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The endocrine system is a system formed by the endocrine glands. Endocrine glands make substances we call hormones and release them into the blood. Hormones are chemical structures that enable communication with every part of our body. They travel through the blood and carry out different functions.

Hormones play a role in regulating the function of many organs in our body. Different types of hormones control reproduction, metabolism, growth and development. Hormones also control our response to our surroundings and help provide the appropriate amount of energy and nutrients needed for the functions of our body. The glands that make up the endocrine system include the hypothalamus and the pituitary in the brain, the thyroid, parathyroid, pancreas, gonads (ovaries in women, testes in men), adrenal gland, adipose tissue, endothelium (the cells lining the inner wall of blood vessels), heart, kidney and small intestine.

Diabetes mellitus, commonly known as sugar disease, is a disease that results from the inability to use glucose (sugar) in the blood. While carrying out its daily functions (during sleep or while awake), our body needs a fuel to use. This fuel is often the sugar we call glucose. The insulin hormone secreted by the pancreas is needed for glucose to be used. Diabetes mellitus occurs when insulin is insufficient or ineffective. In other words, the body cannot use the sugar that is present.
The most important symptoms of the disease are drinking a lot of water and urinating frequently. In the form of diabetes that often appears in adulthood and that we call type 2, patients are generally overweight, and there may have been weight gain before the disease. In contrast, in diabetes that involves insulin deficiency and appears mostly in young people, there is marked weight loss. In diabetic patients, frequent infections can occur anywhere in the body, and in women especially in the urinary tract and genital area.

One of the first goals in diabetes treatment is for the patient to reach their normal weight. For this reason, people who are overweight should lose weight and people who are underweight should gain weight. Patients are given dietary recommendations with as many calories as their body needs, according to their eating habits. People use glucose best during exercise. It is recommended that a healthy person exercise an average of 150 minutes a week (30 minutes, 5 days a week) in addition to daily work activities. This also applies to diabetic patients. The duration of exercise can be decreased or increased by the doctor according to the patient's condition.

Some patients with type 2 diabetes can keep their blood sugar at a normal level for a while with healthy eating recommendations and exercise. When blood sugar is uncontrolled, medication must be started and taken regularly. Unfortunately, diabetes is a disease that is not completely cured. Over the years, the patient's need for medication may vary, decreasing or increasing. For this reason, patients need regular check-ups.

The treatment of patients with type 1 diabetes is insulin from the moment of diagnosis, together with healthy eating recommendations and exercise. The need for insulin can be affected by many things, such as the person's lifestyle and nutritional status. For this reason, very close follow-up of these patients is necessary.

In people with diabetes, blood sugar can rise very quickly, especially if a patient who uses insulin does not take their insulin, eats too many foods containing sugar, which we call carbohydrates, or develops an intervening infection. As a result, patients can go into a coma. Patients in this condition must be treated urgently.

Conversely, when the patient takes too much medication, eats too little or exercises heavily, blood sugar may fall and progress toward a coma. Patients must know the symptoms of low blood sugar very well and should act immediately in this situation.

Apart from these emergencies, diabetes can cause disorders of the kidneys, eyes, heart, skin, the entire vascular system and the nerves. These disorders can be seen at an early stage in patients with type 2 diabetes, because it is not possible to predict the onset of type 2 diabetes. Screening examinations for these disorders should begin at diagnosis.

In contrast, in patients with type 1 diabetes these disorders are not expected in the first 3 years after diagnosis. Screening is generally performed regularly every year starting from the 5th year.

When blood sugar falls, there may be complaints such as palpitations, sweating, a feeling of hunger, sleepiness, blurred vision and irritability. Hypoglycemia is a serious condition that requires immediate action. Because the brain uses sugar as fuel, when sugar falls the nourishment of the brain is impaired, and prolonged low sugar can cause permanent nerve damage.

If the patient is conscious when blood sugar falls, they should immediately eat a sugary food (such as 4 sugar cubes, 2 spoonfuls of granulated sugar or half a glass of fruit juice. Foods such as milk, yogurt and bread are not used in hypoglycemia because they do not raise blood sugar quickly). After eating sugar, the patient needs to monitor their blood sugar. Patients who are not conscious should be taken immediately to the nearest health facility and treated urgently. Glucagon (another hormone that acts opposite to insulin), which raises blood sugar, is available as a medication. If the patient's relatives know how to use this medication, they should administer it immediately.

When women of childbearing age with diabetes are planning a pregnancy, they must consult their doctors and regulate their blood sugar very well. In following patients with diabetes, it is ideal for the hemoglobin A1c value, which is a good indicator of the last 3 months of blood sugar results, to be below 6.5%. Keeping blood sugar very regular throughout pregnancy is important for the health of the baby and the mother. A pregnant woman with diabetes needs to use insulin from the beginning of pregnancy. Oral diabetes medications may cause permanent defects in the baby. The first 8 weeks of pregnancy are the stage in which the organs form, and during this time all expectant mothers need to be careful about the baby's health. Blood sugar that runs high or very low in the mother at this stage can cause permanent organ defects in the baby. Miscarriage and stillbirth are more likely in diabetic mothers. The babies of pregnant women whose blood sugar runs irregularly may be born large. This may cause both a difficult delivery and some disorders in the baby.

If the thyroid gland, our endocrine gland located right at the front of our windpipe, enlarges for any reason, this is called a goiter. The most common cause of goiter is iodine deficiency. Exposure to iodine deficiency, especially from childhood onward, results in goiter. In severe cases, because the thyroid gland cannot maintain normal hormone secretion by enlarging itself, it may also progress to a functional disorder we call hypothyroidism. Other causes of goiter include some medications used for a long time (such as lithium, used in the treatment of depression), thyroid disorders that arise when the body recognizes its own tissues as foreign, benign or malignant tumors of the thyroid, and consuming too much of certain foods. The thyroid gland can enlarge evenly all over and cause a diffuse goiter, or it can enlarge locally in the form of lumps and give rise to what we call a nodular goiter.

When thyroid hormone rises too high in the blood, whether or not there is a goiter, it can cause sweating, palpitations, insomnia, irritability, weight loss despite eating a lot, trembling throughout the body especially in the hands, and menstrual irregularities in women.

If there is a palpable lump in the thyroid gland that is distinct from the gland, it is called a thyroid nodule. If there is more than one nodule, they are called multiple thyroid nodules, or multinodular goiter.

Nodules are important for three reasons.

A) Overactive nodules can cause hyperthyroidism. This excess of thyroid hormone must be treated.

B) Nodules may be cancerous in structure.

C) Very large nodules can press on the windpipe and cause shortness of breath.

In the last two situations, that is, if the nodule is pressing or if there is suspicion of cancer based on its structure, treatment is surgery. For overactive nodules, it is more appropriate first to correct the hormone elevation and then to treat with surgery or radioactive iodine.

Suspicion of cancer in nodules is important. But not every nodule is cancer. More than 90% of all nodules are benign; what matters is to identify the nodule that carries a risk of cancer. For this reason, patients must have an ultrasonographic evaluation and, if necessary, a biopsy.

In patients with excess thyroid hormone, that is, hyperthyroidism, scintigraphy is used to evaluate the function of the thyroid nodule; it is a method that shows how much radioactive material the nodule can take up. If the nodule looks hot on scintigraphy, that is, if it takes up a lot of the radioactive material, it is called a toxic nodule. Because the risk of cancer in hot nodules is very low, in many centers they are treated directly by endocrinologists without the need for a biopsy.

As in all endocrine glands, cancers of thyroid tissue can occur. In the early stage they are noticed as a nodule in the thyroid gland. They are painless. Patients' thyroid function is usually normal; that is, they do not cause a deficiency or excess of hormone.

The diagnosis is made by ultrasound evaluation, examination of the material obtained by fine needle aspiration biopsy, and pathological evaluation of the tissue removed in surgery. Treatment is generally surgery. Rarely, surgery is not performed in very rapidly progressing thyroid cancers. The great majority of thyroid cancers are of the type called papillary thyroid cancer, and since these progress very slowly, complete recovery is achieved with appropriate treatment. Distant spread of these is very rare, and they generally remain in the neck region.

Hypothyroidism is a condition in which thyroid hormone in the blood is decreased. Because thyroid hormone is very important for brain and body development, hypothyroidism can cause intellectual disability, especially in the newborn period. This is preventable if recognized early. In adults, it disrupts the person's social life through problems such as distractibility, sleepiness, weight gain and swelling of the body, causes withdrawal from society and increases the tendency toward depression.

Overweight or obesity, which results from an excessive increase in fatty tissue in the body, was regarded in the past as a sign of health and wealth. Today it is a disease that can cause serious disorders. Obesity is a very common condition. The World Health Organization reports that obesity is widespread throughout the world and that it is rising rapidly over the years, sounding alarm signals. The frequency of obesity is also quite high in our country. The diagnosis of obesity can be made with a simple measurement of weight and height. An index has been defined based on these two values: the body mass index (BMI). It is obtained by dividing weight by the square of height in meters. For example, a person who is 160 cm tall and weighs 80 kilograms has a body mass index of about 31 kg/m2. People with a body mass index of 25-30 kg/m2 are considered overweight, and those above 30 kg/m2 are considered obese. Obesity is itself graded according to body mass index. This measure does not always give an accurate diagnosis of obesity. People who exercise regularly may weigh more because their muscle mass is increased and have a high body mass index. For this reason, for a true diagnosis of obesity, methods that measure the amount of body fat will give the most accurate result.

The areas where fatty tissue is located should be evaluated in terms of harm to organs such as the heart. In the more dangerous type of obesity, which involves fatty infiltration of organs, fatty tissue accumulates mostly in the abdominal area.

The most common cause of obesity is disorders in our eating behavior. Overeating and a sedentary lifestyle are the most common causes of obesity. Besides these, obesity can arise from certain hormone disorders, disorders of the appetite center in the brain, and genetic and hereditary causes.

If the problem of obesity is prevented before it arises, the chance of success is much higher. For this reason, efforts should be made so that society acquires the habit of healthy eating and regular exercise. Unhealthy, very high-calorie ready-made foods, which are increasing day by day, and sitting in front of the television or computer all day are raising the frequency of obesity all over the world.

Most obese people plan to lose weight quickly and easily. When they do not succeed, patients lose their motivation and begin to regain weight. At the beginning of obesity treatment, it is important to set achievable goals (such as a 5-10% weight loss in 6 months). Even a reduction of about 10% in body weight significantly reduces risk factors. More important than losing weight is maintaining the weight that has been lost. More than 95% of those who lose weight regain it. Maintaining weight depends on long-term behavior change, balanced and healthy eating and increased physical activity. To this end, the main point of treatment is to reduce energy intake and increase energy expenditure. Various treatment methods are used in obesity treatment, such as dietary therapy, physical activity, behavioral therapy, drug therapy and surgical treatment.

Obesity surgery is one of the treatment methods that can be applied in severely obese patients. In every case, the first treatment of obesity is healthy eating, reducing the amount of food, increasing daily activities and exercise. Although some alternative treatment methods are used by many obese patients, there is no successful result in the long term. A typical example of this is acupuncture treatment. While most patients lose weight during treatment mainly because they greatly restrict their eating, weight gain begins again when the treatment ends, as the patient is unable to maintain healthy eating habits.

Surgical treatment is a method that can be applied especially in patients who have developed disorders related to obesity (heart disease, uncontrolled hypertension, uncontrolled diabetes). Obesity surgery reduces the volume of the patient's stomach. It is not possible to achieve 100% success with this treatment either. Patients need to eat much more regularly after surgery. The problems that surgery can cause should be explained to them well. A detailed psychiatric and endocrine evaluation must be performed before surgery. Patients continuing their endocrine and psychiatric follow-up after surgery will increase surgical success.

Osteoporosis literally means porous bone tissue. It is a disease that can affect all bones, with a decrease in bone mass and fractures resulting from deterioration of the microscopic structure of the bone. One of the most important causes of osteoporosis is menopause. With menopause, the level of the female hormone (estrogen) falls. Estrogen has a protective effect on bone tissue, and when it is deficient, bone breakdown increases rapidly. Osteoporosis occurs more often especially in early menopause or in patients who enter menopause surgically. Another important cause is aging. As people age, there are decreases both in bone formation and in calcium absorption from the intestines.

It is possible for osteoporosis to occur for reasons other than menopause and aging. One of these is medications. For example, osteoporosis is common and quite severe in patients who use cortisone for a long time, or heparin to prevent blood clotting. Osteoporosis can occur in people who are bedridden for a long time and in rheumatic diseases, small intestine diseases, some blood diseases, hormone disorders, diabetes and long-term severe lung diseases.

The healthiest way to prevent osteoporosis is a balanced diet, eating foods that contain enough calcium, and exercise. Regular exercise increases muscle mass and prevents the loss of bone mass. It is essential to get enough sunlight. Sunlight converts a special cholesterol in the skin into vitamin D, which increases calcium absorption from the intestines.

Vitamin D deficiency can cause many disorders in the body. In recent years, it has been shown that this deficiency increases the risk of coronary artery disease, hypertension, some types of cancer and diabetes. The well-known effect of vitamin D is on muscle and bone. Vitamin D increases the absorption of calcium from the small intestine, allowing good hardening of bone tissue, and by regulating muscle contraction it also helps increase bone strength. In vitamin D deficiency, children develop a disease called rickets, with deformities of the bones, delayed tooth eruption and muscle weakness. In adults, it leads to a condition called osteomalacia, in which diseased bone tissue that has not hardened well appears. These soft bones change shape quickly under pressure. In addition, because of the fall in blood calcium, disorders in the function of many organs as well as muscle tissue can occur.

Male-pattern hair growth in women is a sign of a hormonal disorder. A good distinction must be made between terminal hair and fine vellus hair. When the fine hair of dark-complexioned people is dense and dark, this is generally thought of as hirsutism. For male-pattern hair growth, the typical areas in women are the sideburn area, under the chin (beard area), above the upper lip, the backs of the hands, especially over the fingers, the chest, the inner thighs, the tops of the feet, and again coarse, dark hairs like scalp hair on the fingers.

A significant proportion of women with hirsutism may also have menstrual irregularities. The main causes of hirsutism can be diseases of the ovaries and adrenal gland, certain medications, and sometimes excessive sensitivity of the skin to male hormone.

If there is a menstrual irregularity, the women's ovulation function should be evaluated. These women have more difficulty becoming pregnant.

Cortisone is a hormone made by the adrenal gland. It is also frequently used as a medication in the treatment of many diseases (such as rheumatic diseases, inflammatory bowel diseases and lymphoma-type cancers). Therefore, disorders caused by an excess of this hormone mostly occur as a result of treating other diseases. Excess cortisone production, on the other hand, results either from a tumor in the adrenal gland, or from overproduction, in the pituitary gland or in some cancers, of another hormone that stimulates cortisone production. This disease is known as Cushing's syndrome.

With excess cortisone, patients' most common complaints are excessive weight gain (especially in the abdominal area), weakness, purple stretch marks on the skin, rounding and slight redness of the face (moon face), muscle pain, difficulty walking and climbing stairs, high blood pressure, high blood sugar, abdominal pain and headache.

Conditions in which the adrenal gland is underactive are called adrenal insufficiency. Although adrenal insufficiency has many causes, the most commonly encountered are the body recognizing its own tissues as foreign and reacting against them (autoimmune disease), tuberculosis, and surgical removal of the adrenal glands. The most important complaints of patients with an underactive adrenal gland are weakness, fatigue, nausea, abdominal pain, a feeling of faintness and darkening of skin color. Because they lose salt, they feel a craving for salt. Their blood pressure may fall very low. Fainting spells may occur as a result. It can be fatal if not noticed. Treatment requires replacing the missing hormone. Cortisone is a stress hormone and increases more in stressful situations. In these patients, the medication dose needs to be adjusted in mild or severe stressful situations.

If patients lose fluid and salt through sweating, especially in the summer months, these complaints recur. The medication dose needs to be increased.

In medicine, this condition is called galactorrhea. Prolactin, the hormone that stimulates milk secretion, is produced in the brain by an endocrine gland called the pituitary gland. Its level is high in pregnant and breastfeeding women. It may also remain high for a while after breastfeeding ends. Prolactin production can be stimulated by many medications in use, such as some antidepressants. The first thing to come to mind in this picture is a disorder of the hormone called prolactin, which is secreted by the endocrine gland in the brain called the pituitary gland.

Growth hormone, produced in the pituitary gland, regulates bone growth during childhood together with other hormones such as thyroid hormone and insulin. If growth hormone secretion increases at these ages, a disease called gigantism, or giantism, develops. These people become very tall. If excess growth hormone appears in adulthood, that is, after the lengthwise growth of the bones has stopped, it causes the disease we call acromegaly, which appears mostly as enlargement of the bones of the hands, feet and face, together with an increase in soft tissue. The initial complaints of acromegaly patients are usually sweating and oily skin and hair. Later, enlargement of the hands and feet and changes in facial appearance develop. Since growth hormone can cause growth not only of the bones but of many organs, patients may present with different complaints. In these patients, the frequency of conditions such as heart failure, cardiovascular disease, hypertension, diabetes, various types of cancer, sleep apnea, goiter and prostate enlargement increases. If left untreated, it is a disease that shortens life.