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An endocrinologist is a highly trained specialist physician who has completed years of accredited specialist training in clinical endocrinology, who is skilled in the diagnosis and management of conditions of the endocrine system.

Endocrine conditions are complex and their diagnosis evaluation and management is nuanced and requires expertise.

In Australia an endocrinologist is a specialist physician who has:

• Graduated from medical school,
• Completed internship,
• Completed three years of BPT (Basic Physician Training) accredited by the Royal Australasian College of Physicians*,
  Passed the FRACP clinical examinations
• Undergone a minimum of three further years of APT (Advanced Physician Training) with the RACP *

*(or training from an equivalent college )

A General Physician is a highly trained specialist who provides a range of non-surgical health care to adult patients. They only see patients who are referred to them by other doctors.

They are consultants who care for patients with special, difficult, serious or unusual medical problems and continue to see the patient until these problems have resolved or stabilised.

For more information:
https://www.imsanz.org.au/about-us/what-is-a-general-physician

Endocrinology used to be defined as the study of cell- to- cell communication via messenger molecules (or hormones). This definition has now been extended to also include communications both inside and outside of cells. 

The endocrine system is an essential and complex controlling mechanism of all the other systems of the human body. It is made up of several systems operating via feedback loops. Endocrine glands make and secrete various chemical substances (hormones) which travel through the bloodstream and spread around the body to carry messages or signals to act on distant targets to influence function.

The name hormone comes from the Greek word hormao meaning “I excite” and refers to the fact that each hormone excites or stimulates a particular part of the body known as the target gland. In total more than 200 hormones or hormone-like substances have been discovered.

Generally, the higher the amount of hormone that is in the blood, the greater the effect its the targets.

The main glands and organs of the endocrine system include:

• Pituitary gland
• Thyroid gland 
• Parathyroid gland 
• Adrenal glands
• Pancreas 
• Ovaries 
• Testes 

Others:

• Adipose tissue (fat tissue) 
• Kidneys 
• Gut

Clinical Endocrinology involves the care of patients covering a range of different hormonal imbalances and metabolic conditions causing health concerns, including:

• Diabetes Mellitus (Types 1 and 2; LADA , monogenic, drug induced, and others)
• Conditions affecting the Thyroid (Hashimoto’s thyroiditis; Graves’ Disease; Thyroid nodules; thyroid carcinoma and others)
• Osteoporosis and bone health
• Pituitary gland abnormalities
• Adrenal gland conditions
• Parathyroid /Calcium Disorders
• Obesity /Metabolic Syndrome
• Women’s health – (menopause; Polycystic ovarian syndrome)
• Gestational diabetes and hypertension

Diabetes mellitus, is commonly referred to as diabetes, is a condition in which the body’s blood glucose, is too high. The total number of people living with diabetes worldwide is projected to rise from 171 million in 2000 to 366 million in 2030.

There are different types of diabetes; all types are complex and serious. The three main types of diabetes are type 1, type 2 and gestational diabetes.

An estimated 1.2 million (6%) Australian adults aged 18 years and over had diabetes in 2017–18, based on self-reported data, from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey. This includes people with type 1 diabetes, type 2 diabetes, and type unknown but excludes gestational diabetes.

Information based on self-reported data only is likely to underestimate the prevalence of diabetes as it cannot include people with undiagnosed diabetes. The ABS 2011–12 Australian Health Survey, which included both measured and self-report data showed that for every 4 adults with diagnosed diabetes, there was 1 who was undiagnosed.

Diabetes is a complex condition which can affect the entire body. Diabetes requires daily self care and if complications develop, diabetes can have a significant impact on quality of life and can reduce life expectancy. While there is currently no cure for diabetes, you can live an enjoyable life by learning about the condition and effectively managing it. 

Your pituitary gland is about the size of a pea and is situated in a bony hollow, about 2-3 cm behind the bridge of your nose. It is attached to the base of your brain by a thin stalk- the pituitary stalk. The pituitary gland is often called the master gland because it controls several other hormone glands in your body, including the thyroid and adrenals, the ovaries and testicles.

It secretes hormones from both the front part (anterior) and the back part (posterior) of the gland.

If your pituitary gland is not producing sufficient amounts of one or more hormones this is called hypopituitarism. If on the other hand you are over-producing certain hormones, then you would have features due to the over production of the specific hormone concerned.

The most common problem affecting the pituitary gland is that you could develop an Adenoma – a Benign “tumour”.
Pituitary tumours are not ‘brain tumours’. The term benign is used to describe a swelling which is not cancerous. Some pituitary tumours can exist for years and sometimes even decades without causing symptoms and some will never produce symptoms.

Most pituitary tumours occur in people with no family history of pituitary problems and the condition is not usually passed on from generation to generation. Only very occasionally are tumours inherited – for example, in a condition known as multiple endocrine neoplasia (MEN1).

By far the most common type of adenoma is the ‘non-functioning’ tumour.

This is an adenoma which doesn’t produce any hormones itself. It can cause headaches and visual problems or it can press on the pituitary gland, causing it to stop producing the required amount of one or more of the pituitary hormones. This effect can also occur following treatment you are given for a tumour, such as surgery or radiotherapy.

On the other hand, your pituitary tumour may begin to generate too much of one or more hormones.

The more common pituitary conditions include acromegaly, Cushing’s disease, diabetes insipidus, hypogonadism, hypopituitarism and prolactinoma.

The hypothalamus is important because it influences the functions of temperature regulation, food intake, thirst and water intake, sleep and wake patterns, emotional behaviour and memory.

The hypothalamus is part of the brain, which controls the pituitary by sending messages. It is situated immediately above the pituitary gland. The hypothalamus serves as a communications centre for the pituitary gland, by sending messages or signals to the pituitary in the form of hormones which travel via the bloodstream and nerves down the pituitary stalk. These signals, in turn, control the production and release of further hormones from the pituitary gland, which signal other glands and organs in the body.

The thyroid gland is a butterfly-shaped endocrine gland that is usually located in the lower front of the neck just below the “Adam’s Apple”. In humans the thyroid gland makes two different types of thyroid hormone, T4 and T3, each of which contain the element Iodine in differing proportions. Each T4 molecule has four atoms of iodine attached to it whereas T3 molecules have three iodine atoms attached instead.

Thyroid hormone is stored in the thyroid gland until needed. Then it is released into the blood where it is distributed throughout the body to its targets. This is usually a highly regulated, tightly controlled process. Thyroid hormones (T4 and T3) help the body to use energy, stay warm and keep the brain, heart, muscles, and other organs working appropriately.

Sometimes the Thyroid gland can increase in size (causing a goiter).

Sometimes people have an abnormality in thyroid function. In fact, this is a relatively common occurrence. When this happens there can either be too high or too low levels of thyroid hormone. This may cause various symptoms.

Hyperthyroidism/ thyrotoxicosis is a condition in which thyroid hormone levels are raised. It is usually caused by Graves’ disease, an autoimmune disorder, but may also be caused by an overactive thyroid nodule, excessive exposure to iodine or other causes such as postpartum (post-pregnancy) thyroiditis or excessive thyroid hormone replacement. Symptoms might include weight loss, heat-intolerance, fast heart rate and others.

Hypothyroidism is a thyroid hormone deficiency which may be “overt”, with symptoms like cold sensitivity, menstrual difficulties, dry skin, fatigue, or “subclinical” with few or no symptoms but abnormal levels of thyroid hormones. In Australia where there is usually adequate intake of iodine, autoimmune thyroid disease (Hashimoto’s disease) is the most common cause whereas inadequate iodine intake is a major cause worldwide, particularly in high mountainous regions that are far from the sea.

A careful clinical evaluation involving a detailed discussion of your symptoms, a clinical examination and blood tests are the best initial way to investigate the function of the thyroid gland. Sometimes imaging tests are done.

Medicine has been practised for thousands of years. The Hippocratic Oath (an oath that doctors still take to this day in a modified form) derives from Ancient Greece between the fifth and third centuries BC (~2,500 years ago).

The history of diabetes started in approximately 1550BC, long before the mechanics of the disease were understood. A Greek papyrus from 3000 years ago mentions a rare disease that causes the patient to lose weight rapidly and to urinate frequently. This is thought to be the first reference to diabetes.

Managing conditions associated with the endocrine system has been incorporated in the practise of medicine for hundreds of years- long before the endocrine system was described or understood. Brave, tremendously thorough and (it has to be said) dedicated doctors in centuries past knew their patients had diabetes mellitus because their urine tasted sweet!

It took until the 1900s with the discovery of hormones for endocrinology to evolve as a specific subspecialisation in internal medicine.

Many of the medical breakthroughs of the past century, such as the inspiring discovery of insulin, have been attributed to endocrinologists.

Since then the practise, training and regulation of medicine has evolved even more. Endocrinologists and endocrinology-related research has played a significant part in the medical field. There have been thirty-five endocrine-related Nobel prizes in all awarded over the past century.

Our understanding of endocrine conditions such as diabetes are ever evolving. Over time diabetes has since become classified as different types and treatments have evolved so people can live for longer and reduce the risk of long-term health complications. In tandem with rapid ongoing impressive medical advancements, the training of endocrinologists has become more specialised and sub-specialities have developed. Today endocrinology remains an immensely important speciality because hundreds of millions of people worldwide have conditions and diseases tied to hormone imbalances or disturbances.