Metabolism is, therefore, the science that studies the chemical mechanisms that allow the perfect functioning of our organism.
Endocrinology and metabolism go hand in hand for a better understanding of the reactions that allow for proper growth and development, the control of weight and body composition, in addition to fertility and aging processes, among others.
From this junction, there are four pillars of what would be ideal for a good quality of life:
- Regular physical exercise;
- Balanced diet;
- Sleep quality and stress control;
- Adequate treatment of hormonal disorders.
According to Daniele Zaninelli, it is important to differentiate the term “modulation” from “hormonal replacement”.
“The first term (modulation) refers to the prescription of hormones for people who do not have proven hormonal deficiency, and is usually performed for aesthetic and anti-aging purposes, which can lead to numerous adverse effects. This practice is not recognized by the Brazilian Society of Endocrinology and Metabology, nor by other international medical societies in the area ”.
How does the endocrine system work?
The endocrine system has endocrine glands, structures responsible for the production and release of hormones essential for the proper functioning of the body.
Hormones travel through the bloodstream, exerting their effects on distant organs. Many act on different organs and tissues, so the deficiency or excess of a single hormone can lead to varying symptoms.
Thus, the endocrine system is divided as follows:
Hypothalamus
The hypothalamus is a structure of the brain, and is located at its base. One of its main functions is to establish a connection between the endocrine system and the nervous system.
It produces hormones that control the hormone production of the pituitary gland. These two structures work together to tell other endocrine glands when it is time to release the hormones they produce. These hormones regulate body temperature, appetite and weight, mood, sexual desire, sleep and thirst, among others. Therefore, the function of the hypothalamus is directly related to the overall balance of hormones.
Hypophysis
The pituitary gland, or pituitary gland, is considered a mother gland in the human body, as it is fundamental in the functioning of several other glands and their hormones. It is divided into two parts: neurohypophysis and adenohypophysis .
Neurohypophysis
The neurohypophysis is located in the posterior lobe of the pituitary gland and is the part responsible for releasing two of the main hormones produced by the neurosecretory cells of the hypothalamus: oxytocin and the antidiuretic hormone, also called vasopressin or ADH.
The oxytocin causes pregnant women have uterine contractions at the right time, and contribute to the woman does not suffer bleeding during childbirth, and also promotes the flow of milk in women who are breastfeeding.
The hormone is still related to the development of empathy between people and sexual pleasure. For these reasons, it is considered the love hormone.
In addition to being present in feelings of affection, oxytocin is related to the modulation of sensitivity to fear.
The vasopressin or antidiuretic hormone, plays the role of promoting water reabsorption by the kidney, promotes the balance of body water.
Adenohypophysis
This other part of the pituitary gland, located in the anterior lobe, is capable of producing other hormones dependent on the stimulation of the hypothalamus. They are the follicle-stimulating, luteinizing, thyro-stimulating, adrenocorticotrophic and prolactin hormones. In addition to these, it is also responsible for the production of the growth hormone, GH ( Growth Hormone ).
Each has important and specific functions for the health of our organism:
- Prolactin : stimulates milk production;
- Thyrotrophin : controls the functioning of the thyroid gland;
- Adrenocorticotrophic : has the role of regulating the secretion of glucocorticoids by the adrenal glands;
- Follicle-stimulant : it is the hormone responsible for stimulating ovarian follicles (women) and spermatogenesis (men);
- Luteinizing : In women, this hormone regulates estrogen. In men, it regulates testosterone;
- GH : Promotes growth in childhood and adolescence. In adults, it helps to maintain healthy muscle and bone mass, while also having other important metabolic effects.
Thyroid
The thyroid is located in the anterior region of the neck, below the cartilage popularly known as the Adam’s apple. It has a “butterfly” shape. It works by stimulating the thyroid-stimulating hormone ( TSH ), secreted by the pituitary gland.
Iodine is essential for the production of thyroid hormones. The deficiency of this mineral can lead to complications, such as an enlarged gland (goiter), nodules and hypothyroidism .
Iodized salt is an important source of this nutrient and should be consumed in moderation, since excess iodine can also be responsible for thyroid dysfunction. Another source of iodine in the diet is seafood.
The main hormones produced in the thyroid are triiodothyronine (T3) and thyroxine (T4). When the thyroid produces insufficient amounts of these hormones, hypothyroidism occurs, and when it produces in excess, hyperthyroidism .
In addition to T3 and T4, the thyroid produces calcitonin, which participates in the regulation of calcium and phosphorus levels in the blood.
Parathyroid
There are four parathyroid glands, located in the neck, behind the thyroid. PTH, a hormone secreted by them, is responsible for the balance of calcium and phosphorus concentrations in the bloodstream.
When blood calcium gets low, PTH brings it back to normal, moving calcium from the bones, and increasing calcium retention by the kidneys and intestines.
Excessive levels of PTH (hyperparathyroidism) promote the release of calcium from bones with increased levels in the blood and urine. Over time, this can result in osteoporosis (increased risk of fractures), kidney stones and declining kidney function.
Pancreas
The pancreas is a gland that is located behind the stomach. It has two main functions, which can be classified as: endocrine and exocrine.
The exocrine part is responsible for the production of pancreatic juice, which participates in the digestion of food. The endocrine part is made up of structures called islets of Langerhans, consisting of cells of two types: alpha cells, which produce glucagon, and beta cells, which produce insulin.
The main function of the endocrine pancreas is to maintain balanced blood sugar levels. Glucagon and insulin work together. Insulin will prevent glucose levels from rising to a point that is too high, while glucagon prevents blood glucose levels from becoming too low.
The diabetes type 1 is a disease triggered by a failure in the immune system makes antibodies that attack the insulin-producing cells, which is not produced.
Type 2 diabetes, the most frequent, appears when the pancreas does not produce enough insulin, or when the body is unable to use insulin properly (a process called insulin resistance), which is strongly associated with excess abdominal fat.
Adrenal or adrenal
The adrenal, or adrenal, glands are located over the kidneys. Each is made up of two distinct regions, the cortex and the medulla.
Among the functions of the cortex are the production and secretion of glucocorticoids and mineralocorticoids, in addition to sexual steroids.
Cortisol, a glucocorticoid, interferes with the metabolism of glycids, lipids and proteins . It also has effects on the immune system (antiallergic and anti-inflammatory), on the gastrointestinal tract and bones.
Aldosterone, a mineralocorticoid, promotes sodium reabsorption and potassium excretion by the kidneys, influencing blood pressure.
The hormones produced by the adrenals modulate our reactions to stress . This is because in the marrow happens the production and secretion of catecholamines (adrenaline and norepinephrine).
Adrenaline triggers a series of responses to stress. This reaction causes the air passages to become more dilated to provide your muscles with the oxygen they need to fight danger, or escape. It also causes blood vessels to contract to redirect blood to major muscle groups, in addition to the heart and lungs.
The body’s sensitivity to pain also decreases as a result of the action of adrenaline, and this is what allows one to continue running or fighting danger even when one is injured.
Gonads
It is the glands that produce and secrete sex hormones. They are represented by the ovaries (in women) and the testicles (in men). The main functions of the hormones produced by the gonads are the control of the reproductive cycle, the determination of the typical physical appearance of men and women, and sexual behavior.
In women, estrogen (or estradiol) and progesterone are the main sex hormones. They participate in puberty, prepare the body and the uterus for pregnancy, and regulate the menstrual cycle. During menopause , changes in the level of estrogen cause many of the typical symptoms of that stage.
Testosterone is the main sex hormone in men. It acts on puberty, on increasing bone density, on facial hair growth, on fertility and on increasing muscle mass and strength. Andrology is the area specialized in the treatment of problems related to this hormone.
What does the endocrinologist do?
According to Dr. Daniele Zaninelli, endocrinology is the medical specialty that studies the endocrine glands and the hormones produced by them. In addition, it studies metabolic changes and disorders resulting from hormonal deficiency or excess.
The role of the endocrinologist, in this case, is to investigate, treat and monitor patients who have some of the pathologies caused by a hormonal disorder.
These disorders can occur due to several factors, including genetic, lifestyle, and environmental factors.
Examples of environmental factors are the chemicals present in our daily lives, known as endocrine disruptors, which interfere with the action of hormones. These substances can be found in pesticides, plastic packaging and canned food, in drinking water, and even in household dust.
Endocrine disorders can be divided into three main groups:
- Diseases caused by hormonal deficiency;
- Diseases caused by excessive hormone levels;
- Diseases caused by the development of tumors (benign or malignant) in the endocrine glands.
The list of diseases treated by endocrinologists is quite extensive. These include: hypothyroidism, hyperthyroidism and thyroid nodules, diabetes mellitus, obesity , menstrual and fertility disorders, polycystic ovary syndrome, growth and puberty disorders, excessive hair growth (hirsutism), high cholesterol, pituitary diseases, osteoporosis, menopause, andropause etc.
In Brazil, this medical area has been strengthened since the 1950s, with the emergence of the Brazilian Society of Endocrinology and Metabology (SBEM).
Over the years, professionals in this area have been increasingly requested, due to the increased identification of diseases related to hormonal issues.
One of the pathologies that receives special care from endocrinologists is obesity. The number of people suffering from this condition is worrying in the country.
In the last 10 years the prevalence of obesity has increased by 60%. According to the Ministry of Health, more than half of the population is overweight, which is mainly related to physical inactivity and inadequate nutrition, often resulting from social and behavioral influences.
What is it for?
There are many reasons that lead patients to an endocrinologist’s office. Among the most common we can mention the search for the treatment of diabetes mellitus, overweight and thyroid problems.
However, the area of expertise of this professional is much more extensive, and the follow-up with the specialist can be indicated in the following cases:
Menopause
When a woman goes twelve months without menstruating, the diagnosis of menopause is defined. The climacteric, which includes the transition phase, marks the end of a woman’s fertile life. This phase is usually marked by symptoms such as hot flushes (hot flashes), mood swings, weight gain, vaginal dryness, among others, which can persist for an indefinite period of time.
After considering the indications and possible contraindications, hormone replacement therapy for menopause can be indicated, leading to important improvement of many of these symptoms.
Andropause
Testosterone levels vary widely among men. In general, older men tend to have lower testosterone levels than younger men. Unlike the abrupt drop in hormone levels that occurs with women entering menopause, testosterone levels gradually decrease throughout adult life in men – the drop is about 1% per year after age 30.
The clinical perception of this hormonal variation is different for each individual. While some remain practically asymptomatic, others may experience symptoms such as tiredness , depression , reduced muscle strength and sexual dysfunction.
The endocrinologist, in this case, can help investigate the cause, as well as start hormone replacement treatment, when indicated.
Diabetes
The presence of risk factors for this disease, such as being overweight, changes – even if slight – in blood glucose, family history, changes in cholesterol levels and arterial hypertension, can be a good indication for a consultation with an endocrinologist .
Today we know that the metabolic changes that will result in diabetes begin many years before diagnosis. The sooner preventive measures are implemented, the better, since this is a disease accompanied by serious health risks.
Typical symptoms of diabetes include increased appetite and weight loss, constant thirst, increased urge to urinate throughout the day, weakness, visual changes and mood swings. We cannot wait for the appearance of symptoms to make the diagnosis, since they only occur when diabetes is already decompensated.
In the presence of any of these signs, seek medical attention to investigate and begin treatment.
Problems of growth and puberty
Growth problems, such as short and tall stature, can be caused by disturbances in the pituitary gland. In such cases, the production of GH (growth hormone) may be unregulated.
Periodic medical follow-up allows the proper observation of the growth patterns of children and adolescents, allowing for an adequate diagnosis.
The cause is not always a hormonal issue, it may involve genetic and nutritional factors, among others. To clarify the doubt and check the need for treatment, it is important to consult this specialist.
Problems such as the early presence of pubic hair (pubarche) or breast development (telarca) can also be treated with the endocrinologist.
Menstrual disorders
Changes in the menstrual cycle, such as the occurrence of menstruation more than once a month or the absence of the cycle, can be caused by some hormonal disorder. Therefore, it may be necessary to follow up with an endocrinologist, who can be referred by the gynecologist himself.
Excess hair
Hirsutism (excess hair) is a situation in which women show excessive hair growth with a male distribution pattern, that is, they are hair that can appear on the face, abdomen and chest.
In addition to hirsutism, increased muscle mass and acne , as well as thinning of hair in the central region of the head ( androgenetic alopecia ), may be manifestations of excess male hormones in women.
Faced with these symptoms, the endocrinologist will carry out specific investigation and treatment.
Pituitary diseases
Pituitary tumors, usually benign, can be associated with deficiency or excess of hormones, leading to several symptoms, such as: galactorrhea (milk secretion by the breasts outside the breastfeeding period), facial changes, growth of hands and feet, headaches and vision problems.
These symptoms may be due to conditions such as acromegaly, prolactinoma, or non-functioning tumors (which do not produce hormones).
Obesity
Obesity is a very worrying condition, as it is a risk factor for the development of diabetes, cardiovascular diseases, orthopedic problems, and even for various types of cancer .
The difficulty of losing weight is not always related only to life habits, such as inadequate diet and physical inactivity. Some patients face hormonal problems that interfere with this process.
After conducting a complete clinical evaluation, the endocrinologist usually requests laboratory tests to research not only dysfunctions that may be contributing to weight gain, but also complications resulting from the disease, such as changes in blood cholesterol and glucose levels, in addition to hepatic steatosis (fat in the liver), cholelithiasis (stones in the gallbladder), among others.
Disorders of the adrenal gland
Various symptoms can reveal the presence of a disorder in the adrenal gland. When observing signs such as variations in weight, excessive hair, high or low blood pressure , precocious puberty, purplish stretch marks or skin darkening, consult a specialist.
Thyroid disorders
The thyroid is a gland located in the neck region, responsible for the production of hormones T3 and T4, important for various functions of the organism.
Some symptoms may indicate that there is something wrong with its functioning, such as lumps in the neck, insomnia , irregular bowel, fast heart, nervousness, feeling of cold or excess heat and weight loss or gain.
In the case of hypothyroidism, for example, the metabolism slows down and the patient has a lot of sleepiness, difficulty in losing weight, tiredness, weak hair and nails, infertility, and even impaired reasoning.
When the thyroid is overworked, on the other hand, it’s not good either. This condition is called hyperthyroidism. In this disease, the patient will have symptoms such as muscle weakness, heat, excessive sweating, fast heartbeat, weight loss, diarrhea , irritability, among other signs, which are often mistaken for heart problems.
Upon realizing these symptoms, the patient can seek help from the endocrinologist. Through exams, he will be able to confirm or rule out the hypothesis that the problem is in this gland.
In addition, the presence of thyroid nodules is an increasingly frequent situation. The evaluation by the endocrinologist is indispensable for the definition of how the follow-up will be.
The analysis of clinical factors in association with the characteristics of the nodule at ultrasound can provide clues as to the nature of the nodule in question (whether benign or malignant). With this, many diagnostic punctures and even unnecessary surgeries can be avoided, which is currently one of the main concerns of scholars in this area.
Osteoporosis
Osteoporosis is a silent disease, because when symptoms appear, a fracture may have already occurred. Groups considered to be at higher risk, such as postmenopausal women, patients undergoing bariatric surgery, or using corticosteroids, for example, should be carefully evaluated.
Hormonal disorders are also among the factors that can cause osteoporosis.
The endocrinologist can guide preventive measures, as well as investigate the cause and carry out the treatment of this disease.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) affects about 20% of pre-menopausal women.
It usually presents with a variable combination of signs and symptoms such as menstrual irregularity, hirsutism (increased hair), hair loss and acne.
Laboratory tests can reveal increased blood levels of androgens, in addition to other metabolic changes, and ultrasound can show multiple cysts on the ovaries.
Problems such as abdominal fat, insulin resistance, obesity, metabolic disorders and cardiovascular risk factors may be associated with PCOS.
The treatment aims to control hyperandrogenism (excess of male hormones), the consequences of ovarian dysfunction and / or associated metabolic disorders. It must be carried out over the long term and adapted dynamically according to the changing circumstances and stages of each woman’s life. In addition, the personal needs and expectations of each patient must be respected.
Vitamin D deficiency
Vitamin D is essential for our body to be able to absorb calcium from food. Many studies have evaluated its role on the immune, cardiovascular, and even its influence on some types of cancer.
Our main source of vitamin D is the sun, as it stimulates the production of the vitamin by exposing the skin to UVB rays.
It is believed that 20 minutes of sun exposure a few days a week, without a sunscreen, is sufficient to guarantee adequate production. However, it is not always possible to keep this vitamin at ideal levels, as factors such as the season, in addition to individual characteristics such as skin pigmentation, age and the presence of pathologies, can interfere with the ability to produce the vitamin.
In food, the main sources are fish liver oils and saltwater fish such as salmon, sardines and herring, but the amounts obtained from the diet will not be sufficient to maintain their adequate levels.
Therefore, when someone has low levels of vitamin D, it may be necessary to follow up with an endocrinologist, who can start a treatment to remedy this deficiency.
For diagnosis, a blood dosage is performed, which is recommended in specific cases, such as the following groups and risk factors:
- Elderly – over 60 years old;
- Individuals with a history of recurrent fractures or falls;
- Pregnant women and women who are breastfeeding;
- Osteoporosis and other bone problems;
- Chronic kidney disease;
- Malabsorption syndromes, such as after bariatric surgery and inflammatory bowel disease;
- Use of medications: anti-HIV therapy, glucocorticoids and anticonvulsants;
- Malignant neoplasms;
- People with diabetes;
- People who are not exposed to the sun or who have contraindications to sun exposure;
- Presence of obesity;
- Dark-skinned people.
Low libido
Low libido can be a symptom of problems such as hypothyroidism, menopause or increased prolactin. In such cases it is indicated to seek the help of the endocrinologist.
In addition to hormonal changes, many factors can interfere in people’s sexual life, so before the endocrinologist begins treatment, it is necessary to analyze issues such as the use of medications, psychological problems, relationship problems, in addition to other pathologies.
Specialties and areas of expertise
The endocrinologist, in general, studies and treats diseases related to hormones and the complications caused by them. However, within this field, there are specific areas in which the professional can choose to specialize. Are they:
Neuroendocrinology
This is the area of endocrinology responsible for studying and treating diseases that affect the region of the hypothalamus and pituitary, located in the brain.
The disorders present in the pituitary gland, considered the mother gland in our body, are delicate, as they can cause serious problems for the patient’s health.
In addition to hormonal changes, problems in the pituitary gland can cause headache ( headache ) and change in vision. This is because this gland is very close to structures such as the optic chiasm and the cavernous sinuses, responsible for the movement of the eyes and eyelids, among other functions.
The pituitary gland is considered a major gland in our body because it is related to the production of several hormones, such as growth hormone (GH) and prolactin, responsible for stimulating milk production in the mammary glands.
The hormones produced by the pituitary gland directly affect the functioning of glands such as the adrenal gland, the gonads and the thyroid. So, like a domino effect, a failure here ends up causing other health problems.
The pituitary has an intimate relationship with the hypothalamus, which releases a series of substances that stimulate or inhibit the production of hormones by the gland.
Diseases related to pituitary disorders include, for example, acromegaly and gigantism, in addition to Cushing’s disease, resulting from generally benign pituitary tumors.
Finally, the endocrinologist has the role of diagnosing, treating and monitoring the evolution of these diseases.
The symptoms can be quite different, depending on the dysfunction. When the initial signs are headache, joint pain, tingling and others, the patient can seek out other specialists, who, upon suspecting the problem of hormonal dysfunction, will refer the patient to the endocrinologist.
Female endocrinology
Endocrinology is a medical field that can be present in the lives of many women, at different stages and for different reasons, from puberty to menopause.
The specialist in this area is responsible for investigating and treating problems such as:
- Genitalia altered at birth;
- Irregular menstruation;
- Late or early puberty;
- Difficulty getting pregnant and infertility;
- Menopause, normal or early;
- Osteoporosis;
- Premenstrual syndrome;
- Polycystic ovary syndrome
Women who have any problem related to the hormonal regulation of the female reproductive system should seek this specialist, as he is the most suitable to assess the need for specific treatments.
Andrology
It studies and treats alterations in the reproductive and sexual function in men, being an area considered relatively new in medicine. It began to gain greater notoriety during the 1960s.
Andrology is related to clinical and laboratory specialties aimed at treating male problems. The four pathologies, or pathological groups, most studied, involve the following conditions:
- Varicocele (enlargement of the veins in the scrotum);
- Sexual dysfunctions;
- Sterility;
- Testosterone deficiency.
Pediatric endocrinology
Pediatric endocrinology is the medical field that unites the practices of endocrinology and pediatrics for the treatment of hormonal disorders, from the neonatal period to the end of adolescence.
The monitoring of this professional is essential to avoid complications in the future. It also enables the early diagnosis of pathologies, when there is a preventive routine.
Neonatal period
Clinical conditions involving the endocrinopediatrician in the neonatal period include hypoglycemia , congenital hypothyroidism and congenital adrenal hyperplasia.
During childhood, problems such as growth deficit, hypothyroidism and type 1 diabetes mellitus are part of the routine of attending this specialty.
Adolescence
In adolescence, the endocrinologist has the role of helping with problems such as delayed pubertal development, as well as early puberty, in addition to thyroid dysfunction, type 1 (autoimmune) or type 2 diabetes mellitus, and obesity.
Normally, puberty occurs between 8 and 13 years for girls, and between 9 and 14 years for boys. When puberty signs appear earlier, such as at 6 years of age for them, and at 7 or 8 years of age for them, puberty is considered to be precocious. When it occurs after 13 and 14 years, respectively, for girls and boys, it is considered late.
The endocrinopediatrician investigates the causes of changes in the pace of pubertal development and indicates the most appropriate treatment for each situation.
The heel prick test , or neonatal screening, is an examination that must be carried out in the nursery, in the first 48 to 72 hours of life. It is performed to investigate problems such as congenital hypothyroidism, for example.
This hereditary disease is caused by the inability of the thyroid to produce its hormones, in general, by defects in glandular formation.
Thus, the newborn is not able to produce the hormones T3 and T4, which causes problems in the metabolism, inhibiting the baby’s mental and physical development.
The diagnosis must be early, allowing the beginning of treatment preferably in the first 10 to 15 days of life, which greatly reduces the risk of brain changes.
Although it is rare, the heel prick test can fail. In such cases, it is necessary to pay attention to the symptoms, so that the children can be evaluated again.
The main symptoms of the untreated disease are: prolonged neonatal jaundice, hoarse crying, slow movements, constipation, macroglossia (increased tongue volume), umbilical hernia, large fontanelles (“soft”), reduced muscle tone, and dry skin.
When detecting any of these signs, the doctor must request a laboratory evaluation to confirm the diagnosis, regardless of the result of the heel prick test.
Normal growth
In order to diagnose the child’s growth as normal or not, it is essential to carry out periodic medical follow-up, which allows the creation of curves to assess the growth evolution.
For this, parameters such as:
- Population pattern;
- Expected standard according to family characteristics;
- Growth rate according to age, sex and level of development.
From birth to adolescence, these aspects must be observed by the pediatrician, who refers the patient to the endocrinologist when changes are detected.
Obesity and diabetes
In childhood, problems such as obesity and diabetes can be prevented with guidance from the endocrinologist.
It is necessary for the doctor to see if the child has risk factors for one of these diseases, which can go hand in hand.
The best therapeutic option must be evaluated in each case. Educational measures to prevent and / or control obesity should be prioritized.
Greater care should be taken when the patient already has a family history of obesity, diabetes and high blood pressure. Even in childhood, the first clinical manifestations of insulin resistance can occur, which is associated with increased body fat.
Currently, the focus on preventing these diseases is a global concern. The number of children and adolescents with these manifestations is significantly higher than a few decades ago, and this is due to a combination of factors such as unhealthy eating habits and physical inactivity, high levels of stress, inadequate sleep, among others.
With the exchange of street games for virtual games, and of “real” foods for a wide variety of fast foods , circumventing these pathologies with a balanced diet and encouraging physical exercise ends up being a great challenge.
Thus, the monitoring of an endocrinologist is essential.
Endocrinology and exercise and sport medicine
This aspect of endocrinology, so to speak, is recent. In 2013, the Brazilian Society of Endocrinology and Metabology (SBEM) created the Temporary Commission for the Study of Endocrinology, Exercise and Sport (CTEEE), which has been bringing quality scientific information to associates.
There is an increasing number of patients who seek the endocrinologist to receive guidance on dietary supplementation and other issues related to exercise and sport.
When endocrinology is associated with sports medicine, the objective is not only to guide what can or cannot be done in relation to the indications, risks and benefits of using supplements.
The idea is also to make the population aware of the risks associated with the inappropriate use of supplements and anabolic steroids, which are being increasingly sought after by users of gyms, who seek, in most cases, aesthetic results.
In addition to checking whether everything is right in relation to hormone production and the health of athletes, the endocrinologist can indicate the use of dietary supplements to enhance their results, increasing the chances of standing out in competitions.
When the conscious use of supplements is applied to people who regularly exercise, an improvement in training performance can be obtained.
The work of the endocrinologist happens together with the physical educator and the nutritionist.
One of the tests commonly indicated by these professionals is bioimpedance , which assesses the amount of muscle, fat and body water. Repeating the exam periodically, it is possible to evaluate the results of the treatment and its effects on body composition.
In teams that compete in championships such as the World Cup, Brazilian Championship, Super League and Olympics, for example, it is common for a professional in this area to accompany the athletes.
When to look?
People should seek this professional in the face of any symptom that may indicate an endocrine disease.
This includes thyroid problems, obesity, diabetes, menstrual disorders, menopausal problems, infertility (male or female), excess hair, high cholesterol or triglycerides, abnormal growth (excessive or deficient), osteoporosis, among other conditions.
According to endocrinologist Daniele Zaninelli, the symptoms of endocrine disorders are very varied.
“The symptoms vary according to the hormone in question, and can include increased hair, acne, menstrual changes and infertility, among many others”.
“Thyroid problems, for example, can cause symptoms such as tiredness, weight gain or loss, forgetfulness, change in bowel habits, hair loss, palpitations and many others, because thyroid hormones act throughout the body, determining their rate of functioning ”, says the doctor.
In the case of diabetes, one of the disorders treated by this professional, symptoms such as weight loss, increased urge to urinate and thirst, visual changes, loss of sensation or the appearance of foot ulcers, are signs that the disease is uncontrolled or presenting complications , and should serve as a warning for the immediate search for medical help in this area.
Vitamin D deficiency is also addressed by the endocrinologist, and may be associated with muscle weakness, body aches, osteopenia and osteoporosis, for example.
One of the reasons that most lead people to a consultation with the endocrinologist is to understand why they are unable to lose weight.
Thus, it is also indicated to seek an endocrinologist when the person is unable to lose weight even following a diet prescribed by a nutritionist and performing physical exercises regularly.
In this condition, as well as in all other pathologies related to a glandular dysfunction, this doctor must help in the specific diagnosis and treatment.
The search for an endocrinologist can be done, regardless of age, when there are signs and symptoms of hormonal dysfunction of any kind.
In general, hormonal measurements are not recommended as part of a check-up , unless the clinical evaluation shows the need for this.
However, there are some protocols, such as: women over 35 years old should be tested to assess thyroid function even in the absence of symptoms.
The specialist will know how to indicate the need for tests based on the assessment of the clinical condition and risk factors for endocrine-metabolic disorders, individually.
How does the endocrinologist help those who want to lose weight?
It is not always possible to maintain a healthy weight with just a good diet and physical exercise regularly. Some people may experience greater difficulty and this may be due to the presence of a hormonal problem.
The endocrinologist can help in these cases by assessing when this difficulty may be due to a hormonal issue, as in the case of hypothyroidism, in which the patient’s metabolism slows down.
If the reason is a disorder caused by hormonal imbalance, the specialist will refer the patient for treatment and monitor the results.
According to endocrinologist Daniele Zaninelli, these professionals carry out a global assessment of the patient and his way of life.
“The endocrinologist’s approach to weight loss may include guidance on lifestyle habits (diet, sleep, physical activity), in addition to the use of specific medications that can help control appetite and induce satiety, as well as other positive metabolic effects ”.
“This indication must be precise, respecting the degree of severity of the condition, associated diseases and other special clinical situations, in addition to the preferences of each patient”.
In the case of people with obesity, the monitoring of an endocrinologist is also important.
“It is important to have a thorough understanding of how weight gain occurred in order to determine the best therapeutic approach. Obesity is a chronic disease, and is often accompanied by hormonal disorders or metabolic disorders that must be identified and treated appropriately ”, he reports.
During the consultation with this specialist, some aspects such as weight, age, waist, hip circumference and the patient’s height are evaluated. These characteristics are important to identify the risks of cardiovascular problems and to know what the healthiest weight would be.
After the first consultation, and when a treatment is prescribed, it is important that the patient returns to the endocrinologist so that the doctor can check if the treatment is working.
The treatment of endocrine-metabolic disorders must be dynamic, that is, it is important that the patient undergo periodic monitoring, as recommended in each case, so that there is no stagnation in the treatment, and so that new therapeutic options can be offered when necessary.
When the patient is unable, even with clinical treatment, to lose the necessary weight, it is the endocrinologist who can indicate the need for bariatric surgery.
Common exams and procedures
The list of tests that an endocrinologist can order is quite diverse.
The purpose of the tests is to identify the excessive or deficient production of hormones, which glands are involved and what is the cause of this imbalance.
Tests to determine hormone levels are usually done through blood or urine. Some tests involve stimulating or suppressing specific hormonal axes. If a hereditary disorder is suspected, genetic testing may be ordered.
Among the most common laboratory tests are those that check for the following hormones:
- TSH (thyroid stimulating hormone);
- T3 (triiodothyronine) and T4 (thyroxine);
- Testosterone;
- Progesterone;
- Prolactin;
- IGF-1 (insulin-like growth factor, type 1);
- GH (growth hormone);
- FSH (follicle stimulating hormone);
- LH (luteinizing hormone);
- Estradiol;
- Cortisol.
Imaging tests such as scintigraphy, ultrasound, computed tomography and magnetic resonance imaging can also be performed.
These tests complement the investigation of hormonal disorders, and can still be useful when the doctor suspects the presence of a tumor.
How is the treatment of endocrine diseases?
The treatment of diseases related to glandular disorders depends on their cause and clinical consequences.
That is why it is necessary for this professional to evaluate various aspects of the patient’s profile in order to arrive at the source of the problem, determining the risk of complications.
Some treatments involve hormone replacement, when deficiency is proven, requiring the use of medications.
Patients who have tumors, for example, may need surgical treatment to remove the affected gland, and the patient may need to be monitored by the endocrinologist indefinitely.
It is also possible that the hormonal disorder happens due to the interference of medications, leading to the need to reevaluate the medical prescription.
Starting the use of medications or interrupting a treatment without consulting the doctor are attitudes that should be avoided, as they put the patient’s health at risk.
Is it possible to prevent endocrine disorders?
As Dr. Daniele Zaninelli says, the endocrine system is responsible for several functions in the body, such as controlling pubertal development and growth, reproduction, sleep, thirst, hunger and metabolism.
Hormones also control how we respond to environmental factors.
For the doctor, “several factors act on the endocrine system, among them genetics, lifestyle and even a large number of free substances in the environment. This exposure occurs daily through the air we breathe, the water we drink and bathe, and the food we eat ”.
These factors are known as “endocrine disrupters”.
Thus, it is evident that the control of all these aspects is beyond the possibilities of any individual. Therefore, it is not possible to prevent everything that can cause an endocrine disorder.
However, adopting some healthy habits such as physical exercise and a balanced diet is one of the most important ways to reduce the chances of developing these diseases and their complications.
According to the endocrinologist, it is also essential to maintain adequate sleep, not to smoke, and to consume alcoholic beverages in moderation.
Where to find this professional?
To consult an endocrinologist, patients can resort to the Unified Health System (SUS), and are treated free of charge. In the case of those who have health insurance, there is usually coverage for this type of specialist.
In addition to these two alternatives, it is possible to resort to private consultations, carried out by professionals who attend your clinics.
To ensure that the consultation will be with a qualified professional, the Brazilian Society of Endocrinology and Metabology provides on its website a tool for the patient to seek an associated endocrinologist . The patient must inform only the state and city where he is.
Formation
If your professional dream is to be an endocrinologist, you should already know how much dedication is necessary, because you must first pass the competitive entrance exam for the medical course, one of the most disputed (and expensive) among the universities in the country.
The medical course lasts six years and begins with theoretical subjects. Over the years it becomes more practical. Some materials present in the grid are:
- Anatomy;
- Physiology.
- Biochemistry;
- Genetics;
- Pathology;
- Immunology;
- Biostatistics;
- Otorhinolaryngology;
- Ophthalmology;
- Pediatrics;
- Gynecology and Obstetrics;
- Traumatology and Orthopedics;
- Pharmacology;
- Psychiatry.
As Dr. Zaninelli says, after completing the medical course, you must go through a contest to perform the Medical Residency in Clinical Medicine, which will last 2 years.
“At the end of this stage, another competition is held to win a place in a new Medical Residency program, now in Endocrinology and Metabology, which lasts for another 2 years. From then on, some professionals follow their training with obtaining degrees such as master’s or doctorate, with a duration that varies from 2 to 4 years each, on average ”.
To be an endocrinologist with a degree from the Brazilian Society of Endocrinology and Metabology (SBEM), it is also necessary to pass the exam to obtain the title of specialist, organized by the same society.
Salary: how much does an endocrinologist earn?
The salary range may vary depending on whether you are a doctor who works in your own clinic, in a hospital or with a health plan. It can also vary according to the specialist’s career time.
Initially, the monthly salary can be between R $ 6 to R $ 8 thousand, and can reach R $ 21 thousand or more.
Common questions
Endocrinology is a medical specialty that covers the diagnosis and treatment of several pathologies, so it is normal for many doubts to arise in this area. Check out the most frequent ones:
What is the role of the endocrinologist in bariatric surgery?
The endocrinologist is fundamental in the pre- and postoperative follow-up of patients who need to resort to bariatric surgery, a process that is not simple or fast.
Before surgical indication for the treatment of obesity, the patient must undergo at least 2 years of adequate clinical treatment, which includes changes in eating behavior, physical exercise, and use of specific medications.
If the answer is not adequate, the endocrinologist will identify the need for surgical treatment, making the referral of the patient. In addition, the risks that the patient runs when performing the surgery or not, and the possible clinical complications involved will be taken into account.
Preoperative specialized clinical evaluation is essential to prepare the patient for the procedure.
Many obese people have nutritional deficiencies that are better corrected even before surgery, while the digestive tract is intact, ensuring better absorption of nutrients. This improves the clinical conditions for coping with the surgery.
According to the Brazilian Society of Endocrinology and Metabology, in the post-surgical period the endocrinologist is indispensable for the prevention of nutritional deficiencies and weight gain.
In some cases, the doctor may need to refer the patient for aesthetic treatments, such as surgeries to remove excess skin after weight loss.
Another concern of this specialist should be to monitor and treat pathologies other than obesity, such as diabetes.
In many patients, after bariatric surgery, the condition of diabetes improves significantly, but it is still recommended to follow it indefinitely, as the disease can reoccur at any time.
The team responsible for assisting the patient in this process includes, in addition to the endocrinologist and the surgeon, professionals such as the psychologist, the psychiatrist and the nutritionist.
When to look for an endocrinologist or a nutritionist?
According to the endocrinologist Daniele Zaninelli, to understand which of these two professionals to look for, it is necessary to know the areas of performance of each one.
The nutritionist is a professional trained in nutrition, being responsible for assessing the function of food in the body and seeing what is necessary for each person to maintain or regain health. This professional can specialize in Clinical Nutrition, Public Health, and Sports Nutrition, for example.
In addition to indicating the ideal foods within a balanced diet, a good nutritionist must also carry out a more in-depth analysis of each individual, addressing even social aspects.
From this profile, he will be able to put together a specific menu for the needs of each individual, knowing if he will be able to fulfill it, which is very important. Therefore, the nutritionist should be sought when it comes to a food issue.
The endocrinologist, on the other hand, is a doctor who specializes in the study of glands and metabolism.
“The endocrinologist performs a complete clinical evaluation, with request and interpretation of tests, guiding the need for specific treatments, which may include changes in lifestyle and prescription of medications”, says the endocrinologist.
Just as it can be a matter of diet, weight accumulation can be a hormonal issue.
In the case of people who have some thyroid dysfunction, such as hypothyroidism, just going to the nutritionist will not be enough to understand the cause. Knowing this, what should be the first option for patients?
It is difficult to indicate an answer as the correct one. There are several ways to come up with the right answers to improve our health.
Starting from the principle that the person has no history of specific diseases or symptoms that may indicate that there is some hormonal disorder, the nutritionist can be a starting option.
“The nutritionist can work together with the endocrinologist to guide changes in the diet plan with the elaboration of specific menus directed to the needs of each patient”.
How does hormone replacement treatment work?
After confirming the diagnosis of a hormonal deficiency, the endocrinologist should prescribe the specific replacement according to the case.
“Hypothyroidism is a classic example of hormonal deficiency, and replacement consists of the use of levothyroxine , the exact synthetic copy of the main hormone produced by the thyroid. Its use in adequate doses leads to symptom control ”.
Each patient must be carefully evaluated, with control recommended with periodic clinical and laboratory evaluations.
According to endocrinologist Daniele Zaninelli, the use should never be made based on the experiences of others or by self-medication , as the consequences can be devastating.
Endocrine diseases in pets
Diseases caused by disorders of the hormonal glands are not a problem exclusive to humans, as they are also present in the animal world.
In domestic pets, such as dogs and cats, the main pathologies observed are hypothyroidism and diabetes mellitus.
Early disease diagnosis, however, can be even more complicated in pets than it already is for us.
Bearing in mind that the most common thing is to go to the doctor when there is already a symptom, and not preventively, this is even more distant when it comes to pets.
In addition, the perception of symptoms is in the hands of the owners. Some signs that deserve attention include:
- Excessive water consumption (polydipsia);
- Apathy;
- Excessive urine production (polyuria);
- Excessive appetite (polyphagia);
- Weight gain or loss;
- Neurological problems;
- Eye problems;
- Loss of hair;
- Frequent skin lesions.
Another problem that grows among these animals is obesity. To avoid this type of pathology, it is essential to keep them active and with adequate food.
Considering that the symptoms can be quite nonspecific, the evaluation of a veterinarian specialized in endocrinology is important.
