Who is an endocrinologist, and when should you see one?

Perhaps your family doctor has asked you to “see an endocrinologist”, and you are not quite sure what that means. You are not alone. Endocrinology is one of the less familiar specialties, even though the conditions it covers, such as diabetes and thyroid problems, affect crores of Indians. Here is a simple guide.

What does an endocrinologist do?

An endocrinologist is a doctor who specialises in hormones and metabolism.

Hormones are chemical messengers made by glands in your body. They travel in the blood and control how you grow, use energy, handle sugar, build bones, reproduce and respond to stress. The main hormone glands are:

• The pituitary, a small “master gland” under the brain
• The thyroid, in the front of the neck
• The parathyroid glands, which control calcium
• The adrenal glands, above the kidneys
• The pancreas, which makes insulin
• The ovaries and testes

When a gland makes too much or too little of a hormone, or the body stops responding to it, problems follow. Endocrinologists diagnose and treat these problems, which often affect many parts of the body at once.

What conditions do endocrinologists treat?

The most common reasons people see an endocrinologist in India are:

• Diabetes, including type 1, type 2, diabetes in pregnancy and unusual types. Read about whether diabetes can go into remission.
• Thyroid problems, such as an underactive or overactive thyroid, thyroid nodules and goitre. Even hair fall is often a thyroid question; see is my hair loss because of my thyroid.
• Obesity, including medical treatment of weight.
• PCOS and other causes of irregular periods, acne and excess hair. Read about the 21-day pill pack for PCOS.
• Bone and calcium problems, such as osteoporosis, low vitamin D and high calcium.
• Pituitary and adrenal disorders, such as high prolactin, Cushing’s syndrome and adrenal insufficiency. Some of these are emergencies, such as pituitary apoplexy.
• Male hormone problems, such as low testosterone.
• Cholesterol problems, often alongside diabetes.

Paediatric endocrinologists look after children and teenagers with problems such as short height, early or delayed puberty, type 1 diabetes and thyroid problems in childhood.

What training does an endocrinologist have in India?

Becoming an endocrinologist in India takes many years of study:

1. MBBS, the basic medical degree.
2. MD or DNB in General Medicine (or Paediatrics), about three years.
3. DM, DNB or DrNB in Endocrinology, a further three years of super-specialty training focused on hormones and metabolism.

So a qualified endocrinologist in India will hold an MD/DNB followed by a DM/DNB/DrNB in endocrinology. It is reasonable to ask about your doctor’s qualifications, and you can check any doctor’s registration with the National Medical Commission or your state medical council.

You may also meet doctors called diabetologists. Many are physicians with additional training or experience in diabetes and provide excellent diabetes care. An endocrinologist has formal super-specialty training covering all the hormone glands, which helps when diabetes is unusual or comes with other hormone problems.

How is an endocrinologist different from my family doctor?

Your family doctor or physician manages many everyday health problems, including straightforward diabetes and thyroid conditions. An endocrinologist usually steps in when:

• Standard treatment is not working well.
• The diagnosis is unclear or unusual.
• There is a complication, or several conditions together.
• Special situations arise, such as pregnancy, children, surgery on a hormone gland, or advanced treatments like insulin pumps and continuous glucose monitors.

Endocrinologists often work as part of a team with obstetricians, surgeons, eye specialists, kidney specialists, dietitians and diabetes educators.

When should you see an endocrinologist?

Consider asking for a referral if you have:

• Diabetes that remains uncontrolled, frequent low sugars, or diabetes in pregnancy.
• A thyroid problem with pregnancy, a neck swelling, or symptoms that do not improve with treatment.
• Irregular periods, excess facial hair or difficulty conceiving.
• Unexplained weight gain or weight loss, or severe tiredness.
• Fractures after minor falls.
• A child who is not growing well, or whose puberty is very early or late.
• A scan that has found a growth in the pituitary, adrenal or thyroid gland.

What happens at the first visit?

Your endocrinologist will ask about your symptoms, past illnesses, family history and medicines. They will examine you, which may include checking your neck, skin, blood pressure, weight, waist and, in children, height and growth.

Many hormone tests are blood tests. Some are done at a specific time of day or after fasting, and a few involve stimulation or suppression tests over a few hours. Scans such as an ultrasound of the thyroid, a DEXA bone scan or an MRI of the pituitary may be needed. Some people are offered a small needle test of a thyroid nodule, or a continuous glucose monitor.

How can you prepare for your visit?

• Bring all your previous reports, including old thyroid, sugar and scan reports, ideally in date order.
• Bring a list of all medicines and supplements, including hair vitamins, ayurvedic or homeopathic medicines. Some supplements, such as biotin, can change hormone test results.
• If you check your sugar at home, bring your glucometer or sugar log.
• Note down your questions before the visit, and bring a family member if it helps.
• Ask in advance whether you need to fast for any test.

If your report is about the thyroid, the thyroid report reader can help you understand common patterns before your visit.

What does long-term care look like?

Most endocrine conditions are long-term. Your endocrinologist will plan regular follow-up, with the timing depending on how stable your condition is and what treatment you are on. Honest conversations about how you are taking your medicines, side effects and lifestyle make treatment work better.

Dr. Om J Lakhani is a consultant endocrinologist in Ahmedabad. Read more about Dr. Om J Lakhani, or book a consultation.