Endocrinology, Diabetology & Metabolic Medicine
This department is one of the most well recognised centres in India for diagnosis and management of hormonal and metabolic disorders like diabetes, diseases of thyroid, parathyroid, pituitary glands, male reproductive & ovarian disorders, as well as obesity and metabolic bone disorders.
The diagnosis and treatment of endocrine disorders requires a team of highly experienced and professionally qualified endocrinologists working in close collaboration with specialists in allied disciplines, and ably supported by highly skilled personnel in laboratory medicine providing a wide array of biochemical investigations and hormone assays, alongwith high quality imaging services including latest imaging modalities such as 3D ultrasonography with doppler, helical CT, MRI, MR-angio, Dual Head Gamma Camera, and bone densitometery (DEXA). Batra Hospital has a team of dedicated specialists and technologists, effectively utilising the state of art equipment in the departments of Laboratory Medicine, Radiodiagnosis and Nuclear Medicine, for comprehensive diagnosis and management of hormonal and metabolic disorders. Highly skilled endocrine surgeons work in close collaboration with the endocrinologists and undertake all types of endocrine surgery, as and when required.
• The recommendations and protocols developed by the World Health Organisation and International Diabetes Federation for primary, secondary and tertiary care and prevention of diabetes mellitus and its complications are followed with appropriate adaptation to the needs of individual patients. Diabetes education and nutrition counseling receives major attention.
• The goal is to prevent or delay the onset of diabetes, if possible, in those identified as high risk subjects. Early diagnosis of diabetes and its management aims to prevent the onset of acute or chronic complications. If chronic complications of diabetes are already present, every facility is available for treating them and to optimize quality of life inspite of chronic complications.
• Batra Hospital has a well equipped intensive care unit for acute emergencies like diabetic ketoacidosis, hyperosmolar diabetic coma, and septicemia.
• In close collaboration with department of Ophthalmology and with vitreo-retinal surgeons, state of art facilities are being provided for flourescein angiography and laser treatment. • There is close cooperation with department of Nephrology for the diagnosis and management of diabetic nephropathy, and end-stage renal disease by peritoneal and haemodialysis, and when indicated, by renal transplant surgery.
• The cardiovascular complications including peripheral vascular disease and coronary heart disease are dealt by experienced cardiologists and cardiovascular surgeons with state of art facilities for colour doppler angio, stress thallium, coronary angiography, angioplasty, stenting, and bypass surgery. Interventional cardiology procedures and coronary artery bypass surgery are undertaken by a team of specialists, using supportive facilities of an excellent coronary care unit.
• Expert team of endocrinologists, vascular surgeon, plastic surgeon, orthopaedic surgeon and podiatrist provides services for the prevention and care of diabetic foot disorders.
• Neurophysiological studies including H reflex, F-waves, sensory and motor nerve conduction velocities, are available in the department of neurology for early diagnosis of diabetic neuropathy, and other neurological complications of diabetes.
• Diabetes with pregnancy (gestational diabetes) receives expert care through well coordinated efforts by a team of diabetologists, obstetricians and neonatologists so as to provide proper control of diabetes during pregnancy, ensuring optimal fetal outcome and neonatal health.
• Male reproductive health in persons with diabetes receives special attention with emphasis on diagnosis and management of erectile dysfunction.
• Batra Hospital provides facilities of the highest order for the diagnosis and management of all thyroid disorder like thyrotoxicosis, hypothyroidism, thyroiditis, thyroid adenoma, and malignant lesions of thyroid. All the necessary sophisticated tests like FT3, FT4, TSH, thyroid antibodies, thyroid scan, thyroid ultrasonography and FNAC (fine needle aspiration cytology) are conducted under the care and supervision of experienced specialists.
• Services of highly qualified thyroid surgeons are available. • These investigative facilities alongwith a team of experienced endocrinologists have combined together to make Batra Hospital a centre of repute for thyroid disorders.
Disorders of Parathyroid & Metabolic Bone Disorders: • Patients with these disorders have either high calcium levels, low calcium levels or fragile bones which fracture very easily.
• High calcium levels are generally due to increased functioning of parathyroid glands or malignancy. Low calcium levels are due to low functioning of parathyroid glands or due to low dietary intake of calcium, or diseases which prevent absorption of calcium from the gut, resulting in disease called osteomalacia.
• Osteoporosis is defined as decrease in bone mass which may be due to deficient intake of calcium and Vit D or due to a variety of other causes.
• Comprehensive facilities like CT Scan, Bone scan, MRI, Sestamibi scan, serum PTH, serum Vit D assays, are available for the diagnosis and treatment of all types of disorders of calcium metabolism which result in brittle bones and fractures.
Disorders of Pituitary Gland:
• Pituitary disorders are a result of a number of causes including tumors of the pituitary which may result in excessive production of hormones, or due to deficiency of some pituitary hormones.
• Excess production of growth hormone by this gland produces acromegaly or gigantism. Deficiency of growth hormone may result in stunted growth and dwarfism. Excessive prolactin production by this gland results in galactorrhoea (production of milk in a nonpregnant state), infertility in both sexes, impotence in men, disorders of menstruation like scanty menses or absent menses.
• Pituitary gland, under the influence of hypothalamus, regulates the secretion of hormones which control the function of thyroid, adrenals, ovaries, and testes. Overproduction or underproduction of these hormones will result in malfunction of these glands. The posterior part of pituitary secretes a hormone, ADH (Anti Diuretic Hormone), which regulates the quantity and concentration of urine produced in the body. Deficiency of this hormone results in a disease called Diabetes insipidus in which a patient passes large volume of dilute (sugar free) urine, and also drinks high volumes of fluids due to excessive thirst.
• The available state of art equipment, a team of endocrinologists, excellent neuro-surgeons and ENT surgeons who are well trained in transphenoidal and transnasal surgery for the diagnosis and treatment of all disorders of the pituitary gland, provide the optimal setting for a well coordinated medical and surgical management.
Disorders of Adrenal Gland :
• Adrenal gland is located at the upper pole of each kidney on either side in the abdomen. Adrenal cortex produces major hormones i.e. cortisol, aldosterone, adrenal androgens and estrogens, while adrenal medulla produces catecholamines. These hormones regulate vital body functions.
• Overproduction of cortisol from adrenal cortex results in Cushing’s syndrome in which the patient gains a lot of weight, has a moon face, purple striae all over the body, with wasting of muscles and thinning of bones. Addison’s disease results from insufficient or nonproduction of adrenocorticol hormones, resulting in weakness, weight loss, menstrual disturbances in the female, nausea, vomiting and hypotension. Catecholamine overproduction from adrenal medulla results in pheochromocytoma in which the main feature is severe episodic hypertension which is treatable. Aldosterone overproduction also leads to hypertension with changes in levels of potassium and sodium in the blood.
• Overproduction of adrenal androgenic steroids leads to masculine features, hirsutism, and virilization in females. With recent advances in endocrinology, it is now possible to diagnose and manage (medically and surgically) all such disorders.
Reproductive Endocrinology :
This special branch of endocrinology deals with reproductive health and sexual function. It includes a wide range of disorders like ambiguous genitalia, premature sexual development in the male and the female and delayed puberty in both genders. These disorders are generally grouped as under :
• Testicular disorders including delayed puberty, micropenis, absence of one or both testes, gynaecomastia, impotence, sexual and erectile dysfunction, male infertility and primary and secondary testicular failure. A sound management plan of all these disorders is based on complete investigations including hormonal assays for which state of art facilities are available.
• Ovarian disorders may manifest in young girls as premature development of breast (premature larche) and pubic hair (premature pubarche), at times leading to precocious puberty. A common disorder both in the adolescents and adult females is hirsutism which may be of various grades including excess hair growth on face, chest and abdomen. Hirsutism may be associated with menstrual and ovulatory disorders resulting in infertility.
• A team of expert endocrinologists alongwith andrologists and gynaecologists provide a coordinated approach to the diagnosis and management of all these disorders.
• Obesity is assuming epidemic proportions all over the world. About one-third of all adults in urban areas are overweight. About 15% all school children are obese. Most of obesity is preventable through life style counseling including enhanced physical activity and balanced nutrition. While most of obesity in adults and children is due to overeating of junk food and lack of physical activity, in a small group of obese persons, obesity is due to endocrinal disorders such as hypothyroidism, excessive cortisol production, and in the females, associated with polycystic ovaries resulting in hirsutism, menstrual irregularities, and infertility. Insulin resistance may be an underlying factor in such cases.
• Batra Hospital provides all facilities for the diagnosis including precise measurement of percentage of body fat (DEXA). A coordinated approach is planned jointly by endocrinologists and nutrionist and customized for individual patients.
• Low blood glucose is most commonly due to excess of insulin either produced in the body by tumours of insulin-producing cells (islet-cell adenomas) or following exogenous insulin administration as in the management of diabetes mellitus. Certain oral drugs used in the treatment of diabetes may also lead to hypoglycemia. • However, low blood glucose can sometimes occur in a non-diabetic person due to disease of other organs such as liver and adrenal glands.
• All facilities for the diagnosis and management (medical or surgical) of hypoglycemia are available.
• We have all the facilities for diagnosing and treating hypoglycemia.
FT3, FT4, TSH
RAIU 24 hrs.
Se Ca / P / Alk. Phosphatase
Vit D assays
CT + MRI Adrenals
Se Cortisol / Plasma ACTH
Se 17 alpha OH Progesterone
Se Testosterone, Total, Free
Se LH, FSH
Semen Analysis & Culture
Colour doppler for penile blood flow
Se LH, FSH
Se Estradiol, Progesterone
Laparoscopic Ovarian Biopsy
CT and MRI
Se Growth hormone, Prolactin
Body fat (tissue % fat)
Android, Gynoid (% fat)
Se insulin & C-peptide
Microalbumin Excretion Rate
Medical treatment of thyroid disorders
Medical treatment of Parathyroid disorders.
Treatment of Osteomalecia & Osteoporosis
Medical & Surgical treatment of adrenal disorders.
Medical & surgical treatment of infertility, Medical treatment of impotence, hypogonadism.
Medical & surgical treatment of Ovarian disorders.
Medical & surgical treatment of Acromegaly and other pituitary disorders.
Medical & surgical treatment of Obesity.
Glucometer in every ward.
ICU for serious patients
All kinds of diabetic emergencies are managed.
Dr. Sona S. Abharam
MD (USA), DM (USA)