Diabetes and related problems
1. Diabetes Mellitus
Fasting blood glucose > 126 mg/dL
Blood glucose at 2 hour following 75 gm glucose load > 200 mg/dL
Random blood glucose more than 200 mg/dL and osmotic symptoms (polyurea, polydipsia, polyphagia, weight loss)
HbA1c > 6.5%
Fasting blood glucose between 100 to 126 mg/dL
Blood glucose at 2 hour following 75 gm glucose load between 140 to 200 mg/dL
HbA1c between 5.7 to 6.5%
3. Gestational Diabetes Mellitus
4. Diabetes secondary to pancreatitis, steroid intake, etc
1. Hypothyroidism – TSH above normal range along with low T4 level.
Symptoms: Fatigue, weakness, cold intolerance, weight gain, swelling of legs, cold intolerance, menstrual irregularity, dry skin, constipation, etc.
2. Subclinical Hypothyroidism – TSH above normal range with normal T4 level.
3. Hyperthyroidism – TSH level below normal range
Symptoms: Weight loss, fatigue, increased apetite, palpitation, increased sweating, tremulousmess, anxiety, loss of sleep, increased bowel frequency, prominence of eyes – in Graves’ Disease
4. Goitre – Thyroid swelling
5. Subacute Thyroiditis – Neck pain along with transient derangement in thyroid function
6. Thyroid cancer
7. Solitary thyroid nodule
Obesity and Overweight
Overweight – BMI > 25
Obesity – BMI > 30
Metabolic Bone Disorders
1. Osteoporosis – predisposition to fractures
2. Vitamin D deficiency – bone pain, muscle weakness
3. Raised PTH level – Hyperparathyroidism
4. Rickets – Occurs in children due to vitamin D and calcium deficiency
5. Osteomalacia – Adults with bony pain, muscle weakness due to severe vitamin D deficiency
6. Low calcium levels – perioral tingling, carpopedal spasm, seizures (severe cases)
7. Low Phosphate levels – manifest as rickets or osteomalacia in severe and long standing cases, muscle weakness in sever cases
8. High calcium levels – occurs in primary hyperparathyroidism, sarcoidosis, vitamin D overdosage, etc
1. Growth Hormone Deficiency
2. Turner’s syndrome (females)
4. Celiac Disease
6. Chronic systemic disorders – Chronic liver disease, chronic kidney disease, heart and lung disorder, thalassemia, etc.
Female Hormonal Disorders
1. Polycystic ovary syndrome (manifests as hirsuitism, acne, menstrual irregularity, obesity, infertility, etc)
3. Resistant cases of acne
4. Galactorrhea – Milk discharge from breast due to elevated prolactin and other causes
5. Menopause and related problems like hot flushing
6. Premature ovarian failure – early menopause before 40 years of age
7. Primary ovarian failure
8. Some cases of infertility like hyogonadotropic hypogonadism
9. Lack of breast development
10. Primary amenorrhea – absence of periods after 15 years of age
Male Hormonal Disorders
1. Erectile Dysfunction (impotence)
2. Male Hypogonadism (Loss of libido, erectile dysfunction, loss of beard)
3. Delayed Puberty (Absence of features of puberty after 14 years of age)
4. Micropenis (small sized penis)
5. Gynecomastia (development of breasts in male)
6. Male infertility (azoospermia, oligospermia and other causes)
7. Cryptorchidism (undescended testis)
9. Androgen deficiency in elderly population
10. Those who are on testosterone replacement
11. Those having side effects related to androgen therapy
Disorders of Pituitary Gland
1. Mass effect of pituitary tumors – Mass effect of pituitary tumors can cause headache, visual disturbance, vomiting, etc
2. Hormone Excess Disorder
Acromegaly: Occurs as a result of growth hormone excess. Results in enlarged bones of the face, enlarged feet, enlarged hands, increased sweating, fatigue, joint pain, muscle weakness, diabetes, high blood pressure, etc.
Gigantism: Occurs due to excess growth hormone secretion before puberty
Galactorrhea: Discharge of milk from breast, due to excess prolactin secretion.
Cushing’s Disease: Due to secretion of excess ACTH from pituitary gland, manifestations similar to that of steroid (glucocorticoid) overdosage.
3. Hormone Deficiency Disorder
Weakness, fatigue, loss of apetite, dry skin,etc due to deficiency of ACTH secretion and TSH secretion.
Menstrual irregularity in females due to loss of FSH and LH.
Impotence and infertility in males due to loss of FSH and LH secretion.
Diabetes insipidus occurs from deficiency of antidiuretic hormone, causes excessive urination and thirst. Disorders of
1. Cushing’s Syndrome: Most commonly occurs as a side effect of steroid (glucocorticoid) therapy for kidney disease, rheumatoid arthritis, asthma and other respiratory diseases, ulcerative colitis, etc.
Other rare causes are pituitary tumors secreting ACTH (already discussed), ectopic ACTH secretion (most commonly from tumors of lungs), adrenal adenoma and carcinoma.
Symptoms include rapid weight gain, particularly of the trunk and face with sparing of the limbs (central obesity). A common sign is the growth of fat pads along the collar bone and on the back of the neck (buffalo hump) and a round face often referred to as a “moon face.”
2. Adrenal Insufficiency: May result in loss of appetite, abdominal pain, diarrhea, vomiting, profound muscle weakness and fatigue, extremely low blood pressure, weight loss, electrolyte imbalance (hyponatremia and hyperkalemia) and shock. Most common cause is sudden withdrawal of steroids. Other causes are tuberculosis, fungal infection, autoimmune, genetic causes, sepsis, etc.
3. Primary hyperaldosteronism: A condition associated with secretion of mineralocorticoid hormone called aldosterone. Results in resistant hypertension, often associated with hypokalemia.
4. Pheochromocytoma: A tumor of adrenal medulla causing hypertension and paroxysms of headache, palpitation and sweating.
Disorders of Puberty
1. Delayed Puberty
2. Precocious Puberty