Endocrinology is a complex study of the various hormones and their actions and disorders in the body. Glands are organs that make hormones. These are substances that help to control activities in the body and have several effects on the metabolism, reproduction, food absorption and utilization, growth and development etc.
Hormones also control the way an organism responds to their surroundings and help by providing adequate energy for various functions.
The glands that make up the endocrine system include the pineal, hypothalamus, pituitary, thyroid, parathyroid, thymus, adrenals, pancreas, ovaries and testes.
Who is an endocrinologist?
An endocrinologist is a specially trained doctor who has a basic training in Internal Medicine as well.
Some disorders like low thyroid hormone production or hypothyroidism deals only with an endocrine organ and an endocrinologist alone may detect, diagnose and manage such patients.
Yet other disorders may have endocrine as well and other origins like infertility and may need a deeper understanding of medicine on the part of the endocrinologist to identify and work in collaboration with another specialist (a gynaecologist in cases of infertility).
What do endocrinologists do?
Endocrinologists have the training to diagnose and treat hormone imbalances and problems by helping to restore the normal balance of hormones in the body. The common diseases and disorders of the endocrine system that endocrinologists deal with include diabetes mellitus and thyroid disorders.
Diabetes mellitus
This is one of the most common conditions seen by endocrinologists. This results due to inadequate insulin hormone secreted by the pancreas leading to excess blood sugar that damages various organs.
Endocrinologists treat diabetes with diet and blood sugar reducing medications, including insulin. They also work closely with patients to control blood sugar and monitor them so they can prevent health problems.
Thyroid disorders
This could be an overactive thyroid or hyperthyroidism or underactive thyroid or hypothyroidism.
Endocrinologists treat patients reach a hormone balance by replacing or blocking thyroid hormone depending on whether there is hypo or hyperthyroidism.
Other common diseases and disorders that endocrinologists manage
- Metabolic diseases
- Menopause and its hormonal unbalances
- Over- or underproduction of hormones
- Osteoporosis and vitamin D deficiency leading to osteomalacia and rickets in children
- Infertility
- Precocious puberty
- Lack of growth (short stature)
- Pediatric endocrine diseases
- Excessive growth or acromegaly/gigantism
- Cancers of the endocrine glands
- High blood pressure due to endocrine dysfunctions like adrenal gland tumors pheochromocytoma
- High blood cholesterol or lipid abnormalities associated with heart disease
Training for endocrinologists
Endocrinologists need four years of medical school and then spend three or four years in an internship and residency program. They cover internal medicine, pediatrics, or obstetrics and gynecology during this time.
Thereafter they spend two or three more years learning how to diagnose and treat hormone conditions.
Core training requires knowledge of normal physiology of the endocrine system, including the physiology and biochemistry of hormones, and their actions. Extensive first-hand practical experience in a recognised training centre, of the management of diseases primarily involving the endocrine system follows.
Diabetes specialism
Those training to further specialize in diabetes need experience in eye, blood vessel and kidney diseases associated with diabetes. They need to train in diabetic foot care to prevent gangrene of diabetic foot and amputation of the limbs.
Special training in managing pregnant women, children and adolescents with diabetes and care of the diabetic patient undergoing surgery is needed.
Diabetes education, diet advice, exercises regimens for general masses are also a part of the training. They need to identify and treat obesity and anorexia nervosa, lipid disorders, metabolic bone disease and calcium disorders and fluid and electrolyte disorders.
There is an increasing proliferation of tests and new therapeutic procedures. Thus, the endocrinologist often has an important role in defining the most efficient and cost-effective strategy for their use in patient care. To the practising endocrinologist, laboratory measurement of circulating hormone levels is crucial. Training should therefore include practical experience in an endocrine laboratory. An endocrinologist has access to an up-to-date hormone assay service.
Multidisciplinary training
Several areas need to be accessible in the training of endocrinologists. These include:
- Growth disorders, and disorders of stature with paediatric endocrinologists
- Reproductive endocrinology with gynaecologists in development of the understanding of an endocrine basis of infertility with use of gonadotrophic stimulation therapy and assisted reproduction
- Surgical endocrinology for management of pituitary, thyroid, adrenal tumors operatively
- With radiologists, radiotherapists and nuclear medicine specialists for diagnostic and therapeutic uses and imaging techniques relevant to endocrinology, such as ultrasound
- With oncologists for cancers of the endocrine system
Organizations for endocrinologists
American professional organizations for endocrinologists include:
- The Endocrine Society
- the American Association of Clinical Endocrinologists
- the American Diabetes Association
- the Lawson Wilkins Pediatric Endocrine Society
- the American Thyroid Association
The main professional organisations in United Kingdom include:
- The Society for Endocrinology and the British Society for Paediatric Endocrinology and Diabetes
- European Thyroid association
For pediatric endocrinology the organization revered internationally is the European Society for Paediatric Endocrinology. This is not an exhaustive list and there are more organizations worldwide.
Genetic and environmental drivers shape early type 1 diabetes risk in children