Endocrinology

Our Services

Endocrinologists are sub-specialty trained internists with special knowledge to care for individuals with disorders of hormone-secreting glands. Examples of specific disorders we treat are:

• Diabetes Mellitus - As the principal physicians concerned with diabetes control, we will lead a team approach to prevent complications. A Certified Diabetes Educator, Certified Dietician, ophthalmologist, podiatrist, primary and family physicians are usually part of the team.
• Thyroid disorders - hyper or hypothyroidism, thyroid nodules, goiter and thyroid cancer.
• Pituitary disorders - either excess secretion or decreased secretion, tumors/prolactinoma.
• Osteoporosis and Metabolic bone diseases - treatment and prevention.
• Hypercalcemia - often due to hyperparathyroidsim.
• Abnormalities of cholesterol and triglycerides - elevated LDL cholesterol, elevated triglycerides and low HDL cholesterol (good cholesterol) are often the result of a genetic or familial component, and can contribute to heart disease risk.
• Hirsutism - caused by an increased level of androgens (male hormones) or an oversensitivity of hair follicles to androgensis. It is a symptom rather than a disease and may be a sign of a more serious medical indication.
• Disorders of sex hormones - occur when there is either an overproduction or underproduction of the hormones responsible for sexual characteristics and development.

Ultrasound Guided Biopsy

A biopsy is performed to remove some cells from a suspicious area and examine them under a microscope to determine a diagnosis. We use ultrasound guidance for the fine needle aspiration biopsy procedure, which uses a very small needle to extract fluid or cells from the abnormal area. In an ultrasound-guided biopsy, ultrasound imaging is used to help guide the physician's instruments to the site of the abnormal growth.

Lumps or abnormalities in the thyroid gland can be detected during a routine physical exam, or by an abnormal image of the thyroid. It is not always possible to tell from these imaging tests whether a growth is benign or cancerous, and a biopsy may be necessary. However, nodules on the thyroid are usually benign (less than 15 percent turn out to be malignant).

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. In medicine, ultrasound is used to detect changes in appearance and function of organs, tissues, or abnormal masses, such as tumors. As the high-frequency sound waves bounce off of internal organs, fluids and tissues, these waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on a monitor.

Benefits

• The procedure is less invasive than surgical biopsy, leaves little or no scarring and can be performed in less than an hour.
• Ultrasound-guided biopsy reliably provides tissue samples that can show whether the tissue sampled is benign or malignant.
• With ultrasound it is possible to follow the motion of the biopsy needle as it moves through the body tissue.
• Ultrasound-guided biopsy is less expensive than stereotactic biopsy.
• Recovery time is brief and patients can soon resume their usual activities.

Source: Radiology Info a radiology information resource for patients.

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Diabetes Care

Dr. Sharon Selinger and Dr. Matthew Surgan offer comprehensive diabetes care, including diabetes education and management. Diabetes is a disease caused by a lack of the hormone, insulin, or by an inability of the body to use insulin efficiently.

Diabetes effects all of us at one time or another, either through a personal diagnosis or through a friend or loved one. By providing you with knowledge and resources we hope that we can assist you take control of diabetes and continue to live a long and healthy life.

Diabetes Education

Patient education is an essential component of diabetes care and treatment. All classes are taught by board certified endocrinologists, certified diabetes educators, and registered dietitians.

You will have the opportunity to meet with the diabetes educators on an individual basis. The appointments will focus on your particular concerns including management of blood sugar, blood pressure, and cholesterol, weight loss, and any other aspects of diabetes care that you wish to pursue. Individual attention allows you to make immediate changes and get immediate results.

Every patient starting an insulin regimen will receive appropriate training by one or more of our professional staff. Insulin regimens consist of a thorough explanation of the insulin prescribed by your endocrinologist, injection techniques, and the proper use of insulin syringes, pens, and pumps. A review of pertinent issues such as hypoglycemia, sick day treatment, and blood glucose monitoring is completed for every individual.

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Diabetes: Continous Glucose Monitoring

A continuous glucose monitoring system (CGMS) is an FDA-approved device that records glucose levels throughout the day and night. There are a number of technologies that are being tested but the only approved device -- Medtronic's MiniMed device-can provide up to 288 glucose measurements every 24 hours. The system is used to measure an average blood glucose for up to 3 days, while the person with diabetes continues daily activities at home.

How Does the Device Work?

First, a tiny glucose-sensing device called a "sensor" is inserted just under the skin of your abdomen. The insertion is quick, and is usually not painful. It's very similar to insertion of an insulin pump catheter. Tape is used to hold it in place.

The sensor measures the level of glucose in the tissue every 10 seconds and sends the information via a wire to a pager-sized device called a "monitor" that you attach to a belt or the waistline of your pants. The system automatically records an average glucose value every 5 minutes for up to 72 hours.

Results of at least four finger stick blood glucose readings taken with a standard glucose meter and taken at different times each day are entered into the monitor for calibration. Any insulin taken, exercise engaged in, and meals or snacks consumed are both entered into a paper-based "diary" and recorded into the monitor (by pushing a button to mark the time of the meals, medication, exercise, and other special event you wish to record).

After 3 days, the sensor is removed at the doctor's office and the information stored in the CGMS is downloaded into a computer. You and your doctor or diabetes health care team can then review your glucose levels in relation to the other data collected and make any necessary adjustments in your diabetes management plan. The information will be presented as graphs or charts that can help reveal patterns of glucose fluctuations.

When Is the Device Used?

The CGMS is not intended for day-to-day monitoring or long-term self-care and it is not a replacement for standard blood glucose monitoring. It is only intended for use to discover trends in glucose levels. This helps your health care team make the most appropriate decisions regarding your treatment plan.

The main advantage of continuous glucose monitoring is that it can help identify fluctuations and trends that would otherwise go unnoticed with standard HbA1c tests and intermittent finger stick measurements.

For example, the device can capture dangerously low overnight blood glucose levels which often go undetected, reveal high blood sugar levels between meals, show early morning spikes in blood sugar, evaluate how diet and exercise affect blood sugars, or provide up to a 72-hour complete review of the effects of changes made to your therapy by your health care team.

Your doctor can prescribe the procedure as often as he or she believes it necessary to properly evaluate your blood glucose patterns. Continuous monitoring is reimbursed by Medicare and covered by many private insurance plans (check with your individual carrier).

Source: WebMD

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