Santiago Brugo Olmedo M.D.
Medical Director
Seremas Medicine for men and women
Seremas Home Seremas Specialties Seremas Endocrinology

Endocrinology

SEREMAS department of Endocrinology counts on associated professionals who are in charge of endocrinological problems of Hypothalamic-pituitary-gonadal axis, higher levels of prolactin, as well as thyroid, parathyroid and adrenal diseases.

We also take care of problems derived from phosphocalcic, lipidic and hydrocarbonate metabolism.

This section works close to the endocrinological laboratory and has special interest in the metabolic study of these patients.

GOITER AND NODULES IN THE THYROID

The thyroid is a small gland placed in the neck, under Adam’s apple, which regulates processes of metabolism in the whole body.
There is a wide variety of thyroid diseases, which affect specially women at any age.
Among the most frequent reasons for consulting we have to mention those which have to do with enlargement and/or deformation of thyroid, known as goiter; the word goiter involves every situation in which thyroid gets bigger and grows in a relatively regular way. Besides, one can also find the presence of one or several nodules (lumps of different sizes in the thyroid), which can be benign or malignant. Sometimes it is patients themselves who notice it when looking at themselves in the mirror, or see the doctor because of sore in their necks, or because they can not button up their shirts, or put necklaces around their necks, or even because they have difficulty in swallowing or breathing, some other times it is the specialized physician who detects it by neck palpation or gland ultrasound. We must underline that many patients do not have any symptom, reason why consultation in time can let us get a diagnosis. It is convenient to insist on the importance of premature detection of thyroid nodule, since given the case of a malignant nodule (thyroid cancer), early intervention is accompanied by excellent evolution.

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GYNECOMASTY

Men’s breasts size enlargement is known as gynecomasty, and there are multiple causes which generate this condition.
It is a normal situation when it appears at certain stages of life such as neonatal, puberty and senility.
It is common in puberty and it occurs in 25-50% of teen-agers, in general disappearing between the first and second year after its appearance.
The clinical condition simply involves breasts enlargement, and it can take place in one or both breasts, with or without pain.

CAUSES

Physiological: It is the one which appears at the neonatal stage, puberty or senility. In the first case, the cause is the passage through the mother’s hormones placenta; in puberty, because of increase in sexual hormones, mainly Testosterone, which turns into estrogens and in senility since there is a decrease in Testosterone.

Pathological: The most common causes are:

Seremas Deficit in Testosterone production, traumatism or continuous stimuli in the region.
Seremas Congenital testis diseases such as Klinefelter Syndrome or Anorchidism (absence of testis)
Seremas Acquired diseases such as viral orchidism or castration.
Seremas High hormone production (estrogens) as in some testicular tumors, or in other organs, among them, lungs.
Seremas Hepatic insufficiency and malnutrition.
Seremas The one produced by some drugs, just to mention the most common ones: alcohol, heroin, marihuana, anabolic steroids, isonyazide, reserpine, ethionamide, digital, metroclopramide, ketoconazole, spironolactone, cimetidine, ranitidine, omeprazole, flutamide, cyproterone, gonadotrophins, verapamil, diltiazem, metronidazole, enalapril, captopril, diazepam.

TREATMENT

Physiological causes in general do not require treatment, just like gynecomasty in puberty, which is solved spontaneously in a couple of years, but can also be treated with medication based on antiestrogens. Surgery is left for those cases where clinical condition or gynecomasty magnitude give as a result psychological disorders, or when treatment with medication has not been successful.

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HIRSUTISM

Hair covers most of corporal surface in mammals and its distribution and aspect is different depending on age and sex, in most species. Human beings are not different from the rest of mammals and show hair on many areas of our body, although it is very thin and spread, in such a way that it seems that in many parts of our bodies, skin is naked. As in the rest of mammals, hair distribution changes according to age and sex. Androgens or male sexual hormones (but present in both sexes) are the substances which turn thin, short hair with little pigmentation typical in children, into terminal or adult hair. Adult hair does not appear in our species before twenty years old. It grows progressively since suprarenal glands start to function, at 7-9 years old, increasing remarkably in puberty, with the development of ovaries and testis until it covers arms, legs, pubis and armpits in both sexes and face, abdomen and thorax in men.

In women, when hair is terminal, thick and dark, covering areas where most women only have thin hair, we are in presence of hirsutism.

CAUSES

Idiopathic Hirsutism with unknown cause: because of special or sometimes familiar hair sensitivity to androgens.
- Excess of androgen in circulation, which has effects on hair. Excess of androgen usually is due to the increase in ovaries o suprarenal glands production and it has different causes. In general, its cause is only due to alterations in glandular functioning, on occasions congenital, but in some cases some other more serious diseases can be found, such as benign or malignant tumors. In most cases, when this occurs thick hair appears in areas where the woman says she had thin hair before and is often accompanied by alterations in menstrual cycle, which is extended or disappears, acne or seborrhea and, more rarely, deepening of the voice and redistribution of body fat, with masculine aspect. However, as it is hard to differentiate thin from thick adult hair, it can be difficult to distinguish between normal and pathologic, especially in dark-haired women. Moreover, many cultures consider excess of body hair in women not to be esthetic and, since ancient Egyptians, in many Mediterranean areas women have removed their body hair for centuries, and therefore there is a tendency to magnify this excess of hair because of socio-cultural reasons.

What to do in case of Hirsutism?
When we suspect the existence of excessive hair, it must be the endocrinologist who, after checking the medical history and examination, deters if there is real hirsutism. If this is the case, all the necessary tests will be carried out in order to know its cause.

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OSTEOPOROSIS

During Menopause, the woman’s body suffers from different changes, some of them clearly perceptible such as sleeping disorders, hot flashes or fluctuations in mood; whereas some others become less evident, but not less important. One of these alterations is OSTEOPOROSIS, scientific word to name the loss of minerals which are part of bones, giving them a spongier aspect, and therefore making them more fragile. In Menopause, because of the lack of estrogen (female sexual hormone), the loss of osseous material is more than in previous years. Then, if at 35 years old bones had about 1,200 milligrams of minerals per square centimeter, at 60 years old this amount is only 700 milligrams. In other words, our osseous system is, at that age, doubly fragile. Estrogens have an important function regarding preservation of bones resistance; after menopause bones tend to become weaker, although this happens at different levels. This is the reason why elderly women lose height when they are aging and why risk of fracturing a bone when falling down increases. Nevertheless, modern methods of diagnosis allow easy detection of excessive osseous loss. Treatment with estrogens can help to prevent it. Anyways, osseous resistance is re-enforced with diet and proper exercise. It becomes relevant, now more than ever, to consume enough calcium (milk, yoghurt, low fat cheese or fish) and to keep active.

Consequences of Osteoporosis
When someone suffers from Osteoporosis, resistance to bumps produced by a fall or accidents decreases remarkably and it is common to see fracture of spinal cord, hips and wrists bones as a result. These fractures are habitually painful and deforming and might get to disable us.

Other consequences of Osteoporosis are loss of height and curvature of the spine, due to spinal cord vertebrae deformity.

Risk Factors
We consider risk factors all the conditions that predispose a person to certain suffering:
In the case of Osteoporosis, we identify the following:

Seremas Menopause
Seremas Premature Menopause
Seremas Loss of height (more than 3 cm. per year)
Seremas Fracture of bones due to a mild bumps
Seremas Less than 1.55 m height
Seremas Slim complexion
Seremas White skin
Seremas More than 40 years old
Seremas Cases of osteoporosis in the family
Seremas Alcoholism
Seremas Tobacco
Seremas Coffee drinkers
Seremas Nutrition with calcium deficit
Seremas Medication such as cortisone and antiepileptics
Seremas Physical inactivity


Prevention

It is easier to prevent Osteoporosis than to treat it, and that is the reason why measures to avoid it must be taken as soon as possible.

Even if Osteoporosis appears at about 50s, loss of muscle mass, strength and flexibility, start little after forties. Owing to this reason, starting at this moment a program of physical exercise and stick to a balanced diet, rich in minerals and proteins, will offer benefits which will not only be seen in a younger and healthier appearance but will also help to keep bones strength.

Other useful measures in prevention of Osteoporosis, are reduction in consumption of cigarettes, coffee and alcoholic drinks, as well as estrogen sustitutive treatment.

Exercise

Walking, rhythmic gym, low impact aerobic exercise, swimming and yoga, are activities that will help keeping fit and healthy, and also preventing Osteoporosis, without causing any risk for bone system.

Medical Treatment

Nowadays, thanks to pharmacological advance, perspective of an optimistic future starts for women in order to prevent and treat Osteoporosis. Several medical reports have demonstrated that a simple treatment based on sustitutive hormonal therapy, admistritation of calcium and other minerals, as well as a proper exercise program, not only prevents bone material loss, but also restitutes it.

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