Welcome to EndocrinologyNepal

Endocrinology is a branch of internal medicine which deals with disorders related to hormonal imbalance. It includes not only diabetes and thyroid disorders but also deals with various diseases like hypogonadism, erectile dysfunction, infertility, hirsutism, gynecomastia, PCOS, pubertal disorders, obesity, short stature, tall stature, pituitary disorders, Cushing's syndrome, Pheochromocytoma, parathyroid disorders and metabolic bone diseases.

Endocrinology भनेको हर्मोन को गडबडीबाट हुने रोग सम्बन्धि क्षेत्र हो I हर्मोनको गडबडीका कारण निम्न समस्याहरु हुन सक्छन :
१. मधुमेह (Diabetes)
२. सुगर कम हुने रोग (Hypoglycemia)
३. थाईराइद रोग (Thyroid disorders)
४. महिनाबारीमा गडबड र निसन्तान (Infertility)
५. महिलाहरुको शरीरमा धेरै रौँ उम्रने (Hirsutism)
६. स्तनबाट दुध चुहिने (Galactorrhea)
७. पुरुषहरुमा स्तन बढ्ने (Gynaecomastia)
८. शरीरको उच्चाई नबढी पुड्को हुने (Short stature) वा धेरै अग्लो हुने (Tall Stature)
९. लिङ्ग वा अन्दकोश सानो हुने (Hypogonadism)
१०. यौन इच्छामा कमि आउने वा सम्भोग गर्न गार्हो हुने (Erectile Dysfunction)
११. यौबन अवस्था चांडो देखिने (Precocious puberty) वा ढिलो गरि देखिने (Delayed puberty)
१२. हड्डी बारम्बार टुट्ने , हड्डी बंगिने (Rickets), हड्डी सुन्निन्ने वा हड्डी खिइने (Osteoporosis)
१३. शरीरको मोटोपना बढ्ने(Obesity)
१४. बारम्बार मिर्गौलाको पत्थरी हुने(Kidney stones)
१५. सानो उमेरमा नै रक्तचाप बढ्ने वा रक्तचाप अचानक बढेर टाउको दुख्ने , बान्ता हुने र पसिना आउने
१६. लिङ्ग निर्धारण गर्न गार्हो हुने (Disorders of sexual development)

About Dr Ansu Mali Joshi

My photo
Kathmandu, Nepal
I am an endocrinologist, practising at Kathmandu, Nepal. I did my DM Endocrinology from the prestigious All India Institute of Medical sciences, New Delhi in 2011. DM Endocrinology is a 3 year superspecialized degree which is done after doing 3 years of MD Internal Medicine. Currently I work at KATHMANDU DIABETES & THYROID CENTER PVT LTD (01-5521969).

Wednesday, October 24, 2012

Patient Guide to the Assessment and Treatment of Hypertriglyceridemia (High Triglycerides)

Having high levels of triglycerides, or hypertriglyceridemia, is a common problem. Triglycerides are fats in the blood (also called lipids). Your body needs some blood fats for energy. But when your triglyceride levels are too high, these fats may put you at risk for heart disease, stroke, and other health problems.
Most often, having high triglycerides has no warning signs. The good news, though, is there is a simple test to find high triglycerides, and treatments are available.
This guide for patients comes from The Endocrine Society’s practice guidelines for physicians about the detection and treatment of hypertriglyceridemia.

What are the effects of high triglycerides?

It is unclear if high triglycerides alone are a risk factor for cardiovascular disease (heart disease and stroke). Triglycerides do not directly cause the plaque that can block your heart’s arteries (atherosclerosis) and lead to a heart attack. Yet, cholesterol in triglyceride-rich particles in the blood may add to plaque formation.
Also, many people with high triglycerides have other lipid problems or other risk factors for heart disease. A high triglyceride level is one part of the metabolic syndrome, a cluster of risk factors that increase the risk for heart disease and diabetes.

High triglycerides can affect more than your heart and blood vessels. Very high triglycerides raise the risk for pancreatitis, an inflammation of the pancreas. The pancreas is large gland behind the stomach that makes key hormones like insulin. It helps your body maintain healthy blood glucose (sugar) levels.

Pancreatitis can cause stomach pain and digestive problems. It can damage the pancreas and, over a long time, can lead to diabetes.

What raises the risk for high triglycerides?

Triglycerides normally increase with age. They may become too high for one or more reasons.
Risk factors include
• Lifestyle factors
— Being overweight or obese
— Not getting enough exercise
— Drinking too much alcohol
• Familial (inherited) disorders
• Type 2 diabetes or the metabolic syndrome
• Pregnancy
• Medications
— Some “water” pills (thiazide diuretics)
— Beta-blockers
— Estrogen (birth control pills, hormone therapy)
— Isotretinoin for acne
— Corticosteroids for conditions such as asthma and arthritis
— Certain cholesterol-lowering drugs
— Protease inhibitors for HIV
— Immune suppressants (such as sirolimus)
— Some antipsychotics (mental health medicines)

The most common reasons for high triglycerides include being overweight, lack of exercise, the metabolic syndrome, type 2 diabetes, and familial combined hyperlipidemia. The latter is a genetic disorder that runs in the family. It results in high triglycerides, high “bad” (low-density lipoprotein, or LDL) cholesterol, and low “good” (high-density lipoprotein, or HDL) cholesterol.

How are high triglycerides found?

A blood test called a  lipid panel measures triglycerides and cholesterol. You should have this test after fasting (not eating or drinking anything but water) for at least 12 hours.  Adults should get this screening test every five years or sooner. If you have diabetes, a family history of high triglycerides, or other risk factors, you may need screening more often, according to the National Cholesterol Education
Program (NCEP) Guidelines.

The NCEP defines borderline-high triglycerides as 150 to 199 milligrams per deciliter (mg/dL) and high triglycerides as 200 to 499 mg/dL. Very high triglycerides are 500 mg/dL or higher. The Endocrine Society instead defines hypertriglyceridemia by its disease risk (see chart below). Most people with high triglycerides have levels from 150 to 999 mg/dL, which puts them at risk for heart disease. Above 2,000 mg/dL poses a high risk for pancreatitis.  If your triglycerides are above normal, your doctor will find out if the cause is primary (genetic) or secondary (e.g., due to hormonal disease or medications). Untreated secondary causes
need treatment. If the cause is a medication, ask your doctor if you can switch to a medicine that does not raise triglycerides.  Your health care providers may check you for other risk factors for heart disease, such as high blood pressure, high blood glucose, and too much fat around your waist. They also may ask
about your family history of abnormal lipids and heart disease. This helps to assess your future risk for having a heart attack or a stroke.

What is the treatment for high triglycerides?

The goal of treatment is to lower your triglycerides. Patients with very severe hypertriglyceridemia should try to lower their triglycerides below 1,000 mg/dL, to reduce their risk for pancreatitis.

Lifestyle changes.
The first step for lowering triglycerides is to lose weight if you are overweight, exercise often, and eat a
healthy diet low in saturated (bad) fat and sugar. Also, limit the amount of refined, processed grains you eat, such as white bread, rice, and pasta. Follow your doctor’s advice about limiting intake of alcohol, which raises triglycerides in some people.

Besides lifestyle changes, you may also need drug treatment. For mildly or moderately high triglycerides,
your doctor may prescribe one of these types of drugs:

• Fibrates, which greatly lower triglycerides and sometimes raise HDL (good) cholesterol. In the U.S., these
prescription drugs include gemfibrozil and fenofibrate.

• Niacin, or vitamin B3, at doses of 1,000 to 3,000 mg per day, lowers triglycerides and LDL cholesterol and raises HDL cholesterol. These doses apply to immediate-release (released into the body right away) niacin, available by prescription or as a supplement. The dose of sustained-release (released into the body over time) niacin, which is only available as a supplement, shouldn’t exceed 2,000 mg per day because of the risk of liver damage.

• Omega-3 (n-3) fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) lower triglycerides.These polyunsaturated (good) fats are found in fatty fish such as salmon. In high doses, they can treat high triglycerides. You can get high doses of omega-3 fatty acids in a fish oil supplement or by prescription.Your doctor may add a statin to your other drug treatment. Though statins mainly lower LDL cholesterol, they also can decrease triglycerides. Some studies show that statins reduce the risk of heart attacks and strokes. It is unclear if fibrates and niacin prevent heart attacks and strokes. If your triglycerides are above 1,000 mg/dL, though, the first choice of medicine is a fibrate. You may need a statin, too, but
experts advise against treatment with statins alone if your high triglycerides are severe or very severe. Fibrates are better than statins at lowering triglycerides. However, people with liver disease or gallbladder disease should not take fibrates.  Talk to your doctor about the risks and benefits of all these drugs. Medications do not cure the problem of high triglycerides, so you will need to take them long term. However, weight loss and other lifestyle changes can lower high trigylcerides enough to eliminate the need for medication.

Ask your doctor if you should see an endocrinologist. This physician specialist can find and treat hormonal causes of high triglycerides.

© 2012 Hormone Health Network

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