1. Adrenal disorders
The adrenal glands can under or over produce adrenal hormones. We treat the following rare diseases of the adrenal gland:
- Cushing syndrome – too much of the hormone cortisol
- Pheochromocytoma – A type of adrenal tumor that makes too much adrenaline and similar hormones
- Aldosterone-producing tumor/Conn’s syndrome-too much aldosterone, which causes salt retention and high blood pressure
- Addison’s disease/adrenal insufficiency-too little cortisol
2. Bone disease
Osteoporosis and Osteomalacia
Osteoporosis is the most common type of bone disease. More than 10 million Americans have osteoporosis and another 18 million have low bone mass, or osteopenia, which may eventually lead to osteoporosis.
Osteoporosis occurs when the body fails to form enough new bone, when the rate of old bone breakdown is too fast, or both. The bones become fragile and more likely to fracture.
The leading cause of osteoporosis is a drop in estrogen in women after menopause and a drop in testosterone in men. Women, especially those older than 50, get osteoporosis more often than men.
There are other disorders that can affect bones, such as too much parathyroid hormone, long-term use of steroids, or thyroid disease.
Deficiency in calcium or Vitamin D can cause the bone to become soft. This is known as osteomalacia.
Osteoporosis diagnosis and treatment
- DXA bone density testing
- Oral bisphosphonates such as Fosamax (alendronate), Boniva (risendronate)
- Infusion of intravenous Reclast®, intravenous Boniva®, and subcutaneous Prolia® injections for management of osteoporosis in patients in whom oral anti-osteoporosis medications are not suitable
- Forteo® pen injections
- Workup for secondary endocrine causes of osteoporosis
3. Parathyroid disorders
The parathyroid glands make parathyroid hormone, which balances calcium and phosphorous levels in the blood. Disorders include:
- Hyperparathyroidism-too much parathyroid hormone, causing excess calcium in the blood
- Hypoparathyroidism-too little parathyroid hormone, causing low calcium in the blood
- High or low calcium due to kidney disease, medications, familial conditions, and certain systemic illnesses.
4. Polycystic ovarian syndrome
Polycystic Ovarian Syndrome (PCOS)
PCOS is a condition in which the ovaries contain numerous cysts. PCOS may lead to infertility, excess hair growth, and heavy, irregular or absent periods. Treatments include hormone modifying medications and weight reduction.
What causes PCOS
Low levels of FSH and high levels of androgens (male hormones) do not allow egg follicles in the ovaries to develop and release eggs. Instead, the follicles form multiple small cysts within the ovary. Excess of insulin in the blood can also interfere with ovulation and contribute to polycystic ovarian disease.
Polycystic ovary disease is most frequently diagnosed in women during their reproductive years.
Symptoms of PCOS
- Menstrual periods may be irregular, heavy, very light, or absent.
- Overweight or obesity
- Unwanted hair growth on the face or body.
- Male sex characteristics, such as deepening voice, male pattern baldness, or decreased breast size.
- Insulin resistance or diabetes
Diagnosis of PCOS
- Blood tests may suggest hormonal imbalance.
- An ultrasound may be used to show the size of your ovaries and the thickness of their coverings. A transvaginal ultrasound may be used to obtain even more detailed pictures.
Treatment of PCOS
- Hormonal balance by medications
- Weight loss
- Treatment of insulin resistance and diabetes
5. Pituitary disorders
The pituitary gland is often referred to as the "master gland" because it controls several other glands (e.g. adrenals, thyroid).
It is usually about the size of a pea and consists of two parts (often called lobes) - a front part, called the anterior pituitary, and a back part, called the posterior pituitary.
Anterior pituitary hormones
- Growth hormone (GH)
- Reproductive hormones (gonadotropins): follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
- Thyroid stimulating hormone (TSH)
- Adrenocorticotropic Hormone (ACTH)
Posterior pituitary hormones
- Anti-diuretic hormone (ADH)
Diseases of the pituitary gland
The most common problem with the pituitary gland occurs when a benign growth (often referred to as "adenoma" or 'tumor') develops. This can cause the gland to produce excess hormone, or it can block normal hormone production.
The over or under production of pituitary hormones can cause an imbalance that can lead to infertility, menstrual disorders, growth disorders, thyroid disorders, or too much cortisol production (Cushing’s syndrome). Disorders of the pituitary gland include:
- Cushing’s disease - A condition in which the pituitary gland produces too much of the hormone ACTH (adrenocorticotropic hormone), which stimulates the adrenal glands to produce too much cortisol in the body.
- Acromegaly – A condition in which the pituitary gland produces too much growth hormone during adulthood.
- Prolactinoma – A type of benign pituitary tumor that causes the body to overproduce prolactin, a hormone that produces breast milk.
- Hypopituitarism – A condition in which the pituitary gland produces too little of one or more of the eight hormones it normally secretes.
- Growth hormone deficiency-A condition usually originating in childhood, which can cause growth delays, abnormality in body composition and bone loss
- Diabetes insipidus-a condition due to deficiency in anti-diuretic hormone, which can lead to dehydration
- Syndrome of inappropriate anti-diuretic hormone (SIADH)-a condition caused by excess of ADH, leading to water excess and low concentrations of sodium in the blood.