2023-08-23 07:48:00
Endocrinology, what is it?
It is the medical discipline that treats diseases of the glands of the endocrine system and which may or may not sometimes require medication, diet or surgery depending on the case. Namely: the main glands are the hypothalamus, the pituitary gland, the thyroid, the parathyroid glands (4 in number), the islets of the pancreas, the adrenals, the testicles in men and the ovaries in women. “These are complex sets which explain why certain university hospitals have specialized in some of them: hypothalamus, thyroid, etc.”, points out Dr. Jean-Michel Lecerf.
Beyond the endocrine glands, there are also other tissues or organs that make hormones : adipose tissue, the intestine, the muscles… but which are often not always at the center of the activity of endocrinologists. “These specific skills will therefore depend on the endocrinologist specialist”, specifies the specialist in metabolic diseases, Jean-Michel Lecerf.
What about liberal endocrinologists?
The endocrinologists installed in private practice in town, will mainly take care of the most frequent endocrine diseases (thyroid diseases, diabetes, etc.). From time to time, they will have rare cases which will sometimes be able to be treated or entrusted to other specialists (specialised university hospital centres). Like all medical specialties, endocrinology is evolving a lot, which is why it could be recommended to seek advice from an endocrinologist regarding pathologies and their complications.
When to see an endocrinologist to lose weight? (alarming symptoms)
Knowing that there are approximately and only 1000 endocrinologists in France, whereas 47.3% of French adults are overweight and 17% obese (source 1), it would be better to skip a consultation if you are just 4 kilos overweight when you return from vacation. On the other hand, in the event of a body mass indicator (BMI) > 40, or a unexplained and lasting weight gain over several weeks, appearance of stretch marks, increased hairiness that settles on certain parts of the body, signs of insulin deficiency (unusual tirednessthirst, etc.), cutaneous signs of insulin resistance (gray patches in the neck), fatty liver or even infertility or thyroid disease in the family… In these cases then, it is advisable to take opinion of an endocrinologist.
Do you need a medical prescription to see an endocrinologist?
If he isn’t no need to have a medical prescription to consult an endocrinologist, some secretariats still reserve the right to require it because of the relatively long waiting times (sometimes up to two years). “The endocrinologist follow-up is long and sometimes requires a consultation per quarter”, explains Dr Jean-Michel Lecerf.
It would be better to first consult your general practitioner who will be able to assess the need and the urgency of a consultation with an endocrinologist. Dr. Jean-Michel Lecerf.
Are all endocrinologists specialized in weight loss?
The endocrinologist is normally also a nutritional specialist but some are not very interested in it. “In this case, very often they will inform the patient and say I have eliminated the risk of endocrine diseases now I recommend you to my colleague (doctor-nutritionist, cardiologist, etc.). Or conversely, an endocrine disease is proven but the problem is serious enough for me to refer you to an endocrinologist or to a bariatric surgery center”, nuances Dr. Jean-Michel Lecerf, endocrinologist.
Why go to an endocrinologist for overweight problems? What support: type of test, analysis, etc.?
The endocrinologist will first request a biological assessmente to rule out and diagnose the risk of major endocrine diseases (ovarian problem, thyroid disorder, etc.). He will also make a metabolic balance to detect insulin resistance (the HOMA index) and any associated metabolic abnormalities (cholesterol, hepatic abnormalities, diabetes, etc.)
In the event of stretch marks, localized weight gain in the trunk (Cushing’s syndrome) or even excessive hair growth, the specialist may also prescribe a blood test for cortisol and androgens, systematically requesting a thyroid test ( TSH test). “Depending on the results obtained, he will judge whether it is necessary to go further by possibly performing a thyroid or hepatic ultrasound”, continues Dr. Jean-Michel Lecerf.
“Not forgetting the interrogation work carried out from the first session to learn more about the patient’s history: psychological aspect (eating behavior disorder present or not), repeated diets, family obesity problems, type of eating habits…”, adds the specialist in endocrinology and metabolic diseases. This first consultation may last about 45 minutes or be split into several visits, with a shorter time depending on each consultation.
Endocrinologist who prescribes a diet sheet, distrust!
Sometimes for lack of time, the bad habit of some endocrinologists would be to prescribe a diet sheet to the overweight patient. “Except that’s a disaster. It is useless and may even induce an eating disorder. What is really necessary to manage a weight problem on an endocrinological scale is to have a general vision and to work, if necessary, in a network with other medical disciplines (cardiologist, gynecologist, doctor-nutritionist, behavioral dietician or psychologist in the event of eating disorders in particular)”, specifies the specialist.
How is a treatment carried out in connection with a problem of overweight/obesity (duration of treatment, type of medication, multidisciplinary follow-up, etc.)?
It’s a real long-term follow-up, sometimes there are drug indications (like GLP-1 analogues) prescribed and as a last resort, bariatric surgery. “Obesity is a complex chronic disease that requires multidisciplinary approach (the general practitioner or endocrinologist coordinates with other specialists: hepatologist, cardiologist, gynecologist, psychologist, etc.; but also with professionals who support physical activity (sports coach, physiotherapist, etc.).
Prevention as the final word
Given the complexity of treating overweight problems, it would be better to deal with weight gain fairly quickly, as soon as the first excess pounds appear. “If you can’t do it alone, get help from a nutritionist-dietician or even a doctor-nutritionist who themselves could detect a possible endocrine disorder and refer you to an endocrinologist. In the end, you will understand, Prevention is better than cure especially when we know that appointment times are very long and that obesity is a chronic disease,” concludes Dr. Lecerf.
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