The Daily Schedule Of An Endocrinologist

Endocrinology is a medical specialty that deals with the endocrine system and the diseases and conditions that affect it. The endocrine system has to do with the regulation of hormones in the body, and these hormones affect certain bodily functions and activities such as growth and development, metabolism, sensory perception, sleep, tissue function, respiration, digestion, lactation, stress, mood, excretion, reproduction and movement.

The endocrine system consists of numerous glands that are situated in different parts of the body, and these glands secrete hormones directly into the bloodstream rather than into a duct system. These hormones have various modes of action and perform different duties in the body. A target organ can be affected by many hormones and one hormone can produce several effects on different organs.

Training

An endocrinologist has to complete the following education and training programmes in order to qualify as a specialist physician:

• 5-6 years of a medical undergraduate degree.
• 1-2 years of internship training to be exposed to different medical and surgical disciplines.
• 4 years residency in internal medicine.
• 2 years fellowship training in endocrinology.

It can therefore take a doctor 12-14 years to become a qualified endocrinologist.

Hormones and Glands associated with Endocrinology

There are 3 different classes of hormones and these are based on their chemical structures.

Steroids

These hormones are converted from cholesterol and are divided into 5 groups called mineralocorticoids, glucocorticoids, oestrogens, androgens and progestogens. 

Peptides

Peptide hormones include those secreted by the pituitary gland, ghrelin from the stomach, leptin from adipocytes and insulin from the pancreas.

Amines

The amines include the hormones adrenaline and noradrenaline (secreted by the adrenal glands), dopamine (which is a catecholamine secreted by the brain) and the thyroid hormones T3 and T4 (secreted by the thyroid gland).

Diseases managed by Endocrinologists

Thyroid diseases

• Goiter.
• Hyperthyroidism - due to Graves disease or a toxic multinodular goitre.
• Hypothyroidism.
• Thyroiditis such as Hashimoto's thyroiditis.
• Thyroid cancer.
• Thyroid hormone resistance.

READ Could You Have A Thyroid Disorder?

Glucose homeostasis disorders

• Type 1 diabetes and late onset type 1 diabetes.
• Type 2 diabetes.
• Gestational diabetes.
• Hypoglycemia - due to an insulinoma or other idiopathic causes.
• Glucagonoma.

Calcium homeostasis disorders

• Parathyroid gland disorders such as primary, secondary and tertiary hyperparathyroidism, hypoparathyroidism and pseudohypoparathyroidism.

Metabolic bone diseases

• Osteoporosis.
• Paget's disease.
• Osteomalacia.
• Rickets.

Pituitary gland disorders

• The anterior pituitary - hypopituitarism, pituitary tumours such as pituitary adenomas and prolactinomas, acromegaly (gigantism) and Cushing's disease.

• The posterior pituitary - diabetes insipidus.

Adrenal gland disorders

• Cushing's syndrome - causing excess corticosteroid production primarily due to adrenal gland masses such as pheochromocytomas, and secondary to anterior pituitary tumours.
• Addison's syndrome - causing decreased corticosteroid production due to primary adrenal insufficiency.

Sex hormone disorders

• Disorders of sex development or intersex disorders such as gonadal dysgenesis, hermaphroditism and androgen insensitivity syndromes.
• Puberty disorders such as delayed or precocious puberty.
• Hypogonadism (due to gonadotropin deficiency) in genetic or chromosomal disorders such as Turner syndrome, Kallman syndrome and Klinefelter syndrome. This also occurs in acquired disorders such as testicular and ovarian failure (premature menopause).
• Menstrual dysfunction such as in amenorrhoea, and fertility disorders such as polycystic ovarian syndrome (PCOS).

Other tumours of the endocrine glands

• Multiple endocrine neoplasias such as in MEN syndrome types 1, 2a and 2b.
• Carcinoid syndrome.

The Daily Schedule Of An Endocrinologist

The endocrinologist's duties include consulting with their hospital patients on a daily basis until the patients have been handed over to other specialists such as surgeons, who will remove growths on glands or excise overactive glandular tissue, or they have managed the patient's condition to a point where they can be discharged home. This specialist will also have their office located on the hospital grounds to make it easier to see patients in the ward, when there is an emergency situation, and to consult with patients in the emergency department.

Endocrinologists will consult with surgical specialists, as mentioned, and they will also discuss patients with other internal medicine specialties such as cardiology and nephrology where endocrinology conditions can overlap into these disciplines.

Endocrinologists have to provide on call services for the hospital they work at after hours and on weekends. These specialists will manage emergency endocrinology cases such as Addison's crisis, thyroid storm, myxoedema coma and acute hypercalcaemia.

Monday

The endocrinologist will deal with administrative tasks in the morning before they start seeing patients in their rooms. These aspects can include meetings with staff, hospital management and medical representatives as well as dealing with the financial aspects of the practice.

Once these issues have been dealt with, the specialist will start consulting with patients for the day. The endocrinologist can manage patients conservatively, but most of the time the patients will be admitted to the hospital where further investigations can be performed to diagnose the endocrine disorder so that the appropriate management can be started.

Tuesday

Since an endocrinologist has a wide scope of glandular conditions to focus on, they may decide to split the week up into seeing specific endocrine patients.

A Tuesday, for example, can be used to consult and manage patients with pituitary disorders. These patients can be managed conservatively if the tumours are small and benign, or they may be referred to the neurosurgeons if the growths are large, malignant or cause severe symptoms.

READ Do Thyroid Problems Always Have To Be Treated?

Wednesday

This day can be used to consult and manage patients with thyroid and pancreas related endocrine issues, such as hypothyroidism and diabetes. Most of the time, these patients can be managed conservatively but they might end up being referred to general surgeons who specialise in thyroid and pancreatic conditions, respectively.

Thursday

The endocrinologist may consult with patients with adrenal gland conditions, such as Cushing's syndrome, that occurs due to excessive corticosteroid production as a result of pheochromocytomas. The specialist may have to consult with a general surgeon or urologist to remove these masses on the adrenal glands.

The afternoon would be used for academic purposes where the specialist would offer training to undergraduate medical students and postgraduate clinical assistants.

Friday

At the end of the week the specialist will consult with patients in the morning, and the afternoon will be used to resolve any unfinished administrative tasks. Once all these aspects have been adequately dealt with, then the work week can conclude.