ENDOCRINOLOG & METABOLIGM

Endocrinology:

Diabetes:

The numbers of diabetics in the world is very rapidly increasing .According to the WHO, there is no exact data of patients with diabetes in Nepal. But, the 2016 Diabetes Profile has shown that 9.1 percent Nepali population are living with diabetes. It includes 10.5 percent men and 7.9 percent women. According to the World Health Organization, obesity is found to be a cause of diabetes among 16.6 per cent female population and 13.6 per cent male. Likewise dullness is identified to be another cause among 3.3 per cent populationDiabetes mellitus is the commonest metabolic disorder in the world . The prevalence of diabetes in highest among Asians especially Indians. Due to rapid urbanization, cultural changes and changing socio-economic status the incidence of diabetes in metro cities is now reported to be as high as 16% reaching epidemic proportions.

Diabetes is the commonest cause of blindness, kidney failure, heart attacks and gangrene of limbs. This department is especially equipped to provide state-of-the-art management for diabetes .

The basic aim of diabetes management is to improve quality of life and prevent/delay complications as for as possible. The department is striving hard in this direction. The department interacts very closely with the other departments like – Gynae. & Obst. , Orthopaedics, Neurosurgery, Vascular Surgery, Ophthalmology, Cardiology, Nephrology etc. in order to provide comprehensive endocrine management.

	EYE Diabetes is the commonest cause of blindness in working age group. Diabetic retinopathy (Leading to blindness)
	KIDNEY it is also the commonest cause of Kidney failure.
	HEART Heart Attacks are three times and Paralysis/Strokes are 3 to 5 times more common among diabetics. Complication of Heart (Leading to heart attack)
	LEGS & FEET The incidence of Amputations exp. of legs and feet is 17 times more common in diabetics.
	SEXUAL DISORDERS Sexual problems are much more common in male diabetics. Sexual problems
	Brain & Nerves Paralysis / stroke Pain / Burning sensation over palms, soles & legs

DIABETES

Diabetes is a symptom free disease at onset. It usually takes 5-10 years before it is diagnosed. It is preceded by a prediabetic stage which is called Impaired Glucose Tolerance (IGT) which also last for 5-10 years before progressing to frank diabetes. It is during this pre-diabetic stage (IGT) that long term complications of diabetes start appearing. Hence, it is important to identify the high risk group at earliest and start treatment to prevent/delay diabetes and its complications.

SELF ASSESSMENT FOR DIABETES
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.	Is there any family history of diabetes? Are you over weight? Are you over 40 years of age? Is your job sedentary? Is your waist hip ratio more than one? Did you have diabetes during pregnancy? Do you suffer from high Blood Pressure? Do you have high cholesterol levels? Were you under/ overweight at birth? Does your blood sugar go up during stress?	Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
The more the number of “yes”, the higher is the risk of developing diabetes.

Thyroid

Thyroid diseases are common especially in women. These are :

Hypothyroidism ·         Swelling of body ·         Weight Gain ·         Lethargy ·         Weakness ·         Cold Intolerance ·         Excessive Hair Fall ·         Poor Memory ·         Low Sexual Desire	·         Joint /Body Pains ·         Menstrual Irregularity ·         Dry Skin ·         Chronic constipation ·         Depression
If you are having any two of the above you may be suffering from Hypothyroidism
Thyrotoxicosis ·         Weight Loss ·         Marked Weakness ·         Heat Intolerance ·         Prominent Eyes ·         Excessive Sweating ·         Nervousness ·         Tremors of Hands/Body ·         Palpitation
Goitre Enlargement of Thyroid Gland is called Goitre. It may be due to Cancer, or other diseases of Thyroid.
Obesity Obesity is the mother of all diseases. It is a preventable and treatable condition. The Complications of obesity are as follows :
	·         Depression ·         Disturbed/Excessive sleep ·         Stroke ·         Breathlessness ·         High Cholesterol/Blood Pressure ·         Heart Attack ·         Diabetes ·         Gall Stone ·         Cancer ·         Impotence/Infertility ·         Arthritis ·         More prone to Accidents
Male sexual problems Common male sexual problems are:
·         Impotence ·         Infertility ·         Male Breast Enlargement ·         Micro-penis in Children
Female sexual problems
	·         Abnormal Hair-Growth on face and other parts of the body. ·         Infertility ·         Menstrual Problems ·         Menopause Problems ·         Abnormal Milk Discharge from Breast

Osteoporosis

It is a disease where there is thinning/ weakening of the bones and it leads to fracture with minimum trauma. Even forceful cough can produce fracture in severe osteoporosis. It is the fracture of the hip and vertebrae which immobilizes the patient and is most dreaded. Osteoporosis is a preventable and treatable condition. Majority of the patients remain unrecognized and undiagnosed till fracture develops. It is more common in females esp. after the age of 40-45 yrs.

Normal & Osteoporotic Bone

SELF ASSESSMENT FOR DIABETES
1. 2. 3. 4. 5. 6. 7. 8.	Is there any family history of frequent fractures ? Are you a post menopausal woman ? Are you taking eltroxin/ steroids? Is your physical activity less than normal ? Is your diet low in milk products ? Are you suffering from Arthritis/Asthma ? Do you smoke or consume Alcohol in excess ? Are you under weight ?	Yes Yes Yes Yes Yes Yes Yes Yes
The more the number of “yes”, the higher is the risk of developing osteoporosis.

Other Hormone Diseases

Height & Growth Problem Height of a child is controlled by Growth hormone (GH). Deficiency of this hormone can lead to short stature and if diagnosed and treated in time normal height of the child can be restored. Disorders of Puberty Pubertal period is a phase during which child develops secondary sexual characters and transforms to become an adult. Pubertal development problems can lead to either delayed or early onset of puberty.

Endocrinology & Metabolism

Dedepartment of Endocrinology & Metabolism

Introduction

Endocrinology is an emerging specialty of medicine. It deals with various hormone disorders. These disorders are the commonest among non – communicable diseases, yet the awareness about them is low in general population. To create public awareness and provide comprehensive treatment about various endocrine and metabolic diseases, a new state-of-the-art department of endocrinology and metabolism has been established in this hospital ..

• Diabetes and Obesity Clinic
• Thyroid Clinic
• Bone Health clinic (Osteoporosis)
• Growth clinic
• Andrology Clinic (Impotence, Infertility and Hirsutism)
• Endocrinology Clinic