GLUCOCRINOLOGY The Relationship between Glucose and Endocrine Function
GLUCOCRINOLOGY The Relationship between Glucose and Endocrine Function
Editors
Sanjay Kalra MD DM
Consultant Department of Endocrinology Bharti Hospital Karnal, Haryana, India
Gagan Priya MD DM
Consultant Endocrinologist Department of Endocrinology Fortis Hospital and Ivy Hospital
Mohali, Punjab, India
Forewords
Emanuel Christ
Vivien Lim
Jaypee Brothers Medical Publishers (P) Ltd
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Glucocrinology: The Relationship between Glucose and Endocrine Function/ Sanjay Kalra, Gagan Priya
First Edition: 2020
9789388958677
Printed at
Our Parents
Mrs Sudesh Kalra and Mr Hans Raj Kalra
Mrs Satish Kaur and Mr Balbir Singh Saini
Editors
- Sanjay Kalra MD DM
- Consultant
- Department of Endocrinology
- Bharti Hospital
- Karnal, Haryana, India
- Gagan Priya MD DM
- Consultant Endocrinologist
- Department of Endocrinology
- Fortis Hospital and Ivy Hospital
- Mohali, Punjab, India
Contributing Authors
- A Prem Kumar MD DM
- Consultant Endocrinologist
- SKS Hospital
- Salem, Tamil Nadu, India
- Abilash Nair MD DM
- Assistant Professor
- Department of Endocrinology
- Government Medical College
- Thiruvananthapuram, Kerala, India
- Abraham Alex Kodiatte MD DNB
- Senior Resident
- Department of Medicine
- Christian Medical College and Hospital
- Ludhiana, Punjab, India
- Akshata Desai American Board Certified in Endocrinology, Diabetes and Metabolism
- Consultant Endocrinologist
- Apex Hospital
- Jalandhar, India
- Ali Latheef MD
- Department of Medicine
- Indira Gandhi Memorial Hospital
- Male, Maldives
- Alpesh Goyal MD DM
- Assistant Professor
- Department of Endocrinology
- All India Institute of Medical Sciences
- New Delhi, India
- Altamash Shaikh DNB MNAMS DNB
- Consultant Endocrinologist
- Department of Medicine, Saifee Hospital,
- Mumbai, Maharashtra, India
- Ameya Joshi MD DM
- Consultant In Charge
- Department of Endocrinology
- Bhaktivedanta Hospital and Research Institute
- Thane, Maharashtra, India
- Andrew E Uloko BM BCh FMCP FACE
- Professor of Medicine
- Consultant Physician and Endocrinologist
- Head of Endocrinology, Diabetes and Metabolism, Department of Medicine
- College of Health Sciences
- Bayero University Kano,
- Aminu Kano Teaching Hospital
- Kano, Nigeria
- Ankia Coetzee MBChB MMed FCP MPhil Certificate (Endo and Metab)
- Consultant Endocrinologist
- Department of Internal Medicine, Division of Endocrinology, Stellenbosch University Faculty of Medicine and Health Sciences
- Cape Town, South Africa
- Beatrice Anne MD DM
- Assistant Professor
- Department of Endocrinology
- Nizam's Institute of Medical Sciences
- Hyderabad, Telangana, India
- Belinda George MD DM
- Associate Professor
- Department of Endocrinology
- St John's Medical College Hospital
- Bengaluru, Karnataka, India
- C Jayakumari MD DNB
- Additional Professor
- Government Medical College
- Thiruvananthapuram, Kerala, India
- Darvin V Das MD DNB
- Assistant Professor
- Government Medical College
- Thiruvananthapuram, Kerala, India
- Dayakshi DK Abeyaratne MD
- Clinical Fellow in Endocrinology
- Diabetes and Endocrinology Unit
- National Hospital of Sri Lanka
- Colombo, Sri Lanka
- Deep Dutta MD DM DNB Specialty Certificate (Endo and Diab) FRCP (Edin)
- Director
- CEDAR Superspeciality Center
- New Delhi, India
- Dina Shrestha MD
- Consultant Endocrinologist
- Norvic International Hospital and
- Medical College
- Kathmandu, Nepal
- Emmy Grewal MD DM
- Consultant Endocrinologist
- Ivy Multispeciality Hospital
- Mohali, Punjab, India
- Ganesh HK MD DM
- Consultant Endocrinologist
- AJ Hospital and Research Centre
- Mangaluru, Karnataka, India
- Indira Maisnam MD DM
- Consultant Endocrinologist and Faculty
- Department of Endocrinology
- RG Kar Medical College
- Kolkata, West Bengal, India
- Jaikrit Bhutani MBBS
- Resident, Department of Medicine
- Post Graduate Institute of Medical Sciences
- Rohtak, Haryana, India
- Jubbin Jagan Jacob MD DNB MNAMS
- Professor and Head
- Endocrine and Diabetes Unit
- Department of Medicine
- Christian Medical College and Hospital
- Ludhiana, Punjab, India
- Khalid Sheikh MSc Diab PG Dip (Endocrinology)
- Spe cialist, Department of Internal Medicine
- Royal Oman Police Hospital
- Muscat, Oman
- Kirtida Sandeep Acharya MBChB MRCP (Ire)
- National Chair Diabetes Kenya
- Consultant Endocrinologist, MP Shah Hospital
- Nairobi, Kenya
- Lakshmana Perumal Nandhini MD DM
- Assistant Professor
- Department of Endocrinology
- St John's Medical College
- Bengaluru, Karnataka, India
- Mohammad Wali Naseri MD PGD
- Associate Professor
- Department of Endocrinology Metabolism and Diabetes
- Kabul University of Medical Sciences
- Kabul, Afghanistan
- Nandini Prasad MD
- Senior Resident, Department of Endocrinology
- Government Medical College
- Thiruvananthapuram, Kerala, India
- Ndeye M Ndour Mbaye MD PhD
- Professor
- Department of Internal Medicine
- Cheikh Anta Diop University
- Dakar, Senegal
- Nikhil Gupta MD MPH DABIM FACE
- Endocrinologist
- CanMed Multispeciality Clinics
- Toronto, Canada
- Om J Lakhani MD DNB
- Consultant Endocrinologist
- Department of Endocrinology
- Zydus Hospital
- Ahmedabad, Gujarat, India
- Partha Pratim Chakraborthy MD DM DNB
- Tutor, Department of Endocrinology and Metabolism, Kolkata Medical College
- Kolkata, West Bengal, India
- Perla A Carrillo-González MD
- Department of Endocrinology
- ISSSTE Regional Hospital Lic. Adolfo López Mateos
- Mexico City, Mexico
- PK Jabbar MD DNB (Medicine) DM DNB (Endocrinology) FRCP (Glas)
- Professor and Head
- Department of Endocrinology
- Government Medical College
- Thiruvananthapuram, Kerala, India
- Roberta Lamptey MSC Diab PGDD FWACP FGCP MBChB
- Consultant
- Department of Family Medicine
- Korle Bu Teaching Hospital
- Accra, Ghana
- S Abbas Raza American Board of Internal Medicine, American Board of Diabetes, Endocrinology and Metabolism
- Endocrinologist
- Shaukat Khanum Cancer Hospital and Research Centre
- Lahore, Pakistan
- Sakthivel Sivasubramanian MD DM
- Consultant Endocrinologist
- The Hormone Clinic
- Tiruchirappalli, Tamil Nadu, India
- Sambit Das MD DM PGD (Endocrinology)
- Consultant Endocrinologist
- Apollo Hospitals
- Bhubaneswar, Odisha, India
- Sameer Aggarwal MD DM
- Head
- Department of Endocrinology and Metabolism
- Apex Plus Superspeciality Hospital
- Rohtak, Haryana, India
- Sandeep Chaudhary MD DM
- Specialist
- Department of Endocrinology
- NMC Specialty Hospital
- Al Nahda, Dubai, UAE
- Saptarshi Bhattacharya MD DM FACE
- Senior Consultant and Head
- Department of Endocrinology
- Max Superspeciality Hospital
- Patparganj, Delhi, India
- Senthil Senniappan MD MRCPCH FRCPCH MSC CCT PhD
- Consultant Pediatric Endocrinologist and Honorary Senior Lecturer
- Alder Hey Children's Hospital
- Liverpool, United Kingdom
- Shahjada Selim MD FACE FRSM
- Assistant Professor
- Department of Endocrinology and Metabolism, Bangabandhu Sheikh Mujib Medical University
- Shahbag, Dhaka, Bangladesh
- Silver K Bahendeka MD PhD
- Consultant Endocrinologist
- Mother Kevin Post Graduate Medical School Martyrs University, St Francis Hospital
- Kampala, Uganda
- Soumya S MD
- Senior Resident, Department of Endocrinology
- Government Medical College
- Thiruvananthapuram, Kerala, India
- Sunil K Kota MD DNB
- Consultant Endocrinologist
- Diabetes and Endocare Clinic
- Berhampur, Odisha, India
- Than Than Aye MMedSc DTM&H (London) MRCP (UK) DMedSC FRCP (Edin, Lond)
- Professor Emeritus
- Department of Endocrinology
- University of Medicine 2
- Yangon, Myanmar
- Vishal Bhatia MD FACE
- Director
- Department of Endocrinology,
- Diabetes and Metabolism
- St Vincent Hospital
- Associate Professor
- Department of Internal Medicine and
- Division of Endocrinology
- Indiana University School of Medicine
- Evansville, USA
In addition to the reproductive system, hormones regulate the availability of energy for different situation (i.e. famine and feast, physical exercise, sleep, fasting, eating etc.) in order to adapt and finally survive. Energy is provided by the degradation of carbohydrates, fat and proteins through their respective metabolic pathways. Therefore, the endocrine system (including all hormones) is the key regulator of metabolism and some metabolites regulate hormones leading to regulatory circles. In a healthy subject with an intact endocrine system and regulatory circles, a stable energy balance (energy availability and energy consumption) can be observed with a stable body weight and metabolic parameters over time. On the other hand, autonomous hormone secretion, impairing the regulatory circles and metabolism, very often results in an impaired energy balance and, therefore, a change in body weight and metabolic parameters.
Glucose is a marker of insulin action at the tissue level. The main target tissues of insulin action are skeletal muscle, adipose tissue and liver. In a healthy person, glucose levels are tightly regulated within a small normal range, mainly by insulin and its counter regulatory hormones (glucagon, cortisol, catecholamines and growth hormone), thereby allowing for an adequate supply of glucose to the peripheral tissues. An increased level of glucose has to be considered as an impaired insulin action, an increased action of counter regulatory hormones or a combination of both conditions, whereas a decrease in glucose levels may be due to inadequate insulin secretion, an impaired action of counter regulatory hormones or a combination of both.
“Glucocrinology”—the topic of this book—is defined as the relationship between the endocrine system and glucose metabolism. Importantly, it not only examines the physiological and pathophysiological role of the entire endocrine system on glucose metabolism by summarizing the most important mechanisms of action of all the hormones, but also explors the effect of glucose metabolism on the endocrine system in a bidirectional way (regulatory circles).
In 4 sections and 22 chapters, authors at the cutting edge of science summarize the effect of all endocrine hormones on glucose homeostasis and the effect of glucose metabolism on the endocrine system. This manuscript extends the “glucose-insulin” focused image of diabetes to a global endocrine disease thereby reassembling Endocrinology and Diabetology, which falsely tend to be treated separately.
For me as the secretary-treasurer of the International Society of Endocrinology (ISE) it is a particular honor and pleasure to write the foreword for this book. Similar to “Glucocrinology”, which includes the role of the global endocrine system in regulating glucose metabolism, ISE tries to reach out to the global endocrine community to improve the endocrine knowledge.
I congratulate all the authors and the editors for this wonderful piece of work and I am sure that the readers will appreciate it.
Emanuel Christ MD PhD
Secretary-Treasurer
International Society of Endocrinology
Head of Interdisciplinary Endocrinology
University Hospital of Basel
Switzerland
Foreword
We live in exciting times where the knowledge of our chosen topic of interest— Endocrinology—increases by leaps and bounds. The study of it is wide, given that it spans many glands and systems and hitherto unsuspected and undetected linkages are being teased out every day.
At the same time, diabetes is one of the major conditions under our purview as endocrinologists. Its prevalence is increasing worldwide, not least of which is in Asia and Southeast Asia. At press time, about 1 in 11 people suffer from diabetes worldwide and in some countries the numbers are even greater. In addition, the prevalence seems to be increasing at a tremendous rate. The implications of a patient afflicted with diabetes is wide and far-reaching and contributes greatly to a nation's healthcare burden. It is no surprise therefore that endocrinologists and diabetologists worldwide would band together to try to fight this epidemic of our time.
Meanwhile, it is not uncommon to be suffering from endocrine disorders. As such the overlap between these two conditions is great and it is apt then that this book explores the interlinking influence of glucose metabolism on endocrine systems and vice-versa—coined as Glucocrinology. At the same time, the book lays bare the associations of various endocrine disorders with glucose metabolism and diabetes itself. This knowledge would no doubt enable us to give better care customized to the particular patient.
Kudos are to be given to the various authors who managed to bring forth their knowledge, translating it into clear prose that is a delight to read and sheds light on this new field of Glucocrinology.
Vivien Lim MRCP (UK) MMed FAMS
Specialist in Endocrinology
Immediate Past President Endocrine Metabolic Society of Singapore
Vivien Lim Endocrinology Specialist Centre
Gleneagles Medical Centre
Singapore
Preface
The science of endocrinology and metabolism focuses on the integrated role of various endocrine axes and protein-energy metabolism in the maintenance of homeostasis. Dysfunction of the endocrine and metabolic systems impacts multiple organ systems, and influences long-term health of the individual. Physiological alterations and various pathological states in the endocrine-metabolic milieu impact the individual across the life-span, right from pre-conception till death.
An epidemic of endocrinopathy is sweeping across the world today, and has led to a heightened interest in the subject. Indeed, “Endocrinology and Metabolism” is one of the most rapidly advancing fields of modern medicine. The most prevalent endocrine dysfunction today is dysglycemia, including impaired glucose tolerance and diabetes mellitus. While there is extensive research and discussion regarding the multifaceted pathophysiology of diabetes, the endocrine aspects of this hormonal disease have not been highlighted adequately. This has led to an under-appreciation and under-recognition of the fact that dysglycemia is an endocrine disease.
The novel concept of “Glucocrinology” seeks to address this lacuna. It highlights the challenges and complexity of the endocrine relationships of glucose homeostasis, both in health and disease. Written by eminent authors from all continents, “Glucocrinology” is a book which will change the way we think about, approach and deal with diabetes. The structured layout of the book discusses each gland, covering its impact on glucose physiology, and its bidirectional relationship with diabetes, metabolic syndrome and hypoglycemia. It goes on to cover the concept of glucovigilance in endocrine disease, and endovigilance in diabetes. The need for endocrine pharmacovigilance, and important topics such as bone and reproductive health are given special attention. Wall structured sections explain the concept of glucocrinology in a basic and beautiful manner, making it easy to understand for the endocrinologist and non-endocrinologist alike. Students, clinicians and researchers will benefit from the lucid descriptions and explanations shared in this book.
Sanjay Kalra
Gagan Priya