Experience In Endocrinology & Metabolism: 10+ years
- Fellow of Royal College of Physicians (FRCP), Edinburgh UK
- Fellow of American College of Endocrinology (FACE)
- Specialty Certificate (Endocrinology & Diabetes) from the Federation of Royal Colleges of Physicians of the United Kingdom, the Association of British Clinical Diabetologists and the Society for Endocrinology (MRCP, UK),
- Diplomat of National Board (DNB) Endocrinology from National Board of Examinations, New Delhi
- Doctorate in Medicine (DM) Endocrinology from Institute of Post-graduate Medical Education & Research (IPGMER) & Seth Sukhlal Karnani Memorial (SSKM) Hospital, Calcutta
- Doctor of Medicine (MD) Medicine from Calcutta Medical College& Hospital (CMCH) Calcutta, India
- Bachelor of Medicine & Bachelor of Surgery (MBBS) from Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry University, India
"Chairman, Department of Endocrinology, Cedar Superspecialty Clinics & Cedar Path Labs, Plot 107 & 108, SECTOR 12A, Dwarka, New Delhi, India"
He has published >200 research papers in different international journals in endocrinology, pediatrics and medicine with >2500 citations. He is in the review board of various international journals. He has presented research papers in different countries across the globe (USA, Germany, Spain, Israel, China and the middle east). Has undergone training in advanced molecular methods in diabetes at the Hanover Medical School, Germany in 2014.
- Chairman, Department of Endocrinology, CEDAR SUPERSPECIALTY CLINICS & CEDAR PATH LABS, SECTOR 12, Dwarka, New Delhi, India
- Former Head of the Endocrinology Department, Venkateshwar Hospitals, Dwarka, New Delhi
- Former A. Professor Endocrinology, Member Ethics Committee & Institutional Review Board for MD/MS and DM/Mch, PGIMER & Dr. RML Hospital, New Delhi
Frequently Asked Questions
Endocrinology is a branch of medicine that concerns the study of hormones and its disorders. The endocrine system consists of several glands located in different parts of the body that secrete hormones.
Endocrinologists are doctors who specialize in study of hormonal diseases like diabetes, thyroid disorders, obesity, growth disorders, etc.
The principal endocrine glands in our body are Pituitary, Thyroid, Pancreas, Adrenal, Parathyroid, and Gonads – ovary and testis. Besides hormones are secreted by various other organs like brain (hypothalamus), heart, kidney, gut, placenta, breasts, etc. The pituitary is considered as a master gland and governs the function of other endocrine glands in the body.
These are products of various endocrine glands, which are released in to the bloodstream, which then acts on various cells and tissues of body.
The endocrine disorders are a varied group of diseases resulting from deficiency or excess of various hormones.
2. Thyroid disorders
4. Sexual disorders, erectile dysfunction, hypogonadism & reproductive endocrinology
5. Male infertility
6. Hirsutism (Excessive facial or body hair in females)
7. Polycystic ovary syndrome (PCOS) and other female endocrine disorders
8. Disorders of growth – Short Stature, Growth hormone deficiency & Growth hormone excess.
9. Delayed & premature puberty (delayed or early development of various secondary sexual characters in boys or girls).
10. Osteoporosis (low bone density)
11. Metabolic bone diseases - Vitamin D deficiency, Rickets, Osteomalacia, Hyperparathyroidism
12. Pituitary disorders - pituitary tumors, raised pituitary hormone levels (e.g. Prolactin, GH, etc.), deficiency of pituitary hormones, diabetes insipidus
13. Adrenal disorders - Adrenal tumors, Cushing’s syndrome, Pheochromocytoma, adrenal failure
14.Disorder of Sexual Development - Small penis, hidden testis, genital ambiguity, gynecomastia (development of breast tissue in males), Turner’s syndrome, Klinefelter’s syndrome.
1. Type 1 Diabetes: Type 1 Diabetes develops if the body is unable to produce any insulin. This type of diabetes usually develops before the age of 30 years. Type 1 Diabetes is treated with daily insulin injections, a healthy diet and regular physical activity.
2. Type 2 Diabetes: Type 2 Diabetes develops when the body can still make some insulin, but not enough or when the insulin that is produced does not work properly (known as insulin resistance). Type 2 diabetes is treated with a healthy diet and increased physical activity. In addition to this, medications and/or insulin are often required.
3. Gestational Diabetes: Gestational diabetes develops in 5% to 10% of all pregnancies but usually disappears when the pregnancy is over. Women who have had gestational diabetes are at an increased risk (up to 50%) of developing type 2 diabetes later.
Indians in general are more predisposed for developing Diabetes. In addition, other risk factors are:
1. If any of your close family member has diabetes (parent, brother or sister)
2. Overweight or obese (Body mass index more than 23)
3. Habitual physical inactivity
4. Women who delivered a baby weighing >3.5 kg or were diagnosed with diabetes during pregnancy
5. High blood pressure
6. Those with high blood cholesterol
7. Women with Polycystic ovary syndrome (PCOS)
8. Heart disease patients
When a child is diagnosed with type 1 diabetes it not only affects the child’s life but the family as a whole. The process of learning about diabetes and making adjustments continues for a long time, may be years and in this journey many times one question arises, “why does my child has type 1 diabetes” or a teenager may think, “why do I have diabetes”?
Type 1 diabetes is not caused by wrong eating habits or lifestyle nor is it a sin or punishment. The question still remains unanswered as to why some children get it. The answer to this question is not as important as is the fact that with the help of regular insulin injections, proper monitoring and incorporation of nutritious foods and physical activity into each day, one can enjoy a relatively normal, healthy life.
Every day technology for taking insulin is changing. Now we have finer thin and small needles, which are almost painless. We have smart glucose monitoring devices and somewhere research to find a cure is making progress. While we are not there yet, in our vision of changing diabetes we always hope to find a cure for type 1 diabetes.
1. Frequent urination
2. Increased thirst
3. Sudden weight loss
4. Increased hunger
5. Always tired
6. Wounds that won`t heal
7. Blurring of vision
8. Sexual problems
9. Vaginal infection
10 Tingling or numbness in hands or feet
Majority of diabetics in fact do not have any symptoms. After the age of 45 years all people should get their blood sugar checked routinely even in the absence of symptoms and risk factors. If your blood sugar is normal you should get it checked every 3 yearly.
You need to get your blood sugar checked in fasting as well as 2 hours after taking 75gms of glucose. You should consult your doctor for all precautions & information prior to testing.
Poorly managed diabetes can lead to various complications like blindness, kidney failure, neuropathy, heart attack, paralysis, sexual and urologic problems. Although diabetes cannot yet be cured, it can be successfully managed. In order to stay away from complications, it is important that your blood glucose is adequately controlled. Eating a balanced diet, managing your weight and following a healthy lifestyle together with taking your prescribed treatment and regular monitoring is important.
- - Every visit - blood glucose, blood pressure, foot examination.
- - 3 monthly - HbA1C (Glycated hemoglobin)- This test gives estimate for average blood sugar control over past 3 months
- - Yearly - Kidney function test (KFT), lipid profile, fundus for diabetic retinopathy, urine for mirco albumin.
- Pre meal blood sugar- 70–130 mg/dL
- Post meal blood sugar-<180mg/dl.
- HbA1C (Glycated hemoglobin)- <7.0%
- Blood pressure- <130/80 mmHg
- LDL cholesterol-<100 mg/dL.
A thyroid gland is an endocrine gland; which manufactures thyroid hormone that is essential for the function of every tissue in the body.
The thyroid gland is located in the lower part of the neck.
The thyroid gland produces thyroid hormones which it secretes into the bloodstream, which then act to affect cells and tissues in other parts of the body. Thyroid hormones regulate the speed at which your body cells work. Thyroid hormones also help children grow and develop
Hypothyroidism (underactive thyroid gland)
Hyperthyroidism (overactive thyroid gland)
Goiter (enlargement of thyroid gland, visible as neck swelling)
Thyroid malignancy (cancer of thyroid gland)
Hypothyroidism means that the thyroid gland can`t make enough thyroid hormone to keep the body running normally.
Most cases of hypothyroidism are caused by a condition called Hashimoto's thyroiditis, in which a patient's immune system attacks and destroys the thyroid. Iodine deficiency used to be a common cause in India but after iodized salt became widely available has now become rare. It can also be caused by treatment of hyperthyroidism or by certain medications, and it may be present from birth.
Common complaints include fatigue and lethargy, cold sensitivity, dry skin and lifeless hair, impaired concentration and memory, increased weight, puffiness and constipation. Patients may also fairly often experience a hoarse voice, tingling of the hands, heavy or delayed menstrual periods, deafness and joint aches. In childhood there may be delayed development and puberty. Some patients have a swelling in the front of the neck due to thyroid enlargement (a goiter).
Yes. Many patients have relatively few of the classical signs or symptoms just listed. In fact, nowadays most patients often are diagnosed at an early stage of disease, due to increased awareness and improved testing
Your doctor will be able to get a good assessment of your thyroid gland activity by taking a history of your symptoms and by a physical examination. However to confirm the diagnosis, it is necessary to get laboratory tests that measure thyroid function test (TFT; serum T4 and TSH levels).
With synthetic thyroxine (T4). Thyroxine (T4) is the major hormone produced by the thyroid gland and pure synthetic T4, taken once daily by mouth, successfully treats the symptoms of hypothyroidism in most patients. The current branded forms of synthetic T4 are Eltroxin, Thyronorm, Thyrox, Thyroup, Thyrofit,Thyobuild, Lethyrox, Thyrocheck etc. Because of variations in the potency of T4 made by different manufacturers, including generic preparations, it is best to stay on T4 from a single manufacturer whenever possible.
It depends on diagnosis. It can be a few months as in case of viral thyroiditis. However, in most cases, you may have to take treatment lifelong so as to keep your hormone levels in normal range.
If too much of the thyroid hormones are secreted, the body cells work faster than normal, and you have thyroid overactivity or 'hyperthyroidism' (also referred to as "thyrotoxicosis").
Common complaints include fatigue, heat intolerance, sweating, weight loss despite good appetite, shakiness, inappropriate anxiety, palpitations of the heart, shortness of breath, tetchiness and agitation, poor sleep, thirst, nausea and increased frequency of defecation, enlarged thyroid gland and prominent or bulging eyes. Children tend to have hyperactivity, with a short attention span. It is not uncommon for people to worry that they have cancer, because of the associated weight loss.
Goitre is an enlargement of the thyroid Gland, which is situated in front of the neck. In many cases it is related to abnormal thyroid hormone levels.
Yes, it is possible.
If too much of the thyroid hormones are secreted, the body cells work faster than normal, and you have thyroid overactivity or 'hyperthyroidism' (also referred to as "thyrotoxicosis").
Obesity is a medical condition that occurs when a person weighs considerably more than is considered healthy. This extra weight can put extra strain on the body and serious health complications can arise if treatment is not sought and the weight is not lost.
BMI is a way medical professionals check if you are at a healthy weight for your height. BMI is calculated as -Weight in kilograms/ (height in meter)2 For example if your weight is 60 kg and height is 160 cm = 1.60 m, your BMI will be 60/1.60x 1.60 = 23.4
As per World Health Organization (WHO) criteria, your BMI should fall between 18.5 and 24.9 to be normal. If your BMI is between 25 and 29.9 you are overweight. A BMI ≥ 30 classifies you as obese. People who have a BMI of ≥ 40 fall into the ‘morbidly obese’ weight bracket.
The terms Polycystic Ovary Syndrome (PCOS) and Polycystic Ovarian Disease (PCOD) are commonly used interchangeably. It is a hormonal problem commonly seen in young girls and ladies.
Irregular cycles Hirsutism (excess facial/body hair in females) Excessive acne Excessive scalp hair loss Lack of, or infrequent ovulation resulting in difficulty to conception Ovarian Cysts or enlarged ovaries in ultrasound High levels of testosterone Chronic pelvic pain
PCOD is most common hormonal problem/endocrine disorders in females in reproductive age group. Almost 10-15 % of girls and women have PCOD.
Washing your hands with soap and water or using alcohol-based hand rub kills viruses that may be on your hands.
When someone coughs or sneezes they spray small liquid droplets from their nose or mouth which may contain virus. If you are too close, you can breathe in the droplets, including the COVID-19 virus if the person coughing has the disease.
Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.
Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell. Most people (about 80%) recover from the disease without needing special treatment. Around 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. Older people, and those with underlying medical problems like high blood pressure, heart problems or diabetes, are more likely to develop serious illness. People with fever, cough and difficulty breathing should seek medical attention.
There is no specific medicine to prevent or treat coronavirus disease (COVID-19). People may need supportive care to help them breathe.
If you have mild symptoms, stay at home until you’ve recovered. You can relieve your symptoms if you:
- - Rest and Sleep
- - Weep Warm
- - Drink Plenty of Liquids
- - Use a room humidifier or take a hot shower to help ease a Sore Throat and Cough
If you develop a fever, cough, and have difficulty breathing, promptly seek medical care. Call in advance and tell your health provider of any recent travel or recent contact with travelers.
The following measures ARE NOT effective against COVID-2019 and can be harmful:
- - Smoking
- - Wearing multiple masks
In any case, if you have fever, cough and difficulty breathing seek medical care early to reduce the risk of developing a more severe infection and be sure to share your recent travel history with your health care provider.
Currently, the source of SARS-CoV-2, the coronavirus (CoV) causing COVID-19 is unknown. All available evidence suggests that SARS-CoV-2 has a natural animal origin and is not a constructed virus. SARS-CoV-2 virus most probably has its ecological reservoir in bats. SARS-CoV-2, belongs to a group of genetically related viruses, which also include SARS-CoV and a number of other CoVs isolated from bats populations. MERS-CoV also belongs to this group, but is less closely related.
The virus that causes COVID-19 is mainly transmitted through droplets generated when an infected person coughs, sneezes, or speaks. These droplets are too heavy to hang in the air. They quickly fall on floors or surfaces.
You can be infected by breathing in the virus if you are within 1 metre of a person who has COVID-19, or by touching a contaminated surface and then touching your eyes, nose or mouth before washing your hands.
Testosterone is commonly referred to as ‘Male hormone’. It is a hormone secreted mainly from testes. Small amount of testosterone is also synthesized in females from ovaries. Testosterone results in development and maintenance of secondary sex characters in males and necessary for normal sexual life in males (for example, penile enlargement, facial hair, interest in sex). The testosterone levels are regulated by hormones released the hypothalamus and pituitary glands in the brain.
Hypogonadism is the failure of the body to produce sufficient testosterone to meet the body`s needs. Hypogonadism can be because of testicular failure or due to problem in the pituitary gland or hypothalamus.
Low libido (decrease in desire for sex) Erectile dysfunction (decrease in penis erection leading to sexual dissatisfaction) Decrease in frequency of shaving Decrease in body hairs Gynecomastia (enlargement of breast tissue in males) Lethargy, general malaise, depression, and mood swings It can also result in increased risk for many diseases including Osteoporosis, Alzheimer’s, Diabetes, Arthritis and/or Cardio-vascular problems.
Some people are born with it, due to a genetic problem. Others acquire it because of reasons like environmental effects, alcohol intake, and smoking, drugs, (prescribed or otherwise), various systemic illness or injury.
Blood test for serum testosterone and other hormones like LH and FSH may be required to diagnose hypogonadism. You should consult Endocrinologist to get the required tests done and for precautions before the test.
It depends on the cause of hypogonadism. At present, this condition is fully treatable. Commonly testosterone supplements are used in various forms depending on patient preference. One should consult Endocrinologist before starting treatment.
Erectile dysfunction (ED) is defined as the inability of a man to achieve and maintain an erection sufficient for mutually satisfactory intercourse with his partner.
Approximately 50% of men over the age of 40 have some degree of erectile dysfunction – some mild, some severe. So, erectile dysfunction is very common. However, most men don’t seek help with a doctor. It’s estimated that only about 10-15% of men with Erection problems seek help, despite the fact that effective treatments are available. Embarrassment, fear, and discomfort talking about the subject and inability to find a right doctor, keep many men from the treatment they need to help themselves and their partners.
Causes of erectile dysfunction can be physical and psychological. Reduced blood flow to the penis and leakage of blood out of the penis are the most common causes. A partial list of the many causes of ED includes the following: Hormonal imbalances Diabetes Heart and vascular (blood vessel) disease Neurological disorders Chronic diseases (kidney or liver failure) Drug and alcohol abuse Side effects of some medications (antidepressant) Psychological causes like work-related stress and anxiety, concern about sexual performance, marital or relationship problems, or depression
No. Years ago, doctors felt that ED was caused by 90% psychological problem and 10% by physical problems. Now doctors know the opposite is true. About 90% of Erection problems are caused by physical problems with the blood vessels, veins, or nerves and only about 10% of cases are due primarily to psychological issues. Although, it is very common to have some degree of anxiousness, stress or even depression in patients with erection problems, but most often these come after a physical problem caused the erection problem, not before.
Premature ejaculation is often confused with erectile dysfunction. Premature ejaculation is a condition in which the entire process of arousal, erection, ejaculation, and climax occur very rapidly, often in just a few minutes or even seconds, leaving the partner unsatisfied. Premature ejaculation may accompany an erection problem such as erectile dysfunction, but is generally treated differently.
Infertility may result from a physical condition that is present at birth or that develops later in life. Examples of causes of male infertility include: Physiological dysfunctions, Hormonal imbalances, Testicular failure, Lifestyle factors etc.
Short height is defined when child is short compared to age and sex matched children in respect to parents height.
Once the bones (epiphysis) are fused; height cannot be increased further. Many short children are brought to Endocrinologist so late that bones have already fused and nothing can be done then for increasing height. Almost best outcome are possible when treatment is started earliest in any case of growth disorder.
If he/she is shorter as compared to his/her classmates If child is not outgrowing his/her clothes & shoes He/she is gaining height less than 4-5 cm/year Heavier than his/her friends If you suspect any of above thing in your child; you should consult your doctor
In children the various hormones (as growth hormone, thyroid hormone, and sex hormones), plays the role in normal height gain. Also many nutrients are also required for potential height growth.
Hormone Disorders- Growth hormone deficiency, thyroid hormone deficiency, etc. Malnutrition and Mineral Deficiencies- Under nutrition (of calorie, protein), Vitamin D deficiency, Calcium deficiency, Iron deficiency, etc. Systemic Diseases- Diseases of the kidney, liver, heart, lungs or any body system can affect growth. Familial short stature – if parents have short height Constitutional delayed growth with or without delayed puberty Other genetic disorders such as Turner syndrome Idiopathic Short Stature – if no cause could be found for short stature
Growth hormone is a natural protein produced by the pituitary gland; an endocrine gland found in the brain. A child needs growth hormone for growth and body development during childhood.
Growth hormone deficiency (GHD) is one of the causes of short stature. GHD means that the child’s body does not make enough growth hormone.
Without treatment a child with GHD will usually grow less than 4–5cm (~2 inches) a year. Quite often, the child will grow normally until the age of 2 or 3 and then growth begins to slow down. It’s important to realize that a child may be smaller than average, but will have normal body proportions. In other words, children with GHD tend to seem younger and have more body fat than children of the same age who are growing normally. Children with GHD are generally perfectly healthy in every other aspect.
GHD needs to be tested when other causes of lack of growth have been ruled out. You need to consult an Endocrinologist if your child is not growing normally. A child may have to take a special medicine to stimulate the pituitary gland, which is where growth hormone is produced within the body. In children with GHD, the pituitary gland releases far less growth hormone than normal in response to this stimulation. It is very important to understand that random estimation of single growth hormone value has no role in the diagnosis of GHD.
Once a child is diagnosed as having GHD, growth hormone injections can help the child catch up with the growth of other children of the same age during early childhood. Continuing the injections helps maintain normal growth later in childhood, with the final aim of achieving an adult height within the normal range. The response to growth hormone treatment varies from one individual to another, but most children who receive treatment over several years will reach a normal or near normal adult height.
Growth hormone injections are normally given once-daily in the evening. At the beginning parents are trained to give these injections if the child is very young. Later on, children can inject themselves when they feel confident enough. Devices are now available that make injecting growth hormone much simpler, more comfortable and less painful.
The earlier the treatment started in a child with GHD; the better the prospects of their eventually reaching normal adult height.
If a child doesn’t grow as fast as other children, this can have an impact on the whole family. Many children who are shorter than their schoolmates may experience emotional problems, bullying and difficulties with daily activities such as sports. For these reasons, it’s important to explain to a child that things will improve once the growth hormone treatment has been working for a while. In the meantime, remember to act towards a child according to the age they actually are, not the age they look.
In most cases treatment with growth hormone is needed until the end of puberty till the bones fuses. However, many people will benefit from growth hormone treatment for many years after that; especially those who have severe GHD.
Osteoporosis is a condition in which bones become weak due to decrease in the amount of mineral & bony material in a particular bone characterized by low bone mineral density (BMD). Osteoporosis makes your bones weak and more likely to break. Bones that are affected by osteoporosis can fracture with only a minor fall or injury that normally would not cause a bone fracture.
Anyone can develop osteoporosis, but it is common in older women. As much as 50% women and 25% men older than 50, will have a fracture due to osteoporosis. Risk factors for osteoporosis include- Getting older Being small and thin Having a family history of osteoporosis Taking certain medicines like steroids and ant seizure drugs Being a white or Asian woman Hypogonadism (deficiency of estrogen or testosterone in females and males respectively) Premature menopause in females Thyroid hormone excess/Hyperthyroidism Calcium deficiency & Vitamin D deficiency Drinking large amount of alcohol Heavy Smoking Other systemic diseases like Malabsorption, rheumatoid arthritis, chronic liver disease etc.
Osteoporosis is typically a silent disease. You might not know you have it until you break a bone. Patients typically have fracture with little or no trauma as fall on ground. The most common fractures are spinal bones, hip bone and wrist in people with osteoporosis. Symptoms occurring late in the disease are bony pains, back pain or pain on compression of the bone. Loss of height may occur because of vertebral fractures over time leading to decrease in height of vertebra.
A bone mineral density (BMD) test is the best way to check your bone health. BMD test can measure bone density in various sites of the body, such as the hip, spine, and wrist. Most commonly it is done by through dual-energy x-ray absorptiometry (DEXA) scan. These tests are quick (taking less than 15 minutes), painless, and noninvasive. A bone density test can detect osteoporosis before a fracture occurs and can predict your chances of having a fracture in the future. You should consult your doctor to know more about these tests.
To keep bones strong, eat a diet rich in calcium and vitamin D by drinking milk or eating milk products and taking vitamin D supplements, exercise and do not smoke. Avoid excessive intake of alcohol.
Osteoporosis treatment includes both lifestyle changes and medications. Treatment programs focus on nutrition, exercise, and safety issues to prevent falls that may result in broken bones. Your doctor may prescribe a medication to slow or stop bone loss, increase bone density, and reduce fracture risk.