Diabetes develops when the body does not produce enough insulin, cannot use insulin effectively, or both. This can cause blood glucose levels to become too high.
Over time, persistently high blood glucose can affect the heart, blood vessels, kidneys, eyes, nerves and feet. With appropriate treatment, regular monitoring and healthy lifestyle choices, diabetes can often be effectively managed and the risk of long-term complications reduced.
Types of Diabetes
There are several different types of diabetes, and understanding the type is important in determining the most appropriate treatment.
Type 1 Diabetes
- Type 1 diabetes is an autoimmune condition in which the immune system attacks the insulin-producing cells of the pancreas. As a result, the body produces little or no insulin.
- People with Type 1 diabetes require lifelong insulin treatment to manage their blood glucose levels.
Type 2 Diabetes
- Type 2 diabetes is the most common form of diabetes. It develops when the body becomes resistant to insulin and, over time, may also become unable to produce enough insulin to maintain healthy blood glucose levels.
- Type 2 diabetes is influenced by a combination of genetics, age, weight, lifestyle and other health factors. Management may include lifestyle changes, medications and, for some people, insulin.
Gestational Diabetes
- Gestational diabetes develops during pregnancy when hormonal changes make it more difficult for the body to use insulin effectively.
- It usually resolves after the baby is born, but women who have had gestational diabetes have an increased risk of developing Type 2 diabetes later in life. Follow-up diabetes screening after pregnancy is therefore important.
Other Types of Diabetes
- Less common forms of diabetes can occur due to genetic conditions, pancreatic disease, certain medications or other underlying medical or hormonal conditions.
Symptoms of Diabetes
Type 2 diabetes can develop gradually and may cause few or no symptoms, particularly in its early stages. Some people are diagnosed through routine blood tests before they notice any changes.
Possible symptoms of diabetes include:
- Increased thirst
- Frequent urination
- Persistent tiredness
- Unexplained weight loss
- Increased hunger
- Blurred vision
- Recurrent infections
- Cuts or wounds that are slow to heal
- Tingling or numbness in the hands or feet
These symptoms can have many causes and do not necessarily mean that diabetes is present. Blood testing is required to diagnose diabetes.
Diabetes Assessment
Diabetes assessment may involve reviewing blood glucose results, symptoms, medical history, medications, lifestyle and other health conditions.
Depending on individual circumstances, assessment may include:
- Fasting or random blood glucose testing
- HbA1c, which provides an indication of average blood glucose levels over the previous few months
- Oral glucose tolerance testing when appropriate
- Blood pressure assessment
- Cholesterol and triglyceride testing
- Kidney function and urine testing
- Assessment of cardiovascular risk
- Eye and foot health screening
- Review for other diabetes-related complications
In some circumstances, additional testing may be required to determine which type of diabetes is present.
Diabetes Treatment and Management
Diabetes treatment is individualised according to the type of diabetes, blood glucose levels, other health conditions and individual circumstances.
Management may include:
- Healthy eating and nutrition
- Regular physical activity
- Weight management where appropriate
- Oral or injectable diabetes medications
- Insulin therapy
- Self-monitoring of blood glucose
- Continuous glucose monitoring (CGM)
- Management of blood pressure and cholesterol
- Regular kidney, eye and foot health checks
- Ongoing monitoring of HbA1c and other health indicators
Treatment may need to change over time. Regular monitoring helps determine whether blood glucose is within an appropriate target range and whether medications or other aspects of the management plan need adjustment.
Diabetes Technology
Diabetes technology has become an increasingly important part of diabetes management, particularly for people who use insulin.
Continuous glucose monitoring (CGM) devices can measure glucose levels throughout the day and night, providing information about glucose patterns and trends.
Some people with Type 1 diabetes may also use an insulin pump, which delivers insulin throughout the day and can help provide more flexible and precise insulin management.
The suitability of CGM, insulin pumps and other diabetes technology depends on the type of diabetes and individual treatment needs.
Preventing Diabetes-Related Complications
Good diabetes management involves more than controlling blood glucose. Regular monitoring is important because diabetes can gradually affect different parts of the body.
Long-term complications may include:
- Heart disease and stroke
- Kidney disease
- Diabetic eye disease (retinopathy)
- Nerve damage (neuropathy)
- Foot problems and poor wound healing
Maintaining appropriate blood glucose, blood pressure and cholesterol levels, together with regular health checks, can help reduce the risk of diabetes-related complications.
When Should You Seek Further Assessment?
Further assessment may be appropriate if diabetes has recently been diagnosed, blood glucose or HbA1c remains above target despite treatment, or there are frequent episodes of high or low blood glucose.
Assessment may also be helpful when insulin treatment requires adjustment, diabetes is becoming more difficult to manage, diabetes-related complications are developing, or there is uncertainty about the type of diabetes.
Women with diabetes who are planning a pregnancy or become pregnant may require additional monitoring and changes to their diabetes management. Gestational diabetes diagnosed during pregnancy also requires appropriate monitoring and treatment.
Symptoms such as severe dehydration, vomiting, confusion, difficulty breathing or very high or very low blood glucose levels may require urgent medical attention.
Key Takeaways
- Diabetes causes blood glucose levels to become too high because of problems with insulin production or the way the body responds to insulin.
- The main types are Type 1 diabetes, Type 2 diabetes and gestational diabetes.
- Type 1 diabetes requires lifelong insulin treatment, while Type 2 diabetes may be managed with lifestyle measures, medication and sometimes insulin.
- HbA1c and blood glucose testing are important for diagnosing and monitoring diabetes.
- Diabetes management may include nutrition, physical activity, medication, insulin and glucose-monitoring technology.
- Continuous glucose monitoring (CGM) and insulin pumps can be useful for some people with diabetes.
- Good diabetes management can help reduce the risk of complications affecting the heart, kidneys, eyes, nerves and feet.
- Regular monitoring and an individualised treatment plan are important for maintaining long-term diabetes and metabolic health.
Thyroid disorders can occur when the thyroid produces too much or too little thyroid hormone, becomes enlarged, develops nodules, or is affected by autoimmune or inflammatory conditions.
Thyroid problems are common and can affect people at different stages of life. Because symptoms can sometimes be subtle or overlap with other health conditions, thyroid function tests and appropriate assessment are important for identifying the underlying cause.
Common Thyroid Disorders
There are several different types of thyroid conditions, ranging from changes in thyroid hormone production to structural problems such as thyroid nodules.
Hypothyroidism (Underactive Thyroid)
- Hypothyroidism occurs when the thyroid does not produce enough thyroid hormone. It can cause the body’s processes to slow down.
- Possible symptoms include tiredness, weight gain, feeling unusually cold, constipation, dry skin, difficulty concentrating, muscle aches and changes in mood or menstrual cycles.
Hashimoto’s Thyroiditis
- Hashimoto’s thyroiditis is an autoimmune condition in which the immune system attacks the thyroid gland. It is a common cause of hypothyroidism and may gradually reduce the thyroid’s ability to produce hormones.
Hyperthyroidism (Overactive Thyroid)
- Hyperthyroidism occurs when the thyroid produces excessive amounts of thyroid hormone, causing many of the body’s processes to speed up.
- Symptoms may include a fast or irregular heartbeat, unexplained weight loss, increased sweating, heat intolerance, tremor, anxiety, muscle weakness, difficulty sleeping and more frequent bowel movements.
Graves’ Disease
- Graves’ disease is an autoimmune condition and a common cause of hyperthyroidism. In some people, it can also affect the eyes, causing irritation, dryness, swelling or changes in their appearance.
Thyroid Nodules
- Thyroid nodules are lumps that develop within the thyroid gland. They are common, particularly with increasing age, and most thyroid nodules are benign (non-cancerous).
- Some nodules require further investigation based on their size, appearance, growth or other characteristics.
Goitre (Enlarged Thyroid)
- A goitre is an enlargement of the thyroid gland. It can occur when thyroid hormone levels are normal, too high or too low.
- Depending on its size, an enlarged thyroid may sometimes cause pressure in the neck, difficulty swallowing or other symptoms.
Thyroiditis
- Thyroiditis refers to inflammation of the thyroid gland. Depending on the cause, it may result in temporary hyperthyroidism, hypothyroidism or a period of each.
Symptoms of Thyroid Problems
Thyroid disorders can cause a wide variety of symptoms depending on whether thyroid hormone levels are too high or too low.
Possible symptoms include:
- Persistent tiredness or changes in energy
- Unexplained weight gain or weight loss
- Feeling unusually hot or cold
- Fast, slow or irregular heartbeat
- Tremor or increased sweating
- Anxiety, irritability or changes in mood
- Difficulty concentrating
- Changes in sleep
- Constipation or more frequent bowel movements
- Dry skin or changes in hair
- Muscle weakness or aches
- Changes in menstrual periods
- Swelling or a lump in the neck
- Difficulty swallowing or pressure in the neck
These symptoms are not specific to thyroid disease and can occur with many other conditions. Blood tests can help determine whether thyroid function is contributing to the symptoms.
Thyroid Assessment
Assessment of a possible thyroid disorder usually begins with a review of symptoms, medical history, medications and previous thyroid test results.
Depending on the suspected condition, investigations may include:
- Thyroid stimulating hormone (TSH)
- Free T4 and, where appropriate, T3
- Thyroid antibody testing
- Thyroid ultrasound
- Further assessment of thyroid nodules
- Fine needle aspiration (FNA) biopsy when clinically indicated
- Additional imaging or thyroid testing where appropriate
Thyroid blood test results need to be interpreted together with symptoms, medications, pregnancy status and other health factors.
Thyroid Nodules & Goitre
Thyroid nodules are frequently discovered during a physical examination or incidentally during imaging of the neck.
A thyroid ultrasound can provide information about the size and appearance of a nodule and help determine whether further investigation is required.
Depending on the ultrasound findings, management may involve monitoring the nodule over time or performing a fine needle aspiration biopsy to examine cells from the nodule.
Most thyroid nodules do not cause symptoms and are non-cancerous. However, appropriate assessment is important to identify the smaller number of nodules that may require additional investigation or treatment.
Thyroid Treatment and Management
Treatment depends on the specific thyroid condition, symptoms, hormone levels and individual health circumstances.
Management may include:
- Thyroid hormone replacement for hypothyroidism
- Medication to reduce excessive thyroid hormone production
- Regular thyroid function blood tests
- Monitoring thyroid nodules with ultrasound when appropriate
- Management of autoimmune thyroid conditions
- Treatment for thyroid inflammation where required
- Radioactive iodine treatment in selected circumstances
- Referral for thyroid surgery when appropriate
- Adjustment of thyroid medication during pregnancy
Some thyroid conditions require short-term treatment, while others may require long-term medication and regular monitoring.
Thyroid Disorders & Pregnancy
Healthy thyroid hormone levels are particularly important before and during pregnancy, as thyroid hormones contribute to the baby’s growth and development.
Women with existing hypothyroidism, hyperthyroidism, Hashimoto’s thyroiditis or Graves’ disease may require closer monitoring during pregnancy. Thyroid medication requirements can also change as pregnancy progresses.
Thyroid function may also change after giving birth. Postpartum thyroiditis can develop during the first year after pregnancy and may temporarily cause an overactive or underactive thyroid.
When Should You Seek Further Assessment?
Further assessment may be appropriate if thyroid blood tests are persistently abnormal, symptoms suggest an overactive or underactive thyroid, or thyroid medication is not adequately controlling the condition.
Assessment may also be recommended if a thyroid nodule, neck lump or enlarged thyroid is discovered, particularly if it is increasing in size or associated with other symptoms.
People with known thyroid disease who are planning pregnancy or become pregnant may also require additional thyroid monitoring.
A rapidly enlarging neck lump, persistent difficulty swallowing or breathing, or significant unexplained changes in the voice should be assessed promptly.
Key Takeaways
- The thyroid gland produces hormones that regulate metabolism, energy, heart rate, temperature and many other body functions.
- Hypothyroidism occurs when the thyroid produces too little thyroid hormone, while hyperthyroidism occurs when it produces too much.
- Hashimoto’s thyroiditis and Graves’ disease are common autoimmune thyroid disorders.
- Thyroid nodules are common and most are non-cancerous, although some require ultrasound, biopsy or ongoing monitoring.
- TSH and thyroid hormone blood tests are commonly used to assess thyroid function.
- Thyroid ultrasound can help assess thyroid nodules and an enlarged thyroid (goitre).
- Treatment may include thyroid hormone replacement, anti-thyroid medication, monitoring, radioactive iodine or surgery, depending on the condition.
- Thyroid function is particularly important before, during and after pregnancy, when hormone levels and medication requirements may change.
- Most thyroid disorders can be effectively managed with appropriate diagnosis, treatment and ongoing monitoring.
Healthy bones are constantly being broken down and rebuilt. As we age, particularly after menopause, bone loss can occur faster than new bone is formed. Certain medical conditions, medications, hormonal changes and lifestyle factors can also contribute to reduced bone strength.
Early assessment and appropriate management can help protect bone health, reduce further bone loss and lower the risk of osteoporosis-related fractures.
What Is Osteoporosis?
Osteoporosis means that the bones have become less dense and more fragile than normal. This can make them more likely to fracture from a minor fall, injury or, in some cases, everyday activities.
Common osteoporosis-related fractures occur in the:
- Hip
- Spine
- Wrist
- Upper arm
Osteoporosis is sometimes called a “silent disease” because bone loss usually occurs without pain or other noticeable symptoms.
Osteopenia (Low Bone Density)
- Osteopenia means bone density is lower than normal but has not reached the level classified as osteoporosis. Not everyone with osteopenia will develop osteoporosis, but assessment of overall fracture risk can help determine whether monitoring, lifestyle changes or treatment may be appropriate.
Who Is at Risk of Osteoporosis?
Osteoporosis can affect both women and men. The risk generally increases with age, although younger people may also develop low bone density due to certain medical conditions or medications.
Factors that may increase the risk of osteoporosis include:
- Increasing age
- Menopause, particularly early menopause
- Family history of osteoporosis or hip fracture
- Previous fracture after a minor fall or injury
- Long-term use of corticosteroid medications
- Low body weight
- Low calcium or vitamin D levels
- Smoking
- Excessive alcohol consumption
- Limited weight-bearing physical activity
- Certain hormonal, gastrointestinal, inflammatory or kidney conditions
- Conditions or treatments that affect normal hormone levels
Understanding these risk factors can help identify people who may benefit from further bone health assessment.
Symptoms of Osteoporosis
Osteoporosis often causes no symptoms in its early stages. Many people are unaware that their bones have become weaker until they experience a fracture.
Possible signs of more advanced osteoporosis may include:
- A fracture following a minor fall or injury
- Back pain caused by a spinal fracture
- Loss of height over time
- Changes in posture or a more stooped appearance
- Repeated fractures
A fracture occurring after relatively minor trauma can be an important sign of reduced bone strength and may require further investigation.
Osteoporosis and Bone Health Assessment
Assessment of bone health may involve reviewing your medical history, fracture history, medications, lifestyle and risk factors.
Depending on individual circumstances, investigations may include:
- Bone mineral density (BMD) testing, commonly performed using a DEXA or DXA scan
- Assessment of overall fracture risk
- Blood tests to investigate calcium, vitamin D and other factors affecting bone health
- Investigation for underlying hormonal or metabolic causes of bone loss
- Review of medications that may affect bone density
- Assessment following a low-trauma or fragility fracture
A bone density scan can help determine whether bone density is within the expected range or whether osteopenia or osteoporosis is present.
Osteoporosis Treatment and Bone Health Management
Treatment is tailored to a person’s bone density, fracture risk, age, medical history and other health conditions.
Management may include:
- Ensuring adequate calcium and vitamin D
- Regular weight-bearing and resistance exercise
- Maintaining healthy nutrition and body weight
- Reducing smoking and excessive alcohol consumption
- Strategies to reduce the risk of falls
- Osteoporosis medications where appropriate
- Treatment of underlying medical or hormonal conditions contributing to bone loss
- Regular monitoring of bone density and treatment response
The aim of osteoporosis treatment is not only to improve or maintain bone density but, importantly, to reduce the risk of future fractures.
When Should You Seek Specialist Bone Health Care?
Further assessment may be recommended if a bone density scan shows osteoporosis or significantly reduced bone density, or if you have experienced a fracture following a minor fall or injury.
Assessment may also be appropriate if you have multiple risk factors for osteoporosis, develop osteoporosis at a younger age, experience repeated fractures, require long-term corticosteroid treatment, or have a medical or hormonal condition that may affect bone health.
Women experiencing early menopause and men or women with unexplained low bone density may also benefit from investigation for underlying causes.
Key Takeaways
- Osteoporosis causes bones to become weaker and more likely to fracture, often without noticeable symptoms.
- Osteopenia means bone density is lower than normal but has not reached the level of osteoporosis.
- Osteoporosis can affect both women and men, although the risk increases with age and after menopause.
- A bone density (DEXA/DXA) scan is commonly used to assess bone mineral density and help evaluate fracture risk.
- A fracture after a minor fall or injury may be an important sign of underlying osteoporosis.
- Calcium, vitamin D, appropriate exercise and healthy lifestyle habits are important components of maintaining good bone health.
- Osteoporosis medications may be recommended for people at increased risk of fracture.
- Early assessment and appropriate treatment can help reduce bone loss and prevent future fractures.
Excess weight can affect more than appearance. Over time, it may increase the risk of conditions such as Type 2 diabetes, high blood pressure, high cholesterol, fatty liver disease, sleep apnoea and cardiovascular disease.
Assessment of weight and metabolic health aims to understand the factors contributing to weight changes, identify associated health risks and develop an appropriate, sustainable management approach.
What Is Metabolic Health?
Metabolic health refers to how effectively the body processes and uses energy, including the regulation of blood glucose, insulin, cholesterol and other fats in the blood.
Poor metabolic health can occur at different body weights and may be associated with conditions such as:
- Overweight and obesity
- Insulin resistance
- Prediabetes
- Type 2 diabetes
- High cholesterol and triglycerides
- High blood pressure
- Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as fatty liver disease
- Polycystic ovary syndrome (PCOS)
- Metabolic syndrome
Identifying these conditions early can provide an opportunity to reduce future health risks.
Why Can Weight Be Difficult to Manage?
Body weight is regulated by complex interactions between the brain, hormones, metabolism and environment. It is not simply determined by how much someone eats or exercises.
Factors that may contribute to weight gain or difficulty losing weight include:
- Genetics and family history
- Age and changes in metabolism
- Insulin resistance
- Certain hormonal or endocrine conditions
- Menopause and other hormonal changes
- Some medications
- Poor sleep or sleep disorders
- Dietary patterns
- Reduced physical activity
- Previous cycles of weight loss and regain
- Other underlying medical conditions
Part of a comprehensive weight assessment is determining whether there are medical, hormonal or metabolic factors that may be contributing to weight changes.
Weight & Metabolic Health Assessment
Assessment is individualised and may include a review of weight history, lifestyle, medications, family history and existing medical conditions.
Depending on individual circumstances, further assessment may include:
- Body weight, BMI and waist circumference
- Blood glucose and HbA1c
- Cholesterol and triglyceride levels
- Blood pressure
- Liver function and assessment for fatty liver disease
- Thyroid function testing when appropriate
- Assessment for insulin resistance or diabetes
- Review of medications that may contribute to weight gain
- Investigation for hormonal or endocrine conditions when clinically indicated
- Assessment of other weight-related health risks
The purpose of assessment is not only to consider weight itself, but also to understand a person’s overall metabolic health and future health risks.
Weight Management and Treatment
Weight management is most effective when it is individualised and focuses on improving overall health rather than weight alone.
Depending on individual needs, management may include:
- Nutrition and dietary strategies
- Regular physical activity and resistance exercise
- Improving sleep and other lifestyle factors
- Management of diabetes, high cholesterol or high blood pressure
- Treatment of underlying hormonal or metabolic conditions
- Review of medications that may affect weight
- Weight management medications when clinically appropriate
- Ongoing monitoring of weight and metabolic health
- Referral to other healthcare professionals where appropriate
For some people, lifestyle changes alone may not achieve sufficient or sustainable weight loss. Medical treatment may be considered as part of a broader weight management plan after assessing potential benefits, risks and individual health circumstances.
When Should You Seek Specialist Weight & Metabolic Health Care?
Further assessment may be helpful if you are experiencing unexplained or progressive weight gain, have difficulty achieving or maintaining weight loss despite lifestyle changes, or have concerns that a hormonal or metabolic condition may be contributing to your weight.
Assessment may also be appropriate if excess weight is associated with conditions such as prediabetes, Type 2 diabetes, high cholesterol, high blood pressure, fatty liver disease or PCOS.
People who are considering medical treatment for weight management may also benefit from an assessment of their overall metabolic health and whether treatment is appropriate for their individual circumstances.
Key Takeaways
- Weight is influenced by a complex combination of hormones, genetics, metabolism, lifestyle, medications and medical conditions.
- Metabolic health involves more than body weight and includes factors such as blood glucose, cholesterol, blood pressure and liver health.
- Excess weight can increase the risk of Type 2 diabetes, cardiovascular disease, fatty liver disease and other metabolic conditions.
- Assessment can help identify hormonal, medical or metabolic factors that may contribute to weight gain or difficulty losing weight.
- Effective weight management may involve nutrition, physical activity, sleep, treatment of underlying conditions and medication where appropriate.
- Weight management medications may be considered for suitable patients as part of a comprehensive, medically supervised treatment plan.
- The goal of weight management is not simply weight loss, but to improve metabolic health, reduce future health risks and support sustainable long-term health.
Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions affecting women of reproductive age. Other reproductive hormone disorders can affect both women and men and may occur at different stages of life.
Identifying the underlying cause of a hormonal imbalance can help guide appropriate treatment and reduce potential long-term health risks.
What Is PCOS?
Polycystic ovary syndrome (PCOS) is a hormonal and metabolic condition that can affect ovulation, menstrual cycles and androgen (male-type hormone) levels.
Despite its name, having ovarian cysts is not required to have PCOS. Diagnosis is based on a combination of symptoms, hormone assessment and, in some cases, ultrasound findings after other possible causes have been considered.
Common features of PCOS may include:
- Irregular, infrequent or absent periods
- Difficulty with ovulation
- Excess facial or body hair
- Acne or oily skin
- Thinning hair or hair loss from the scalp
- Weight gain or difficulty managing weight
- Insulin resistance
- Difficulty becoming pregnant
Symptoms vary considerably between individuals, and not everyone with PCOS will experience all of these features.
PCOS and Metabolic Health
PCOS is not only a reproductive condition. It can also affect metabolic health, particularly the way the body responds to insulin.
People with PCOS may have an increased risk of:
- Insulin resistance
- Prediabetes
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Weight-related health concerns
Regular assessment of blood glucose, cholesterol, blood pressure and other metabolic risk factors can therefore be an important part of long-term PCOS management.
Other Reproductive Hormone Disorders
Hormonal conditions can affect reproductive function in both women and men.
These may include:
- Irregular or absent menstrual periods
- Early or premature menopause
- Hormonal causes of fertility difficulties
- Excess androgen levels
- Low testosterone
- Male hypogonadism
- Menstrual disturbances related to hormonal conditions
- Hormonal changes affecting sexual function
- Reproductive hormone abnormalities caused by pituitary or other endocrine disorders
Because similar symptoms can have many different causes, appropriate assessment is important before determining whether a hormonal disorder is present.
PCOS & Reproductive Hormone Assessment
Assessment usually involves reviewing symptoms, menstrual and reproductive history, medications, family history and other relevant medical conditions.
Depending on the symptoms and individual circumstances, investigations may include:
- Reproductive hormone blood tests
- Testosterone and other androgen levels
- Thyroid function tests
- Prolactin levels
- Blood glucose and HbA1c
- Cholesterol and triglyceride levels
- Assessment for insulin resistance and other metabolic risk factors
- Pelvic ultrasound when clinically appropriate
- Investigation for other endocrine conditions that can cause similar symptoms
The specific investigations required will depend on the symptoms and suspected underlying condition.
PCOS Treatment and Management
There is no single treatment that is appropriate for everyone with PCOS. Management is based on individual symptoms, health risks and whether pregnancy is currently being considered.
Treatment may include:
- Lifestyle and weight management where appropriate
- Management of irregular menstrual cycles
- Treatment for acne or excessive hair growth
- Management of insulin resistance, prediabetes or diabetes
- Medications to help manage hormonal or metabolic symptoms
- Support with fertility and ovulation concerns
- Management of cholesterol, blood pressure and other cardiovascular risk factors
- Ongoing monitoring of metabolic and reproductive health
Treatment of other reproductive hormone disorders depends on the underlying cause and may involve hormone replacement or other targeted therapies where appropriate.
When Should You Seek Further Assessment?
Further assessment may be appropriate if you experience irregular or absent periods, unexplained excessive facial or body hair, persistent acne, unexplained changes in weight, difficulty becoming pregnant or other symptoms suggesting a hormonal imbalance.
Assessment may also be helpful if PCOS has already been diagnosed but symptoms remain difficult to manage, or if there are concerns about associated conditions such as insulin resistance, prediabetes, Type 2 diabetes or high cholesterol.
For men, symptoms such as reduced libido, reduced muscle mass, fertility difficulties or other features suggesting low testosterone may warrant further hormonal assessment.
Key Takeaways
- PCOS is a common hormonal and metabolic condition that can affect menstrual cycles, ovulation, fertility and androgen levels.
- You do not need to have ovarian cysts to have PCOS, despite the name of the condition.
- Common PCOS symptoms include irregular periods, acne, excess facial or body hair, weight changes and difficulty becoming pregnant.
- PCOS can also affect metabolic health and may increase the risk of insulin resistance, prediabetes and Type 2 diabetes.
- Reproductive hormone disorders can affect both women and men and may have several different underlying causes.
- Blood tests and other investigations can help identify the cause of hormonal and reproductive symptoms.
- Treatment is individualised and may address menstrual symptoms, metabolic health, fertility, weight management and other hormonal concerns.
- Appropriate treatment and ongoing monitoring can help manage symptoms and support long-term reproductive and metabolic health.
Disorders affecting these glands can cause the body to produce too much or too little of certain hormones. Because the symptoms can be varied and sometimes overlap with other medical conditions, appropriate hormonal testing and assessment are important for identifying the underlying cause.
Many adrenal and pituitary disorders can be effectively managed once an accurate diagnosis has been established.
What Are the Adrenal Glands?
The adrenal glands are small glands located above each kidney. They produce several important hormones, including cortisol, aldosterone and adrenaline, as well as small amounts of sex hormones.
These hormones help regulate the body’s response to stress, blood pressure, salt and fluid balance, metabolism and other important functions.
Common adrenal disorders include:
Adrenal Insufficiency & Addison’s Disease
- Adrenal insufficiency occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone. Addison’s disease is a form of primary adrenal insufficiency.
- Symptoms may include persistent tiredness, muscle weakness, weight loss, low blood pressure, dizziness, nausea and changes in skin pigmentation.
Cushing’s Syndrome
- Cushing’s syndrome occurs when the body is exposed to excessive levels of cortisol over a prolonged period.
- Possible features include weight gain, particularly around the abdomen and face, easy bruising, muscle weakness, high blood pressure, changes in blood glucose, thinning of the skin and changes in mood.
Primary Aldosteronism
- Primary aldosteronism occurs when the adrenal glands produce too much aldosterone. It can cause high blood pressure and sometimes low potassium levels.
- It is an important potential cause of difficult-to-control or resistant hypertension.
Adrenal Nodules
- Adrenal nodules or masses are sometimes discovered unexpectedly during CT or MRI scans performed for another reason. These are often referred to as adrenal incidentalomas.
- Most adrenal nodules are benign, but further assessment may be required to determine whether the nodule is producing excess hormones or has features that require additional investigation.
What Is the Pituitary Gland?
The pituitary is a small gland located at the base of the brain. Although it is only about the size of a pea, it plays a major role in controlling other hormone-producing glands throughout the body.
Pituitary hormones influence the thyroid gland, adrenal glands, reproductive system, growth, breast milk production and fluid balance.
Pituitary disorders may develop when the gland produces too much or too little of a particular hormone or when a pituitary tumour affects normal hormone production.
Common Pituitary Disorders
Pituitary conditions may include:
Pituitary Adenomas
- Pituitary adenomas are usually benign tumours of the pituitary gland. Some produce excess hormones, while others may affect normal pituitary function because of their size.
Prolactinoma & High Prolactin
- A prolactinoma is a pituitary adenoma that produces excessive prolactin. High prolactin levels can cause irregular or absent periods, breast milk production when not breastfeeding, fertility difficulties, reduced libido and low testosterone.
Acromegaly
- Acromegaly occurs when the body produces too much growth hormone in adulthood. It may cause gradual enlargement of the hands and feet, changes in facial features, headaches, joint problems and other metabolic complications.
Pituitary Hormone Deficiency
- The pituitary gland may sometimes produce insufficient amounts of one or more hormones. This can affect thyroid function, adrenal function, reproductive hormones, growth hormone and other body systems.
Symptoms of Adrenal & Pituitary Disorders
Symptoms vary depending on which hormone is affected and whether hormone levels are too high or too low.
Possible symptoms may include:
- Persistent or unexplained fatigue
- Unexplained weight gain or weight loss
- Muscle weakness
- High or low blood pressure
- Dizziness or fainting
- Changes in blood glucose
- Headaches
- Changes in vision
- Irregular or absent menstrual periods
- Fertility difficulties
- Reduced libido
- Low testosterone
- Unexplained breast milk production
- Changes in facial appearance, hands or feet
- Excessive thirst or urination
- Changes in skin or body hair
These symptoms are not specific to adrenal or pituitary disorders and can occur with many other medical conditions. Hormonal testing can help determine whether an endocrine condition is contributing to the symptoms.
Adrenal & Pituitary Assessment
Assessment may involve a combination of medical history, physical examination, specialised hormone testing and imaging.
Depending on the suspected condition, investigations may include:
- Cortisol and ACTH testing
- Aldosterone and renin testing
- Prolactin levels
- Growth hormone-related testing
- Pituitary and reproductive hormone testing
- Thyroid function tests
- Electrolytes, including sodium and potassium
- Specialised hormone stimulation or suppression tests
- CT or MRI imaging of the adrenal glands
- MRI of the pituitary gland when clinically appropriate
Some hormone tests need to be performed at specific times of the day or under particular conditions to provide accurate results.
Treatment and Management
Treatment depends on the specific adrenal or pituitary disorder and whether the condition is causing excess or insufficient hormone production.
Management may include:
- Hormone replacement when the body does not produce enough of a particular hormone
- Medications to reduce excessive hormone production
- Management of associated blood pressure or metabolic problems
- Regular blood tests and hormonal monitoring
- Monitoring adrenal or pituitary nodules with imaging
- Referral for surgery when appropriate
- Long-term monitoring following treatment
Some conditions require ongoing treatment and monitoring to maintain healthy hormone levels and prevent complications.
When Should You Seek Further Assessment?
Further assessment may be recommended when blood tests show unexplained hormonal abnormalities, an adrenal or pituitary nodule is identified on imaging, or symptoms suggest excessive or insufficient hormone production.
Assessment may also be appropriate for difficult-to-control high blood pressure, unexplained low potassium levels, persistent abnormalities in cortisol or prolactin, unexplained menstrual or reproductive changes, or symptoms associated with pituitary hormone deficiencies.
New or severe headaches accompanied by changes in vision, particularly in someone with a known pituitary condition, require prompt medical assessment.
Key Takeaways
- The adrenal and pituitary glands regulate hormones that affect many important functions throughout the body.
- Adrenal disorders include adrenal insufficiency, Addison’s disease, Cushing’s syndrome, primary aldosteronism and adrenal nodules.
- Pituitary disorders include pituitary adenomas, prolactinoma, acromegaly and pituitary hormone deficiencies.
- Adrenal nodules are often found incidentally and are usually benign, but some require hormonal testing or further investigation.
- Pituitary disorders can affect thyroid, adrenal, reproductive, growth and fluid-regulating hormones.
- Diagnosis may require specialised hormone blood tests and CT or MRI imaging.
- Treatment depends on whether the body is producing too much or too little of a particular hormone.
- With accurate diagnosis, appropriate treatment and ongoing monitoring, many adrenal and pituitary disorders can be effectively managed.
The parathyroid glands are small glands located in the neck, usually behind the thyroid gland. Their main role is to produce parathyroid hormone (PTH), which helps maintain the correct balance of calcium in the blood and bones.
Disorders of the parathyroid glands can cause calcium levels to become too high or too low. These abnormalities may affect the bones, kidneys, muscles, nerves and other parts of the body.
What Are the Parathyroid Glands?
Most people have four parathyroid glands located behind or near the thyroid gland. Despite their similar name and location, the parathyroid glands and thyroid gland have different functions.
The parathyroid glands monitor calcium levels in the blood and release PTH when calcium levels need to increase. PTH helps regulate calcium by influencing the bones, kidneys and vitamin D metabolism.
When too much or too little PTH is produced, this balance can be disrupted.
Hyperparathyroidism
Hyperparathyroidism occurs when the parathyroid glands produce too much PTH. This can lead to elevated calcium levels in the blood and may gradually affect bone and kidney health.
Primary hyperparathyroidism is commonly caused by one or more parathyroid glands becoming overactive.
Some people have no noticeable symptoms and the condition is discovered after a routine blood test shows high calcium levels.
Possible symptoms may include:
- Persistent tiredness or weakness
- Increased thirst
- Frequent urination
- Constipation
- Abdominal discomfort
- Difficulty concentrating
- Changes in mood
- Bone or joint discomfort
- Kidney stones
- Reduced bone density or osteoporosis
Not everyone with hyperparathyroidism experiences symptoms, which is why further assessment of unexplained high calcium levels can be important.
Hypoparathyroidism
Hypoparathyroidism occurs when the parathyroid glands do not produce enough PTH, resulting in low calcium levels.
It can sometimes occur following surgery involving the thyroid or neck, although there are other less common causes.
Symptoms of low calcium may include:
- Tingling or numbness around the mouth, fingers or toes
- Muscle cramps or spasms
- Muscle stiffness
- Fatigue
- Changes in sensation
- In more severe cases, abnormal heart rhythms or seizures
Treatment aims to maintain calcium levels within a safe range and prevent symptoms and long-term complications.
High Calcium Levels – Hypercalcaemia
Hypercalcaemia means there is too much calcium in the blood. Primary hyperparathyroidism is a common cause, but high calcium levels can occur for several other reasons.
Possible causes include:
- Primary hyperparathyroidism
- Certain medications
- Excessive calcium or vitamin D intake
- Some cancers
- Other hormonal or medical conditions
Mild hypercalcaemia may cause no symptoms, while higher calcium levels can cause thirst, frequent urination, constipation, nausea, weakness, confusion or kidney problems.
The underlying cause needs to be identified before appropriate treatment can be determined.
Low Calcium Levels – Hypocalcaemia
Hypocalcaemia refers to calcium levels that are lower than normal.
Possible causes include:
- Hypoparathyroidism
- Vitamin D deficiency
- Kidney disease
- Low magnesium levels
- Certain medications
- Problems with calcium or vitamin D absorption
Treatment depends on the cause and severity of the low calcium level.
Calcium & Parathyroid Assessment
Assessment usually involves reviewing blood test results, symptoms, medications, medical history and factors that may affect calcium metabolism.
Depending on the circumstances, investigations may include:
- Blood calcium levels
- Parathyroid hormone (PTH)
- Vitamin D levels
- Phosphate and magnesium levels
- Kidney function tests
- Urine calcium testing
- Bone mineral density (DEXA/DXA) scan
- Assessment for kidney stones
- Further imaging when clinically appropriate
It is important to interpret calcium and PTH results together, as the relationship between these levels can help identify the underlying cause of a calcium abnormality.
Treatment and Management
Treatment depends on whether calcium levels are too high or too low, the underlying cause and whether complications are present.
Management may include:
- Monitoring calcium and PTH levels
- Calcium or vitamin D supplementation when appropriate
- Reviewing medications and supplements that may affect calcium levels
- Treatment of vitamin D deficiency
- Management of osteoporosis or reduced bone density
- Medication for certain parathyroid or calcium disorders
- Monitoring kidney and bone health
- Referral for parathyroid surgery when appropriate
For primary hyperparathyroidism, surgery may be recommended in certain circumstances, particularly when calcium levels are significantly elevated or there are concerns about kidney stones, kidney function or bone health.
When Should You Seek Further Assessment?
Further assessment may be appropriate if routine blood tests repeatedly show high or low calcium levels, PTH levels are abnormal, or the cause of a calcium abnormality is unclear.
Assessment may also be recommended for people with recurrent kidney stones, osteoporosis or unexplained low bone density, particularly when abnormal calcium or PTH levels are present.
Symptoms such as severe weakness, confusion, significant muscle spasms, seizures or heart rhythm changes associated with markedly abnormal calcium levels require urgent medical assessment.
Key Takeaways
- Calcium is essential for healthy bones, muscles, nerves and normal heart function.
- The parathyroid glands produce PTH, one of the main hormones responsible for regulating calcium levels.
- Hyperparathyroidism can cause high calcium levels and may affect bone and kidney health.
- Hypoparathyroidism can result in low calcium levels and symptoms such as tingling and muscle cramps.
- High or low calcium can have several different causes, so identifying the underlying condition is important.
- Blood tests for calcium, PTH, vitamin D and kidney function are commonly used to investigate calcium and parathyroid disorders.
- Bone density testing and assessment for kidney stones may be recommended in some people with parathyroid disease.
- Most calcium and parathyroid disorders can be effectively managed once the underlying cause has been identified.
Hormonal disorders can occur when the body produces too much or too little of a particular hormone, when hormone-producing glands do not function normally, or when the body does not respond appropriately to certain hormones.
Because hormonal symptoms can be subtle and may overlap with many other health conditions, identifying an endocrine disorder often requires careful assessment and targeted testing.
What Are Hormonal & Endocrine Disorders?
Hormones act as chemical messengers, travelling through the bloodstream to communicate with different organs and tissues. Even relatively small changes in hormone levels can sometimes affect several body systems.
Endocrine disorders can involve the:
- Thyroid gland
- Pituitary gland
- Adrenal glands
- Parathyroid glands
- Pancreas and insulin regulation
- Ovaries and reproductive hormones
- Testes and testosterone
- Hormones involved in growth, metabolism and fluid balance
Some endocrine conditions are common, while others are uncommon and may require more specialised investigation.
Common Symptoms of Hormonal Imbalance
The symptoms of a hormonal or endocrine disorder vary depending on which hormone or gland is affected.
Possible symptoms may include:
- Persistent or unexplained fatigue
- Unexplained weight gain or weight loss
- Changes in appetite
- Excessive thirst or frequent urination
- Feeling unusually hot or cold
- Changes in heart rate or palpitations
- Muscle weakness
- Changes in blood pressure
- Irregular or absent menstrual periods
- Excessive facial or body hair
- Acne or changes in skin
- Reduced libido or sexual function
- Fertility difficulties
- Changes in mood or concentration
- Unexplained changes in growth or physical appearance
These symptoms do not necessarily indicate a hormonal disorder. Many can be caused by other medical conditions, lifestyle factors or medications, which is why appropriate assessment is important.
Other Endocrine Conditions
In addition to common conditions such as diabetes and thyroid disease, endocrine disorders may include a range of less common hormonal conditions.
These may include:
Testosterone & Male Hormone Disorders
- Low testosterone, also known as male hypogonadism, can occur when the testes or the hormone-regulating centres in the brain do not produce appropriate hormone levels. Symptoms may include reduced libido, reduced energy, loss of muscle mass or fertility difficulties.
Prolactin Disorders
- Abnormal prolactin levels can affect menstrual cycles, fertility, breast milk production and testosterone levels. Elevated prolactin may be related to medications, pituitary conditions or other causes.
Growth Hormone Disorders
- Too much or too little growth hormone can affect growth, body composition, bones and metabolism. In adults, excessive growth hormone can cause a condition known as acromegaly.
Disorders of Water & Sodium Balance
- Certain hormonal conditions can affect the body’s ability to regulate water and sodium. Symptoms may include excessive thirst, frequent urination or abnormal blood sodium levels.
Multiple Endocrine Disorders
- Some autoimmune or genetic conditions can affect more than one hormone-producing gland. Investigation may be appropriate when several endocrine abnormalities occur together or there is a significant family history of endocrine disease.
Hormonal & Endocrine Assessment
Assessment usually begins with a detailed review of symptoms, medical history, medications and previous test results.
Depending on the symptoms and suspected condition, investigations may include:
- Blood tests to measure specific hormone levels
- Blood glucose and metabolic testing
- Electrolytes, including sodium, potassium and calcium
- Thyroid function tests
- Testosterone or other reproductive hormone testing
- Prolactin testing
- Cortisol and adrenal hormone testing
- Pituitary hormone testing
- Specialised hormone stimulation or suppression tests
- Urine testing where appropriate
- Ultrasound, CT or MRI imaging when clinically indicated
Hormone levels can vary according to the time of day, age, medications, menstrual cycle, pregnancy and other health factors. Some hormonal tests therefore need to be performed under specific conditions to ensure the results can be interpreted accurately.
Treatment and Management
Treatment depends on the specific endocrine disorder and whether hormone levels are too high, too low or being affected by another underlying condition.
Management may include:
- Hormone replacement therapy when appropriate
- Medications to reduce excessive hormone production
- Treatment of the underlying medical condition
- Review or adjustment of medications that may affect hormone levels
- Lifestyle and metabolic health management
- Regular blood tests and hormone monitoring
- Monitoring with imaging when required
- Referral for additional treatment or surgery where appropriate
Some endocrine conditions can be treated and resolved, while others require ongoing monitoring and long-term management.
When Should You Seek Further Assessment?
Further assessment may be appropriate when symptoms suggest a possible hormonal imbalance, particularly when they are persistent, unexplained or accompanied by abnormal blood test results.
This may include unexplained changes in weight, persistent fatigue, abnormal menstrual cycles, fertility difficulties, reduced libido, excessive thirst or urination, unusual changes in blood pressure, or abnormalities in hormone levels discovered during routine testing.
Further investigation may also be appropriate when several hormonal abnormalities occur together, symptoms do not have an obvious explanation, or there is a family history of certain endocrine conditions.
Key Takeaways
- The endocrine system produces hormones that regulate many essential functions throughout the body.
- Hormonal disorders can develop when the body produces too much or too little of a hormone, or when the body does not respond to hormones normally.
- Symptoms of hormonal imbalance can include fatigue, weight changes, menstrual changes, fertility problems, reduced libido, excessive thirst or changes in blood pressure.
- Endocrine disorders can involve many different glands, including the thyroid, pituitary, adrenal and parathyroid glands, pancreas, ovaries and testes.
- Hormonal symptoms can overlap with many other medical conditions, so symptoms alone cannot confirm an endocrine disorder.
- Diagnosis may involve specialised blood tests, urine tests and imaging, depending on the suspected condition.
- Some hormone tests need to be performed at specific times or under particular conditions for accurate interpretation.
- Identifying the underlying cause allows treatment to be tailored to the individual and can help support long-term hormonal and metabolic health.
