Diabetes/ Endocrinology

Type 1 diabetes is a form of diabetes in which insulin is not produced at all and insulin therapy is the main treatment. At our hospital, we also manage using an insulin pump.

Insulin Pump.jp, an information site for patients

Type 2 diabetes is a state in which insulin secretion remains, and diabetes is caused by lifestyle disorders, etc., but insulin secretion is said to be lower than in healthy people. Add drug therapy if blood sugar levels do not improve with diet and exercise.

Although it is not diabetes, it is a pathological condition in which blood sugar increases during pregnancy, and the diagnostic criteria are stricter than general diabetes. Considering the effects on the fetus, insulin injections are used to control blood sugar. In many cases, it returns to normal after childbirth, but it is said that it is easy to develop diabetes in the future. We work closely with obstetricians to manage blood sugar.

Major endocrine organs include the hypothalamus, pituitary, thyroid, parathyroid, pancreas, adrenal glands, ovaries, and testes. Substances (hormones) with various functions are secreted into the blood from there and act on the organs of the whole body to maintain the homeostasis of the body.

Endocrine disorders are broadly divided into those with excess hormones (hyperfunction), those with insufficient hormones (hypofunction), and those with tumors in endocrine organs. Among endocrine diseases, there are rare diseases whose causes have been unknown until now, and accurate diagnosis and treatment are important. In order to make a correct diagnosis, blood tests may be performed while the patient is at rest or fasting, or blood tests may be performed while the patient is hospitalized for several days and given medication. Imaging tests such as ultrasonography, CT, MRI, and scintigraphy, and vein sampling are also performed to investigate the nature and location of the lesion.

Basedow's disease is caused by autoantibodies that stimulate the thyroid gland, resulting in swelling of the thyroid gland and excessive secretion of thyroid hormone. It is more common in women, and some people have bulging eyes. If you have too much thyroid hormone, you may have appetite but lose weight, sweat a lot, have a slight fever, palpitations, tremors in your hands, diarrhea, and low cholesterol.

Treatment includes oral treatment with antithyroid drugs, radiotherapy, and surgical treatment. Antithyroid drugs may cause side effects, so the course should be monitored carefully. It usually requires several years of internal medicine. Radiation therapy destroys thyroid tissue by taking a radioactive iodine capsule (I-131). In many cases, post-treatment thyroid hormone replacement is required. Surgical treatment is performed when the goiter is large or when oral medication cannot be used due to side effects. Because most or all of the thyroid gland is removed, postoperative thyroid hormone replacement is required.

Hashimoto's disease is a chronic inflammatory disease of the thyroid gland. Some people produce less thyroid hormone.

A lack of thyroid hormone causes swelling, sensitivity to cold, constipation, weight gain, increased cholesterol, and high CPK levels. If thyroid hormone is insufficient, thyroid hormone should be supplemented (there are no side effects if the dose is adequate). Excessive intake of iodine may adversely affect the secretion of hormones.

The thyroid gland may develop nodules (nodules) and cysts (fluid sacs). There are no subjective symptoms until they grow large, and they are often discovered during medical examinations. To diagnose benign or malignant tumors, ultrasonography (echo) and fine needle aspiration cytology are performed to collect cells by inserting a fine needle into the nodule and examining them under a microscope.

If it appears to be benign, follow up with regular check-ups and tests. If malignancy is suspected, the thyroid gland is surgically removed. After surgery for thyroid cancer, internal therapy with radioactive iodine (I-131) is performed to prevent recurrence and treat distant metastases. Metastatic lesions may be treated with surgery or external radiation therapy (external beam radiation). If the disease progresses rapidly, we may administer an anti-cancer agent called a molecular-targeted drug, which is a new treatment, in cooperation with the Oncology.

Radioactive iodine (I-131) can be administered internally after total thyroidectomy for thyroid cancer. I-131 internal therapy has been used all over the world for a long time, and its therapeutic efficacy and safety have been proven.

For those with metastasis, this I-131 internal therapy is repeated every six months to one year (treatment). In addition, even if there is no obvious metastasis, I-131 internal therapy can be used after surgery to destroy normal thyroid cells to simplify follow-up (ablation), or to destroy the few remaining cancer cells to prevent recurrence. or (adjuvant therapy).

The only way is to take I-131 capsules. After entering the body, I-131 is selectively taken up by cells that have the properties of the thyroid gland, and I-131 emits radiation called beta rays and gradually destroys the cells. Since beta rays reach only about 1 to 2 mm, there is almost no effect on surrounding organs. Also, since I-131 disappears from the body in a short period of time, it has little effect on the body. Even multiple metastases can hopefully be treated together with this treatment. After administration, an imaging test for metastasis called whole-body scintigraphy is also performed (it has better detection power for disease than tests such as CT).

To perform I-131 internal therapy, it is necessary to completely remove the thyroid gland, temporarily stop thyroid hormone supplementation, and strictly restrict iodine in the diet. When thyroid hormone is stopped, thyroid function becomes hypothyroid, which causes swelling, constipation, and loss of appetite. Also, immediately after taking I-131, the amount of radiation emitted from the body is large, so it is necessary to stay in the isolation room for several days. Our treatment room is located on the 6th floor and has a window so you can see the scenery outside. There are few treatment rooms nationwide, but our hospital has two rooms and can treat about 100 patients a year. At our hospital, patients are hospitalized for 11 days for reliable treatment effects and accurate assessment of disease status.

Many patients who underwent surgery at other hospitals are also undergoing I-131 internal therapy. If you wish to receive I-131 internal therapy, please consult with your doctor and make an outpatient appointment at the endocrinology department through our Regional Medical Cooperation Center. In addition, there may be cases where treatment is not suitable, such as when a part of the thyroid gland remains, when there is brain metastasis, or when spinal cord metastases are compressing the spinal cord. confirmation is required).

The pituitary gland is an organ about 1 cm long that hangs from the center of the brain. It secretes adrenocorticotropic hormone, thyroid-stimulating hormone, growth hormone, prolactin, gonadotropic hormone, and antidiuretic hormone.

Some pituitary tumors secrete too much hormone. Acromegaly, Cushing's disease, prolactinoma, etc. depend on the type of hormone. For treatment, tumor removal is performed in cooperation with Neurosurgery, and drug therapy and radiotherapy are performed. Also, large tumors that do not produce hormones may cause visual field defects and require surgery.

On the other hand, if the pituitary gland is damaged for some reason, it will stop producing hormones. Low adrenocorticotropic hormone causes malaise and loss of appetite, low growth hormone causes malaise and increased body fat, low gonadotropin causes infertility and amenorrhea, and low antidiuretic hormone causes infertility and amenorrhea. Polyuria occurs. In the case of hypofunction, symptoms improve with appropriate hormone replacement. It is difficult to distinguish hypopituitarism from other diseases that cause indefinite complaints, and it may go unnoticed for a long time unless an endocrine disorder is suspected. Therefore, it is important to accurately diagnose and treat hypopituitarism.

Many pituitary diseases are designated as intractable diseases by the Ministry of Health, Labor and ministry of Health, Labor and Welfare notation, and our department can handle their diagnosis and treatment.

The adrenal glands are small, triangular organs that overlay the left and right kidneys. Aldosterone and cortisol, which regulate blood pressure and metabolism, and catecholamine, which regulates heart and blood pressure, are secreted.

In primary aldosteronism, hyperaldosterone secretion causes hypertension and hypokalemia. Cushing's syndrome, in which excess cortisol is secreted, causes hypertension, diabetes, a full-moon face, central body obesity, and thin, fragile skin. Pheochromocytoma, in which catecholamine is secreted excessively, causes paroxysmal hypertension, palpitations, sweating, and headache. Functional diagnosis and site diagnosis are important for these tumors, and it is determined whether surgery is indicated by functional tests, CT, scintigraphy, and adrenal vein sampling tests during hospitalization.

Recently, adrenal tumors have been found incidentally by CT scans, etc. Most are benign, but surgery is done if the tumor is large or has an excess of hormones. Surgery is performed in collaboration with Urology.

Hypertension is caused by excessive secretion of aldosterone from the adrenal glands, leading to hypertension and hypokalemia. Recent studies have shown that approximately 5-15% of hypertension cases are primary aldosteronism. Complications such as myocardial infarction, cardiac hypertrophy, heart failure, arrhythmia, stroke, and renal failure are more likely to occur than normal hypertension. Proper diagnosis and treatment can prevent these.

Primary aldosteronism can be caused by aldosterone-secreting tumors in the adrenal glands (aldosterone-producing adenomas) or by an increased number of aldosterone-secreting cells (hyperplasia). The adrenal glands are bilateral, usually unilateral and bilateral.

For diagnosis, blood renin activity and aldosterone concentration are first measured as a screening test. If this is positive (aldosterone concentration/renin activity ratio ≥ 200 + aldosterone concentration ≥ 60 pg/ml), a stress test will be performed to confirm the diagnosis. Challenge tests include the captopril challenge test and the saline challenge test. The The Japan Endocrine Society defines a definitive diagnosis if one or more of these types are positive. In order to make an accurate diagnosis at our hospital, these tests are performed in hospitals for two nights and three days. Next, if primary aldosteronism is diagnosed, adrenal vein sampling will be performed for localization if necessary. Adrenal vein sampling is a test method in which a medical tube called a catheter is inserted through the base of the leg to collect blood from the left and right adrenal veins. At our hospital, in cooperation with the Diagnostic Radiology, we are hospitalized for 2 nights and 3 days. If the lesion is confirmed to be unilateral, a request is made to a Urology for laparoscopic adrenalectomy (hospitalization for about a week). In addition, in the case of bilateral lesions, oral treatment with anti-aldosterone drugs is performed.

The parathyroid glands are four small rice-grain-sized organs on the back of the thyroid that secrete parathyroid hormone, which regulates calcium.

In primary hyperparathyroidism, tumors form primarily in the parathyroid glands and produce too much parathyroid hormone. As a result, calcium in the blood rises, resulting in decreased bone mineral density and urinary tract stones. Treatment is removal of the parathyroid tumor, but if it is mild, drug therapy may be performed. As with other endocrine disorders, functional tests and imaging studies are done.

On the other hand, when parathyroid hormone is insufficient, calcium in the blood decreases, numbness in the hands and feet, and muscle stiffness occur. Treatment includes vitamin D and calcium supplementation.

The pancreas is an organ located deep in the stomach behind the stomach, and has an endocrine function that releases hormones into the blood in addition to an exocrine function that releases digestive juices. Hormones related to sugar metabolism such as insulin, which lowers blood sugar level, and glucagon, which raises blood sugar level, are secreted.

Hypoglycemia occurs in tumors that produce too much insulin (insulinoma). A fasting test and an elective intra-arterial calcium infusion test are performed for diagnosis. Treatment is surgical removal of the tumor.
On the other hand, when insulin secretion decreases, blood sugar level rises and diabetes occurs.

Neuroendocrine tumors (NETs) are tumors derived from hormone-secreting neuroendocrine cells and commonly occur in various organs throughout the body, particularly the pancreas, gastrointestinal tract, and lungs. Drug therapy for unresectable NETs is limited, but peptide receptor radionuclide therapy (PRRT) using a radioactive isotope (lutetium 177), which has already been approved in Europe and the United States, will finally be available in Japan in 2021. approved in the year.

PRRT is a therapeutic method in which a drug containing a radioactive isotope (lutetium 177) attached to a peptide that binds to the somatostatin receptor present in the tumor is injected into the patient and irradiated from within the body. International clinical trials have confirmed its usefulness, and it is a promising treatment method.

In our department, patients are hospitalized for two nights and three days, and this is repeated four times every eight weeks. The presence of somatostatin receptors in the tumor should be tested using OctreoScan before treatment.

If you are a patient undergoing treatment at another hospital and wish to have PRRT, please consult with your attending physician and make an outpatient appointment for endocrinology through our Regional Medical Cooperation Center. Please note that treatment may come first depending on the availability of treatment rooms.