Deepak Khandelwal

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Endocrinology

  1. What is Endocrinology?

    Endocrinology is a branch of medicine that concerns the study of hormones and its disorders. The endocrine system consists of several glands located in different parts of the body that secrete hormones.

  2. Who are Endocrinologists?

    Endocrinologists are doctors who specialize in study of hormonal diseases like diabetes, thyroid disorders, obesity, growth disorders, etc.

  3. What are the endocrine glands in our body?

    The principal endocrine glands in our body are Pituitary, Thyroid, Pancreas, Adrenal, Parathyroid, and Gonads – ovary and testis. Besides hormones are secreted by various other organs like brain (hypothalamus), heart, kidney, gut, placenta, breasts, etc. The pituitary is considered as a master gland and governs the function of other endocrine glands in the body.

  4. What is hormone?

    These are products of various endocrine glands, which are released in to the bloodstream, which then acts on various cells and tissues of body.

  5. What are Endocrine disorders?

    The endocrine disorders are a varied group of diseases resulting from deficiency or excess of various hormones.

  6. What all disorders come under Endocrine disorders?

    1. Diabetes

    2. Thyroid disorders

    3. Obesity

    4. Sexual disorders, erectile dysfunction, hypogonadism & reproductive endocrinology

    5. Male infertility

    6. Hirsutism (Excessive facial or body hair in females)

    7. Polycystic ovary syndrome (PCOS) and other female endocrine disorders

    8. Disorders of growth – Short Stature, Growth hormone deficiency & Growth hormone excess

    9. Delayed & premature puberty (delayed or early development of various secondary sexual characters in boys or girls)

    10. Osteoporosis (low bone density)

    11. Metabolic bone diseases - Vitamin D deficiency, Rickets, Osteomalacia, Hyperparathyroidism

    12. Pituitary disorders - pituitary tumors, raised pituitary hormone levels (e.g. Prolactin, GH, etc.), deficiency of pituitary hormones, diabetes insipidus

    13. Adrenal disorders - Adrenal tumors, Cushing’s syndrome, Pheochromocytoma, adrenal failure

    14. Disorder of Sexual Development - Small penis, hidden testis, genital ambiguity, gynecomastia (development of breast tissue in males), Turner’s syndrome, Klinefelter’s syndrome

     

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Diabetes

  1. What is Diabetes?

    1. Type 1 Diabetes:

    Type 1 Diabetes develops if the body is unable to produce any insulin. This type of diabetes usually develops before the age of 30 years. Type 1 Diabetes is treated with daily insulin injections, a healthy diet and regular physical activity.

    2. Type 2 Diabetes:

    Type 2 Diabetes develops when the body can still make some insulin, but not enough or when the insulin that is produced does not work properly (known as insulin resistance). Type 2 diabetes is treated with a healthy diet and increased physical activity. In addition to this, medications and/or insulin are often required.

    3. Gestational Diabetes:

    Gestational diabetes develops in 5% to 10% of all pregnancies but usually disappears when the pregnancy is over. Women who have had gestational diabetes are at an increased risk (up to 50%) of developing type 2 diabetes later.

     

  2. Who all are at more risk of developing Diabetes?

    Indians in general are more predisposed for developing Diabetes. In addition, other risk factors are:

    • If any of your close family member has diabetes (parent, brother or sister)

    • Overweight or obese (Body mass index more than 23)

    • Habitual physical inactivity

    • Women who delivered a baby weighing >3.5 kg or were diagnosed with diabetes during pregnancy

    • High blood pressure

    • Those with high blood cholesterol

    • Women with Polycystic ovary syndrome (PCOS)

    • Heart disease patients

     

  3. Why does my child have type 1 diabetes?

    Why does my child have type 1 diabetes?

    When a child is diagnosed with type 1 diabetes it not only affects the child’s life but the family as a whole. The process of learning about diabetes and making adjustments continues for a long time, may be years and in this journey many times one question arises, “why does my child has type 1 diabetes” or a teenager may think, “why do I have diabetes”?

    Type 1 diabetes is not caused by wrong eating habits or lifestyle nor is it a sin or punishment. The question still remains unanswered as to why some children get it. The answer to this question is not as important as is the fact that with the help of regular insulin injections, proper monitoring and incorporation of nutritious foods and physical activity into each day, one can enjoy a relatively normal, healthy life.

    Every day technology for taking insulin is changing. Now we have finer thin and small needles, which are almost painless. We have smart glucose monitoring devices and somewhere research to find a cure is making progress. While we're not there yet, in our vision of changing diabetes we always hope to find a cure for type 1 diabetes.

  4. What are signs and symptoms of diabetes?

     Frequent urination  Increased thirst

     Sudden weight loss  Increased hunger

     Always tired  Wounds that won't heal

     Blurring of vision  Sexual problems

     Vaginal infection  Tingling or numbness in hands or feet

     

  5. Do I need to check myself for diabetes even if I do not have any symptoms?

    Majority of diabetics in fact do not have any symptoms. After the age of 45 years all people should get their blood sugar checked routinely even in the absence of symptoms and risk factors. If your blood sugar is normal you should get it checked every 3 yearly.

  6. How can I check myself for diabetes?

    You need to get your blood sugar checked in fasting as well as 2 hours after taking 75gms of glucose. You should consult your doctor for all precautions & information prior to testing.

  7. Why to control diabetes?

    Poorly managed diabetes can lead to various complications like blindness, kidney failure, neuropathy, heart attack, paralysis, sexual and urologic problems. Although diabetes cannot yet be cured, it can be successfully managed. In order to stay away from complications, it is important that your blood glucose is adequately controlled. Eating a balanced diet, managing your weight and following a healthy lifestyle together with taking your prescribed treatment and regular monitoring is important.

  8. What are regular investigations required in diabetics?

    • Every visit - blood glucose, blood pressure, foot examination.

    • 3 monthly - HbA1C (Glycated hemoglobin)- This test gives estimate for average blood sugar control over past 3 months

    • Yearly - Kidney function test (KFT), lipid profile, fundus for diabetic retinopathy, urine for mirco albumin

     

  9. What are the goals to achieve for good diabetes control?

    • Pre meal blood sugar- 70–130 mg/dL

    • Post meal blood sugar- <180 mg/dL

    • HbA1C (Glycated hemoglobin)- <7.0%

    • Blood pressure- <130/80 mmHg

    • LDL cholesterol-<100 mg/dL

     

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Thyroid

  1. What is thyroid gland?

    A thyroid gland is an endocrine gland; which manufactures thyroid hormone that is essential for the function of every tissue in the body.

  2. Where is the thyroid gland in our body?

    The thyroid gland is located in the lower part of the neck.

  3. What does the thyroid gland do?

    The thyroid gland produces thyroid hormones which it secretes into the bloodstream, which then act to affect cells and tissues in other parts of the body. Thyroid hormones regulate the speed at which your body cells work. Thyroid hormones also help children grow and develop

  4. What are common disorders of thyroid gland?

    • Hypothyroidism (underactive thyroid gland)

    • Hyperthyroidism (overactive thyroid gland)

    • Goiter (enlargement of thyroid gland, visible as neck swelling)

    • Thyroid malignancy (cancer of thyroid gland)

     

  5. What is hypothyroidism?

    Hypothyroidism means that the thyroid gland can't make enough thyroid hormone to keep the body running normally.

  6. What causes hypothyroidism?

    Most cases of hypothyroidism are caused by a condition called Hashimoto's thyroiditis, in which a patient's immune system attacks and destroys the thyroid. Iodine deficiency used to be a common cause in India but after iodized salt became widely available has now become rare. It can also be caused by treatment of hyperthyroidism or by certain medications, and it may be present from birth.

  7. How do I suspect hypothyroidism (under functioning of thyroid)?

    Common complaints include fatigue and lethargy, cold sensitivity, dry skin and lifeless hair, impaired concentration and memory, increased weight, puffiness and constipation. Patients may also fairly often experience a hoarse voice, tingling of the hands, heavy or delayed menstrual periods, deafness and joint aches. In childhood there may be delayed development and puberty. Some patients have a swelling in the front of the neck due to thyroid enlargement (a goiter).

  8. Can I have hypothyroidism even if I don?t have any of above mentioned symptoms?

    Yes. Many patients have relatively few of the classical signs or symptoms just listed. In fact, nowadays most patients often are diagnosed at an early stage of disease, due to increased awareness and improved testing

  9. How is the diagnosis of hypothyroidism made?

    Your doctor will be able to get a good assessment of your thyroid gland activity by taking a history of your symptoms and by a physical examination. However to confirm the diagnosis, it is necessary to get laboratory tests that measure thyroid function test (TFT; serum T4 and TSH levels).

  10. How is hypothyroidism treated?

    With synthetic thyroxine (T4). Thyroxine (T4) is the major hormone produced by the thyroid gland and pure synthetic T4, taken once daily by mouth, successfully treats the symptoms of hypothyroidism in most patients. The current branded forms of synthetic T4 are Eltroxin, Thyronorm, Thyrox, Thyroup, Thyrofit,Thyobuild, Lethyrox, Thyrocheck etc. Because of variations in the potency of T4 made by different manufacturers, including generic preparations, it is best to stay on T4 from a single manufacturer whenever possible.

  11. How long do I need to take treatment, if I have hypothyroidism?

    It depends on diagnosis. It can be a few months as in case of viral thyroiditis. However, in most cases, you may have to take treatment lifelong so as to keep your hormone levels in normal range.

  12. Why I need to regularly monitor my treatment, if I am on treatment for hypothyroidism?

    If you are not taking enough T4, some of the symptoms of hypothyroidism may continue. If you take too much, you may have symptoms of an overactive thyroid, including nervousness, a racing heart, trouble sleeping, and shaking. You should get repeated your thyroid function test as per advice of your doctor.

  13. What is hyperthyroidism (over functioning of thyroid)?

    If too much of the thyroid hormones are secreted, the body cells work faster than normal, and you have thyroid overactivity or 'hyperthyroidism' (also referred to as "thyrotoxicosis").

  14. How do I suspect hyperthyroidism (over functioning of thyroid)?

    Common complaints include fatigue, heat intolerance, sweating, weight loss despite good appetite, shakiness, inappropriate anxiety, palpitations of the heart, shortness of breath, tetchiness and agitation, poor sleep, thirst, nausea and increased frequency of defecation, enlarged thyroid gland and prominent or bulging eyes. Children tend to have hyperactivity, with a short attention span. It is not uncommon for people to worry that they have cancer, because of the associated weight loss.

  15. What is Goitre?

    Goitre is an enlargement of the thyroid Gland, which is situated in front of the neck. In many cases it is related to abnormal thyroid hormone levels.

  16. Can I have a normal hormone level and yet have Goitre?

    Yes, it is possible.

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Obesity

  1. What is obesity?

    Obesity is a medical condition that occurs when a person weighs considerably more than is considered healthy. This extra weight can put extra strain on the body and serious health complications can arise if treatment is not sought and the weight is not lost.

  2. What is Body mass index (BMI)?

    BMI is a way medical professionals check if you are at a healthy weight for your height. BMI is calculated as -Weight in kilograms/ (height in meter)2 For example if your weight is 60 kg and height is 160 cm = 1.60 m, your BMI will be 60/1.60x 1.60 = 23.4

  3. What is cut off for BMI, to classify a person as overweight or obese worldwide?

    As per World Health Organization (WHO) criteria, your BMI should fall between 18.5 and 24.9 to be normal. If your BMI is between 25 and 29.9 you are overweight. A BMI ≥ 30 classifies you as obese. People who have a BMI of ≥ 40 fall into the ‘morbidly obese’ weight bracket.

  4. Is these cut off of BMI different for Indians, to classify them as overweight or obese?

    Yes. As per classification system suggested for Indians, if your BMI is between 23 and 24.9 you are overweight. A BMI between ≥ 25 classifies you as obese.

  5. Are Indians at more risk of bad effects of overweight or obese at lower BMI as compared to other races?

    Yes. At the same level of BMI, Indians have higher body fat, higher risk of diabetes, hypertension, cardiac and other problems related to obesity as compared to other races. That’s why a lower cut off for BMI has been suggested to classify them as overweight or obese.

  6. Why obesity is an Endocrine problem?

    Many cases cause of obesity may be because of hormonal disturbances like hypothyroidism (underactive thyroid gland), excess of cortisol (a hormone secreted by adrenal gland); in these cases cure of hormonal problem may results in normalization of weight. Also, obesity itself may results in disturbance in other hormones in our body, like increase in serum insulin and insulin resistance, which predisposes one to increased risk of developing diabetes. All obese people should seek consultation with Endocrinologist, and get themselves evaluated as per their advice.

  7. What factors contribute to the development of obesity?

    Numerous factors can lead to obesity, but the most common cause is a sedentary lifestyle combined with bad diet and lack of exercise. As most of us do not have physical occupations, it becomes harder to get enough exercise during our daily routine. Consuming large portions of fatty foods, sweet foods and sugary drinks (high in calories and low in nutrients) consumed on a frequent basis leads rapid weight gain. Other possible causes can be due to stress or insomnia; the use of antidepressants and steroids; and hormone problems, such as polycystic ovarian syndrome or Cushing’s syndrome.

  8. Is obesity hereditary?

    Obesity often runs in families, which suggests there is a genetic link. Parents also pass on common dietary habits to their children and may share a similar attitude towards physical exercise and lifestyle habits. However, there is no certainty that these factors must result in obesity; they may contribute, but do not make obesity a certainty.

  9. Can anyone become obese?

    Potentially, any individual could become obese. However, certain groups of people will be more inclined to the condition than others, depending on certain genetic, medical and environmental factors. People who have a bad diet and do not exercise regularly are far more likely to become obese than those who eat healthily and exercise.

  10. Is obesity only a cosmetic problem or a medically dangerous too?

    Obesity is considered to be a dangerous condition because it may lead to a number of serious health problems, such as high cholesterol, heart disease, diabetes and high blood pressure, osteoarthritis, sleep apnea and various cancers. Other problems that can arise as a result of obesity include depression, acne, gallstones, breathlessness, difficulty sleeping, social anxiety and trouble with walking or running. Also, women who are obese are more likely to have problems during and after pregnancy.

  11. How can I prevent obesity from developing?

    Following a healthy eating plan, decreasing the size of your meals, more regular exercise, regular monitoring of your weight helps you in preventing yourself from getting obese. Experts recommend exercising for at least half an hour every day to stay active and healthy. You should make a particular effort to do this if you have a predominantly sedentary lifestyle.

  12. How to lose weight?

    First line treatment is proper diet and exercise. Almost everyone who receives a diagnosis of obesity will be advised to first make a serious of lifestyle changes before any form of medical treatment is attempted. This is because, for most people, healthy diet and regular exercise will be all that is needed to lose weight healthily and permanently. As results can take some time to become visible, it is often difficult to stay motivated, and for this reason many people find some form of support group helpful. If there is a specific medical condition that is giving rise to obesity that needs to be corrected. If these changes are implemented but do not produce results, you may be prescribed medication to help produce effective results.

  13. Will medications help me losing weight?

    Some medications like orlistat, sibutramine etc. are clinically proven to help people lose weight, but their effect is modest only. Medications should be taken alongside a healthy diet and regular exercise for effective and long-term results. For Indians medications are recommended for BMI above 27 kg/m2 without any co-morbidity, or a BMI above 25 kg/m2 if person has any obesity related co-morbidities like diabetes, high blood pressure, high cholesterol.

  14. What is bariatric surgery?

    Bariatric surgery helps you lose weight by altering your body’s food digestion and absorption. It is the treatment option for those with morbid obesity. Various procedures are gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass. You can get detailed information related to these procedures from Bariatric surgeon or Endocrinologist. For Indians bariatric surgery is recommended for BMI above BMI above 37.5 kg/m2 without co-morbidity, and BMI above 37.5 kg/m2, if person has any obesity related co-morbidities like diabetes, high blood pressure, high cholesterol.

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PCOD

  1. What is PCOD or PCOS?

    The terms Polycystic Ovary Syndrome (PCOS) and Polycystic Ovarian Disease (PCOD) are commonly used interchangeably. It is a hormonal problem commonly seen in young girls and ladies.

  2. What are the symptoms of PCOD?

    • Irregular cycles
    • Hirsutism (excess facial/body hair in females)
    • Excessive acne
    • Excessive scalp hair loss
    • Lack of, or infrequent ovulation resulting in difficulty to conception
    • Ovarian Cysts or enlarged ovaries in ultrasound
    • High levels of testosterone
    • Chronic pelvic pain

  3. How common is PCOD?

    PCOD is most common hormonal problem/endocrine disorders in females in reproductive age group. Almost 10-15 % of girls and women have PCOD.

  4. What is Hirsutism?

    Hirsutism is the excess growth hairs over face or other body parts in females. Women affected by PCOS commonly experience hirsutism due to increased levels of the male hormones called androgens/testosterone.

  5. Who all are at increased risk for developing PCOD?

    • Indian girls and women are in general at higher risk as compared to other races
    • Ladies who are overweight/obese
    • Ladies with family background of PCOD (Who have sisters/mothers/aunts with PCOD)
    • Ladies with family background of diabetes

  6. What causes PCOD?

    An exact cause of PCOD has yet to be determined. There may be a genetic link; that this condition is passed through generations. Studies show that a large number of women with PCOD also have insulin resistance, and that insulin resistance can alter or negatively affect hormone levels, causing infertility and other cycle irregularities.

  7. What is Insulin resistance?

    Insulin resistance is a condition common to PCOD in which the tissues of the body become less responsive to the hormone insulin. If left untreated, these people are at risk of developing diabetes in future. If diagnosed appropriately, there are treatments available which can prevent the progression to diabetes.

  8. Are depression and anxiety common in women with PCOD?

    Recent studies show that many women with PCOD suffer some type of depression or anxiety issues. This is believed to be caused by the possible link between hormone imbalances and depression.

  9. How do you make the diagnosis of PCOD?

    In order for your doctor to make the diagnosis of PCOD he/she will have to obtain a detailed medical history. In addition blood tests for various hormones and ultrasound pelvis are required.

  10. What all health hazards are associated with PCOD?

    It’s so important to understand the long-term health risks associated with PCOD. Not all women with PCOD will develop all of these, but PCOD does increase your risk.

    • Endometrial hyperplasia and/or endometrial cancer
    • Type 2 diabetes
    • Sleep Apnea
    • High blood pressure and High cholesterol
    • Heart disease
    • Stroke
    Regular monitoring of PCOD and its symptoms are so important. Regular blood tests including blood sugar, cholesterol and triglycerides are important.

  11. What is the lifestyle precautions advised for PCOD ladies?

    All patients of PCOD should follow a healthy lifestyle. Those who are overweight/obese, losing weight in these ladies make marked relief in their symptoms. Ladies with PCOD should follow a healthy diet and should do regular exercises.

  12. What is the treatment of PCOD?

    With proper treatment many of the symptoms can be controlled and possibly even eliminated. With appropriate treatment hirsutism, acne, irregular periods, weight gain, and infertility all can be treated. All women with PCOD should seek the care of an Endocrinologist to optimize their health and prevent progression of symptoms.

  13. Can ladies with PCOD get pregnant?

    Women with PCOD generally have irregular, infrequent, or even absent ovulation. Without ovulation there is no egg or ovum that is available for fertilization. Also, there is increased risk of miscarriage in women with PCOD. Your doctor can provide you with medications that can help you ovulate, in a process called ovulation induction.

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Male Sexual health and Hypogonadism

  1. What is testosterone?

    Testosterone is commonly referred to as ‘Male hormone’. It is a hormone secreted mainly from testes. Small amount of testosterone is also synthesized in females from ovaries. Testosterone results in development and maintenance of secondary sex characters in males and necessary for normal sexual life in males (for example, penile enlargement, facial hair, interest in sex). The testosterone levels are regulated by hormones released the hypothalamus and pituitary glands in the brain.

  2. What is male hypogonadism?

    Hypogonadism is the failure of the body to produce sufficient testosterone to meet the body's needs. Hypogonadism can be because of testicular failure or due to problem in the pituitary gland or hypothalamus.

  3. What are the symptoms of Hypogonadism?

    • Low libido (decrease in desire for sex)
    • Erectile dysfunction (decrease in penis erection leading to sexual dissatisfaction)
    • Decrease in frequency of shaving
    • Decrease in body hairs
    • Gynecomastia (enlargement of breast tissue in males)
    • Lethargy, general malaise, depression, and mood swings
    • It can also result in increased risk for many diseases including Osteoporosis, Alzheimer’s, Diabetes, Arthritis and/or Cardio-vascular problems.

  4. What is the cause of hypogonadism?

    Some people are born with it, due to a genetic problem. Others acquire it because of reasons like environmental effects, alcohol intake, and smoking, drugs, (prescribed or otherwise), various systemic illness or injury.

  5. What tests are done to diagnose hypogonadism?

    Blood test for serum testosterone and other hormones like LH and FSH may be required to diagnose hypogonadism. You should consult Endocrinologist to get the required tests done and for precautions before the test.

  6. What is the treatment of hypogonadism?

    It depends on the cause of hypogonadism. At present, this condition is fully treatable. Commonly testosterone supplements are used in various forms depending on patient preference. One should consult Endocrinologist before starting treatment.

  7. What is erectile dysfunction?

    Erectile dysfunction (ED) is defined as the inability of a man to achieve and maintain an erection sufficient for mutually satisfactory intercourse with his partner.

  8. How common is erectile dysfunction?

    Approximately 50% of men over the age of 40 have some degree of erectile dysfunction – some mild, some severe. So, erectile dysfunction is very common. However, most men don’t seek help with a doctor. It’s estimated that only about 10-15% of men with Erection problems seek help, despite the fact that effective treatments are available. Embarrassment, fear, and discomfort talking about the subject and inability to find a right doctor, keep many men from the treatment they need to help themselves and their partners.

  9. What causes erectile dysfunction?

    Causes of erectile dysfunction can be physical and psychological. Reduced blood flow to the penis and leakage of blood out of the penis are the most common causes. A partial list of the many causes of ED includes the following:

    • Hormonal imbalances
    • Diabetes
    • Heart and vascular (blood vessel) disease
    • Neurological disorders
    • Chronic diseases (kidney or liver failure)
    • Drug and alcohol abuse
    • Side effects of some medications (antidepressant)
    • Psychological causes like work-related stress and anxiety, concern about sexual performance, marital or relationship problems, or depression

  10. Are most cases of erectile dysfunction because of psychological causes?

    No. Years ago, doctors felt that ED was caused by 90% psychological problem and 10% by physical problems. Now doctors know the opposite is true. About 90% of Erection problems are caused by physical problems with the blood vessels, veins, or nerves and only about 10% of cases are due primarily to psychological issues. Although, it is very common to have some degree of anxiousness, stress or even depression in patients with erection problems, but most often these come after a physical problem caused the erection problem, not before.

  11. What is premature ejaculation?

    Premature ejaculation is often confused with erectile dysfunction. Premature ejaculation is a condition in which the entire process of arousal, erection, ejaculation, and climax occur very rapidly, often in just a few minutes or even seconds, leaving the partner unsatisfied. Premature ejaculation may accompany an erection problem such as erectile dysfunction, but is generally treated differently.

  12. What causes male infertility?

    Infertility may result from a physical condition that is present at birth or that develops later in life. Examples of causes of male infertility include: Physiological dysfunctions, Hormonal imbalances, Testicular failure, Lifestyle factors etc.

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SHORT STATURE & GROWTH DISORDERS

  1. What is Short stature (short height)?

    Short height is defined when child is short compared to age and sex matched children in respect to parents height.

  2. Why timely consultation important for children with short stature?

    Once the bones (epiphysis) are fused; height cannot be increased further. Many short children are brought to Endocrinologist so late that bones have already fused and nothing can be done then for increasing height. Almost best outcome are possible when treatment is started earliest in any case of growth disorder.

  3. How growth problems could be suspected in a child?

    • If he/she is shorter as compared to his/her classmates
    • If child is not outgrowing his/her clothes & shoes
    • He/she is gaining height less than 4-5 cm/year
    • Heavier than his/her friends

    If you suspect any of above thing in your child; you should consult your doctor

  4. What factors can contribute to normal height gain in children?

    In children the various hormones (as growth hormone, thyroid hormone, and sex hormones), plays the role in normal height gain. Also many nutrients are also required for potential height growth.

  5. What are the causes of short stature?

    • Hormone Disorders- Growth hormone deficiency, thyroid hormone deficiency, etc.
    • Malnutrition and Mineral Deficiencies- Under nutrition (of calorie, protein), Vitamin D deficiency, Calcium deficiency, Iron deficiency, etc.
    • Systemic Diseases- Diseases of the kidney, liver, heart, lungs or any body system can affect growth.
    • Familial short stature – if parents have short height
    • Constitutional delayed growth with or without delayed puberty
    • Other genetic disorders such as Turner syndrome
    • Idiopathic Short Stature – if no cause could be found for short stature
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GROWTH HORMONE DEFICIENCY (GHD)

  1. What is Growth hormone?

    Growth hormone is a natural protein produced by the pituitary gland; an endocrine gland found in the brain. A child needs growth hormone for growth and body development during childhood.

  2. What is Growth hormone deficiency (GHD)?

    Growth hormone deficiency (GHD) is one of the causes of short stature. GHD means that the child’s body does not make enough growth hormone.

  3. How GHD affect a child’s height?

    Without treatment a child with GHD will usually grow less than 4–5cm (~2 inches) a year. Quite often, the child will grow normally until the age of 2 or 3 and then growth begins to slow down. It’s important to realize that a child may be smaller than average, but will have normal body proportions. In other words, children with GHD tend to seem younger and have more body fat than children of the same age who are growing normally. Children with GHD are generally perfectly healthy in every other aspect.

  4. How is GHD diagnosed?

    GHD needs to be tested when other causes of lack of growth have been ruled out. You need to consult an Endocrinologist if your child is not growing normally. A child may have to take a special medicine to stimulate the pituitary gland, which is where growth hormone is produced within the body. In children with GHD, the pituitary gland releases far less growth hormone than normal in response to this stimulation. It is very important to understand that random estimation of single growth hormone value has no role in the diagnosis of GHD.

  5. How GHD is being treated?

    Once a child is diagnosed as having GHD, growth hormone injections can help the child catch up with the growth of other children of the same age during early childhood. Continuing the injections helps maintain normal growth later in childhood, with the final aim of achieving an adult height within the normal range. The response to growth hormone treatment varies from one individual to another, but most children who receive treatment over several years will reach a normal or near normal adult height.

  6. How Growth Hormone injections are being given?

    Growth hormone injections are normally given once-daily in the evening. At the beginning parents are trained to give these injections if the child is very young. Later on, children can inject themselves when they feel confident enough. Devices are now available that make injecting growth hormone much simpler, more comfortable and less painful.

  7. What is the importance of early treatment?

    The earlier the treatment started in a child with GHD; the better the prospects of their eventually reaching normal adult height.

  8. What are the other challenges of children with GHD?

    If a child doesn’t grow as fast as other children, this can have an impact on the whole family. Many children who are shorter than their schoolmates may experience emotional problems, bullying and difficulties with daily activities such as sports. For these reasons, it’s important to explain to a child that things will improve once the growth hormone treatment has been working for a while. In the meantime, remember to act towards a child according to the age they actually are, not the age they look.

  9. How long does a child need treatment?

    In most cases treatment with growth hormone is needed until the end of puberty till the bones fuses. However, many people will benefit from growth hormone treatment for many years after that; especially those who have severe GHD.

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OSTEOPOROSIS

  1. What is osteoporosis?

    Osteoporosis is a condition in which bones become weak due to decrease in the amount of mineral & bony material in a particular bone characterized by low bone mineral density (BMD). Osteoporosis makes your bones weak and more likely to break. Bones that are affected by osteoporosis can fracture with only a minor fall or injury that normally would not cause a bone fracture.

  2. Who all are at risk of developing osteoporosis?

    Anyone can develop osteoporosis, but it is common in older women. As much as 50% women and 25% men older than 50, will have a fracture due to osteoporosis.
    Risk factors for osteoporosis include-

    • Getting older
    • Being small and thin
    • Having a family history of osteoporosis
    • Taking certain medicines like steroids and ant seizure drugs
    • Being a white or Asian woman
    • Hypogonadism (deficiency of estrogen or testosterone in females and males respectively)
    • Premature menopause in females
    • Thyroid hormone excess/Hyperthyroidism
    • Calcium deficiency & Vitamin D deficiency
    • Drinking large amount of alcohol
    • Heavy Smoking
    • Other systemic diseases like Malabsorption, rheumatoid arthritis, chronic liver disease etc.

  3. What are the symptoms of osteoporosis?

    Osteoporosis is typically a silent disease. You might not know you have it until you break a bone. Patients typically have fracture with little or no trauma as fall on ground. The most common fractures are spinal bones, hip bone and wrist in people with osteoporosis. Symptoms occurring late in the disease are bony pains, back pain or pain on compression of the bone. Loss of height may occur because of vertebral fractures over time leading to decrease in height of vertebra.

  4. How is osteoporosis diagnosed?

    A bone mineral density (BMD) test is the best way to check your bone health. BMD test can measure bone density in various sites of the body, such as the hip, spine, and wrist. Most commonly it is done by through dual-energy x-ray absorptiometry (DEXA) scan. These tests are quick (taking less than 15 minutes), painless, and noninvasive. A bone density test can detect osteoporosis before a fracture occurs and can predict your chances of having a fracture in the future. You should consult your doctor to know more about these tests.

  5. How Can Osteoporosis Be Prevented?

    To keep bones strong, eat a diet rich in calcium and vitamin D by drinking milk or eating milk products and taking vitamin D supplements, exercise and do not smoke. Avoid excessive intake of alcohol.

  6. How is osteoporosis treated?

    Osteoporosis treatment includes both lifestyle changes and medications. Treatment programs focus on nutrition, exercise, and safety issues to prevent falls that may result in broken bones. Your doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk.

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