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.

The main endocrine organs include the hypothalamus, pituitary gland, thyroid gland, parathyroid gland, pancreas, adrenal glands, ovaries, testes, etc. Substances with various functions (hormones) are secreted from these organs into the blood and act on organs throughout the body to maintain homeostasis.

Endocrine disorders can be broadly divided into conditions in which hormones are secreted excessively (hyperfunction), in which hormones are deficient (hypofunction), and in which tumors have developed in endocrine organs. Some of these disorders can be difficult to distinguish from other disorders because their symptoms are similar, so accurate diagnosis and appropriate treatment are important. For accurate diagnosis, blood tests under resting and fasting conditions, blood tests after several days of hospitalization for drug administration, etc. may be required. In addition, imaging tests such as ultrasound, CT, MRI, and scintigraphy, as well as venous sampling, are performed to examine the nature and location of the lesion in detail.

Graves' disease develops when autoantibodies that stimulate the thyroid gland are produced. This causes the thyroid gland to swell and produce excess thyroid hormones. This disease is more common in women, and in some cases symptoms such as bulging eyes may appear.

If thyroid hormone is produced in excess, symptoms may include weight loss despite appetite, excessive sweating, persistent low-grade fever, heart palpitations, shortness of breath when moving, trembling hands, and diarrhea.

There are several ways to treat it. One is to take oral medication called antithyroid drugs. This medication can have side effects, so treatment is carried out while carefully monitoring the progress. Usually, it is necessary to take the medication for several years or more. The other is radioactive iodine therapy (isotope therapy). In this treatment, radioactive iodine (I-131) is taken orally to destroy thyroid cells. However, after this treatment, in many cases, thyroid hormone supplementation medication is required afterwards. There is also a surgical treatment method. This is performed when the thyroid gland is significantly swollen or when antithyroid drugs cannot be used. Since the entire thyroid gland is removed by surgery, thyroid hormone supplementation medication is required after surgery.

Hashimoto's disease is a disease in which chronic inflammation of the thyroid gland occurs. With this disease, the thyroid gland swells, and in some people, the secretion of thyroid hormones may decrease. When the secretion of thyroid hormones decreases, various physical disorders may appear. For example, swelling may occur, the body may become weak in the cold, and the body may become easily constipated. When the secretion of thyroid hormones decreases, thyroid hormone replacement therapy (treatment to supplement hormones) is performed.

Also, taking in too much iodine can worsen the secretion of thyroid hormones. Iodine is found in large amounts in seaweed such as kelp, so it is important to be careful not to consume too much of these foods.

Lumps (tumors) and fluid-filled sacs (cysts) can develop in the thyroid gland. These often do not cause symptoms when they are small, and are often discovered by chance during health checkups. To determine whether a lump is benign or malignant, an ultrasound (echo) test or a test in which a thin needle is inserted to collect cells and then examined in detail under a microscope (fine needle aspiration cytology) is performed.

If it is judged to be benign, the progress will be monitored through regular examinations and tests. On the other hand, if there is a possibility of it being malignant, the thyroid will be removed through surgery. After surgery for thyroid cancer, treatment using radioactive iodine (I-131) may be performed. In addition, if the disease progresses quickly, treatment using a new type of anti-cancer drug called a "molecular targeted drug" may be performed in cooperation with Oncology.

One of the treatments for thyroid cancer is radioactive iodine (I-131) therapy after total thyroidectomy. This treatment has been used for a long time around the world and its safety and effectiveness have been established.

If there is metastasis, this treatment is repeated every six months to one year (treatment). On the other hand, even if there is no metastasis, this treatment can be received after surgery to destroy remaining normal thyroid cells and simplify follow-up (ablation), or to destroy the few remaining cancer cells and prevent recurrence (adjuvant therapy).

I-131 is only taken up by cells with thyroid properties, emitting radiation called beta rays to destroy the cells. This radiation only reaches a range of about 1 to 2 millimeters, so the impact on surrounding organs is kept to a minimum. The main side effects are nausea and taste disorders, but they usually recover within about a week.

Treatment involves simply taking a small capsule containing I-131. However, there are some preparations that need to be made before the treatment can begin. First, the thyroid gland must be completely removed, then thyroid hormone medication must be discontinued, and iodine-containing foods must be avoided. When thyroid hormone medication is discontinued, symptoms such as swelling, constipation, and loss of appetite may appear. In addition, radiation is released from the body for a while after treatment, so patients will be required to stay in an isolated treatment room for several days. Our treatment room is on the sixth floor, with a window that allows a view of the outside. There are only a limited number of treatment rooms nationwide, but we have two rooms, and we can treat approximately 100 patients per year. In order to increase the certainty of treatment, we have set an 11-day hospital stay.

At our hospital, we also provide radioactive iodine therapy to many patients who have undergone surgery at other hospitals. If you would like to receive this treatment, please consult with your doctor and make an appointment with the Endocrinology Department through our hospital's Regional Medical Cooperation Center.

The pituitary gland is a small organ that hangs down 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 excessive amounts of hormones. These tumors can cause certain diseases. For example, excessive secretion of growth hormone causes acromegaly, excessive secretion of adrenocorticotropic hormone causes Cushing's disease, and excessive secretion of prolactin causes prolactinoma. These tumors are treated with surgery to remove the tumor in collaboration with Neurosurgery, as well as drug therapy and radiation therapy. Even tumors that do not secrete hormones can cause symptoms such as narrowing of the visual field if they grow large, and in such cases surgery is still required.

On the other hand, if the pituitary gland is damaged, hormones may not be secreted sufficiently. For example, a lack of adrenocorticotropic hormone may cause fatigue and loss of appetite. A lack of growth hormone may cause fatigue and an increase in body fat. A lack of gonadotropic hormone may also cause infertility and the cessation of menstruation, while a lack of antidiuretic hormone may cause polyuria. However, with appropriate hormone replacement therapy, these symptoms can be improved and it is possible to lead a normal daily life.

The adrenal glands are small, triangular organs located above each kidney. They secrete hormones such as cortisol, aldosterone, and catecholamines that regulate blood pressure and metabolism.

Some adrenal tumors secrete excessive hormones. These tumors can cause certain diseases. For example, excessive cortisol secretion causes Cushing's syndrome, which can lead to high blood pressure, diabetes, a round face, abdominal obesity, and thin, easily damaged skin. Excessive secretion of aldosterone causes primary aldosteronism, which can lead to high blood pressure and a decrease in potassium in the blood. Excessive secretion of catecholamines causes pheochromocytoma, which can lead to sudden episodes of high blood pressure, palpitations, excessive sweating, and headaches.

Detailed examinations are required to diagnose these diseases and determine the treatment plan. These include functional tests to examine hormone function, imaging tests such as CT and scintigraphy, and adrenal vein sampling tests. Based on these tests, we decide whether surgery is necessary. If surgery is deemed necessary, we will refer you to Urology.

Recently, there has been an increase in cases where tumors are accidentally found in the adrenal glands even in the absence of symptoms through CT scans, etc. Most of these are benign, but if the tumor is large or if excessive hormones are being secreted, surgery may be recommended.

Primary aldosteronism is a disease caused by excessive secretion of the hormone aldosterone from the adrenal glands. This disease causes high blood pressure and a decrease in blood potassium levels. Recent research suggests that approximately 5-15% of hypertension patients are attributable to this disease.

Compared to normal hypertension, primary aldosteronism is said to have a higher risk of complications such as myocardial infarction, cardiac hypertrophy, heart failure, arrhythmia, stroke, and renal failure. However, these complications can be prevented by receiving appropriate diagnosis and treatment.

There are two main types of this disease: one is caused by a tumor in the adrenal gland that produces too much aldosterone (aldosterone-producing adenoma), usually in one adrenal gland, and the other is caused by an overgrowth of adrenal cells (hyperplasia), often affecting both adrenal glands.

To make a diagnosis, we first measure renin activity and aldosterone levels through blood tests. If abnormalities are found in these tests, we will perform a functional test to confirm the diagnosis. In the functional test, the amount of hormone secretion is measured using medicines and saline drips. At our hospital, these tests are performed with a 2-night, 3-day hospital stay to ensure they are performed accurately.

If you are diagnosed with primary aldosteronism, a test (adrenal venous sampling) may be performed to identify the location of the problematic adrenal gland. In this test, a thin tube is inserted from the groin and blood is taken from both adrenal glands. At our hospital, this test is also performed with a 2-night, 3-day hospitalization.

If the test results show that there is an abnormality in only one adrenal gland, the patient will be referred to Urology to have the abnormal adrenal gland removed (hospitalization will be about one week). On the other hand, if there is an abnormality in both adrenal glands, treatment will involve oral medication to suppress the action of aldosterone.

The parathyroid glands are very small organs (usually four) located behind the thyroid gland that secrete the parathyroid hormone and play an important role in regulating calcium levels in the body.

Primary hyperparathyroidism is a disease in which a tumor develops in the parathyroid gland and causes excessive secretion of parathyroid hormone. As a result, the calcium concentration in the blood becomes abnormally high, and symptoms such as brittle bones (osteoporosis) and urinary stones may appear. Surgery to remove the tumor is the general treatment for this disease, but if symptoms are mild, observation may be chosen. Hormonal tests and imaging tests are used for diagnosis.

On the other hand, if there is a deficiency of parathyroid hormone, the calcium concentration in the blood will decrease, and symptoms such as numbness in the hands and feet and muscle stiffness may occur. In this case, vitamin D and calcium preparations are administered as treatment.

The pancreas is an organ located deep inside the abdomen, behind the stomach. The pancreas has two roles: secreting digestive juices that aid digestion (exocrine function) and secreting hormones into the bloodstream (endocrine function). In particular, the endocrine function secretes hormones such as insulin, which lowers blood sugar levels, and glucagon, which raises blood sugar levels, to regulate sugar metabolism in the body.

Tumors that secrete excess insulin (insulinomas) can cause hypoglycemia. Fasting tests and selective intra-arterial calcium injection tests are used to diagnose this disease. The most common treatment is surgical removal of the tumor.

Neuroendocrine tumors are tumors that arise from neuroendocrine cells that secrete hormones, and are commonly found in various organs in the body, especially the pancreas, digestive tract, and lungs. Drug therapy options for neuroendocrine tumors are limited, and the limited treatment options are a challenge, especially when surgery is not possible. However, peptide receptor radionuclide therapy (PRRT), which uses a radioisotope (lutetium-177) that has been used in Europe and the United States, was approved in Japan in 2021 and is attracting attention as a new treatment method.

PRRT is a method of treating tumors by injecting a drug that binds to the "somatostatin receptors" present in the tumor and irradiating the body with radiation. The effectiveness of this treatment has been confirmed in international clinical trials, and hopes are high for its therapeutic effects.

At our hospital, this treatment is performed over a 2-night, 3-day hospital stay, and is repeated 4 times every 8 weeks. Before starting treatment, an Octreoscan test is required to check whether the tumor has somatostatin receptors.

If you are undergoing treatment at another hospital and would like to undergo PRRT, please consult with your doctor and make an appointment for an outpatient endocrinology appointment through our hospital's Regional Medical Cooperation Center.

Thyroid eye disease is an eye disease that occurs in association with thyroid diseases such as Graves' disease and Hashimoto's disease. This disease causes inflammation of the tissues behind the eyes, resulting in symptoms such as bulging eyes, double vision, and decreased vision, which can seriously impede daily life.

The cause of thyroid eye disease is thought to be an autoimmune reaction to the TSH receptor. It is also known that genetic predisposition and lifestyle habits such as smoking affect the onset of the disease.

Treatment methods vary depending on the severity and progression of the symptoms. If the symptoms are mild, treatments such as eye drops and local injections are used to relieve the symptoms while monitoring the condition regularly. If the symptoms are severe, steroid drip treatments and radiation therapy are used to suppress inflammation and prevent the condition from worsening. In addition, after the inflammation has subsided, eye surgery may be performed to improve the appearance and vision.

A new drug called "teprotumumab" was approved in 2024. This drug has the effect of suppressing inflammation behind the eye and improving exophthalmos. Conventional steroid treatment required hospitalization for about one month, but this drug only requires eight infusions every three weeks as an outpatient treatment, so it is expected to reduce the burden on patients. However, hearing loss and elevated blood sugar levels have been reported as side effects, so it must be administered under careful management.

Patient information site "Thyroid Eye Disease.jp"
Click here for Thyroid Eye Disease.jp:https://www.kojosen-gansho.jp

Hypophosphatasia (HPP) is a rare inherited metabolic bone disorder. It is caused by a mutation in the ALPL gene that results in the body not producing enough of the enzyme alkaline phosphatase (ALP). It is usually diagnosed during childhood, but can also be detected in adulthood.

Adults with HPP may experience symptoms such as fractures or pseudofractures, bone and joint pain, and muscle pain and weakness, which can interfere with daily life. Because these symptoms resemble those of other diseases, it can often be difficult to diagnose.

When making a diagnosis, a blood test showing a decrease in serum ALP levels is an important clue. Furthermore, a definitive diagnosis can be made by confirming an increase in a substance called phosphoethanolamine in a urine test or by conducting a genetic test.

Treatment involves ALP enzyme replacement therapy (asfotase alfa), which is expected to alleviate the symptoms of HPP and improve quality of life.

"HPP Guide" - Information site for patients
HPP Guide is here:https://hpp-life.jp