Disruptions in the endocrine system are no less dangerous than, for example, disruption of the cardiovascular or digestive system, because they can lead to such serious consequences as the development of diabetes, visual impairment ... The therapist tells readers of the site how identify the first signs of hormonal disorders.

All diseases have different roles. One disease comes at once, with all its might, throwing a daring challenge to the body: who wins?!

The other sneaks up imperceptibly and systematically torments: it “bites”, then it releases, gradually making our existence unbearable.

And the third walks with us hand in hand all our lives, influencing the character, worldview and quality of life on a par with genes and external factors.

Hiding under different masks, diseases often become elusive. It is especially difficult to recognize an endocrine disease (when the normal production of hormones is disturbed in the body).

Often, people with such disorders before getting to the "address" are examined by a variety of specialists, and, disappointed in traditional medicine, self-medicate in vain.

Such patients come to an endocrinologist already when the disease has reached its climax or has changed its face so much as a result of numerous health experiments that it is extremely difficult to diagnose and treat it.

Hormonal balance

Hormonal disorders do not always have specific symptoms. Often their manifestations are similar to a variety of ailments, and sometimes they are perceived only as cosmetic defects.

Therefore, you need to know the warning signs, when they appear, you must immediately seek qualified help.

It is better to exclude a dangerous pathology in a timely manner than to pay with health for your self-confidence and negligence later.

What is the endocrine system?

In the body, there are many organs and individual cell clusters that can produce hormones and participate in the endocrine regulation of vital functions.

The most important are the pituitary and hypothalamus. These glands are located in the brain and, according to their position, control all other organs of the endocrine system: thyroid and parathyroid glands, adrenal glands, gonads and pancreas.

Lesions of the hypothalamus and pituitary gland rarely present with isolated, specific symptoms. Usually, the function of the endocrine glands subject to them also suffers.

What to do?

Possible signs of hormonal imbalance

Hormonal balance

1. Losing weight on the background of increased appetite. Under the advertising slogan “Eat means losing weight!”, Perhaps, a person with an increased function of the thyroid gland is hiding.

In addition to weight loss, usually worries unreasonable and prolonged increase in body temperature up to 37-37.5 ° C, interruptions in the work of the heart, excessive sweating, tremor (trembling) of the fingers, sudden mood swings, nervousness, sleep is disturbed.

With the progression of the disease, sexual function is impaired.

Often, a constantly surprised look - bulging eyes attracts attention. When the eyes are wide open, they shine and seem to stick out: between the iris and the eyelids, a strip of white sclera remains above and below.

2. Obesity can be not only a problem of malnutrition and physical inactivity. Obesity accompanies many endocrinological disorders.

If adipose tissue is deposited evenly throughout the body, appetite is either not changed or slightly reduced, worries dry skin, weakness, lethargy, constant drowsiness, hair loss and brittleness, This suggests a decrease in thyroid function.

Such people have chilliness, decrease in body temperature and blood pressure, hoarseness of voice, periodic constipation.

Hormonal balance

5. A change in appearance is an early sign of acromegaly. Facial features become rough: superciliary arches, cheekbones, lower jaw increase.

The lips "grow", the tongue becomes so large that the bite is disturbed.

This condition develops in adults with excessive formation of growth hormone - somatotropin, which is produced in the hypothalamus.

going on rapid growth of hands and feet. A person is forced to change shoes very often.

Worried about complaints numbness in the limbs, joint pain, hoarseness of the voice, sexual dysfunction. The skin becomes thick, oily, there is increased hair growth.

6. visual impairment can also be a consequence of the pathology of the endocrine system. Rapid and persistent visual impairment, accompanied by persistent headaches, is a reason to suspect a pituitary tumor.

In this case, a characteristic feature is the loss of temporal fields of vision, and other signs of hormonal regulation disorders mentioned above often develop.

7. Skin itching should be a reason for checking blood sugar levels and may be an early sign diabetes mellitus.

In this case, itching often occurs in the perineum (which makes you turn to a gynecologist or dermatovenereologist).

Appears thirst, dry mouth, increased amount of urine and frequent urination.

Furunculosis is a common disease wounds and scratches heal very slowly, weakness and fatigue gradually develop.

Weight can fluctuate both in the direction of obesity and in the direction of weight loss, depending on the form of the disease and the constitution of the person.

Hormones largely determine the functioning of the female reproductive system. They are in such a close relationship that the lack or excess of one of them leads to the fact that after it the incorrect production of other hormones begins.

As a result, irregularities in the menstrual cycle begin, which are difficult to correct. The process of restoring the endocrine system takes a lot of time, and in some cases it is completely impossible.

There can be two reasons for this: improper use of hormonal drugs or congenital dysfunctions of the organs responsible for the production of hormones.

If in the first case it is possible to completely restore the endocrine system, then in the second case only treatment regimens can help, which will temporarily correct the abnormal production of hormones.

The endocrine system of a woman - how it works

Failure of the hormonal system can begin at any age, but most often it affects either teenage girls or women during menopause, when the endocrine system undergoes drastic changes.

Hormones in the female body are produced by certain glands, which in medical science are called the glandular apparatus.

Some of these glands are directly related to the functioning of the organs of the female reproductive system:

The pituitary gland is a cerebral appendage located on the lower surface of the brain. Responsible for the production of prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), oxytocin.

Thyroid- located in the neck, above the larynx. Responsible for the production of thyroxine, which affects the growth of the endometrium in the uterus.

The adrenal glands are paired glands that sit above the kidneys. Responsible for the production of progesterone, a number of androgens and a small amount of estrogen.

The ovaries are paired glands located in the pelvic cavity. Responsible for the production of estrogens, weak androgens and progesterone.

If in older women the disruption of the functions of the endocrine system occurs due to the consumption of the reserve of eggs and the fading of the ability to bear children, then the hormonal failure in girls, on the contrary, indicates the maturation of the body and its preparation for reproductive functions.

Hormones affecting the female reproductive system

Estrogens is the common name for three hormones: estriol, estradiol and estrone. Produced by the ovaries and partly by the adrenal glands. They are hormones of the first phase of the menstrual cycle.

Prolactin - affects the formation of milk in the mammary glands. Helps reduce estrogen levels and inhibit ovulation during breastfeeding.

Follicle stimulating hormone - Produced by the pituitary and hypothalamus. Accelerates the growth of follicles in the ovaries in the first phase of the menstrual cycle. Influences the production of estrogen.

luteinizing hormone - produced by the pituitary gland, stimulates the production of estrogens, provokes the rupture of the capsule of the dominant follicle and the release of a mature egg from it. It is in close relationship with the production of follicle-stimulating hormone.

Testosterone - male sex hormone. In women, it is produced in small amounts by the adrenal cortex and ovaries. Promotes breast enlargement during pregnancy.

Progesterone - the hormone of the corpus luteum, which is formed after the rupture of the capsule of the dominant follicle during ovulation. In addition, it is produced in large quantities by the ovaries and placenta if a woman is pregnant.

These are the main hormones that affect the menstrual cycle to a greater extent than all the others, which are also produced by the endocrine glands.

7 causes of hormonal failure

Improper production of hormones can be both congenital and acquired during life. Treatment for this problem will depend on what caused the endocrine system to malfunction:

1) Taking oral contraceptives. Despite the fact that some gynecologists are sure that oral contraceptives normalize a woman's hormonal background, this is not always the case. After the abolition of tablets in some patients, the endocrine system cannot adjust its functions.

2) Taking drugs for emergency contraception. It leads to a strong jump in hormones, after which the menstrual cycle may not return to normal for a long time.

3) Unauthorized intake of other hormonal drugs. Funds that regulate the work of the endocrine system should be prescribed by a doctor of the appropriate profile. Even if the results of the analyzes show a deviation from the norm of any hormone, it is not advisable to independently select medicines for correction. Only an endocrinologist can prescribe an adequate treatment regimen.

4) Violation of the functions of the endocrine glands. It can occur both as a result of their diseases, and as a result of anomalies in their development.

5) Age-related physiological changes. This refers to puberty and menopause - two periods in a woman's life, in which the most cardinal restructuring of the endocrine system is noted.

6) Artificial termination of pregnancy. The sudden cessation of hCG production entails a disruption in the production of estrogen, progesterone and testosterone. Both medical and surgical abortion equally negatively affect the functioning of the endocrine system.

7) Prolonged stressful conditions. Influence the suppression of the production of the hormone oxytocin. A decrease in oxytocin levels affects the production of prolactin.

Pregnancy can also be the cause of hormonal failure, but in this case, the body has programmed natural ways to normalize the functioning of the endocrine glands, which are activated after childbirth.

Symptoms of hormonal failure in women

Hormonal disorders never go away without consequences. Depending on which of the endocrine glands does not function properly, a woman experiences certain symptoms of hormonal failure.

In medicine, a symptom is a set of manifestations of a disease that the patient himself notices. In this case, the symptoms will be the following:

1. Violation of the duration of the menstrual cycle;
2. Excessive growth of body hair;
3. Isolation of milk from the mammary glands in the absence of breastfeeding;
4. Frequent mood swings;
5. Weight gain with relatively moderate food intake;
6. Hair loss;
7. Decreased libido.

These symptoms should alert and become a reason to visit an endocrinologist.

Signs of disruption of the endocrine system

In medicine, a sign is a set of manifestations of a disease that a doctor observes. It draws up a clinical picture of the disease, based not only on the data of medical research, but also on the complaints of the patient herself.

As signs of a hormonal failure in a woman, the following can be distinguished:

• Shortening or lengthening of the first or second phase of the cycle;
• Lack of ovulation;
• ovarian cysts;
• cysts of the corpus luteum;
• Thin or too thick endometrium;
• The presence of fibroids;
• Violation of the process of maturation of follicles (regression of the dominant follicle, follicular cyst);
• A large number of antral follicles in one ovary, not exceeding 8-9 mm in diameter (MFN);
• A large number of follicles in one ovary that are larger than 9 mm in diameter but still smaller than the dominant follicle (PCOS).

Hormonal failure during pregnancy

The body undergoes changes after the conception of a child. From the day a fertilized egg is implanted in one of the walls of the uterus, the production of the hormone hCG begins. An increase in its concentration in the blood provokes a change in the amount of production of other hormones.

The endocrine system is forced to adapt to the changes that have occurred in the body, however, hormonal failure during pregnancy is a natural process necessary for the successful bearing of a child.

But there are violations that can lead to the threat of miscarriage:

1. Lack of progesterone.
2. Excess testosterone.
3. Lack of estrogen.

These are the three main hormonal disorders that pregnant women experience most often. To correct them, the gynecologist will prescribe medication.

Consequences of improper functioning of the endocrine system

Hormonal failure is a factor that negatively affects a woman's health. This is not only a violation of reproductive functions, but also a general deterioration in health.

Lack or excess of certain hormones, in the absence of timely treatment, can lead to serious consequences, including:

• Infertility;
• miscarriage;
• Obesity;
• The occurrence of oncological diseases;
• Decreased immunity;
• high fatigue;
• The formation of benign tumors;
• Diabetes;
• Osteoporosis;
• Decreased sexual activity.

If the cause of hormonal imbalance lies in the malfunctioning of the endocrine glands, which has been observed since birth, then constant monitoring by an endocrinologist and systematic correction of the production of a particular hormone is required.

The treatment regimen will depend on which hormone deviates from the normal values. Sometimes there are problems with the production of any one hormone, but most often a blood test indicates the presence of problems with several hormones at once.

Each doctor has his own views on methods of treatment, but gynecologists-endocrinologists can be conditionally divided into two categories: the former prefer to prescribe oral contraceptives as therapy, and the latter prefer to regulate each hormone with individual drugs.

Correction of hormonal failure with oral contraceptives

To normalize the production of hormones, drugs such as Yarina, Diana 35, Jess, Lindinet can be prescribed. On the one hand, this is convenient for the doctor: there is no need to select a special treatment regimen - in tablets, all synthetic analogues of hormones are pre-distributed according to the days of the cycle.

On the other hand, such a correction is fraught with negative consequences:

• Intolerance to oral contraceptives, expressed in daily severe nausea and vomiting.
• Unplanned pregnancy after canceling a course of pills. And, thanks to the rebound effect, it may turn out that a woman is carrying twins or triplets.
• Increased signs of hormonal imbalance after discontinuation of oral contraceptives

Correction of hormonal failure with the help of an individual selection of hormonal preparations

It is more difficult to formulate such a treatment regimen. There is a need to use several hormonal agents at once, so the gynecologist-endocrinologist must choose the drugs in such a way as not to provoke a violation of the production of other hormones that are normal.

• Excess testosterone - Dexamethasone, Cyproterone, Metipred is used for treatment.
• Lack of Progesterone - Duphaston, Utrozhestan are used to normalize the indicators.
• Lack of estrogen - corrected with the help of Divigel, Premarin, Proginova.
• Excess estrogen - treated with Clomiphene, Tamoxifen.

These are just a few examples of solving problems with the production of certain hormones. In fact, there can be much more of them, and an endocrinologist should draw up a specific treatment regimen. To correct the hormonal background, herbal preparations are also used, but they must also be taken. only on doctor's advice.

As a preventive measure, it can be advised not to take hormonal drugs without permission, without the appointment and supervision of a doctor. Once a year, you need to donate blood for the analysis of the main female hormones, and if one or more of them deviate from the norm, contact an endocrinologist or gynecologist.

Endocrine system - a set of specific endocrine glands (endocrine glands) and endocrine cells.

It includes:

• pituitary;
• epiphysis (pineal gland);
• thyroid gland;
• parathyroid glands;
• adrenal glands;
• APUD-system, or diffuse system, formed by hormonal cells scattered in various organs and tissues of the body - endocrine cells of the gastrointestinal tract, producing gastrin, glucagon, somatostatin, etc.;
• interstitial cells of the kidneys, producing, for example, prostaglandin E 2 , erythropoietin, and similar endocrine cells of some other organs.

endocrine cell - a cell that synthesizes and secretes a hormone into the liquid media of the body - blood, lymph, intercellular fluid, cerebrospinal fluid.

Hormone - a biologically active substance that circulates in body fluids and has a specific effect on certain target cells.

The chemical structure of hormones is different. Most of them are peptides (proteins), steroid substances, amines, prostaglandins.

Hormone target cell - This is a cell that specifically interacts with a hormone with the help of a receptor and responds to this by changing its vital activity and function.

GENERAL PATHOLOGY OF THE ENDOCRINE SYSTEM

Violations of the activity of the endocrine glands manifest themselves in two main forms: hyperfunctions (redundant function) and hypofunction (insufficient function).

The main initial links in the pathogenesis of endocrine disorders can be centrogenous, primary glandular and postglandular disorders.

Centrogenic disorders are caused by a violation of the mechanisms of neurohumoral regulation of the endocrine glands at the level of the brain and the hypothalamic-pituitary complex. The causes of these disorders can be damage to the brain tissue as a result of hemorrhage, tumor growth, the action of toxins and infectious agents, prolonged stress reactions, psychosis, etc.

The consequences of damage to the brain and the hypothalamic-pituitary system are a violation of the formation of neurohormones of the hypothalamus and pituitary hormones, as well as disorders of the functions of the endocrine glands, the activity of which is regulated by these hormones. So, for example, neuropsychic trauma can lead to disruption of the central nervous system, which leads to excessive thyroid function and the development of thyrotoxicosis.

Primary glandular disorders are caused by disorders in the biosynthesis or release of hormones by peripheral endocrine glands as a result of a decrease or increase in the mass of the gland and, accordingly, the level of the hormone in the blood.

The causes of these disorders can be tumors of the endocrine glands, as a result of which an excessive amount of the hormone is synthesized, atrophy of the glandular tissue, including age-related involution, which is accompanied by a decrease in hormonal influences, as well as a deficiency of hormone synthesis substrates, such as iodine, which is required for the formation of thyroid hormones, or insufficient levels of hormone biosynthesis.

Primary glandular feedback disorders can affect the function of the cerebral cortex and the hypothalamic-pituitary system. So, a decrease in thyroid function (for example, hereditary hypothyroidism) leads to disruption of the central nervous system and the development of dementia (thyroid cretinism).

Post glandular disorders caused by violations transport hormones of their reception, i.e., a violation of the interaction of the hormone with a specific receptor of the cell and tissue, and meta6ism hormones, which is a violation of their biochemical reactions, interactions and destruction.

DISEASES OF THE ENDOCRINE SYSTEM

DISEASES OF THE HYPOPHYSIS

Pituitary - an endocrine organ that connects the nervous and endocrine systems, ensuring the unity of the neurohumoral regulation of the body.

The pituitary gland consists of the adenohypophysis and the neurohypophysis.

The main functions of the pituitary gland.

Adenohypophysis produces hormones:

• follitropin (previously called follicle-stimulating hormone, FSH);
• lutropin (formerly luteinizing hormone, LH);
• prolactin (formerly luteomammatropic hormone, LTH);
• corticotropin (formerly adrenocorticotropic hormone, ACTH);
• thyrotropin (formerly thyroid-stimulating hormone. TSH) and a number of other hormones.

neurohypophysis releases two hormones into the blood: antidiuretic and oxytocin.

Antidiuretic hormone (ADH), or arginine vasopressin, enhances water reabsorption in the renal tubules, and in high concentrations causes contraction of glomerular arterioles and an increase in blood pressure in them.

Oxytocin regulates physiological processes in the female reproductive system, increases the contractile function of the pregnant uterus.

DISEASES ASSOCIATED WITH HYPERFUNCTION OF THE ADENOGYPOPHISIS

Hyperpituitarism - an excess of the content or effects of one or more hormones of the adenohypophysis.

The reasons. In most cases, hyperpituitarism is the result of a tumor of the adenohypophysis or its damage during intoxications and infections.

Hypophyar gigantism manifested by an excessive increase in growth and internal organs. At the same time, height is usually above 200 cm in men and 190 cm in women, the size and mass of internal organs do not correspond to the size of the body, more often the organs are also enlarged, less often they are relatively reduced compared to significant growth.

Rice. 76. Acromegaly. On the right - healthy, on the left - a patient with acromegaly.

In this regard, the development of functional insufficiency of the heart and liver is possible. As a rule, hyperglycemia is observed, often diabetes mellitus; there is an underdevelopment of the genital organs (hypogenitalism). often infertility; mental disorders - emotional instability, irritability, sleep disturbances, decreased mental performance, psychasthenia.

Acromegaly - a disease in which the size of individual parts of the body disproportionately increases (more often - hands, feet), facial features become rough due to an increase in the lower jaw, nose, superciliary arches, cheekbones (Fig. 76).

These changes are combined with violations of the body's vital functions and the gradual development of multiple organ failure.

Syndrome of precocious puberty - a condition characterized by accelerated development of the gonads, the appearance of secondary sexual characteristics, in some cases - the onset of puberty in girls up to 8 years old, in boys up to 9 years old, which, however, is accompanied by mental underdevelopment.

Pituitary hypercortisolism (Itsenko-Cushing's disease) occurs with excessive production of corticotropin, which leads to hyperfunction of the adrenal cortex. Clinically, Itsenko-Cushing's disease is manifested by obesity, trophic changes in the skin, arterial hypertension, the development of cardiomyopathy, osteoporosis, sexual dysfunction, skin hyperpigmentation, and mental disorders.

DISEASES ASSOCIATED WITH HYPOFUNCTION OF ADENOHYPOPHYSIS

hypopituitarism - deficiency of pituitary hormones.

The reasons.

Hypofunction of the adenohypophysis can develop after meningitis or encephalitis, circulatory disorders in the pituitary gland (thrombosis, embolism, hemorrhage), traumatic brain injury with damage to the base of the skull, and also as a result of protein starvation.

Hypofunction of the adenohypophysis may present with pituitary cachexia, pituitary dwarfism, and pituitary hypogonadism.

Pituitary cachexia develops with total hypofunction of the adenohypophysis, manifested by a decrease in the formation of almost all hormones, which leads to disruption of all types of metabolism and progressive exhaustion.

Pituitary dwarfism , or pituitary nanism , develops in case of somatotropin deficiency and is characterized by a progressive lag in growth and body weight (by the time the body is formed, growth usually does not exceed 110 cm in women and 130 cm in men), an senile appearance of the face (wrinkles, dry and flabby skin), underdevelopment of the genital glands and secondary sexual characteristics in combination with primary infertility. Intelligence in most cases is not impaired, but signs of a decrease in mental performance and memory are often revealed.

Pituitary hypogonadism develops with a lack of sex hormones due to hypofunction of the adenohypophysis. It shows up:

• at husband's- eunuchoidism, which is characterized by underdevelopment of the testicles and external genital organs, mild secondary sexual characteristics, high (effeminate) voice timbre, infertility, development of an effeminate figure, obesity;
• among women- female infantilism, accompanied by underdevelopment of the mammary glands, late onset of menstruation, menstrual irregularities up to amenorrhea, infertility, asthenic physique, emotional instability.

Hypofunction of the neurohypophysis may occur as a result of the development of a tumor in it, inflammatory processes, injuries, which is manifested diabetes insipidus due to a decrease in the formation of ADH. This disease is characterized by the release of a large amount of urine (from 4 to 40 l / day) with its low relative density. The loss of water and an increase in the osmotic pressure of the blood plasma are accompanied by indomitable thirst ( polydipsia), due to which patients drink large amounts of water.

ADDRENAL DISEASES

The adrenal glands are paired endocrine glands located at the upper poles of the kidneys and consisting of a cortex (cortex) and a medulla.

Main functions of the adrenal glands.

Three groups of steroid hormones are synthesized in the adrenal cortex: glucocorticoids, mineralocorticoids, and sex steroids.

• Glucocorticoids affect carbohydrate metabolism, have an anti-inflammatory effect and reduce the activity of the immune system.
• Mineralocorticoids (in humans, mainly aldosterone) regulate the exchange of electrolytes, primarily sodium and potassium ions.
• sex steroids (androgens and estrogens) determine the development of secondary sexual characteristics, and also stimulate the synthesis of nucleic acids and protein.
• Diseases caused by hyperfunction of the adrenal cortex (hypercorticism), are associated with an increase in the content of corticosteroids in the blood and is manifested by hyperaldosteronism and Itsenko-Cushing's syndrome.
• Hyperaldosteronism usually associated with the development of aldosteroma - a tumor of the adrenal cortex. Plasma sodium retention and hypernatremia are characteristic. Blood pressure rises, cardiac arrhythmias appear.
• Itsenko-Cushing syndrome develops, as a rule, with a tumor of the adrenal cortex, which is accompanied by an excess of glucocorticoids. Obesity with deposition of fat on the face, neck, in the area of ​​the upper shoulder girdle is characteristic. Patients have elevated blood pressure and blood glucose levels, often elevated body temperature. Due to the suppression of the immune system, resistance to infections decreases. In boys, the development of secondary sexual characteristics is accelerated and does not correspond to age, but primary sexual characteristics and behavior lag behind in development. Girls have features of a male physique.

Diseases caused by hypofunction of the adrenal cortex, or adrenal insufficiency. Depending on the extent of damage to the adrenal glands, 2 types of adrenal insufficiency are distinguished: total and partial.

Total adrenal insufficiency due to a deficiency of all hormones of the adrenal cortex - glucomineralocorticoids and androgenic steroids. At the same time, there is a normal level of catecholamines produced by the adrenal medulla.

Partial adrenal insufficiency - insufficiency of any one class of hormones of the adrenal cortex, most often - mineral or glucocorticoids.

Depending on the nature of the course, acute and chronic total insufficiency of the adrenal cortex is distinguished.

Acute total insufficiency of the adrenal cortex.

Her the reasons:

• Cessation of the introduction of corticosteroids into the body after their long-term use for therapeutic purposes. The resulting state is referred to as corticosteroid withdrawal syndrome or iatrogenic adrenal insufficiency. It is caused by prolonged inhibition of the function of the hypothalamic-pituitary-adrenal system and atrophy of the adrenal cortex.
• Damage to the cortex of both adrenal glands, for example, when falling from a great height, bilateral hemorrhage in its tissue with thrombohemorrhagic syndrome, lightning-fast sepsis.
• Removal of the adrenal gland affected by a hormone-producing tumor. However, insufficiency develops only with hypo- or atrophy of the cortical substance of the second adrenal gland.

Manifestations:

• acute hypotension;
• increasing circulatory insufficiency due to acute heart failure, decreased muscle tone of arterial vessels, and a decrease in the mass of circulating blood due to its deposition. As a rule, acute severe circulatory failure is the cause of death of most patients.

Chronic total insufficiency of the adrenal cortex (Adcison's disease).

Basic cause is the destruction of the tissue of the adrenal cortex as a result of immune autoaggression, tuberculous lesions, tumor metastases, amyloidosis.

Manifestations

• muscle weakness, fatigue;
• arterial hypotension;
• polyuria;
• hypohydration of the body and hemoconcentration as a result of a decrease in the volume of fluid in the vascular bed, leading to hypovolemia;
• hypoglycemia;
• hyperpigmentation of the skin and mucous membranes due to increased secretion of ACTH and melanocyte-stimulating hormone by the adenohypophysis, since both hormones stimulate the formation of melanin. Characteristic of primary adrenal insufficiency, in which the pituitary gland is not affected.

Diseases caused by hyperfunction of the adrenal medulla.

The reasons: tumors from chromaffin cells of the medulla - benign (pheochromocytomas) and less often malignant (pheochromoblastomas). Pheochromocytomas produce an excess of catecholamines, mainly norepinephrine.

Manifestations of hypercatecholaminemia:

• arterial hypertension;
• acute hypotensive reactions with short-term loss of consciousness as a result of cerebral ischemia (fainting), developing against the background of arterial hypertension, pallor, sweating, muscle weakness, fatigue;
• catecholamine hypertensive crises - periods of significant increase in blood pressure (systolic up to 200 mm Hg and above);
• heart rhythm disturbances in the form of sinus tachycardia and extrasystole;
• hyperglycemia and hyperlipidemia.

Insufficiency of the level or effects of adrenal catecholamines as an independent form of pathology is not observed, which is due to the pairing of the adrenal glands and their high compensatory-adaptive capabilities.

THYROID DISEASES

The thyroid gland is a component of the hypothalamus-pituitary-thyroid gland system. The thyroid parenchyma consists of three types of cells: A-, B- and C-cells.

• A-cells, or follicular, produce iodine-containing hormones. They make up the majority of the mass of the gland.
• B cells produce biogenic amines (eg serotonin).
• C-cells synthesize the hormone calcitonin and some other peptides.

The structural unit of the thyroid gland is the follicle - a cavity lined with A- and C-cells and filled with colloid.

The thyroid gland produces iodine-containing and peptide hormones that regulate the physical, mental and sexual development of the body.

Peptide hormones(calcitonin, katacalcin, etc.) are synthesized by C-cells. An increase in the content of calcitonin in the blood occurs with tumors of the thyroid gland and with renal failure, accompanied by a violation of calcium reabsorption in the tubules of the kidneys.

Rice. 77. Goiter.

Numerous diseases of the thyroid gland, characterized by a change in the level or effects of iodine-containing hormones, are combined into two groups: hyperthyroidism and hypothyroidism.

Hyperthyroidism , or thyrotoxicosis, characterized by an excess of the effects of iodine-containing hormones in the body. With the development of hypothyroidism, there is a lack of effects of these hormones.

Diseases of the thyroid gland, accompanied by hyperthyroidism.

These diseases occur when the activity of the gland itself is disturbed or as a result of a disorder in the functions of the pituitary gland or hypothalamus. The most important among these diseases are goiter (struma) and tumors.

Goiter (struma) is a nodular or diffuse growth of thyroid tissue (Fig. 77).

Types of goiter.

By prevalence:

• endemic goiter, the cause of which is a lack of iodine in water and food in some regions (in our country, a number of regions of the Urals and Siberia);
• sporadic goiter occurring in residents of non-endemic areas.

By morphology:

• diffuse goiter. characterized by uniform growth of gland tissue;
• nodular goiter, in which the growing tissue of the gland forms dense nodular formations of various sizes;
• colloid goiter, which is characterized by the accumulation of colloid in the follicles;
• parenchymal goiter, which is characterized by the growth of the epithelium of the follicles in the almost complete absence of colloid.

Diffuse toxic goiter (Graves' disease) accounts for more than 80% of cases of hyperthyroidism. It usually occurs after 20-50 years. women get sick 5-7 times more often than men.

The reasons:

• hereditary predisposition;
• repetitive mental trauma (stress) that causes the activation of the hypothalamus and sympathetic-adrenal system, which leads to an intensive production of thyroid hormones.

Pathogenesis.

The initial link in pathogenesis is an inherited genetic defect in lymphocytes, which causes the synthesis of a large number of “autoaggressive” immunoglobulins by plasma cells. The peculiarity of these immunoglobulins is the ability to specifically interact with receptors for TSH on A-cells of the epithelium of the follicles, stimulate the formation and incretion of triiodothyronine into the blood, an excess of which causes hyperthyroidism or even thyrotoxicosis. The more autoaggressive immunoglobulins in the blood, the more severe thyrotoxicosis, characterized by a significant change in metabolism: an increase in the level of oxidative processes, basal metabolism and body temperature, which leads to a sharp increase in the body's sensitivity to hypoxia. The breakdown of glycogen, proteins and fats increases, hyperglycemia occurs, and water metabolism is disturbed.

Morphology.

Goiter is usually diffuse, sometimes nodular. Histologically, it is characterized by papillary growths of the epithelium of the follicles and lymphoplasmacytic infiltration of the stroma. There is very little colloid in the follicles.

Due to a violation of water metabolism in the heart muscle, vacuolar degeneration develops, the heart increases in size; in the liver there is a serous edema and subsequently - sclerosis; frequent dystrophic changes in the nervous tissue, including the brain (thyrotoxic encephalitis). Disturbances in the activity of the nervous system and muscles are caused by the emerging ATP deficiency, depletion of glycogen stores in the muscles, and other metabolic disorders.

clinical picture.

Patients develop a characteristic triad - goiter, bulging eyes (exophthalmos) and tachycardia. Patients lose weight, they are easily excitable, restless; characterized by rapid mood swings, fussiness, fatigue, trembling fingers, increased reflexes. Tachycardia is associated with activation of the sympathetic-adrenal system. Patients have shortness of breath, increased systolic blood pressure, polyuria.

Hypothyroid conditions (hypothyroidism) characterized by insufficient effects of iodine-containing hormones in the body. They occur in 0.5-1% of the population, including newborns.

The reasons.

Various etiological factors can cause hypothyroidism, acting either directly on the thyroid gland, pituitary gland, hypothalamic centers, or by reducing the sensitivity of target cells to thyroid hormones.

Cretinism and myxedema are among the most common diseases based on hypothyroidism.

Cretinism - a form of hypothyroidism observed in newborns and in early childhood.

Pathogenesis The disease is associated with a deficiency of the hormones triiodothyronine and thyroxine.

Main manifestations: lag of young children in physical and mental development. Patients have dwarf growth, coarse facial features, due to soft tissue swelling; a large tongue that often does not fit in the mouth; wide flat "square" nose with retraction of its back: eyes far apart from each other; a large belly, often with the presence of an umbilical hernia, which indicates weakness of the muscles.

Myxedema - a severe form of hypothyroidism, which develops, as a rule, in adults, as well as in older children.

A characteristic sign of myxedema is swelling of the skin and subcutaneous tissue, in which, after pressing on the tissue, a fossa (mucosal edema) does not form.

Cause myxedema is the insufficiency of the effects of thyroid hormones as a result of primary damage to the thyroid gland (in 90% of cases), less often - secondary (trauma, surgical removal of most of the gland, inflammation, administration of drugs that disrupt hormone synthesis, iodine deficiency, etc.), as well as dysfunction of the adenohypophysis and hypothalamus.

Pathogenesis.

The essence of the mucosal edema characteristic of the disease is the accumulation of water not only in the extracellular, but also in the intracellular environment due to changes in the properties of skin proteins and subcutaneous adipose tissue. With a lack of thyroid hormones, proteins are converted into a mucin-like substance with high hydrophilicity. The development of edema is promoted by water retention in the body due to increased reabsorption in the renal tubules with a lack of thyroid hormones.

Patients have reduced heart rate and systolic blood pressure. Oxidative processes are weakened, basal metabolism and body temperature are lowered. The breakdown of glycogen, proteins and fats is reduced; hypoglycemia is noted in the blood. The development of atherosclerosis and coronary insufficiency increases and accelerates due to the weakening of the breakdown of fats, especially cholesterol.

clinical picture.

Characteristic appearance and behavior of the patient: puffy face, dry, cold to the touch skin, swollen eyelids, narrowed palpebral fissures. Typical lethargy, apathy, drowsiness, lack of interest in the environment, weakening of memory. Muscle tone is reduced, reflexes are weakened, patients quickly get tired. All these changes are associated with the weakening of excitatory processes in the central nervous system and metabolic disorders.

Exodus. The outcome of myxedema, extremely severe, often fatal, is hypothyroid, or myxedematous coma. It can be the end stage of any type of hypothyroidism when it is inadequately treated or in untreated patients.

DISEASES OF THE PANCREAS

The pancreas performs, in addition to excretory, an important endocrine function that ensures the normal course of metabolism in tissues. Hormone produced in a-cells of the pancreas glucagon, and in p-cells of the islet apparatus - insulin.

• Insulin is intensively produced with an increase in the level of glucose in the blood, it increases the utilization of glucose by tissues and at the same time increases the supply of energy sources in the form of glycogen and fats. Insulin provides an active process of transport of glucose from the extracellular environment into the cell. In the cell itself, it increases the activity of the important hexokinase enzyme, as a result of which glucose-6-phosphate is formed from glucose. It is in this form that glucose enters into various metabolic transformations in the cell. Insulin stimulates the synthesis of glycogen and inhibits its breakdown, increasing the supply of glycogen in tissues, primarily in the liver and muscles.
• Glucagon belongs to the group of contrainsular hormones: it stimulates the breakdown of glycogen, inhibits its synthesis and causes hyperglycemia.

Diseases accompanied by hyperfunction of the islet apparatus of the pancreas

An increase in the level of insulin in the body occurs with a hormone-producing tumor of the β-cells of the pancreas - insuloma; with an overdose of insulin used to treat diabetes; with some brain tumors. This state manifests itself hypoglycemia, up to development hypoglycemic coma.

Allocate absolute and relative insufficiency of the islet apparatus. In absolute insufficiency, the pancreas produces little or no insulin. There is a deficiency of this hormone in the body. With relative insufficiency, the amount of insulin produced is normal.

Diabetes - a chronic disease caused by absolute or relative insulin deficiency, leading to disruption of all types of metabolism (primarily carbohydrate, manifested in hyperglycemia ), vascular damage ( angiopathy), nervous system ( neuropathy) and pathological changes in various organs and tissues.

More than 200 million people suffer from diabetes mellitus in the world, and there is a constant trend of increasing incidence by 6-10%, especially in industrialized countries. In Russia, over the past 15 years, the number of patients with diabetes has doubled and in some regions it reaches 4% of the total population, and among people over 70 years old it even exceeds 10%.

Classification of diabetes.

• Type I diabetes - insulin dependent, develops mainly in children and adolescents (juvenile diabetes) and is caused by the death of p-cells of the islets of Langerhans.
• Type II diabetes - insulin-independent, develops in adults, more often after 40 years, and is caused by insufficient function of β-cells. and insulin resistance (resistance to insulin) tissues.

The reasons diseases: hereditary inferiority of β-cells of the islets, often also sclerotic changes in the pancreas that develop as a person ages, sometimes - mental trauma. The development of diabetes can contribute to excessive consumption of carbohydrates. Change can be significant antigenic properties insulin at its normal physiological activity. In this case, antibodies are formed in the body that bind insulin and prevent its entry into the tissue. An increase in insulin inactivation under the influence of the enzyme may be important. insulinase, which is activated by the growth hormone of the pituitary gland.

Diabetes mellitus can occur with a significant increase in hormones that reduce the action of insulin and cause hyperglycemia. With a prolonged excess of contrainsular hormones, relative insulin deficiency can become absolute due to the depletion of β-cells of the islet apparatus under the influence of hyperglycemia.

Pathogenesis. Characteristic of diabetes mellitus is an increase in blood glucose levels (hyperglycemia), which can reach up to 22 mmol / l or more at a rate of 4.2-6.4 mmol / l.

Hyperglycemia is caused by a violation of the entry of glucose into cells, a weakening of its use by tissues, a decrease in synthesis and an increase in the breakdown of glycogen and an increase in the synthesis of glucose from proteins and fats. Under normal conditions, complete reabsorption of glucose into the blood occurs in the renal tubules. The maximum concentration of glucose in blood plasma and primary urine, at which it is completely reabsorbed, is 10.0-11.1 mmol / l. Above this level (the elimination threshold for glucose), the excess is excreted in the urine. This phenomenon is called "glucosuria". Glucosuria is associated not only with hyperglycemia, but also with a decrease in the renal excretion threshold, since the process of glucose reabsorption can occur normally only when it is converted into glucose-6-phosphate in the epithelium of the renal tubules. In diabetes, this process is disrupted. In connection with the increased breakdown of fats, keto acids are formed; when they accumulate in the blood, patients develop hyperketonemia. Characteristic of diabetes is also an increase in blood cholesterol levels.

Hyperglycemia leads to an increase in the osmotic pressure of the blood plasma, which in turn causes the loss of water by the tissues (dehydration); this is accompanied by thirst, increased water intake and consequently polyuria. An increase in the level of glucose in the secondary urine and its osmotic pressure reduces the reabsorption of water in the tubules, as a result of which diuresis increases. Hyperketonemia contributes to the occurrence of acidosis and causes intoxication of the body.

pathological anatomy.

Morphological changes in diabetes mellitus are presented quite clearly. The pancreas is somewhat reduced in size, sclerosed. Part of the insular apparatus atrophies and scleroses, the remaining islets undergo hypertrophy.

Vascular pathology is associated with a violation of carbohydrate, protein and fat metabolism. develop in large arteries atherosclerotic changes, and in the vessels of the microvasculature, damage to their basement membranes, proliferation of the endothelium and perithelium occur. All these changes end with sclerosis of the vessels of the entire microcirculatory bed - microangiopathy. It leads to damage to the brain, digestive tract, retina, peripheral nervous system. Microangiopathy causes the most profound changes in the kidneys. Due to damage to the basement membranes and increased permeability of the glomerular capillaries, fibrin falls out on the capillary loops, which leads to glomerular hyalinosis. Developing diabetic glomerulosclerosis. Clinically, it is characterized by proteinuria and edema, arterial hypertension. The liver in diabetes mellitus is enlarged in size, there is no glycogen in hepatocytes, their fatty degeneration develops. Lipid infiltration is also noted in the spleen and lymph nodes.

Variants of the course and complications of diabetes mellitus.

In people of different ages, diabetes mellitus has its own characteristics and proceeds in different ways. In young people the disease is characterized by a malignant course, old people- relatively benign. Diabetes causes a variety of complications. Development of a diabetic coma is possible. Diabetic glomerulosclerosis complicates diabetes by the development of uremia. As a result of macroangiopathy, thrombosis of the vessels of the extremities and gangrene can occur. Decreased body resistance often manifested by activation of a purulent infection in the form of boils, pyoderma, pneumonia, and sometimes sepsis. These complications of diabetes are the most common causes of death in patients.

The endocrine system is very important for the smooth and precise work of the human body, it regulates the work of hormonal processes. This happens through the production of hormones - special substances that affect physiological processes, physical characteristics and mental state.

Symptoms and disorders of the endocrine system can be different, and quite often they disguise themselves as other diseases, which makes it difficult to diagnose them, and, therefore, the treatment may turn out to be incorrect. Endocrine problems and disorders provoke various pathologies in people, as a result of which the production of hormones is disrupted, their transportation and absorption fail, hormones begin to be produced in more or less quantities than necessary, and a person may develop resistance to the action of these substances.

Naturally, such disorders cause various endocrine diseases, the most common of which are the following:

• hypothyroidism;
• diabetes;
• thyrotoxicosis;
• autoimmune thyroiditis;
• hypoparathyroidism;
• gigantism.

Of course, the list of endocrine ailments is much more extensive, but within the framework of this article, only these pathologies will be considered, since practical endocrinology encounters them most often.

Diseases of the endocrine system in each of its individual manifestations certainly have their own characteristic symptoms, but there are also general signs by which an endocrine disease can be suspected.

Due to the fact that all endocrine glands are closely connected with the endocrine system, the symptoms can be very diverse:

• unreasonable constant fatigue;
• excess weight or pathological weight loss despite the fact that the diet does not change;
• heart pain and symptoms of tachycardia;
• excessive sweating;
• excitability of the nervous system, or vice versa drowsiness;
• increased excretion of urine;
• thirst;
• arterial hypertension;
• indigestion;
• bad memory syndrome.

Diseases of the endocrine system can occur with equal frequency in both women and men, in addition, most diseases of the endocrine glands are absolutely not tied to a person's age, and can occur in both adults and children.

Causes of pathologies

All endocrine diseases have either one or several causes at once:

• hormonal deficiency;
• excess hormones;
• the gland produces an abnormal hormone;
• the body has resistance to the effects of hormonal substances;
• failure in the process of transportation and delivery of the hormone;
• simultaneous violation of several hormonal processes at once.

Lack of hormones may be congenital, may be acquired during life, for example:

• infectious processes occurring in the glands,
• intrauterine underdevelopment,
• poor blood supply to the gland or hemorrhage into it,
• inflammatory processes,
• autoimmune (endocrine) pathologies,
• lack of substances necessary for hormonal synthesis,
• the negative impact of poisons and toxic substances.

Excessive amounts of hormones most often occur with:

• excessive stimulation of the endocrine gland;
• the production of hormones by some tissues that should not do this;
• liver damage;
• hormone therapy.

The transport of hormones is most often disrupted during pathological processes in the liver, but sometimes a failure can occur under physiological and completely normal conditions, for example, when carrying a child.

Abnormal hormones are produced quite rarely, the reason for this can be mutational processes in the genes. As for the body's resistance to the influence of hormones, this phenomenon occurs when there is a pathology of hormone-sensitive receptors.

A malfunction in the operation of this system can develop with multiple pathologies in the work of various endocrine glands. The fact is that all glands are somehow connected with each other, and a violation in the work of one gland leads to negative processes in other glands.

Diagnosis of endocrine pathologies

If the patient has pathological symptoms, diseases of the endocrine system must be carefully diagnosed and differentiated from other ailments. Already during the clinical examination of the patient, one or another pathology of the endocrine system can be assumed.

An external examination gives the doctor a large amount of information, since a violation of the work of the endocrine glands is almost always accompanied by some changes in the external appearance of a person. For example, if a patient has a disorder in the thyroid gland, then he most often has pigmentation on the skin of the eyelids, rare blinking, in some cases there are problems with facial expressions, and the face resembles a mask. In hypothyroidism, the patient's skin is pale, cold, the hair is dry, lifeless and brittle.

Other pathologies are accompanied by a violation of the proportion of the body, as well as non-standard growth. With toxic goiter, the patient's skin is too elastic.

In some cases, endocrine disorders (in women) are accompanied by male pattern hair growth, as well as facial hair growth. The patient's weight can also tell a lot to the endocrinologist.

In addition to an external examination, the doctor directs the patient to laboratory diagnostics, where he will have to donate blood for hormones. In addition, in the diagnosis of endocrine disorders, hardware methods are widely used - ultrasound, CT, MRI.

An endocrinologist deals with the problems of diseases of the endocrine glands, he will tell in detail how the process of restoring and normalizing the functioning of the endocrine glands is carried out, and will explain how to treat endocrine ailments. The treatment of endocrine diseases certainly differs among themselves, below will be given an approximate treatment regimen for the most common ailments.

Important! Only a qualified doctor of a narrow specialization should prescribe drug therapy, self-medication can lead to a deterioration in the patient's condition.

Treatment of endocrine diseases

It is very difficult and long to restore internal pathologies and hormonal imbalance, but modern medicine knows how to restore the endocrine system - for this it has a large number of different drugs in its arsenal. But this does not reduce the complexity of the treatment of diseases of the endocrine glands; most often, patients have to take drugs for life.

As a rule, the patient is prescribed hormonal agents that increase or decrease the activity of the endocrine glands. In addition, patients are prescribed strengthening and anti-inflammatory drugs, and therapy can also be provided with the help of radioactive iodine. Of course, surgery remains the most effective treatment for pathologies, but endocrinologists try to resort to it only in extreme cases.

Patients are prescribed dietary nutrition, in each case the diet is selected individually, based on the disease itself, its stage, the age of the patient and his general condition.

I must say that these endocrine disorders respond well to treatment with folk methods. They also help very well when prevention of diseases of the endocrine system is needed, which is necessary for people who have a hereditary predisposition to such disruptions in the body.

Treatment of hypothyroidism

Treatment for hypothyroidism is based on:

1. Etiotropic therapy- treatment of diseases that provoked hypothyroidism, as well as background ailments.
2. Replacement therapy- taking hormonal drugs that can replace natural thyroid hormones. As a rule, such drugs are well tolerated by patients, but in most cases they have to be taken for life. It can be Euthyrox, Bagothyrox, Levothyroxine and others.
3. symptomatic treatment. It is prescribed to improve the quality of life of the patient - it is aimed at maintaining other organs, the work of which can be inhibited during hypothyroidism, as well as at stopping unpleasant symptoms. The doctor chooses drugs from the following groups - cardioprotectors, cardiac glycosides, nootropic drugs, medicines, which are based on female sex hormones, vitamins.
4. Diet food. It is recommended to exclude foods high in fatty acids and cholesterol from the diet, it is better to steam food so that the vitamins are preserved in the maximum amount. If the patient has constipation, he needs to consume more vegetable fiber. In principle, nutrition with hypothyroidism is not particularly toughened, the main thing is not recommended pickles, fast foods, alcohol, fatty and fried foods.

Treatment of diabetes

Treatment for diabetes aims to:

• normalization of metabolic processes in the body;
• decrease in sugar levels;
• prevention of complications.

From medicines appoint:

1. Pancreatic stimulants - Gliclazide, Glipizide, Nateglinite.
2. Drugs that enhance cellular sensitivity to insulin - Siofor, Pioglitazone, Avandia.
3. Receptor inhibitors and agonists - Sitagliptin, Liraglutide.
4. Glucose absorption blockers in the digestive tract - Acarbose.

In addition to medications prescribed by doctors, patients with diabetes must adhere to a strict diet, which is prescribed in detail by the doctor.

Preventive actions

Given the fact that endocrine diseases are quite specific, general recommendations on preventive measures in this case will not be enough. Prevention of diseases of the endocrine system has its own characteristics.

In particular, this is the use of certain drugs, without a doctor's prescription, which is not only not recommended, but strictly prohibited! The same applies to the use of traditional medicine, as well as the use of biologically active additives for preventive purposes.

As for general recommendations, for example, the prevention of endocrine diseases that are associated with thyroid disorders involves the use of iodized salt in cooking, it is also recommended to eat seafood. Pathological processes in the thyroid gland can provoke bad habits and excessive exposure to ultraviolet rays.

Speaking about the prevention of diabetes, it must be said that it is mainly aimed at a balanced and proper diet, exclusion from the diet of preservatives, flavorings, reducing the consumption of animal fats and fast carbohydrates.

What symptoms require consultation with an endocrinologist:

• Lack or excess weight, a sharp decrease or increase in weight for no apparent reason, more than 3-4 kg.
• "Fragile" physique in combination with early menopause (up to 53 years), pain in the thoracic spine, hip joints. More than 1 fracture in the last 5 years, or fractures that occurred “accidentally”, i.e. without severe trauma.
• Pressing sensations in the neck, swallowing, breathing disorders, discomfort when wearing a tight collar, turtlenecks.
• Palpitations, heart rhythm disturbances, trembling of the fingers, internal trembling, excessive emotional lability, tearfulness, constipation, swelling of the face.
• Unpleasant sensations in the eyes - dry eyes, lacrimation, "bulging eyes", a visible increase in the anterior surface of the neck.
• Dry mouth, thirst, increased fluid intake, frequent urination, especially at night.
• General weakness, fatigue, drowsiness, memory impairment, frequent headaches, changes in the nature of pre-existing headaches.
• A sharp deterioration in vision.
• Discharge from the mammary glands, menstrual irregularities. Infertility. Miscarriage.
• Excessive hair growth, hair loss. Persistent acne.
• Newly detected rises in blood pressure, especially at the age of 45 years. Very high blood pressure, not controlled by tablet preparations, frequent hypertensive crises.

When should you undergo a preventive examination by an endocrinologist, even if the above symptoms are absent:

• If close relatives have thyroid diseases, diabetes mellitus, hip fractures, early strokes and heart attacks, if there were periods of life in areas with high radiation (Chernobyl, military training grounds, etc.).
• When planning pregnancy or in early pregnancy.
• Everyone it is important to examine the thyroid gland after 35 years with an interval of 5-7 years, control blood sugar 1 time in 2-3 years, with excess weight 1 time per year, undergo an examination for osteoporosis after 55 years.

Remember that the detection and treatment of endocrine diseases in the early stages is much more effective and cheaper!

What can I do as an endocrinologist:

• consultations, examinations in preparation for surgical interventions, spa treatment, planned medical examination.
• Diagnosis and treatment of diseases of the thyroid gland (ultrasound diagnostics of the thyroid gland, evaluation of the results of a puncture biopsy of the thyroid gland, hormonal parameters). Follow-up after thyroid surgery.
• DIETOLOGY: Comprehensive weight correction programs, incl. for children and teenagers. Preparation for pregnancy, nutrition during pregnancy. Development of individual healthy nutrition programs for various metabolic disorders, optimization of nutrition for children and adolescents.
• Diagnosis and treatment of diabetes mellitus, selection of proper nutrition, correction of insulin therapy, individual "diabetes school". Timely detection and treatment of possible complications of diabetes mellitus.
• Diagnosis and treatment of osteoporosis, selection of proper nutrition, physical activity, orthopedic correction.
• Diagnosis and treatment of metabolic syndrome.
• Hirsutism - identifying the causes and correcting excessive hair growth.
• Diagnosis and treatment of rare endocrinological diseases. Versatile examination of patients with "unclear diagnosis".