Global Summit on Diabetes & Endocrinology August 24-25, 2020 Kyoto, Japan

• Endocrine Disorders causes when a gland produces too much or too little of an endocrine hormone, called as hormone imbalance and due to the development of lesions in the endocrine system, which may or may not affect hormone levels.
• Adrenal insufficiency: The adrenal gland releases little hormone cortisol and sometimes, aldosterone. Symptoms include stomach upset, dehydration, fatigue.
•  Cushing's disease. Overproduction of a pituitary gland hormones leads to overactive adrenal gland. A similar condition called Cushing's syndrome may occur particularly in children, who take high doses of corticosteroid medications.
• Hypothyroidism. The thyroid gland does not produce enough thyroid hormone, leading to fatigue, depression, constipation, dry skin.
• Hypopituitarism. The pituitary gland releases less or no hormones. It may be caused by several different diseases. Women with this condition may stop getting their periods regularly.
• cromegaly and other growth hormone problems. If the pituitary gland produces too much growth hormone, a child's bones and other body parts may grow abnormally. If growth hormone levels are too low, a child may stop growing in height.
•  Multiple endocrine neoplasia: These rare, genetic conditions are passed through the families. They cause tumors of the adrenal, parathyroid and thyroid glands, leading to overproduction of the hormones.
•  Precocious puberty. Abnormally early puberty that occurs when glands tell the body to release the sex hormones too soon in life.

Endocrine disorders can be classified according to the origin of endocrine disorder and according to the intensity of hormonal activity. From intensity of the hormonal activity of endocrine gland we can distinguish hyper function of endocrine gland, which is characterized by increased secretion of its hormone and by increased concentration of this hormone in circulating blood. Hypo function of endocrine gland, which is characterized by decreased concentration of this hormone in circulating blood and decreased secretion of its hormone as well.

Endocrine disease results when a gland produces too little or too much of an endocrine hormone called hormone imbalance. Diabetic Ketoacidosis is caused in type 1 diabetes where there is reliance on fatty acids for energy and complete lack of insulin. This uncontrolled lipid breakdown leads to formation of causes acidosis, ketones and ketonemia. This is a medical emergency.

Pediatric endocrinology deals with the disorders of endocrine glands, such as variations of sexual development in childhood, diabetes, physical growth and many more. The most common disease of the specialty is type 1 diabetes, which usually accounts for 50% of a typical clinical practice.

Pediatric endocrinologists are usually the primary physicians involved in the medical care of children and infants with intersex disorders. This deals with hypoglycemia and the other forms of hyperglycemia in childhood, variations of puberty, as well other adrenal, pituitary and thyroid problems.

• Adrenal Venous Sampling for Aldosterone, Androgen Levels,  Angiography, Arterial Stimulation with Venous Sampling, Arginine Stimulation Test, Autonomic Function Tests
• Basal Acid Output (BAO), Bilateral Simultaneous Inferior Petrosal Sinus Sampling (IPSS) with CRF, Bone Marrow Aspirate
• C-peptide Suppression Test, Captopril Test, Clomiphene Test, Calcium Infusion Test for Medullary Cancer of the Thyroid, Clonidine Suppression Test, Cortisol Day Curve, CRH Test, Combined Pituitary Function Tests (CPT).
• Glycated hemoglobin (A1C) test, Exercise Test, Finger Size Assessment, Gastric Acid Secretion, Glucagon Test, Glucose Tolerance Test, Fasting Test, Fine Needle Aspiration of a Thyroid Nodule (FNA), Gonadotrophin Releasing Hormone GnRH/LHRH Test
• High Dose Dexamethasone Suppression Test, Hydrocortisone Day Curve (HCDC), Hydroxycorticosterone (18-OHB) and, Hyperparathyroidism Investigations, - cortisol (18-OHF) Tests, Hyperaldosteronism Investigation.

Reproductive Endocrinology is a sub-specialty of Gynecology & Obstetrics. Reproductive endocrinologist is a very important part of obstetrics and gynecology in which physician is trained in reproductive medicine explaining about the hormonal functioning as it is indirectly related to reproduction. They are prepared to evaluate and treat malfunctioning in males and females outside infertility. Reproductive endocrinologists have specific training in obstetrics and gynecology before they undergo sub-specialty training in Reproductive endocrinology and infertility.

Male Endocrinology

The glands testes produce abnormally low amounts of testosterone, may receive testosterone replacement therapy. For some men, lower than normal testosterone produces no apparent effects; for others, effects of this condition may include:

• Reduced sexual function, in terms of desire, erections and fertility
• Reduced muscle size and strength, more body fat and lower bone density
• Insomnia or other sleep problems

Female endocrinology

Female endocrinology has to do largely with the reproductive cycle driven by estrogen and other cyclical female hormones. Related issues that the endocrinologist may help evaluate:

• Heavy, light or absent menses
• Premenstrual syndrome
• Abnormalities that may produce symptoms that cycle with menses, such as ovarian cysts or uterine fibroids
• Early or delayed menarche

Menstrual irregularity

Check your risk of diabetes: Risk assessment test and learn more about your risk of developing type 2 diabetes. A 12+ score indicate that you are at high risk and may be eligible for the Life! Program - a free Victorian lifestyle modification program that helps you reduce your risk of type 2 diabetes and cardiovascular disease. 

Manage your weight. Excess body fat, particularly if stored around the abdomen, can increase the body’s resistance to the hormone insulin. This can lead to type 2 diabetes.

Exercise regularly. Moderate physical activity on most days of the week helps manage weight, reduce blood glucose levels and may also improve blood pressure and cholesterol.

Eat a balanced, healthy diet. Reduce the amount of fat in the diet, especially saturated and trans fats. Eat more fruit, vegetables and high-fiber foods. Cut back on salt.

Limit takeaway and processed foods. ‘Convenience meals’ are usually high in salt, fat and kilojoules. It’s best to cook for yourself using fresh ingredients whenever possible.

Limit your alcohol intake. Too much alcohol can lead to weight gain and may increase your blood pressure and triglyceride levels. Men should have no more than two standard drinks a day and women should have no more than one.

Quit smoking. Smokers are twice as likely to develop diabetes as non-smokers.

Control your blood pressure. Most people can do this with regular exercise, a balanced diet and by keeping a healthy weight. In some cases, it might need medication prescribed by the doctor.

Reduce your risk of cardiovascular disease. Diabetes and cardiovascular disease have many risk factors in common, including obesity and physical inactivity.

Diabetic nephropathy is a disease/ the damage caused by diabetes to your kidney, which in some sever cases can lead to kidney failure. The waste from our blood is filtered by tiny blood vessels present in our kidney, and they can be destroyed by high sugar level in our body. The body retains excess salts and water than required leading to weight gain and ankle swelling. This leads to malfunction or kidney failure in further stages. No symptoms are shown in primary stages so, regular urine tests are required to detect kidney damage.

Diabetes may also lead to damage to nerves, which can lead to difficulty in emptying bladder and creating pressure injuring your kidney. Long time retention of urine in bladder leads to infections as bacterial growth in urine with high blood sugar level is high.

About 10 to 40 % of those with Type 2 diabetes  and 30% of patients with Type 1 diabetes  gradually will suffer from kidney failure.

Diabetes may also lead to damage to nerves, which can lead to difficulty in emptying bladder and creating pressure injuring your kidney. Long time retention of urine in bladder leads to infections as bacterial growth in urine with high blood sugar level is high.

About 10 to 40 % of those with Type 2 diabetes  and 30% of patients with Type 1 diabetes  gradually will suffer from kidney failure.

Diabetic retinopathy is caused due to damage of the blood vessels in the tissue of retina. Poor control of blood sugar levels is one of the risk factors. The blood vessels may swell and leak fluid and the abnormal development of new blood vessels on the surface of the retina is observed. The accompanying scar tissue might contract and detach from the retina.

Symptoms in initial stages include blurriness, floaters, dark areas of vision and difficulty perceiving colors. There is no cure for diabetic retinopathy but can be treated laser treatments and the surgical removal of vitreous gel (vitrectomy) for good vision.

Diabetes can affect every part of body including the skin. It sometimes helps in recognizing people with diabetes earlier. Most of the skin conditions can be easily treatable. Other skin problem like necrobiosis lipoidica, diabetic dermopathy, diabeticorum, eruptive xanthomatosis  and diabetic blisters are mostly likely affected in diabetic persons only.

Adults with diabetes are more inclined to cardiovascular complication (6% of  individuals) like atherosclerosis which narrow the arteries and leads to reduced blood flow to heart. The partial blockage of  coronary arteries produces angina and the complete blockage lead to heart stroke. Atherosclerosis also leads to stoke and the complete blockage of blood flow to brain and the arterial disease – poor supply of blood to the legs. These are the major reasons for the death of people with diabetes.

Maintaining a suitable diet is very essential in the diabetic patients in order to reduce the risk of diabetic complications. A proper physical activity and healthy eating pattern is the key component. Generally low carbohydrate is insisted as these are macronutrients which raises the blood glucose levels, foods like whole grains, vegetables, fruits, and nuts, low fat food are best source and high fiber diet is preferred. Some of the methods for healthy diet plan are carbohydrate counting, Glycemic index , the My Plate method, and  TLC diet plan.

Diabetic patients should monitor their feet on regularly basis to avoid the risks which leads to amputation. Even minor wounds like blisters to foot lead to serious consequences, as blood flow decreases in diabetic cases and the wound healing is delayed leading to infection. Predominant pathogens include gram +ve cocci especially streptococci and staphylococci. Chronic or previously treated wounds lead to several microbial cultures for which proper antimicrobial therapy is required.

Molecular biomarker is a naturally occurring gene, molecule or a character which helps in recognizing the diseases. In case of diabetes HbA1c is considered as a biomarker to identify the risk factors for retinopathy, vascular diseases and nephropathy. These provides preventive measures during subclinical stage. The well usage of biomarker within the growth of anti-diabetes medication can help in quick  and better understanding of the pathological process of diabetes.

The main aim of diabetes management and complication is to bring the carbohydrate metabolism to balanced state. In order to achieve the patients with the insulin deficiency are with pumps or insulin injections and patients with insulin resistance are treated with proper exercise and diet maintenance. The other complication caused due to other disease are to be treated or to be prevented. Maintaining a healthy diet is the best to have a healthy living.

Diabetes is a main factor for development of other secondary conditions and cardiovascular disease. Regular check-ups on blood pressure, HDL, cholesterol, LDL and triglyceride levels, eye examination to prevent diabetic retinopathy.

The butterfly shaped gland located at the base of neck at Adams apple is called as thyroid. It is a part of the endocrine system, which is responsible to co-ordinate many body’s activities. Thyroid glands produce androgen prohormones which regulates the body’s metabolism. When thyroid produces less hormones leading hypothyroidism  and when excess hormones are produced leads to hyperthyroidism. Thyroid diseases are mostly affects women than men. In women infertility, problems during pregnancy, miscarriage, menstrual period and childbirth. 

Graves’ disease is an immune disorder that leads to excess production of thyroid hormones called hyperthyroidism. The thyroid hormones metabolism is regulated by carbohydrates, protein and fat.

Genomic endocrinology is explained as the insights that may be gained about physiology and endocrine pathology from application of full range of genetic approaches. Genetic mechanisms leads to endocrine disease and functional studies of genetic mutations that shed novel insights into the pathogenesis and aetiology of endocrine disorders.

Genomic endocrinology is explained as the insights that may be gained about physiology and endocrine pathology from application of full range of genetic approaches. Genetic mechanisms leads to endocrine disease and functional studies of genetic mutations that shed novel insights into the pathogenesis and aetiology of endocrine disorders.

Endocrine system regulates the interactions of organisms with the environment. The endocrine system comprises all the glands and tissues in the body that synthesize, and release chemical-signaling molecules called as hormones. Hormones are made by specific glands, including the hypothalamus, thyroid gland, pituitary gland, adrenal glands, pancreas, ovaries, testes, parathyroid glands and pineal gland. Several other tissues in the body, including the adipose cells, gastrointestinal tract.