DS is an elderly 75-year-old gentleman. Usually fit and independent, he became slow, confused and drowsy recently. He stopped doing his routine activities. He was diagnosed as having low salt in the body and was admitted to the hospital for the same. Physicians tried but could not get the salt levels (sodium) up. Finally, a general practitioner told him that he needed to see an endocrinologist for his problem.
The hormonal causes of low sodium are frequently overlooked. He had extremely low hormones produced from the brain because of a poorly functioning gland called pituitary. Luckily, both of the hormones that were low (cortisol and thyroid hormones) are very easy to replace by tablets. We prescribed him the required medications with careful explanation of how to take the medications. He went off to the village. I recently saw him again after 3 months.
Mr DS was back to his old self. He was walking 6 kms daily and doing all his activities of daily living independently. Fit and alert, he thanked me profusely for making him well. His family was also very grateful to me for making him well.
That’s what’s great about hormonal diseases. They are easy and inexpensive to treat and can change a person’s life. And how rewarding to be the person to bring it about.
However, a word of caution here. Most of the times after the patient feels better they tend to discontinue medications because of fear of addiction or kidney damage or well-meaning relatives and friends giving them dire warnings of side effects.
If a hormone is low in the body, its replacement is not only safe but life-saving.
A 32 year old man was almost 30 kilos overweight and was desperate to lose weight. I thought the option of Bariatric surgery would be a great option for him as he had considerable weight to lose. But during the evaluation he said something that rang an alarm bell. He said that recently he did not feel like having sexual relations with his wife, had difficulty in getting erections and was tired all the time.
Many obese patients may have slightly low male hormone (testosterone ) levels because of the excess fat but they are unlikely to cause such profound symptoms. We sent him for lab tests and found that he had very low testosterone levels (1/10th of normal) with high prolactin levels (6 times more than normal). An MRI confirmed a small tumor in the brain (pituitary gland).
Well, this is what we call a prolactin-secreting tumour or prolactinoma. The best part of this tumour is that it gets better with just tablets and does not require any surgery. Within months of treatment initiation, he was back to a happy married life.