Austin TypeOneNation Summit

Dr. Tira Chaicha-Brom, MD ECNU, of Texas Diabetes and Endocrinology, has joined a panel of experts who will be discussing Type 1 diabetes (T1D) and pregnancy at the upcoming Austin TypeOneNation Summit on Sunday, March 1, 2020.  

This educational conference is a great opportunity for those living with T1D, parents, caregivers, siblings and anyone interested in learning more about T1D. Topics include advancements in the treatment of T1D,  T1D and pregnancy and will showcase learning tracks for children and teens as well. Please join Dr. Chaicha-Brom at this important event.

Learn more and register today at bit.ly/TON2020

POLYCYSTIC OVARIAN SYNDROME

Do you have irregular periods? There are several reasons for missing periods, but one of the most common reasons is PCOS, polycystic ovarian syndrome.  

Symptoms of PCOS include:

  • Missing periods (usually having less than 9 periods per year)
  • Excess testosterone on blood work or on exam (excess hair growth, acne)
  • Ovarian cysts

PCOS is a diagnosis of exclusion so other diseases like thyroid or other hormone problems should be ruled out before making the diagnosis of PCOS.  The diagnosis is based on symptoms, laboratory findings, and sometimes imaging studies.

The risk of having PCOS is that it can be associated with diabetes or insulin resistance, sleep apnea, cardiovascular disease, weight issues, uterine cancer, infertility, and sleep apnea.

The cause of PCOS is unknown and treatment involves controlling the symptoms.  A healthy lifestyle with weight loss can oftentimes improve symptoms and prevent associated medical complications.  Birth control pills are typically used to help regulate periods and can sometimes decrease facial hair or acne. Metformin is another medication that is typically used to help control the blood sugar.

When a woman has regular periods, this is a good indication that her hormones are appropriate. 

You should let your healthcare provider know if you have irregular periods or excess hair growth or acne in order to do a proper evaluation.

The following references:

https://www.hormone.org/diseases-and-conditions/polycystic-ovary-syndrome

PCOSChallenge.com

What is the pituitary?

The pituitary is a hormone-producing gland that sits just beneath the base of the brain. It is very small – only about the size of a pea. The pituitary gland has two parts. The front portion of the gland makes hormones that affect the breasts, adrenals, thyroid, ovaries and testes, as well as several other hormones. The main glands affected by the back portion of the gland are the kidneys. It plays a major role in regulating vital body functions and general wellbeing. It is referred to as the body’s ‘master gland’ because it controls the activity of most other hormone-secreting glands.

What could go wrong with my pituitary gland?
Conditions that affect the pituitary gland directly can be divided into three main categories:

• Conditions that cause the pituitary gland to produce too much of one or more hormone(s). Examples include acromegaly, Cushing’s disease and prolactinoma.

• Conditions that cause the pituitary gland to produce too little of one or more hormone(s). Examples include adult-onset growth hormone deficiency, diabetes insipidus and hypopituitarism.

• Conditions that alter the size and/or shape of the pituitary gland. Examples include empty sella syndrome.

What are the symptoms of pituitary conditions that produce too much of one or more hormones?

A prolactinoma is a tumor of the pituitary gland that produces too much of the hormone prolactin. High prolactin levels can cause women to have irregular or absent periods, infertility, or abnormal breast milk production. In men, high prolactin levels cause low testosterone which leads to fatigue, decreased muscle strength, low libido, erectile dysfunction, and infertility.

Cushing’s Disease is a hormonal disorder caused by a tumor of the pituitary gland. The tumor makes too much of a hormone called ACTH (adrenocorticotropic hormone). ACTH causes an increase in the stress hormone cortisol. Cortisol is a hormone that regulates blood pressure, blood sugar, and the immune system.

Acromegaly is caused by a tumor in the pituitary gland that makes too much growth hormone. Common symptoms of acromegaly are abnormal growth of the hands and feet, joint pain, face changes (enlarging forehead, nose, tongue, lips, widened space between teeth, and underbite), carpal tunnel syndrome, sleep apnea, diabetes, high blood pressure.

What are the symptoms of pituitary conditions that produce too little of one or more hormone(s)?

Hypopituitarism is a rare disorder in which your pituitary gland fails to produce one or more hormones, or doesn’t produce enough hormones. This can cause a variety of different symptoms depending on which hormone has been affected.

Growth hormone (GH) deficiency
In children, GH deficiency may cause growth problems and short stature. Most adults who have GH deficiency don’t have any symptoms, but for some adults it can cause fatigue, changes in body fat and muscle weakness.

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency
Deficiency of these hormones affect the body’s reproductive system. In women, the deficiency can cause irregular periods, hot flashes, low libido and the inability to produce milk for breast feeding. Men may also have symptoms such as erectile dysfunction, decreased facial or body hair, low libido and mood changes.

Thyroid-stimulating hormone (TSH) deficiency
This hormone controls the thyroid gland. A TSH deficiency leads to low levels of thyroid hormones (hypothyroidism). Symptoms include fatigue, weight gain, dry skin, constipation, hair loss and feeling unusually cold.

Adrenocorticotropic hormone (ACTH) deficiency
This hormone helps your adrenal glands work properly, and helps your body react to stress. Symptoms of ACTH deficiency include severe fatigue, nausea or abdominal pain, and low blood pressure, which may lead to fainting.

Anti-diuretic hormone (ADH) deficiency
This hormone helps your body balance its fluid levels. Symptoms of ADH deficiency can cause a disorder called diabetes insipidus, which can cause excessive urination and thirst.

Prolactin deficiency
Prolactin is the hormone that tells the body when to start making breast milk. Low levels of prolactin can cause women to have problems making milk for breast-feeding.

What are the symptoms of pituitary conditions that alter the size and/or shape of the pituitary gland?

Empty Sella
Most individuals with empty sella syndrome do not have any associated symptoms, but the finding raises concerns about hormone deficiencies.

What is the treatment?

The treatment for pituitary problems are vast. Sometimes only monitoring the patient is needed. Other times a simple medication can resolve problems; however, in some cases surgery is required.

Why you should contact TD&E?

Pituitary disorders are often complex, and successful diagnosis and treatment can be a challenge. The physicians at TD&E offer an integrated, comprehensive approach to all pituitary problems. To ensure the best chances for successful treatment, you should be cared for by experts who specialize in pituitary diseases.

Resources

1. http://pituitarysociety.org/patient-education/pituitary-disorders
2. http://www.yourhormones.info/glands/pituitary-gland/
3. https://www.hormone.org/diseases-and-conditions/pituitary-tumors
4. https://www.mayoclinic.org/diseases-conditions/hypopituitarism/symptoms-causes/syc-20351645

Low testosterone (hypogonadism) in men

What is testosterone?

Testosterone is the most important androgen (male hormone) that men make. It helps regulate muscle mass and strength, it can effect sex drive and sexual function, and it helps maintain bone strength.

What is “low T”?

Low testosterone is when the body does not produce sufficient testosterone. With age, it is normal for levels of testosterone to get a bit lower. When the levels of testosterone get too low, men can have symptoms.

What are the symptoms?

The symptoms may change from person to person.
If someone has had low testosterone for a relatively short period of time, he may experience: fatigue, low libido (little or no interest in sex), or he may feel sad or depressed
If low T goes unnoticed for a long time, some people experience loss of bone and / or muscle mass, loss of facial or body hair, increase in breast size (gynecomastia)

What are the causes?

  • Normal aging
  • Diseases affecting the testicles (which produce testosterone in men)
  • Certain treatments for cancer, including radiation, chemotherapy or certain types of hormone therapy
  • Disorders that affect the pituitary gland, a gland at the base of the brain that regulates all other hormones in the body

Other medical problems: liver and kidney disease, obesity, diabetes, AIDS, and some relatively rare hereditary conditions

Why should you see us for this?

There are many things that can cause these symptoms. Your provider can try to find out what might be causing them. A blood test can show whether you have low T, but you might not need that test if something else is causing your symptoms. Also finding the cause of low T is important, since treatment may change depending on the cause.

What is the treatment?

Low testosterone can be treated with testosterone replacement, which comes in patches, gels, injections, and other options. It is very important to pick the treatment that will work best for you and to monitor your testosterone levels to optimize the results. The providers at Texas Diabetes & Endocrinology are experts in low testosterone management and can help you achieve personalized results!


Why you should contact TD&E

  • It is very important to evaluate and understand the specific cause of low T before starting treatment for it. Treatment depends on the cause, and sometimes starting treatment before detailed evaluation can make it harder to understand the underlying cause
  • Getting your testosterone levels to optimal has health benefits including improved muscle mass, increased bone density, better energy levels, and improved sexual function.
  • The providers at Texas Diabetes & Endocrinology are experts in low testosterone management and can help you achieve personalized results!

 


The History of Metformin

Metformin is one of the most commonly used medications in endocrinology. It is the preferred first-line oral blood glucose-lowering medicine to manage type 2 diabetes. It is also used in the treatment of polycystic ovary syndrome. Sometimes it is used, along with other medications, to treat infertility.

The journal Diabetologia dedicated a special issue this month to Metformin, which is celebrating 60 years of clinical use.

Most people don’t know that metformin has been in use for sixty years! The effectiveness of the plant from which metformin is derived has been known since 1918. The plant Gallegos officinalis (goat’s rue, also known as French lilac or Italian fitch) was noted to have sugar-reducing properties then. Initial experiments with metformin went well, but the discovery of human insulin for the treatment of diabetes put metformin on the back-burner. Metformin was rediscovered in the 1940s. The French physician Jean Sterne was the first to pursue the glucose-lowering effect of metformin. He reported the use of metformin to treat diabetes in 1957.

Over the years, the ability of metformin to improve the way the body processes and responds to insulin was appreciated more and more through Europe. After intensive research, metformin was introduced into the USA in 1995.

Long-term benefits on heart health were identified by the UK Prospective Diabetes Study (UKPDS) in 1998. This provided yet another reason for metformin to become first-line treatment for diabetes.

Sixty years after its introduction, metformin has become the most prescribed sugar-lowering medicine worldwide with the potential for other uses.

Metformin timeline
1772 Galega officinalis used anecdotally to treat symptoms of diabetes
1929 First scientific experiments on lab animals
1957 Jean Sterne publishes on the use of metformin to treat diabetes
1958 Metformin introduced as a diabetes medication in the UK
1994 Metformin introduced in the USA
1998 UKPDS reports heart benefits of metformin in people with type 2 diabetes
2002 Metformin shown to reduce progression of prediabetes to diabetes
2011 Metformin included in the essential medications list of the World Health Organization

For further insights into the history and multiple uses of metformin – see Diabetologia (2017) 60

One of world’s most prestigious endocrinology conferences comes to Austin!

Texas Diabetes & Endocrinology was excited about one the world’s largest endocrinology conferences being in Austin this year. The Annual Scientific & Clinical Congress of the American Association of Clinical Endocrinologists was held in Downtown Austin between May 3rd and 7th. This is a world-renowned meeting which highlights the latest technological and medical advances in endocrinology. The program included expert speakers covering the latest developments and workshops presenting cutting-edge research to practitioners from around the world.

The most recent developments in diabetes treatment received extensive coverage at the conference. Dr. Thomas Blevins from Texas Diabetes & Endocrinology presented our clinic’s early experience with the new closed-loop insulin pump system in patients with type 1 diabetes.

In other sessions, attendees learned about recent developments in diabetes care. A special workshop reviewed data from recent studies evaluating the impact of diabetes medications on heart health.

One of the messages was that good sugar level control can have a significant impact on heart health. A study published in Diabetologia, showed that about 2.5% of patients with type 2 diabetes had known heart failure. Further detailed evaluation showed that up to 27.7% of patients had early signs or findings of heart failure. Importantly, by using medications that are known to reduce the risk of heart disease in patients with diabetes we can prevent the development and progression of these early stages of heart problems.

The special session also touched on different diabetes medications and their effects on heart function. The EMPA-REG outcome study which showed a significant reduction in heart disease and stroke-related deaths with the use of empagliflozin was reviewed. Another agent, liraglutide also reduced cardiovascular deaths, and the study that demonstrated this finding was the LEADER study.

The meeting was a major success overall, and it was a great opportunity for Texas Diabetes & Endocrinology providers to show off their city to colleagues from around the world!

Texas Diabetes & Endocrinology is awarded AlUM Ultrasound Practice Accreditation

The Ultrasound Practice Accreditation Council of the American Institute of Ultrasound in Medicine is pleased to announce that Texas Diabetes & Endocrinology has been awarded practice accreditation in the area of thyroid ultrasound.

Texas Diabetes & Endocrinology achieved this recognition by meeting rigorous voluntary guidelines set by the diagnostic ultrasound profession. All facets of the practice were assessed, including the training and qualifications of physicians and sonographers; ultrasound equipment maintenance; documentation; storage, and record-keeping practices; policies and procedures to protect patients and staff; quality assurance methods; and the thoroughness, technical quality and interpretation of the sonograms the practice performs.

About the AIUM

The American Institute of Ultrasound in Medicine is a multidisciplinary medical association of more than 9900 physicians, sonographers, and scientists dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation. Participation in the AlUM’s Ultrasound Practice Accreditation program is available to practices in the following areas of ultrasound: abdominal/general, breast, complete obstetric or trimester-specific obstetric, OB with adjunct detailed fetal anatomic ultrasound, musculoskeletal (diagnostic), musculoskeletal (ultrasound-guided interventional procedures), fetal echocardiography, gynecologic (with or without 3D), dedicated thyroid/parathyroid, urologic, ultrasound-guided regional anesthesia and head and neck. For more information, visit www.aium.org.

Dr. Luis Casaubon Achieves American Board of Internal Medicine Recertification

Congratulations to Dr. Casaubon at our Central Austin office for completing all the required stages, and achieving recertification in Diabetes, Endocrinology and Metabolism. All our endocrinologists are board certified by the American Board of Internal Medicine. In order to maintain board certification, a specialist needs to take a comprehensive exam every ten years, and fulfill rigorous continuing education requirements. Dr. Casaubon successfully passed his recertification exam, and demonstrated completion of continuous education requirements. All our specialists maintain their specialty board certification as a way to demonstrate their commitment to staying up to date on the newest developments in their field for excellent patient care.

New Postmenopausal Osteoporosis Guidelines

The American Association of Clinical Endocrinologists (AACE) has updated its postmenopausal osteoporosis guidelines. The new guidelines cover risk factors and fall prevention measures in more detail than prior guidelines. Pharmacological treatment is recommended for patients with osteoporosis, patients with osteopenia who have had a fragility fracture of the hip or spine, and for patients with osteopenia who have a 10-year FRAX major fracture risk at or above 20%, or a 10-year FRAX hip fracture risk of 3% or above.          https://www.aace.com/files/final-appendix-sept-7.pdf

Kerem Ozer, MD inducted as a Fellow of the American College of Endocrinology

The American College of Endocrinology (ACE), the educational and research arm of the American Association of Clinical Endocrinologists (AACE), inducted Dr. Kerem Ozer, Texas Diabetes & Endocrinology physician partner, as a Fellow of the American College of Endocrinology during its recent convocation ceremony at the 2016 AACE Annual Meeting and Clinical Congress in Orlando, Florida.

Designation as a Fellow of the American College of Endocrinology (FACE) means an endocrinologist has achieved a level of training and experience consistent with the highest standards established and adopted by the clinical specialty of endocrinology.

To be accepted into the College as a Fellow, Dr. Ozer had to fulfill several rigorous academic and clinical requirements. He also had to meet service and membership expectations from the college. Alan Garber, MD, PhD, FACE, ACE president, emphasized that the FACE title also underlines international recognition of a physician’s exceptional clinical and research achievements.

About 140 endocrinologists from around the world were inducted during the ceremony. The mission of ACE is to provide and promote education, research and communication in the art and science of clinical endocrinology and to provide appropriate recognition of advances and achievements relating to clinical endocrinology.

AACE is currently the world’s largest organization representing clinical endocrinologists. With more than 6,500 members in the United States and 91 other countries, the organization has developed a robust network of professional associates.

For more information, visit www.aace.com.

Lindsay Harrison, MD authors study published in the Journal of Clinical Endocrinology & Metabolism

Texas Diabetes & Endocrinology physician Lindsay Harrison, MD authored a study that was recently published in the JCEM titled Mechanisms of Action of Liraglutide in Patients with Type 2 Diabetes Treated with High Dose Insulin.

The study concluded that Treatment with liraglutide significantly improved insulin secretion even in patients with long-standing T2D requiring high-dose insulin treatment. Liraglutide also decreased liver and subcutaneous fat, but did not alter glucagon secretion. – See more at: http://press.endocrine.org/doi/abs/10.1210/jc.2015-3906#sthash.rGdwKIl1.dpuf

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is an important cause of menstrual irregularity and androgen excess (elevations in testosterone) in women. It is one of the most common endocrine disorders affecting up to 8% of women overall.  Symptoms often include irregular menstrual cycles, facial hair, thinning hair on the scalp, acne and infertility.   Affected women also tend to carry risk factors for cardiovascular disease including obesity, diabetes or pre-diabetes and high cholesterol.  Approximately 40-85% of women with PCOS are overweight or obese and carry a higher risk of developing type 2 diabetes mellitus. PCOS is also associated with depression and anxiety, fatty liver and obstructive sleep apnea.Most women with PCOS grow many small cysts on their ovaries–these cysts are not necessarily harmful but are associated with hormonal imbalances that cause the manifestations noted above.

Making a diagnosis of PCOS involves taking a thorough medical history as well as performing a comprehensive physical exam.  If indicated, your doctor may also perform ovarian ultrasound (although this latter test may not be necessary to make the diagnosis), and blood testing to diagnose PCOS.  Once diagnosed, treatment for this disorder should be initiated promptly.   The first recommendation is usually weight loss through healthful dietary changes and daily exercise.  If you are overweight, even a small amount of weight loss will help the manifestations of PCOS.  There are also some medications that can be used to improve metabolic profiles as well as increase fertility by regulating menstrual cycles.  Birth control pills and Metformin are examples of common medications used to treat PCOS.  Hormonal therapies are also used to treat infertility associated with PCOS.

Having PCOS can significantly negatively impact quality of life and as such, should be promptly diagnosed and treated.  Early treatment can help control the symptoms of PCOS and may help prevent long term health problems.

Testosterone Deficiency and Aveed

Testosterone levels are checked in men at an increased frequency and more men are being prescribed testosterone replacement therapy than ever before.  Typical symptoms of low testosterone include fatigue, erectile dysfunction, low libido, and loss of muscle mass.

As Endocrinologists, we try to find the underlying reason for the testosterone deficiency (or Hypogonadism) prior to initiating therapy.   Often times the reason is either due to pituitary dysfunction (a gland in the brain), benign pituitary tumors or testicular dysfunction.  Some risk factors for low testosterone are chronic opioid use (a type of narcotic pain medication), head trauma, testicular trauma, or HIV.

The testosterone levels should be checked on a fasting, morning blood draw and the levels should be confirmed with a second blood draw.

The aim of testosterone therapy is to help improve quality of life by enhancing bone and muscle function and possibly other areas like mood or sexual function.  Use of testosterone replacement, like any other drug, is not without risks.   The adverse effects of testosterone replacement medication include effects on liver function tests, blood count, sleep apnea, and fertility.  It can also make undiagnosed prostate cancer grow.

Blood work should be checked on a regular basis to monitor these parameters.  There are no long-term clinical safety trials assessing cardiovascular risks however some data suggest that the risk may be increased in certain patient populations.

Testosterone medication comes in various formulations: a daily topical gel or patch, a three-month subcutaneous insertion of a pellet, or injections given every 1-2 weeks.  The traditional testosterone injections that can be given at home are injected every 1 to 2 weeks.

One of the newer injectable formulations is Aveed. It is a depot testosterone that is injected intramuscularly by a medical professional in a clinic at initiation, 4 weeks, and then every 10 weeks thereafter.  One of the serious, but rare, drug reactions associated with Aveed is pulmonary oil microemboli (a small oil droplet that can travel to the lungs) and anaphylaxis (severe allergic reactions). After each Aveed injection, the patient must be monitored in the clinic for 30 minutes for any respiratory reactions.