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MD, JIPMER Puducherry and DM, AIIMS New Delhi
Our Specialities
and Services
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Our Specialities
We provide a range of professional services to meet your needs
What is the role of the endocrinologist?
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Assessment of the type of diabetes, medical history and personal characteristics.
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Control of blood glucose levels and long-term maintenance of blood glucose levels by most appropriate medications for you.
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Control of blood pressure.
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Management of lipid(cholesterol) abnormalities.
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Endocrinological clearance for procedures or surgeries- it is very important to normalize blood glucose levels prior to surgery to avoid complications and improve healing and recovery
Diabetes
Mellitus
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A disease that affects how the body uses blood sugar (glucose).
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Many different types- Type 1, Type 2, Secondary diabetes, Gestational diabetes
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Each type has its own cause.
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Every person with DM is different.
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Treatment is specific to the type of diabetes one has, one’s medical history and personal characteristics.
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Uncontrolled DM causes dangerous complications in different important body organs like the heart, kidney, liver, nervous system, eyes and limbs.
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Controlling blood glucose levels helps to reduce these complications
Thyroid Disorders
Thyroid Gland
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It is located in the front of the neck and produces important hormones.
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Thyroid hormones control the body’s metabolism — how your body uses energy.
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Essential for growth, reproduction, heart, muscle and brain function
Do you have a thyroid problem?
There are some symptoms that could indicate that you have an issue in your thyroid gland. These are:
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Tiredness.
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Feeling excessively cold or excessively hot and sweaty.
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Constipation or frequent passage of stools.
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Dry flaky skin or rashes on the skin.
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Puffiness of the face or body, weight gain or unexplained weight loss.
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Thin hair.
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Low mood, memory problems and difficulty to concentrate.
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Heavier or irregular periods or no periods.
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Muscle weakness.
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Tremors or shakiness of hands.
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Rapid or slow pulse rate, high blood pressure.
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Inability to sleep at night, restlessness, anxiety.
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Swelling in the front of the neck in the region of the thyroid gland.
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Pain in the front of the neck in the region of the thyroid gland.
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Change in voice.
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Difficulty in swallowing food.
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Breathing difficulty.
What to do?
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You should consult a thyroid specialist and get your thyroid checked if you:
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Have more than one of these symptoms for more than a few weeks.
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Are on thyroid medications for a long time.
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Are planning pregnancy.
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Are scheduled for any major surgery.
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Have an incidentally detected abnormality in any routine blood test.
What is the role of the endocrinologist?
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Advice the right thyroid tests to make your diagnosis.
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Treatment of thyroid disorders depends on your disease.
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Thyroid hormone replacement
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Evaluation of cause is of utmost importance- followed by treatment as per the cause.
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Thyroid nodules- Evaluation of the risk of malignancy- decide on the need and extent of surgery followed by surgical referral
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Dietary
Planning
Diet plays a crucial role in managing various endocrine conditions and promoting overall health. At our clinic, we recognize the significance of personalized diet plans tailored to each patient's specific needs and goals.
Hormone
Therapy
Hormone therapy is a specialized treatment approach used to address hormonal imbalances and manage various endocrine disorders such as menopause, hypothyroidism etc. We offer comprehensive hormone therapy options tailored to each patient's unique needs and medical condition.
Referrals to best Specialists
Referrals play a crucial role in ensuring that patients receive the specialized care they need for their endocrine health. At our clinic, we understand the importance of collaborative healthcare and value the trust placed in us by referring physicians and healthcare professionals.
Women’s Health
Galactorrhoea
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Refers to a milky nipple discharge in non- pregnant, non- breast feeding women.
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More common in women but it can happen in children, elderly and men
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Possible causes of gynaecomastia are:
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Certain medications
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Birth control pills
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Disorders/ tumour in the pituitary gland
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Chronic kidney disease
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Spinal cord surgery/ injury or tumors
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Underactive thyroid gland
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Nerve damage to chest wall from chest surgery, burns, chest injuries
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Polycystic ovarian syndrome (PCOS)
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Most common hormonal disorder among women of reproductive age
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Many women don’t know they have it.
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Presents differently in every woman
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Needs to be managed according to the woman’s concerns and stage in life.
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Some aspects of PCOS do require collaboration with specialist in other fields like dermatologists and gynaecologists at the appropriate time.
A Delicate Balance
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Hormone profiles in women are much more dynamic than men and unique at each stage of life from puberty, pregnancy followed by menopause.
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It is essential that at every stage there is a favorable age- appropriate balance to maintain reproductive as well as global health of the woman.
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Several hormone issues affect women and need attention and evaluation.
Premature ovarian failure
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Primary ovarian insufficiency occurs when the ovaries stop functioning before age 40yrs.
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Ovaries don't produce required amounts of the hormone estrogen or release eggs regularly.
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Irregular cycles/ complete absence of cycles, inability to conceive, reduction in breast size are some symptoms
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Replacing estrogen levels in these women is essential.
Post- menopausal hormone replacement therapy
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Menopause is a challenging time in every woman’s life.
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During menopause, the estrogen levels fall causing some troublesome symptoms.
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Some of these symptoms are vasomotor symptoms like hot flashes, or they can get other symptoms such as vaginal dryness.
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HRT (also known as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy) is the most effective treatment for menopause symptoms.
What is the role of an endocrinologist?
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PCOS needs a holistic approach to management- multiple aspects of the disease need to be treated with the right medications as per symptoms.
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Ovarian failure needs to be treated even if one is not desirous of pregnancy for ones own health.
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Causes of breast discharge need to be evaluated and managed appropriately.
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While looking for relief from menopause symptoms, knowing the pros and cons of hormone replacement therapy (HRT) can help decide whether it’s right for them.
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Your doctor will help you to undergo the right tests to decide whether you can tolerate the medications as per your need.
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You need to be monitored for side effects and medications adjusted as per your personal characteristics.
Pituitary Gland Disorders
What disorders can affect the pituitary gland?
Pituitary tumours
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Pituitary gland tumours need to be evaluated for any pituitary hormone over production
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Sometimes they can cause deficiency in pituitary hormones by compression of the normal pituitary gland.
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Most pituitary gland tumours that measure > 1cm require immediate surgical removal as it can compress important nerves, blood vessels and structures close to it.
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If there are any symptoms like headache, low blood pressure or decreased vision caused by compression of the pituitary tumour- the surgery needs to be done on emergency basis.
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Prior to the surgery, endocrinological evaluation and clearance is of utmost importance for 2 reasons
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To confirm that it is not a prolactinoma- which can be managed easily with medicines, usually not requiring surgery in majority of cases
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To ensure that other pituitary hormone levels are normal in order to have a safe surgery.
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Post-surgery, there may be a deficiency of pituitary hormones which needs to be treated.
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Treatment of most pituitary tumours is by surgical excision EXCEPT prolactinomas (pituitary gland tumours that produce prolactin)
What is the pituitary gland?
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It is the master endocrine gland that sends hormone signals to other endocrine glands in the body.
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Diseases that can occur in this small gland require immediate management because of the important nature of the gland and its location in the centre of the head as well as the widespread effects it has on all the endocrine glands in the body
Pituitary hormone excesses
There are situations in which there is excessive secretion of certain hormones from the pituitary gland.
Hyperprolactinemia
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Excessive production of prolactin hormone from the pituitary gland.
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There are several causes for the same- most common are drug induced causes and pituitary tumours.
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Prolactin secreting pituitary tumour can be managed very well by medicines which cause the tumour to shrink.
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So appropriate diagnosis needs to be made to avoid unnecessary pituitary neurosurgery.
Acromegaly
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Excessive growth hormone production in the body.
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When there is growth hormone excess in a child it results in gigantitsm.
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When the hormone excess happens in adults, it results in certain deformities and issues referred to acromegaly.
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This needs to be identified and treated immediately so as to avoid long term complications and reduction in life span.
Cushings disease - this is a condition of steroid excess caused by excessive stimulation of adrenal gland to produced steroid hormones
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It is a very debilitating disease that needs to be managed appropriately.
Pituitary hormone deficiencies
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There may be partial or complete deficiency of all the hormones produced by the pituitary gland resulting in a state of “hypopituitarism”.
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The stimulus given by the pituitary gland to the endocrine glands to produce their respective hormones is lost resulting in “secondary” hormone deficiencies that need to be managed in a proper fashion.
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The glands affected due to pituitary issues are the following:
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Thyroid gland
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Gonads(testes and ovaries)
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Adrenal glands
Our Services
We provide a range of professional services to meet your needs
Adrenal Gland Disorders
The Adrenal Glands
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Adrenal glands are located in the abdomen.
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Problems in the adrenal gland affect the secretion of these hormones resulting in serious consequences.
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They secrete important hormones
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Glucocorticoids (stress hormones): affect immune system responses, fighting inflammation, monitoring heart functions, and converting fats, proteins, and carbohydrates into energy. balances salt and water within the bloodstream, regulating the body’s blood pressure.
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Sex hormones (Androgens and estrogens)
Common Adrenal related Disorders
Adrenal insufficiency
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Failure to produce adequate amounts of hormones
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Results in fatigue, nausea, muscle weakness, loss of weight, appetite, low sodium.
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Severe untreated deficiency– a life-threatening situation that requires immediate treatment and hospitalization.
Adrenal masses or tumours or incidentalomas
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Adrenal gland masses need to be evaluated.
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They can produce of excessive adrenal hormones or be cancerous.
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Specialised tests are essential.
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Surgery is often needed to remove them.
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Pre-operative management and surgical clearance from an endocrinologist is compulsorily required in order to avoid complications arising from the surgery.
Adrenal hormone excesses
excessive levels of these lifesaving hormones are also harmful
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Cushing syndrome- excessive secretion of glucocorticoids
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Pheochromocytoma- excessive secretion of catecholamines
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Conn’s disease- excessive secretion of aldosterone
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They need to be evaluated and managed appropriately to avoid the devastating effects.
Adrenal gland suppression from steroid use
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Steroid usage leads to the suppression of adrenal glands.
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As steroids we take from outside mimics cortisol hormone produced by the adrenal glands, the function of the adrenal glands is shut down at the time of active steroid usage.
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When steroid medication is suddenly halted, the adrenal glands are still suppressed and take time to recover their function and restart hormone secretion.
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During this recovery, which can sometimes almost up to one year, there is a period when there is a deficiency of adrenal corticosteroids in the body.
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During this time a low dose of steroids need to be carefully given and slowly withdrawn so avoid to avoid imbalances and slowly coax the adrenal gland to resume steroid synthesis.
Management of chronic steroid related side effects
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Screening for eye complications like cataract and glaucoma, bone involvement, uncontrolled blood glucose and pressure levels
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Regular reassessment of adrenal gland recovery is essential during ongoing steroid therapy to reduce complications related to steroids
Gender affirming hormonal therapy
What we offer?
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Compassionate health care that’s appropriate for your needs- no matter your gender identity.
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Appropriate referrals to psychologists, surgeons, fertility experts for best possible care
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Long term medication dosage and side effect management
Hormones may be used alone or along with gender affirmation surgery. These are of two types.
“Feminizing”* Gender-Affirming Hormones:
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Testosterone Blockers and Estrogen- The goal is to increase “feminine” secondary sex characteristics.
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Breast growth, the redistribution of body fat to hips and thighs, the reduction of muscle mass, and potential thinning or slowing of facial and body hair growth are the expected effects.
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*Gender-affirming hormones affect each person differently—it is not possible to choose which changes that one may experience.
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There are also certain side effects that can occur that need to be monitored and doses of medications need to be adjusted to achieve best results with least side effects.
“Masculinizing”* Gender Affirming Hormone:
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Testosterone- The goal is to increasing “masculine” secondary sex characteristics.
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Development of a deeper voice, the redistribution of body fat away from hips and thighs, increased body and facial hair, increased muscle mass, and changes to monthly bleeding/menstrual cycle are the expected effects
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*Gender-affirming hormones affect each person differently—it is not possible to choose which changes that one may experience.
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There are also certain side effects that can occur that need to be monitored and doses of medications need to be adjusted to achieve best results with least side effects.
Puberty blockers- Puberty blockers, also called hormone blockers, help delay unwanted physical changes that don’t match someone’s gender identity.
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Delaying these changes can be an important step in a young person’s transition.
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It can also give a child more time to explore their options before deciding whether or how to transition.
*the terminology used is grounded in our commitment to honouring gender-diverse people.
Parathyroid and Calcium related Disorders
What is the role of the endocrinologist?
Assessment and appropriate management for the raised or low parathyroid levels as this is a rare disease and needs clinical expertise to avoid unnecessary or even harmful medications or interventions.
When to suspect parathyroid problems?
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You have recurrent kidney stones despite treatment
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You have recurrent fractures or fractures that are happening with minimal or no trauma
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Bony swellings in your body
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Feeling excessively thirsty and pass urine frequently
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You have kidney failure
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You have any problem with digestion and absorption of food like chronic pancreatitis, celiac disease etc
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You feel very depressed or low
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You have constipation and abdominal pain frequently
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You find a raised PTH or calcium level in a routine blood test
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If you have undergone thyroid surgery.
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If you have sudden episodes of tingling in your face and stiffening of fingers or low calcium levels in routine blood test.
Parathyroid Gland
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Parathyroid glands secrete parathyroid hormone, which maintains blood calcium levels and ensures healthy bones.
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Excessive hormone secretion from one or more of the parathyroid glands results in “hyperparathyroidism” and under secretion of parathyroid hormone results in “hypoparathyroidism”
Bone Health
Bone Health
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Several hormones are involved in maintaining bone health like:
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Estrogen and Testosterone
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Thyroid hormone
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Parathyroid hormone.
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The following diseases fall under the purview of an endocrinologist expertise:
Osteoporosis
“Osteoporosis” literally means “porous bones.”
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It occurs when bones lose an excessive amount of their protein and mineral content, particularly calcium.
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With age, and with hormonal changes of menopause the bone mass, and therefore bone strength, is decreased so bones become fragile and break easily.
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Certain diseases or medications like steroids can cause osteoporosis.
When you need to worry about osteoporosis?
If you answer “yes” to any of these questions you need to consult an endocrinologist along with your orthopaedic or bone doctor.
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If you are a woman aged 65 years and older or a man aged 70 years and older regardless of clinical risk factors.
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If you are a younger postmenopausal woman, in menopausal transition, or a man in age 50 to 69 years with clinical risk factors for fracture.
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Have a fracture(with minor trauma) after age 50 years.
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Have a condition (eg, rheumatoid arthritis) or taking a medication (eg, steroids) associated with low bone mass or bone loss.
Metabolic bone disease:
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Could be an endocrine disorder.
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Can present with bony pains, pathological or frequent fractures, bony deformities, swellings or weakness.
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Common metabolic bone diseases (MBD) include
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Rickets/ osteomalacia
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Hyperparathyroidism (HPT)
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Paget's disease
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Tumor induced osteomalacia
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Fibrous dysplasia
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Osteogenesis imperfecta
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What is the role of the endocrinologist?
To evaluate the strength of the bone and the reason for any abnormalities and to prescribe the appropriate treatment for the same.
Men's Health
Hypogonadism/ Low testosterone
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Testosterone is the male sex hormone that helps maintain external appearance of facial hair, muscular appearance, libido.
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Low levels result in decreased facial hair, difficulties with sexual function, increase in body fat and loss of muscular appearance.
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It can happen as a result of incorrect use/abuse of hormones and supplements at gyms etc.
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The cause of low testosterone levels or hypogonadism needs to be carefully evaluated and medicines given as per requirement.
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Testosterone hormone replacement therapy is a treatment that is given to males with testosterone deficiency who show symptoms of hypogonadism.
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There are specific guidelines regarding initiating and monitoring testosterone therapy as unregulated usage can create more harm than benefit.
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Prior to initiating the therapy, certain tests have to be understand to confirm the requirement for the therapy and to assess for possible side effects of the therapy.
Male infertility
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Low or absent sperm count can result in inability to conceive a baby
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It can be caused by diseases of the testes, pituitary or hypothalamus.
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This may or may not be accompanied by a low testosterone or male sex hormone level.
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This condition needs to be treated whether or not pregnancy is desired.
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Lack of male sex hormones results in global health issues in males.
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Sperm production can usually be stimulated by medications to a level sufficient to achieve or restore fertility in men who have disorders of the pituitary or hypothalamus.
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This condition requires careful assessment and management by endocrinologist in collaboration with fertility specialist if pregnancy is desired.
Abnormal breast development in males/ gynaecomastia
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There is an abnormal enlargement of one or two breast in men or boys.
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There may sometimes be pain in the breast.
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It may or may not be associated with features of hypogonadism or low testosterone like decreased facial hair, difficulties with sexual intercourse, increase in body fat and loss of muscular appearance.
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It needs careful evaluation and appropriate management to avoid long term problems.