The endocrine system is a critical but complex component of the body that regulates and controls a wide range of functions related to metabolism, growth and development, sexual function, reproduction, sleep, mood and many other elements that make us functional human beings. But it’s a system that has to operate in balance, and with so many moving parts — glands, organs, tissues and hormones — it’s not uncommon for one element to fall out of alignment. When something does go wrong, you may need to seek the help of an endocrinologist, a specialist who understands the various components of the system and how they need to work in harmony.
“Endocrinology basically encompasses glands — any glands throughout the body will be under the purview of an endocrinologist,” says Dr. David Bradley, an endocrinologist at The Ohio State University Wexner Medical Center. This includes the pituitary gland, a tiny structure in the brain that acts as “kind of the master gland and secretes hormones that control other glands in the body.” These other glands include:
— The thyroid, a butterfly-shaped gland that sits along the front of the windpipe. This gland controls metabolism, and over- or under-production of thyroid hormones can be associated with changes in body weight and energy levels.
— The adrenal glands, located above the kidneys, produce adrenaline and steroids that stimulate the heart and metabolism to control behavior during emergencies (triggering the so-called fight-or-flight response).
— The pancreas, which lies in the abdomen and produces insulin to regulate blood sugar levels and help turn food into energy.
— The gonads — in women, the ovaries, and in men, the testes — which produce sex hormones such as estrogen, progesterone and testosterone and regulate reproduction and sexual function.
— Other glands, tissues and structures that regulate a range of other hormones and processes throughout the body.
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“In general,” Bradley says, endocrinology addresses the “overproduction or under-production of hormones by glands,” and an endocrinologist can prescribe treatments that help regulate these secretions when needed. An endocrinologist can help you with a range of different diseases and conditions, from diabetes and bone disease to polycystic ovary syndrome, pituitary adenomas, (tiny tumors on the pituitary gland), adrenal adenomas (small masses on the adrenal glands), obesity, metabolic disorders, reproductive problems, hypo- or hyperthyroidism (conditions in which the thyroid malfunctions), calcium levels that are too high or too low, and issues related to puberty. Endocrinologists may also treat cancers and other diseases that affect parts of the endocrine system, such as thyroid or pancreatic cancer.
The endocrinologist’s scope is broad, but focuses on balance. “When I’m explaining endocrinology to my patients who aren’t familiar with it, I describe it as the ‘too much, too little’ specialty,” says Dr. Alicia Diaz-Thomas, a pediatric endocrinologist and assistant professor at the University of Tennessee Health Science Center and Le Bonheur Children’s Hospital in Memphis. “It’s really a specialty of balance,” and addressing issues when the body isn’t making the right proportion of a certain hormone is the core of what these physicians do.
Some endocrinologists subspecialize, and Diaz-Thomas, who focuses on treating Type 2 diabetes in children, says “the main difference between pediatric endocrinology and adult endocrinology is that children change over time. That extra area of growth really influences and colors what a pediatric endocrinologist will do and the conditions that we’ll see in pediatrics.” These issues sometimes arise when children approach puberty or have issues growing and developing normally because certain hormones related to growth and development aren’t in the right balance. “You can be too tall or too small. You can be growing too fast or too slow. You can have too much puberty or not enough puberty,” and too much or not enough of a range of hormones, so it’s all about maintaining balance, she says. If one of these factors is out of alignment, it might be time to visit an endocrinologist.
When it comes time to find an endocrinologist, it’s important to look for a doctor who has expertise or experience treating your specific condition. “A primary care physician is a good place to begin,” says Dr. Rachel Pessah-Pollack, assistant clinical professor of medicine, endocrinology, diabetes and bone disease at the Mount Sinai Hospital in New York, “because they can often point you in the right direction.” She says patients will sometimes come to her “and they’re not sure why they’re there. That leads to frustration,” especially if it turns out they need to see a different doctor with more expertise in a specific area.
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For example, if you have thyroid cancer, look for an endocrinologist who specializes in treating that disease rather than seeing someone who specializes in the treatment of diabetes. Pessah-Pollack recommends asking your primary care physician for help in selecting the right doctor to “make sure you’re getting the appropriate evaluation. A great primary care doctor can often point you in the right direction for a referral.”
Diaz-Thomas says if you need to do more research to find the right endocrinologist for your situation, “the Hormone Health Network from the Endocrine Society and the Pediatric Endocrine Society, have Find an Endocrinologist pages on their websites that can be very helpful.” These listings include information about doctors’ subspecializations and can be conducted via zip code so you can find the right doctor close to you.
In addition, Bradley says it’s important to find a doctor “who will listen to you and will not just go by the numbers and dismiss things.” There can be a bit of detective work involved with appropriately diagnosing and managing endocrine-related diseases, especially rarer ones, because they often produce nonspecific symptoms like fatigue or weight gain, that could result from a variety of causes. Therefore, “it’s very important to have a thoughtful endocrinologist,” Pessah-Pollack says. “Someone who’s going to take the time to take a history and to listen to you,” because what you’re experiencing is an important clue about what the underlying problem may be.
When you make an appointment with an endocrinologist, it’s helpful if you can be sure to have any previous lab work and test results sent on ahead or bring them with you so the doctor can see what’s been done already and help narrow the search for an answer. That reduces the need to replicate testing and can help speed up getting the right treatment.
You should also be prepared to wait a while to get an appointment. Diaz-Thomas notes that there’s a workforce shortage among endocrinologists that’s only expected to get worse as rates of obesity and Type 2 diabetes continue to climb. The good news is that many primary care doctors can manage some of the more common endocrine disorders, such as Type 2 diabetes or hypothyroidism, so depending on your situation, you might not need to see an endocrinologist regularly. In other situations, you may need to see one frequently, and in those cases, it’s critical to find a doctor you’re comfortable with who you feel understands your disease. With many endocrine disorders, you’re looking at a lifelong condition, so finding a doctor you can partner with for the long term is important.
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In addition, because hormones are implicated in so many different bodily functions and aspects of growth, development and healthy aging, endocrinology overlaps with many other specialty fields of medicine and your endocrinologist should be adept at working with other doctors as needed. “It’s not an isolated specialty,” Pessah-Pollack says. “We really have to know the latest treatments and work with other specialists as well to make sure it’s comprehensive care for the patient.” She adds that rapid evolution in the treatment of common endocrine diseases such as diabetes means that endocrinologists, who have extensive training that involves medical school, an internship and residency and fellowship training, need to constantly stay on top of new treatment advances and innovations.
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How Can I Find the Best Endocrinologist? originally appeared on usnews.com
