Endocrine Diseases In Patients Admitted To Endocrinology Ward

Introduction

Endocrine system is a system of specialized glands called endocrine glands that secrete hormones into the blood and via blood travel to tissues and organs all over the body. The endocrine glands consist of pineal, pituitary, thyroid and parathyroids, thymus, adrenals, pancreas, ovaries and testes. Endocrine system, together with the nervous system, acts as the body's communication network. The functions of endocrine system includes growth and development, metabolism, sexual development, sleep, hunger, and electrolyte balance. Endocrine disorders result due to dysfunction of endocrine glands, leading to either lack or excess of hormone synthesis, secretion and transport. Excessive action may be due to tumors secreting excess hormone, resetting of normal feedback loop, antibody mediated stimulation or excess hormone ingestion. A lack of hormone effect may result from a lack of hormone, caused by genetic deletions, damage to the endocrine gland or lack of a synthetic enzyme. Additionally, the hormone receptor may be structurally abnormal and inactive leading to hormone resistance.

Physiologically, endocrine diseases can be broadly classified into four main types, i. e glucose homeostasis disorders, thyroid disorders, pituitary gland disorders and sex hormone disorders. Glucose homeostasis disorders include diabetes mellitus and hypoglycemia. Diabetes mellitus can be classified into three main types which are type-I diabetes mellitus, type-II diabetes mellitus and gestational diabetes mellitus. Thyroid/parathyroid disorders are classified into hyperthyroidism, hypothyroidism, thyroiditis, thyroid carcinoma, hyperparathyroidism and hypoparathyroidism.

Pituitary gland disorders consist of diabetes insipidus, pituitary tumors, hypopituitarism and cushing syndrome, while sex hormone disorders include inherited genetic disorders like turner syndrome and kleinfelter syndrome, disorders of sex development, hermaphroditism, delayed maturation, amenorrhea, hypogonadism and multiple endocrine neoplasia. In Pakistan, adequate knowledge regarding prevalence and causes of common endocrine diseases is lacking. More researches are needed to provide physicians with adequate knowledge, guidelines and estimates about endocrine diseases.

Material & Methods

Study duration: About 2 months form July-August 2018.

Sample size: The sample size was 62.

Sampling technique: Non-probability, Convenient sampling technique.

Data Analysis: SPSS 20 was used for data analysis.

Data Collection Procedure: Detail Structured Questionnaire was used to collect data. A face to face interview was also conducted. Only admitted patients were included in the research.

Results

Majority of the patients, 77. 4% cases (n = 48) (Fig A), were reported with having glucose homeostasis disorders, with 64. 5% (n = 40) having Diabetes Mellitus and 12. 9% (n = 8) Hypoglycemia. About 48. 4% cases (n = 30) had type-II diabetes mellitus, 8. 1% (n = 5) type-I diabetes mellitus and 8. 1% (n = 5) with gestational diabetes mellitus. Diabetic patients were clinically associated with symptoms of polyurea, polydypsia, polyphagia, weight loss, neuropathy, blurring of vision, urinary tract infection, hypoglycemic episodes, obesity and comorbidities like hypertension, ischemic heart disease and stroke, as seen in Fig B. 9. 7% cases (n = 6) were reported with having thyroid disorders, with 6. 5% (n = 4) having hyperthyroidism and 3. 2% (n = 2) hypothyroidism. 2 out of 4 cases of hyperthyroidism were associated with nodular goitre and also 2 out of 4 cases were associated with graves disease. The clinical features of hyperthyroidism included heat intolerance, tachycardia, tremors, fever, rigors, hypertension, increased appetitie, insomnia and diplopia. Hypothyroidism was associated with delayed growth and maturation, while clinical signs and symptoms included cold intolerance, bradycardia, constipation, decreased appetite, fatigue, and anemia. 8. 1% (n = 5) of the cases were diagnosed with pituitary gland disorders including 4. 8% cushing syndrome cases (n = 3). Cushing syndrome cases were iatrogenic, with features of obesity, abdominal striae, acne, bruising, dificulty in walking and osteoporosis. Other 3. 2% cases of pituitary gland disorders (n = 2) were hypopitutarism and hypocortisolism. Remaining 4. 8% cases constituted sex hormone disorders (n = 3) that were Turner syndrome, Delayed maturation and Amenorrhea.

Discussion

Endocrinology is a field that needs adequate attention in Pakistan. More data/research is needed about different endocrine pathologies to adequately manage these public health problems. The current study indicates that there's a high prevalence of glucose homeostasis disorders, among which Diabetes Mellitus constituted the majority (50%) with 30 out of 60 cases, similar to research conducted in the United States constituting 22 out of 42 cases (52%) of Diabetes Mellitus. Research indicated similarity based on thyroid disorders with 6 out of 60 cases (10%), similar to 3 out of 42 (7%) and pituitary disorders (8. 3%) with 5 out of 60 cases as compared to (5%) 2 out of 42.

Study showed dissimilarity compared to other studies as far as gender ratio in cases of Diabetes Mellitus is concerned. It showed a male to female ratio of 15:26 (36. 6% males) as compared to 1332:1128 (54. 1% males). The study had quite a contrast with other studies when it came to association of weight loss with diabetes. Weight loss was associated with 15 out of 40 cases (37. 5%) as compared to 69 out of 1087 cases (6. 3%) in a study conducted in United Kingdom. Similarly there was also quite a contrast with diabetes association with obesity. Obesity was associated with 6 out of 35 patients (17. 1%) as compared to 52% in the same study. Research has also indicated dissimilarity as far as ratio of thyroid disorders are concerned with hyperthyroidism more prevalent than hypothyroidism with a ratio of 6. 7% vs 3. 3% as compared to 1. 6% vs 1. 8% in a research conducted in the United States.

Conclusion

The research, like other researches indicated that glucose homeostasis disorders constitute as highest in prevalence in Pakistan, followed by thyroid disorders and pituitary gland disorders. There is a need to promote public education program and proper counseling so that people become more literate about various etiological factors causing endocrine diseases and means of preventing them.