Singapore is facing a diabetes tsunami. In year 2004, only 8.2% of Singaporeans age 18-69 was affected. In year 2010, this number has increased at an alarming rate to 11.3% of Singaporeans. This makes Singapore one of the developed countries with the highest incidence of diabetes. In Europe, it is generally around 6 to 9 percent, and worldwide it is 8.5 percent. There are many more out there who are probably unaware and are undiagnosed. The rise of diabetes in Singapore mirrors the rise in obesity from 6.9% in 2004 to 10.8% in 2010. Besides obesity, one of the other biggest risk factor of diabetes is advancing age. For many people out there, it is no longer a question of whether they will get diabetes, but rather when they will get diabetes.
While severe diabetes can have a myriad of symptoms such as thirst and frequent urination, the majority of diabetics can be silent. Without proper screening, many patients with diabetes can go undetected.
Many forms of diabetes exist. Some can be managed with oral tablets. Some require insulin. Some diabetes develops in young patients and adolescent. Some women have diabetes associated with their pregnancy. Diabetes is a chronic illness that can result in multiple serious long-term complications such as blindness, heart attacks, kidney failure, strokes, amputations if not managed well. With proper management, many patients’ diabetes can be well controlled with a marked reduction in the risk of these dreaded complications.
Treatment of diabetes has progressed tremendously in the last few decades. Advanced treatment such as new oral medications and insulin exists today to keep diabetes under control. Technologies such as continuous glucose monitoring and insulin pumps can be utilized to optimize diabetes treatment.
The thyroid is a gland in the neck that regulates the body metabolism. Over-active (hyperthyroidism) and under-active (hypothyroidism) thyroid can cause serious complications if left untreated. Thyroid conditions in pregnancy can cause serious complications to the mother and to the baby.
Thyroid nodules are growth in the thyroid gland. Although the majority of these nodules are benign, some may harbor malignant tissues and may be cancerous. An ultrasound evaluation with aspiration cytology may be necessary in some cases to fully ascertain the nature of these nodules.
Thyroid conditions are generally highly treatable with good results in the long term.
Osteoporosis is a common disorder occurring not only in post-menopausal women but can also affect men and younger woman as well. Osteoporosis is a silent disease. Without screening and proper treatment, osteoporosis can result in fractures with significant risk of disability and mortality.
Many effective treatment are available for osteoporosis nowadays. With proper optimization of bone heath and treatment of osteoporosis, the risk of fractures and debilitating complications can be markedly reduced in women and men suffering from this silent disease.
Obesity and Metabolic Disorder
Obesity is a culmination of multiple factors including lack of exercise and poor dietary habits. Obesity and related diseases like diabetes have gained epidemic proportions in many developed countries. According to the World Health Organisation (WHO), obesity nearly doubled worldwide from 1980 to 2008. Some obesity may be related to an underlying hormonal problems.
The true perils of obesity lies in its associated metabolic disorders (including diabetes, hypertension, hypercholesterolemia), and the complications downstream as a result of these metabolic disorders. These complications include heart disease, stroke, sleep apnea, gallstones and even cancers. With proper management of obesity and these metabolic disorders, the risks of many of these serious complications can be reduced.
Calcium, Vitamin D and Parathyroid
Calcium, vitamin D and the parathyroid hormones worked together to ensure optimal bone health. Conditions relating to calcium and parathyroid hormones not only lead to poor bone health and osteoporosis, but also to other complications such as kidney problems.
Many studies have reported associations between low vitamin D levels and poor health outcomes. Vitamin D deficiency can result in osteomalacia, a condition marked by inadequate mineralization of bones. This can give rise to body aches, muscle weakness and bone fragility.
Proper work up and treatment of calcium, vitamin D and parathyroid hormones problems are important in preventing the complications associated with dysregulation of these electrolytes and hormones.
While the majority of hypertension are due to increasing age and genetic factors (termed essential hypertension), a significant proportion of hypertension, especially those that are difficult to control, are due to an underlying hormonal conditions. All patients with hypertension developing before the age of 40, or those with difficult hypertension, should have these hormonal causes properly evaluated.
Hypertension can lead to heart attacks, strokes, blindness and kidney failure if poorly treatment. Proper work up and treatment of difficult and young hypertension can reduce these risks significantly.
A study, conducted from 2004 to 2007 with some 5,000 Singaporeans showed that 48.1 percent had high cholesterol. But 17.3 percent were unaware of their condition until they were tested during the study.
Leaving high cholesterol untreated increases the risk of debilitating heart attacks and strokes. Some patients remain reluctant to take statins (a class of medication used to treat hypercholesterolaemia), for fear of side effects such as liver inflammation and muscle aches. Some cholesterol problems are secondary to underlying hormonal problems, and some are difficult to treat, yielding poor results with the usual medications. Endocrinologists are able to provide comprehensive lipids treatment, especially for difficult cases.
In general hypercholesterolaemia is a highly treatable condition, often with significant reduction of vascular risk with proper treatment.
Hypoglycemia (Low Blood Sugar)
Hypoglycemia occurs commonly in patients on diabetic medications. Often this requires proper education and adjustment of diabetic treatment regimens. Sometimes hypoglycemia may occur in patients not on any diabetic drugs. Rarely this might be due to hormonal conditions such as an insulin-producing tumour.
Proper work up and evaluation of hypoglycemia is crucial in diagnosing these conditions as these conditions can be hazardous if left untreated. Prompt diagnosis and treatment of these underlying conditions can bring about excellent clinical outcomes in the long term.
Electrolyte Issues Including Sodium and Potassium
Low sodium problems are fairly common, especially in the elderly. Most often, these are related to medications or their underlying medical conditions. In some cases, it can be due to a hormonal condition. Low sodium can bring upon significant health issues, such as seizures and recurrent falls in the elderly. Proper work up and treatment of low sodium are important to avert these consequences.
Similarly potassium issues are fairly common. While many of these are again due to medications, some can be the results of hormonal conditions such as Conn’s syndrome, Cushing syndrome etc. Proper work up is essential to diagnose and treat these conditions effectively.
The pituitary is a gland situated in the brain and secrets hormones that regulate many other hormones in the body. Sometimes a pituitary tumour may develop, producing excessive hormones, and causing conditions such as hyperthyroidism (high TSH hormones), Cushing’s disease (high steroid level) and acromegaly (high growth hormone level).
A pituitary tumour may also produce high prolactin levels (prolactinoma), leading to irregular or absence menses, milky breast discharge and infertility.
Pituitary gland may also be under secreting these hormones, causing problems such as growth hormone deficiency, hypothyroidism, low sex hormones levels, resulting in a host of problems with sexual health, fertility and poor bone health etc.
Proper work up of the pituitary function can diagnosed these conditions and appropriate treatment can be rendered to treat these conditions effectively.
The adrenal glands are a pair of endocrine glands situated right above the kidneys. They are responsible for producing stress hormones such as the cortisol and adrenaline for maintaining your blood pressure and your body response to stress. In women, the adrenal produces some sex hormone and are important for maintaining libido. Adrenal over-secreting (hyper-functioning) are well recognized clinical syndromes and can give rise to severe conditions such as Cushing Syndrome, Conn’s Syndrome, pheochromocytoma, manifesting as hypertension amongst other clinical symptoms and signs. The adrenal can also under-secretes hormones (hypo-functioning) giving rise to condition such as Addison disease. Without treatment, these conditions can be very serious and debilitating.
Advanced tests are available to diagnose and treat these conditions to good clinical outcomes.
The growth and development of young adults can be plagued with medical issues, many of these with an underlying hormonal basis. While many cases of delayed puberty can be due to constitutional delay, underlying hormonal endocrine problems may be the cause of such delay.
Gynaecomastia, the development of breast tissue in men, can happen as part of normal puberty. Often this presents a source of concern and embarrassment to the patient. Some of these cases may be secondary to a hormonal issue and may be amenable to treatment.
The young are often physically active and may sustain fractures in the course of their physical activities. In some of these cases, these fractures are the results of poor bone health and osteoporosis, which in turn could be secondary to a hormonal problem. Proper work up and treatment of these conditions can lead to significant improvement in bone health in the years to come.
Women’s Health / Reproductive Endocrinology
A woman menstrual cycle is often tightly regulated. Premature cessation of menses (premature ovarian failure) may signal underlying significant hormonal problems. In younger women with amenorrhea (absence menses) a multitude of hormonal problems such as PCOS, prolactinoma, thyroid problems, cortisol issues etc, may be the underlying cause. A proper hormonal work up is essential in the absence of a reasonable cause of amenorrhea.
Polycystic ovarian syndrome (PCOS), in short, is a condition in which a woman’s hormones are out of balance. The condition is frequently associated with weight gain in a young woman. This results in androgenization (acne, excessive facial and body hair), menstrual irregularities and infertility. PCOS is common, affecting as many as 1 out of 10 women. It is thought to be one of the leading causes of female subfertility and the most frequent endocrine problem in women of reproductive age. Besides the disturbances in the sex hormones, the sinister feature of the syndrome is insulin resistance and obesity, which lead to diabetes. In fact, as many as 1 in 4 women with PCOS have diabetes. As a result of these metabolic disturbances, women with PCOS have a higher risk of cardiovascular event in their lifetime. Although termed as an ‘ovarian’ syndrome, the underlying pathology is not restricted to the ovaries. Often, there is a conglomeration of endocrine and metabolic problems in a woman with PCOS. These hormonal and metabolic disturbances can be amenable to treatment, with restoration of menstrual cycles and fertility in many instances.
Erectile dysfunction commonly occurs with aging and chronic disease such as obesity and diabetes. Andropause (a decline in testosterone levels occurring in aging) can give rise to symptoms of testosterone deficiency such as fatigue, low mood and erectile dysfunction. Testosterone deficiency may also result from problems with the pituitary gland or with the testes.
Testosterone replacement can be helpful in men who are suffering from hypogonadism (a condition marked by low sex hormone). However testosterone treatment if administered indiscriminately can lead to a host of adverse effects. It is therefore important to consult a physician who is well versed with testosterone therapy, its adverse effects and means of monitoring the therapy, before embarking on such replacement. If administered appropriately, testosterone replacement therapy can be helpful in many of these patients who suffer from sex hormone deficiency.
Many people with vague or non-specific symptoms may turn to supplements and/or alternative medicines to boost their health or ‘jump start’ their systems. What is unknown is that, many of these unwarranted treatment or supplements obtained from unreliable sources may be adulterated with hormones such as steroids, thyroid hormones or other hormones. Consumption of these products may result in hormones abuse and bring about long term detrimental effects. Anyone with chronic debilitating symptoms should consult a physician for a proper work up and should avoid relying on supplements from unreliable sources to resolve their symptoms. Many of such hormonal abuse cases need to be promptly managed with care and endocrine expertise to avoid long term complications.