Endocrinology and Metabolic Diseases

Endocrinology and Metabolism Diseases is a sub-specialty of internal medicine that undertakes the diagnosis, treatment, and follow-up of diseases of the hormone-producing glands (endocrine glands) and metabolic disorders in the body. Functional disorders of endocrine organs such as the thyroid, pituitary, adrenal glands, pancreas, parathyroid, gonads, and hypothalamus fall within the scope of this department. The Koru Hospital Department of Endocrinology and Metabolism Diseases provides high-level healthcare services in the diagnosis and treatment of hormonal and metabolic diseases with its experienced specialist staff and comprehensive laboratory infrastructure.

What is the Endocrine System and How Does It Work?

The endocrine system is a communication network consisting of glands that produce, store, and secrete hormones, which are the body's chemical messengers. Hormones reach target organs through the bloodstream and regulate many vital functions such as metabolism, growth and development, reproduction, sleep-wake cycle, stress response, blood sugar balance, and calcium metabolism.

The main components of the endocrine system are:

• Hypothalamus: The command center of the endocrine system, which regulates the hormone secretion of the pituitary gland.
• Pituitary gland: A small but critical organ called the "master gland" that manages the function of other endocrine glands.
• Thyroid gland: Located in the neck in the shape of a butterfly, it secretes hormones that regulate metabolic rate.
• Parathyroid glands: Produce parathyroid hormone, which regulates calcium and phosphorus metabolism.
• Adrenal glands: Secrete vital hormones such as cortisol, aldosterone, and adrenaline.
• Pancreas: Regulates blood sugar balance by producing insulin and glucagon.
• Gonads (Ovaries and Testes): Secrete reproductive hormones.

Diabetes (Sugar Disease) and Treatment Approaches

Diabetes is the most important and common disease in endocrinology practice. Affecting approximately 15 percent of the adult population in Turkey, diabetes is a metabolic disease characterized by chronically high blood sugar resulting from insufficient production or ineffectiveness of the insulin hormone.

Type 1 Diabetes

Type 1 diabetes develops as a result of the destruction of insulin-producing beta cells in the pancreas through autoimmune mechanisms. It usually begins in childhood and adolescence but can occur at any age. Patients require lifelong insulin therapy. At Koru Hospital, comprehensive services are provided regarding multiple-dose insulin therapy and insulin pump applications in the treatment of Type 1 diabetes.

Type 2 Diabetes

Type 2 diabetes is characterized by insulin resistance and relative insulin deficiency, accounting for approximately 90 percent of diabetes cases. Obesity, a sedentary lifestyle, genetic predisposition, and age are the most important risk factors. Treatment involves lifestyle changes, oral antidiabetic drugs, injectable GLP-1 receptor agonists, and insulin therapy when necessary.

Gestational Diabetes

Gestational diabetes is glucose intolerance that first appears or is diagnosed during pregnancy. Early diagnosis and appropriate management of this condition, which can negatively affect maternal and infant health, are of great importance.

The main approaches applied in diabetes treatment and follow-up are:

• Individualized treatment goals: HbA1c targets are determined based on the patient's age, comorbidities, and life expectancy.
• Continuous glucose monitoring (CGM): Instant monitoring of blood sugar throughout the day is possible with sensor technology.
• Diabetes education: Comprehensive training is provided to patients and their relatives on nutrition, exercise, medication use, and hypoglycemia management.
• Diabetic complication screening: Regular assessment of retinopathy, nephropathy, neuropathy, and cardiovascular risk factors.

Thyroid Diseases

Thyroid diseases constitute the most frequently encountered group of diseases in endocrinology practice after diabetes. The thyroid gland produces T3 (triiodothyronine) and T4 (thyroxine) hormones to control the body's energy metabolism, heat regulation, heart rate, and nervous system functions.

• Hypothyroidism: A condition where the thyroid gland produces insufficient hormones. Hashimoto's thyroiditis is the most common cause. Fatigue, weight gain, cold sensitivity, constipation, and depression are the main symptoms.
• Hyperthyroidism: A condition where the thyroid gland produces excessive hormones. Graves' disease is the most common cause. Palpitations, weight loss, nervousness, sweating, and tremors are the main symptoms.
• Thyroid nodules: Masses that form in the thyroid gland. Although most are benign, they need to be evaluated due to the risk of malignancy.
• Thyroid cancer: A small portion of thyroid nodules may be cancerous. Diagnosis is made via fine-needle aspiration biopsy.
• Subacute thyroiditis: A condition that can develop after viral infections, characterized by painful thyroid enlargement.
• Types of thyroiditis: Different forms of thyroiditis such as Hashimoto's thyroiditis, postpartum thyroiditis, silent thyroiditis, and Riedel's thyroiditis are evaluated.

Thyroid Nodule Evaluation

The evaluation process for patients with thyroid nodules includes the following steps: Thyroid function tests (TSH, free T3, free T4), evaluation of the nodule's size, structure, and characteristics via thyroid ultrasonography, risk determination according to the TIRADS classification, and fine-needle aspiration biopsy (FNAB) if indicated. Biopsy results are evaluated according to the Bethesda classification to create a treatment plan.

Obesity and Metabolic Syndrome

Obesity is one of the most important public health problems of our time and is the fundamental risk factor for many chronic diseases. Services offered within the scope of obesity treatment in the endocrinology department include:

• Hormonal evaluation: Investigation of thyroid functions, cortisol levels, insulin resistance, and other hormonal disorders.
• Body composition analysis: Detailed measurement of adipose tissue, muscle mass, and water ratio.
• Individualized nutrition plan: Preparation of a patient-specific nutrition program in cooperation with a dietitian.
• Pharmacotherapy: Evaluation of medication treatment options in indicated patients (GLP-1 receptor agonists, orlistat, etc.).
• Pre-bariatric surgery evaluation: Comprehensive endocrinological evaluation of surgical candidates.

Metabolic syndrome is the co-occurrence of risk factors such as abdominal obesity, insulin resistance, hypertension, hypertriglyceridemia, and low HDL cholesterol. Early diagnosis and management of this syndrome significantly reduce the risk of developing Type 2 diabetes and cardiovascular diseases.

Pituitary Diseases

The pituitary gland is a small but extremely important gland located at the base of the brain that manages the function of other endocrine glands in the body. Pituitary diseases include:

• Pituitary adenomas: Usually benign tumors that form in the pituitary gland. Prolactinoma, growth hormone-secreting adenomas, and ACTH-secreting adenomas are the most common types.
• Hyperprolactinemia: Excessive elevation of the prolactin hormone, which can cause menstrual irregularities, galactorrhea, and infertility.
• Acromegaly: A disease characterized by growth in the hands, feet, and facial bones resulting from excessive secretion of growth hormone.
• Cushing's disease: Chronic cortisol elevation that develops due to an ACTH-secreting pituitary adenoma.
• Hypopituitarism: A condition where the pituitary gland fails to secrete one or more hormones sufficiently.
• Diabetes insipidus: A disease characterized by excessive thirst and urination resulting from antidiuretic hormone deficiency or ineffectiveness.

Adrenal Gland Diseases

The adrenal glands are organs that produce vital hormones such as cortisol, aldosterone, and androgens. Diseases of these glands include:

• Cushing's syndrome: A condition characterized by chronic cortisol excess. Central obesity, purple striae, hypertension, and muscle weakness are typical symptoms.
• Addison's disease: Adrenal insufficiency, which manifests as fatigue, weight loss, hypotension, and skin darkening.
• Pheochromocytoma: A tumor originating from the adrenal medulla that secretes adrenaline and noradrenaline.
• Primary hyperaldosteronism: Resistant hypertension and hypokalemia develop as a result of excessive secretion of the aldosterone hormone.
• Adrenal incidentaloma: Adrenal masses incidentally detected during imaging performed for other reasons.

Calcium and Bone Metabolism Diseases

Calcium metabolism disorders and metabolic bone diseases constitute an important sub-field of endocrinology:

• Osteoporosis: A disease characterized by decreased bone density and impaired bone quality, increasing the risk of fractures. It is especially common in postmenopausal women.
• Hyperparathyroidism: An increase in blood calcium levels resulting from excessive hormone secretion by the parathyroid glands.
• Hypoparathyroidism: A decrease in blood calcium levels due to parathyroid hormone deficiency.
• Vitamin D deficiency: A common problem with negative effects on bone health and general health.
• Paget's disease: A chronic bone disease characterized by impaired bone formation and resorption.

Reproductive Endocrinology and Sex Hormones

Reproductive endocrinology is a sub-field dealing with disorders of female and male sex hormones:

• Polycystic ovary syndrome (PCOS): The most common endocrine disorder in women of reproductive age. It is characterized by menstrual irregularity, hyperandrogenism, and polycystic ovary morphology.
• Hirsutism: Male-pattern hair growth in women, a condition requiring hormonal evaluation.
• Male hypogonadism: Sexual dysfunction, muscle loss, and bone loss resulting from insufficient production of the testosterone hormone.
• Gynecomastia: Enlargement of breast tissue in men, which may be related to hormonal imbalances.
• Menopause management: Management of hormonal changes that occur during menopause and evaluation of hormone replacement therapy.

When Should You Consult an Endocrinologist?

It is recommended that you consult an endocrinologist in the following situations:

• Patients with a diagnosis or suspicion of diabetes.
• Individuals with detected enlargement, nodules, or functional disorders in the thyroid gland.
• Unexplained weight gain or weight loss.
• Complaints of excessive sweating, palpitations, nervousness, or fatigue.
• Women experiencing menstrual irregularities, increased hair growth, or infertility problems.
• Individuals diagnosed with osteoporosis or at high risk of fracture.
• Patients with detected abnormalities in blood calcium levels.
• Suspicion of diseases related to the pituitary or adrenal glands.
• Individuals identified with metabolic syndrome or insulin resistance.

In the Koru Hospital Endocrinology and Metabolism Diseases department, our specialist physicians provide comprehensive and individualized healthcare services to our patients based on the most current scientific data and international guidelines in the diagnosis and treatment of hormonal and metabolic diseases. You may apply to our outpatient clinic for your endocrinological complaints.