosterone, problems of growth and development, hirsutes, polycystic ovarian syndrome and obesity.
The thyroid gland is a small gland situated in the midline of the neck. The gland makes two hormones, T3 and T4. Over activity results in symptoms of thyrotoxicosis: heat intolerance, increased sweating, weight loss or gain, increased appetite, a fast heart rate, breathlessness, tremor of the hands, weakness, fatigue, emotional problems and, depending on the cause of the thyroid, over activity, an enlarged gland and changes to the eyes, which may become more prominent.
Under-activity of the thyroid is termed hypothyroidism and may result in weight gain, fatigue, constipation, a slow heart rate, dry skin and hair, mental sluggishness and memory disturbance, psychiatric symptoms, heavy menstrual periods, muscle cramps etc. The thyroid gland may also be enlarged.
Thyroid nodules or an enlarged gland, termed a goiter, may be associated with normal thyroid function and this needs careful evaluation to exclude obstructive symptoms or cancer. Most nodules however are benign.
Thyroid problems are initially assessed clinically. Further tests may include blood tests and in some instances, ultrasound or nuclear scanning to more clearly evaluate the size and function of the gland. A needle biopsy may be necessary to more carefully evaluate a thyroid nodule. In some cases, referral to a surgeon specialising in thyroid pathology may be required to evaluate a nodule if cancer is suspected.
Thyroid eye disease may have to be treated promptly, and referral to an Ophthalmologist may be necessary.
Pituitary disorders include conditions like hormone-secreting tumours causing changes to facial features, changes to the body build in various ways, alteration to the menstrual cycle, galactorrhoea (milk from breasts), abnormalities of blood pressure, problems of growth and development in children and adolescents, and changes to thyroid, adrenal and sexual function. Non-functioning tumours often cause pressure symptoms like headache and changes to the visual fields may also occur.
Thinning of the bones (Osteoporosis) sometimes with fracture, may occur in many different settings. Not only is it important to establish the cause of the Osteoporosis, but to treat the pathology appropriately to avoid disabling and painful fractures.
Osteoporosis, occurring in the setting of hormone-deficiency post menopausal or with Testosterone deficiency in men, may require consideration for hormone replacement therapy. Other conditions causing osteoporosis include Hyperparathyroidism and calcium disorders, Thyrotoxicosis, Cushings’ syndrome from abnormally elevated cortisone levels, cortisone treatment for conditions like chronic asthma or allergy and rheumatoid arthritis, alcohol excess, prolonged bed rest and certain cancers. There is also a long list of commonly used medication for a whole range of medical conditions that may result in thinning of the bones. Familial predisposition to Osteoporosis is also commonly found.
Elevated calcium levels may cause many unrelated problems like fatigue, bone ache, kidney stones, osteoporosis, mental changes etc. The causes of elevated calcium are many and include Hyperparathyroidism, an elevated Parathyroid level secreted by the tiny glands in the neck behind the thyroid. This needs careful assessment and investigation to decide on appropriate therapy. When the calcium levels are very high, consideration of surgical removal of the parathyroid tumour or partial resection of some of the parathyroid glands when a tumour is not localized is necessary.
Disease of the Adrenal glands include conditions resulting in either under- or over-activity causing many different syndromes affecting blood pressure, glucose metabolism, water and electrolyte balance, etc. Certain distinct syndromes may result e.g. Cushing’s syndrome, Addison’s disease, and Phaeochromocytoma. Adrenal pathology may also cause hirsutes and affect general well being. Adrenal tumours and cancer require careful evaluation.
Diseases of the Ovary include polycystic disease (PCOS) resulting in abnormal menstrual periods, hairiness (hirsutes), acne and infertility. It is often also associated with the metabolic syndrome, pre-diabetes or type 2 diabetes.
Problems affecting the testicles include cancer and underdeveloped testicles with abnormally low secretion of testosterone. Genetic or developmental problems need careful diagnosis and treatment.Disorders causing low testesterone resulting in symptoms including low libido, fatigue, restlessness, poor sleep pattern, mood changes, and abnormal sweating patterns and often associated with male menopause (andropause) and should be carefully evaluated and treated.
There is an epidemic of obesity in most Western and developing countries in the world. Obesity is defined as a BMI (Wt (Kg)/HT (m) of >30). Endocrine causes account for a small percentage of these cases; the cause is most often a combination of genetic predisposition, metabolic factors, and an imbalance of food intake and energy expenditure. While the cornerstone of treatment remains diet and exercise, patients with extreme obesity may benefit from Bariatric surgery. I am associated with the Chrysalis Clinic (founder member), a Nationally recognised unit for this type of surgery (see links to Chrysalis Clinic).
The Metabolic Syndrome is a clustering of findings including a weight circumference in men of >94cm and women >80cm, impaired glucose tolerance, elevated triglycerides and low HDL-Cholesterol, hypertension and microalbuminuria, all factors that increase cardiovascular risk and may result in coronary artery disease and atherosclerosis.
A careful general medical examination may uncover or define risk factors associated with this syndrome.
By aggressively managing Lipid (Cholesterol), blood sugar and Blood Pressure problems it may be possible to prevent these complications before they arise.
The importance of regular medical check-ups cannot be over-emphasised. Patients with an adverse family history may be at even a higher risk.