Condition -Diabetes

Diabetes is a disease which affects the production and supply of insulin in the body. The food we eat is converted into glucose, a type of sugar. This sugar is then used as energy needed by our body to perform various activities. Glucose is then transported in our blood. In order for our muscles and other tissues to absorb glucose from our blood, we need a hormone called insulin. Without insulin, our bodies cannot obtain the necessary energy from food.

In case, a person is suffering from diabetes, his or her body doesn't produce enough amount of insulin as required. This leads to increase in the amount of glucose in the blood. This high level of glucose or "high blood sugar" is called hyperglycemia. High levels of glucose in the blood can lead to serious complications.

Diabetes is generally a chronic disease in which there are high levels of sugar in the blood. There are mainly two types of diabetes:

• Type 1 diabetes can occur at any age, but it is most often found in children, teens, or young adults. In this type, the body makes little or no insulin. Regular injections of insulin are required.
• Type 2 diabetes consists of most diabetes cases. It occurs most often in adulthood. However, due to high obesity rates, teens and young adults are also being diagnosed with it. Many people with type 2 diabetes do not know they have it.

Signs and Symptoms

There could be many signs and symptoms of high blood sugar including:

• Blurry vision
• Increased thirst
• Fatigue
• Hunger
• Urinating often
• Weight loss

Causes

Insulin hormone is known to be the major cause of diabetes. Other causes are:

• Genetic defects of β-cell function
• Genetic defects in insulin processing or insulin action
• Exocrine pancreatic defects
• Growth hormone excess
• Infections
• Drugs

Treatment

When it comes to the treatment of type 1 and type 2 diabetes, doctors primarily suggest making lifestyle changes to ensure a happy life. It is also true that type 2 diabetes can be cured with weight-loss surgery.

• There is no cure for type 1 diabetes
• General treatment involves medicines, diet, and exercise that control blood sugar level and prevent symptoms and problems
• Controlled diet
• Insulin - Type 1 diabetes is generally treated with combinations of regular and NPH insulin, or synthetic insulin analogs
• Physical exercise
• Medication
• Weight loss surgery
• Bariatric surgery – At Max Hospital, we help obese patients lose their weight through either laparoscopic gastric binding or sleeve gastrectomy or gastric bypass surgery. Our team of experts comprising surgeons, physicians, endocrinologists, nurses, dieticians, physiotherapists and psychologists is willing to meet with patients one-on-one to share their knowledge and expertise and ensure their full recovery. Our holistic, multi-disciplinary approach addresses all aspects of health - including psychological and medically related conditions - before, during and after surgery.
• Gastric banding - A band of special material (Siliastic band) is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach.
• Sleeve gastrectomy - In this surgery approximately 80 percent of the stomach is removed laparoscopically with the help of staplers so that the stomach takes the shape of a tube or "sleeve".

Condition - Obesity

In general terms, Obesity refers to the excess amount of fat stored in the body. It is also known as overweight which means weighing too much. A person may be overweight from extra muscle, bone, or water, as well as from having too much fat. Obesity is generally not a disease but is known to be a major cause for the onset of various other diseases. Consuming more food means consuming more calories which then leads to obesity because our body stores unused calories as fat. Not only a major cause of other diseases, obesity sometimes makes it really difficult for the people to carry out their daily activities like washing, walking, bathing, running, lifting etc. Therefore, it should be treated at the earliest to ensure minimal damage. Being overweight puts strain on your heart and can lead to serious health problems. These problems include:

• Heart disease
• High blood pressure
• Sleep apnea
• Type 2 diabetes
• Varicose veins

Signs and Symptoms

Following symptoms of obesity are:

• BMI – refers to Body Mass Index. This is actually a measurement to determine your weight with respect to your height. If your BMI is over 25, you will be considered overweight. However, if it goes beyond 40, you will come under the category – morbidly obese.
• Waist circumference - Extra weight around your middle or stomach area increases your risk for type 2 diabetes, heart disease, and stroke.
• Blood tests may be conducted to check for thyroid or hormone problems that could lead to weight gain.

Causes

In general, more calories stored means excess fat. However, the major causes of obesity are:

• Eating more food than your body demands
• Consuming too much alcohol
• Not involved in physical exercise
• Underactive thyroid gland
• Medicines such as birth control pills, antidepressants, and antipsychotics
• Smoking
• Stress, anxiety

Treatment

The most basic and foremost treatment of obesity is to gain control over your calories intake.

• Lifestyle changes – an active and healthy lifestyle combined with healthy eating is found to be the safest way to reduce weight.
• Reading nutrition labels before consuming something can help you know more about calorie intake you should choose.
• Medications and herbal remedies.
• Significant effort to lose weight through dietician advised dietary changes, exercise or changing your lifestyle.
• Surgery – Surgery may help people who are obese for more than 5 years or more and have not lost weight through other ways such as diet, exercise, or medicine. There are different types of weight loss surgeries done to reduce weight significantly. They are:
• Laparoscopic adjustable gastric binding (LAGB) - This is a surgical procedure where a silicon band lined with an inflated balloon is placed laparoscopically around the stomach in its upper section which creates a small pouch and a narrow passage. When you eat, the sensation of full stomach comes early and you will stop eating. In this, you will do less calories intake. This procedure is done with 5 small incisions and involves the use of adjustable silastic gastric band. Moreover, it can be done within one hour.
• Laparoscopic gastric bypass surgery (LGBS) - In this type of surgery, the stomach size is reduced by creating a small pouch in its upper part using surgical staples. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum). The small stomach makes you feel full more quickly and part of the small intestine bypass causes reduced calories and nutrient absorption, which ultimately leads to weight loss.
• Laparoscopic sleeve gastrectomy - This procedure produces similar results to a gastric bypass but with lesser risks. The Gastric Sleeve is a new procedure that induces weight loss by restricting food intake (a restrictive procedure). In this procedure, the gastric surgeons remove almost 80% of the stomach laparoscopically. Using staples, the surgeons give it the shape of a tube or "sleeve" to measuring 30 to 50 cc. This surgery takes about 1-2 hours to complete and involves the use of endoplaster to divide the stomach. A patient can even start drinking from the second day after surgery. This surgery is extremely safe and effective as it doesn't involve disconnection of intestines compared to gastric bypass surgery.

Condition - Pituitary Adenoma

Pituitary adenomas are a type of tumour that are noncancerous and occur in the pituitary gland. These types of noncancerous tumours are generally divided into three categories on the basis of their biological functioning - benign adenoma, invasive adenoma or carcinomas, with carcinomas accounting for 0.1% to 0.2%, approximately 35% being invasive adenomas and most being benign adenomas.

The pituitary gland is a pea-sized, reddish-grey gland, located in the centre of the brain, just above the back of the nose. It is made up of three lobes, each of which produces hormones. The hormones produced in this gland controls most of the basic body activities.

Signs and Symptoms

Hormone secreting pituitary adenomas can cause one of different types of hyperpituitarism. Symptoms may vary on the basis of tumour's size, its location, and whether it's secreting or not.

• Overproduction of hormones – As these hormones are responsible for milk production in women, extremely high level can cause milk production in both men and women who are not pregnant. Another sign is menstrual irregularity.
• Underproduction of hormones – It is studied that some 75% of pituitary tumour don't produce hormones. This condition can lead to a damaged gland tissue. This can cause irregularity or loss of menstruation in women and sterility with loss of sex drive in men and women.
• Growth disorders – These disorders cause excessive growth in children. In case of adults, they can lead to acromegaly, or abnormal growth of the face bones, enlarged hands and feet, excessive sweating and heart disease.
• If the tumour is present on the optic nerves, disturbances in vision will occur.

Causes

The cause of this uncontrolled cell growth in the pituitary gland and resulting into a tumour remains unknown.

Treatment

With the advances in medical technology such as endoscope, surgical microscope and image guided systems, doctors and surgeons can now perform highly sophisticated surgeries that were not possible few years back. At Max Department of Endocrinology & Diabetes, doctors perform state-of-the-art minimally invasive pituitary surgery that allows for precise removal of tumours, in or around the pituitary gland. This surgery also ensures faster recovery, no scarring and fewer complications. This surgery is done for the following:

• to remove hormone-producing tissue (typically in Acromegaly or Cushing's disease)
• to reduce the volume of a tumour that is compressing the optic chiasm or other structures
• to reduce the volume of or to remove non hormone-producing tissue that is likely to threaten surrounding structures in the future, for example, in a relatively young patient, in whom continued growth of the tumour is suspected or has been proven by sequential scans

Condition - Thyroid

Thyroid is a small gland, similar to a butterfly, situated in the lower part of the neck. The primary objective of this gland is to secrete hormones such as tri-iodothyronine, abbreviated as T3, and thyroxin, abbreviated as T4.  These thyroid hormones provide energy to cells of the body and are one of the most important hormones to control the body’s metabolism.

The most common thyroid problems include:

• Hypothyroidism - An underactive thyroid
• Hyperthyroidism - An overactive thyroid
• Goitre - An enlarged thyroid
• Thyroid nodules - Lumps in the thyroid gland
• Thyroid cancer - Malignant thyroid nodules or tissue
• Thyroiditis - Inflammation of the thyroid

Signs and Symptoms

• Thyroid goiter
• Palpitations
• Excess sweating
• Diarrhea
• Weight loss
• Muscle weakness
• Unusual sensitivity to heat
• Increased appetite

Causes

Most common causes of hypothyroidism are:

• Hashimoto’s thyroiditis
• Pituitary or hypothalamic disease
• Medications
• Severe iodine deficiency

Treatment

With the exception of certain conditions, thyroid problems require life-long treatment. The treatment options are:

• Dietary changes
• Medication - The two main types of medicines used to treat hyperthyroidism are anti-thyroid drugs and beta-blockers.
• Lifestyle changes
• Physical exercise
• Radioactive iodine - Destroying the thyroid with radiation, called radioiodine ablation, is a permanent way to resolve hyperthyroidism. The amount of radiation used is small and does not cause cancer.
• Surgery - Although it is a permanent cure for hyperthyroidism, surgery to remove the thyroid gland is used far less often than anti-thyroid drugs or radioactive iodine because of the risks associated with thyroid surgery.