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We now present a few common symptoms and the possible relationships to specific endocrine diseases. Clinical experience is certainly important in interpreting these relationships. Nevertheless, the suspicion that there is something wrong is often the first step toward an accurate diagnosis.

Weakness and increased fatigability are without doubt the most frequent symptom of adults seeking medical diagnosis. In the majority, these complaints derive primarily from emotional or psychological disturbances. When hormone abnormalities are suspected, one should inquire first whether the symptoms have been accompanied by weight loss. If so, insufficiency of the adrenal gland, overactivity of the thyroid, and diabetes mellitus should be considered.

Adrenal insufficiency is usually accompanied by increased pigmentation, low blood pressure, and perhaps salt craving. Hyperthyroidism is suggested by goiter (enlargement of the thyroid gland), bulging eye changes, tremor, and heat intolerance. Sugar diabetes is usually accompanied by excessive urination and increased thirst. Without weight loss, but with symptoms of weakness and fatigability one could consider underactive thyroid, underactive pituitary gland, overactive parathyroid gland with high calcium levels, and hypersecretions of aldosterone, another hormone from the adrenal gland regulating the salt balance. The first of these are associated with hypoactive reflexes, intolerance to cold, dry skin. Hypopituitarism is suggested by delayed or absent menstrual cycle, impotence, decreased tolerance to cold, hypoglycemia, and low blood pressure. Hyperparathyroidism is usually associated with bone pain, kidney stones, and increased urination. Elevated aldosterone levels are accompanied by high blood pressure, muscle weakness, and signs of potassium depletion.

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One of the rapidly growing areas of scientific research involving body processes is the specialty of endocrinology. This science deals with hormones and the related glands producing them. Interacting closely with all hormone mechanisms is the field of nutrition. Dealing primarily with the science of body chemicals, nutrition relates to foods and diseases produced by overabundance or lack of these specific nutrients. It is now generally agreed that hormones do not initiate new events in the complicated chemistry of metabolic processes, but rather produce their effect by regulating enzyme systems of the body. From this one may conclude that a true understanding of any disease and the factors regulating their production. Characteristically, abnormalities in the hormone or endocrine system arise from either an increased or decreased hormone secretion. This deviation from “normal” produces the characteristic syndromes of endocrine disease.

The suspicion that a hormone problem may play a role in the patient’ s illness often comes initially from the physical appearance of a patient. Hypothyroidism or myxedema often produces puffiness of the face and appearance of mental dullness, with drying of the skin, hair loss, and tendency to fluid retention. Overactivity of the thyroid gland, on the other hand produces just the opposite hyperthyroid state, with nervousness, tremor, weight loss, prominence of the eyes, and a continuous perspiration.

Dwarfs and giants are commonly produced from variation in pituitary glands secretions, particularly growth hormone. The adult form of giantism is called acromegaly and occurs after the normal body height has been reached.

This hormone excess often enlarges the hands and feet. Overactivity of the cortex of the adrenal gland, called Cushing’s syndrome produces a characteristic obesity with thin arms and legs, increased tendency to bruising, a hump on the back of the shoulders, and roundness of the face like a full moon. Reduced function of the adrenal cortex is called Addison’s disease. It is characterized by increase pigmentation of the skin, weakness, salt craving, weight loss, and low blood pressure.

A rapid step towards the accurate diagnosis of these hormone problems has come with new laboratory tests, such as the radioimmunoassay. Most of the body’s endocrine hormones can be analyzed now. Although the tests are expensive they are available in most large cities. One single determination of the hormone level does not necessarily establish or exclude an endocrine abnormality. Wide fluctuations in hormone secretions are seen during a twenty-four hour period, Some disorders of the adrenal glands, particularly, may result from a loss of the normal cyclic 24-hour pattern. This is particularly seen in conjunction with disturbed sleep pattern, work schedules, and other tendencies toward irregularity.

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Inability to void may develop abruptly, but is usually preceded by a history of diminished size and force of the urinary system, hesitancy, nocturnal urination, and dribbling. Many of these individuals are older men, having developed gradual prostate enlargement, but scarring and stricture from infection in the urinary tract can also produce these symptoms.

One of the most important ways of relieving these conditions, short of actual surgical cure, is the use of the urinary catheter. Unless the obstruction is severe this soft, flexible tube with a rounded end can be passed successfully into the bladder in most people. The catheter should be sterilized, the opening of the urethra (meatus) cleansed carefully with antiseptic solution, and with appropriate lubrication the catheter passed gently into the bladder. Usually relief is obtained and this technique is easily learned at home thus allowing either for the necessary time to seek medical care or a chronic relief in older patients deemed unsuitable for surgery.

The Foley catheter, which contains an inflatable balloon, can be used for indwelling drainage of the bladder. This, connected to a closed, sterile system of collection can provide comfort for a longer time. However, infection may result from the presence of this foreign substance after only two to three days. In association with gentle catheter placement techniques, bladder irrigation may be learned.

Different patients require varying intervals between catheter change and this can often be prolonged by the use of irrigating solutions. Some of these inhibit bacterial formation and others improve patency of the catheter by reducing bladder sludge. All instrumentation of the bladder may produce hematuria or the presence of blood. Persistence of this and other urinary symptoms should cause a patient to seek counsel from a competent physician.

Although the urinary tract is complex and mysterious it is usually amenable to simple home remedies. The early use of these preventive measures can frequently restore health before chronic illness or disability becomes a problem.

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Injury to the urinary tract may at times produce blood in the urine. This is particularly a problem in contact sports, since the kidneys are easily traumatized. Long distance runners also frequently show signs of kidney damage with elevated enzymes and blood in the urine. This may be related not only to the metabolic breakdown of muscle during severe exercise, but also to the dehydration that results from profound sweating. In most cases of urinary trauma where the urethra, bladder, or ureters have not been ruptured bed rest combined with hot packs and adequate fluid intake will produce a rapid cure.

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Failure of the kidneys to form urine properly can be either of an acute or chronic nature. The acute types are called nephritis, referring to the inflammation of the functional kidney complex. This may occur in conjunction with a Strep. throat or other bacterial infection. At times it develops suddenly, associated with protein loss, edema, and high blood pressure. These cases need to be evaluated with laboratory tests and medical expertise. But several simple approaches are helpful.

First of all it is important to recognize the influence of diet on kidney function. Many years ago it was discovered that a high protein diet predisposes to kidney complications. For this reason it is wise to avoid an excess of animal products, particularly flesh foods. Adequate fluid intake is also important. In treating these symptoms hot packs as well as hydration will be beneficial.

Chronic failure of the kidneys frequently produces metabolic disturbances in water, sodium, potassium, calcium, and acid-base balance. The onset of renal failure is usually insidious. Excessive formation of urine and passage of urine at night may be only signs at first. Later a patient complains of feeling weak, fatiguing easily, sleeping poorly, and becoming slightly breathless. The appetite is lost and there is a bad taste in the mouth. Nausea, especially in the morning or anemia may be present. With increasing kidney failure, a person becomes lethargic, may develop twitching of the limbs, hemorrhages, and eventually develops a breath with an odor of urine, dry skin, and if not treated may progress into a coma and die.

Therapy of kidney failure demands an early determination of the cause. The role of dietary protein is very important. To reduce the blood urea accumulation a good quality protein is used with restriction in quantity to around 20 gm. daily. Sweating treatments may help eliminate toxins through the pores. The most efficacious are usually the hot blanket pack or steam bath. However, the latter is not advised (contraindicated) in severe hypertension.

Scientific research has offered a number of artificial approaches to kidney disease, such as dialysis of the blood (hemodialysis) or abdominal (peritoneal) fluid, and even transplants from a healthy donor. All of these have hazards, however, and if approached early and controlled, many cases of chronic kidney failure can be arrested.

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