Diabetes & Endocrinology

Diabetes

Diabetes is a condition in which there is uncontrolled blood sugar levels in the body due to a problem with either the production of a hormone called insulin or the function of insulin.

There are various types of diabetes, the most common being Type 2 Diabetes which usually affects people with a family history of diabetes, overweight and older. Type 1 Diabetes affects younger people and requires treatment with insulin injections. Gestational Diabetes is a temporary state of high sugar levels occurring during pregnancy.

  • Type 1 Diabetes Mellitus
  • Type 2 Diabetes Mellitus
  • Gestational Diabetes (Diabetes in Pregnancy)
  • Prediabetes
  • Nutritional and lifestyle counselling
  • Oral hypoglycemic (antidiabetic) agents
  • Weight loss medications
  • Insulin injections
  • Insulin pump treatment (Continuous Subcutaneous Insulin Infusion - CSII)
  • Diabetes education
  • Retinal screening
  • Diabetes retinopathy treatment with laser or injections
  • Screening for diabetic foot disease including ulcers, infections and neuropathy
  • Screening for diabetic kidney disease (nephropathy)
  • Screening for heart disease
  • Maintenance of blood pressure and cholesterol levels

At Acacia Medical Centre we help diagnose and treat thyroid disorders such as:

  • Graves disease
  • Hashimoto’s thyroiditis (autoimmune hypothyroidism)
  • Toxic multinodular goitre
  • Subacute thyroiditis
  • Non toxic multinodular goitre
  • Single thyroid nodules
  • Thyroid cancer, including papillary, follicular, medullary and anaplastic cancers

Our services include:

  • Thyroid hormone testing (thyroid function tests for FT3, FT4 and TSH)
  • Thyroid antibody testing (Anti-TPO, Anti-Thyroglobulin, Anti-TSH antibodies)
  • Thyroid ultrasound scanning including lymph node mapping
  • Fine needle aspiration biopsy of thyroid nodules
  • Thyroid cyst aspiration
  • Diagnosis of parathyroid disorders
  • Referral for thyroid nuclear scintigraphy and radioactive iodine ablation
  • Referral for thyroid surgery if required

The thyroid gland is a small butterfly shaped gland located in the anterior (front) part of the neck. It regulates several body functions via its secretion of thyroid hormone. Diseases affecting the thyroid gland can either be functional; related to either excess production of thyroid hormone (hyperthyroidism) or reduced production of thyroid hormone (hypothyroidism) or structural; related to the appearance of nodules in the thyroid or an enlargement of the size of the gland.

Symptoms of thyroid hormone dysfunction may include the following:

Hypothyroidism

  • Increasing weight or difficulty in losing weight despite genuine attempts at losing weight
  • Lethargy, tiredness or excessive sleeping
  • Constipation
  • Cold intolerance
  • Dry skin
  • Hair loss
  • Heavy bleeding during periods (menorrhagia) or irregular periods
  • Infertility
  • Depression
  • Poor concentration

Hyperthyroidism

  • Excessive or rapid weight loss despite a good appetite
  • Palpitations (a fast heartbeat)
  • Hyperactivity
  • Diarrhea
  • Heat intolerance and sweating
  • Hair loss
  • Delay or stop in periods or reduction in menstrual flow
  • Infertility
  • Anxiety
  • A change in appearance of the eyes

Structural thyroid disease such can present with the noticing of a lump in the neck or a goitre. Occasionally it is detected incidentally when neck scans are done for other reasons or as part of screening for a thyroid hormone dysfunction.

Endocrinology

Endocrinology concerns the field of study of hormones and hormonal disorders. Multiple glands in the human body secrete several types of hormones which are involved in the regulation of numerous body functions.

We help diagnose and treat conditions related to structural and functional disorders of endocrine glands such as the pituitary gland, thyroid gland, adrenal glands, testes and ovaries (gonads), and pancreas.

Common endocrine disorders include:

  • Pituitary adenoma (microadenoma or macroadenoma)
  • Panhypopituitarism and deficiency of pituitary hormones such as growth hormone
  • Hyperprolactinemia/prolactinoma (excess prolactin)
  • Acromegaly
  • Cushing’s disease
  • Non-functioning pituitary tumours
  • Gonadotrophinomas
  • Thyrotrophinomas
  • Parasellar and suprasellar tumours affecting the pituitary gland such as craniopharyngiomas
  • Pituitary disease or dysfunction following surgical treatment of brain tumours or external beam irradiation (radiotherapy)
  • Diabetes Insipidus
  • Dizziness and weakness
  • Lethargy and tiredness
  • Headaches
  • Visual problems
  • Erectile dysfunction
  • Infertility
  • Weight loss or gain
  • Change in bowel habit
  • Palpitations
  • Flushing
  • Milky discharge or change in breast size
  • Irregular periods
  • Muscle wasting
  • Poor growth in children or pubescents
  • MRI sella for the pituitary
  • Pituitary hormone profile
  • Genetic testing
  • Sex hormone profile
  • Adrenal and thyroid hormone profile
  • Dynamic endocrine tests such as insulin tolerance test and GnRH test.
  • Medications such as cabergoline or bromocriptine
  • Somatostatin
  • Growth hormone injections
  • Testosterone injections
  • HCG and HMG injections
  • Female hormone replacement
  • Referral to neurosurgery

Many hormonal disorders can affect the sex hormones. Common disorders include:

  • Polycystic ovarian syndrome (PCOS)
  • Congenital adrenal hyperplasia (CAH, classical and non classical)
  • Idiopathic hirsutism
  • Menopause
  • Premature ovarian failure
  • Gynecomastia
  • Reduced libido and hypogonadism in men and women
  • Female and male infertility
  • Disorders of sexual differentiation such as in androgen insensitivity disorder
  • Hormonal dysfunction as a result of genetic syndromes such as Down’s syndrome, Turner’s syndrome, Kallman’s syndrome and Klinefelter’s syndrome.

Symptoms of sex hormone dysfunction such as an excess of testosterone (hyperandrogenism) or reduction may include:

  • Hirsutism (excess body and facial hair, especially in women)
  • Reduced body hair and reduced frequency of shaving in men
  • Change in voice (masculine in women and feminine in men)
  • Acne and scalp hair loss
  • Increase in muscle bulk in women and reduction of muscle bulk with excessive fat in men
  • Irregular or delayed periods or absence of periods
  • Hypogonadism, reduced libido, erectile dysfunction or male infertility
  • Female infertility
  • Obesity and excess weight
  • Delayed puberty and growth
  • Precocious puberty (early puberty)
  • Lack of secondary sexual characteristics in pubescents or adults, eg small penis and testicles in boys or small breast size in females

At Acacia Medical Centre we offer full hormonal profile and genetic testing and monitoring to help diagnose reproductive hormone disorders. This includes a clinical examination and options for treatment including hormone replacement, medication that adjusts the hormone balance or surgical and cosmetic treatments that reverse some of the effects of the hormone imbalance.

The adrenals are glands that are located above the kidneys on both sides. They secrete hormones such as cortisol that help regulate blood pressure and stress response.

  • Addison’s disease (primary adrenal insufficiency) and hypocortisolism
  • Phaeochromocytoma
  • Carcinoid syndrome
  • Palpitations
  • Weight gain
  • Flushing and sweating
  • Dizziness and tiredness
  • Low or high blood pressure
  • Nausea and vomiting

Tests would include adrenal hormone tests for cortisol levels, ACTH and mineralocorticoids, renin, angiotensin, catecholamines, metanephrines and CT scans or ultrasound of the adrenal glands. Referral to general surgeons or urologists may occasionally be necessary if considering adrenalectomy (removal of adrenal glands), otherwise treatment is with steroid replacement and other medications to regulate blood pressure.

Various body minerals can either be elevated or reduced in certain disorders or as a result of medication. We treat disorders related to:

  • Hypernatremia (excess sodium)
  • Hyponatremia including SIADH Syndrome of inappropriate secretion of antidiuretic hormone (low sodium)
  • Hyperkalemia (excess potassium)
  • Hypokalemia (low potassium)
  • Hypercalcemia (excess calcium, related to primary hyperparathyroidism or certain blood or bone cancers)
  • Hypocalcemia (low calcium, related to hypoparathyroidism or vitamin D deficiency)
  • Vitamin D Deficieny
  • Osteopenia and osteoporosis
  • Hormonal disorders that may lead to bone loss

Tests would include clinical biochemistry blood and urine tests, vitamin D levels and DEXA scans for osteoporosis screening (bone densitometry).

Excess cholesterol can lead to cardiovascular disease. There are some acquired and inherited disorders of lipid metabolism including:

  • Familial hypercholesterolemia
  • Familial defective apolipoprotein B-100 (FDB)
  • Familial hypertriglyceridemia
  • Familial combined hyperlipidemia
  • Familial dysbetalipoproteinemia

We help diagnose and classify disorders of lipid metabolism (elevated cholesterol) and offer tests for total cholesterol levels, LDL, HDL and Triglycerides. We choose the appropriate treatment choice with lifestyle, nutritional counselling, statins (eg. atorvastatin or rosuvastatin), fenofibrates, nicotinic acid, or omega 3 fatty acids based on your history and side effect profile.