The increasing prevalence of certain endocrine disorders has the potential to seriously impact public health. This is often due to the nature of the consequences of the disorder and the difficulty in preventing certain diseases. Endocrine disorders can affect people of all ages but can have profound effects on the elderly and young. Changes to the state of health in these age groups are important as the elderly represent an increasing proportion of the population, and the health of the young can have lasting effects on the health of future generations.
An important aspect of public health comes from endocrine disorders and their impact on the health of the population. Hormones have a profound effect on our everyday health and well-being, and any imbalance can have a far-reaching effect. Endocrine disorders can be difficult to diagnose due to the nature of the symptoms and the slow onset. The effects are often subtle and can be mistakenly attributed to other causes. Symptoms can often be masked by the normal aging process or can be mistaken for symptoms of mental health issues.
2. Prevalence of Endocrine Disorders
The presence of endocrine diseases (EDs) is very hard to measure and reliable data on their prevalence are scarce. As a general observation, their prevalence seems to be increasing in recent years in all European countries. This statement is only partly true because the increased frequency of certain EDs such as type 2 diabetes and obesity is counterbalanced by a fall in the frequency of other EDs such as endemic goiter in the same regions. The problem is so complex that a correct assessment of the real burden of EDs at the present time are merely wild guesses. Even in the specific case of diabetes we do not have reliable data. It has been shown that the accuracy of the World Health Organization (WHO) European region diabetes projections for 25 and 64 years of age in 1995 was poor and a large number of countries had no information available. The projections for the year 2003 were also highly discrepant from results derived from independent sources collected at about the same time. For example, the UK projected about 1.9 million persons with known diabetes in 2003 but the General Practice Research Database (a national level data source) showed that estimates for that year were close to 3 million. WHO projections were however fairly accurate for Bulgaria, Finland, and Norway, but only 3 of the 10 countries in the European region for which data was available. Only a relatively short 10 year period from 1973-84 has been examined for changes in the true incidence of diabetes in Europe. This study concluded that the disease increased by approximately 3% annually for the whole region, and by 5% annually in Finland. These results suggest that the changing incidence of a chronic disease is best monitored by epidemiological studies using specific national diagnosis criteria, as well as general practitioner and hospital registers which are relatively free from administrative decisions during exhaustive ICD coding.
3. Health Consequences of Endocrine Disorders
Other hormone imbalances drastically change physical appearance and can cause severe psychological distress. Several endocrine imbalances are a cause of obesity. Cushing’s syndrome is an endocrine disorder that leads to excessive and prolonged levels of cortisol in the body. This hormone excess leads to a buildup of fat in adipose tissue. High levels of cortisol can cause a redistribution of body fat, leading to increased fat on the upper body and abdomen, but thin arms and legs. A rounded face and acne can also be apparent. The adverse effects of this can cause serious psychological damage to the individual, with an increased risk of depression being just one result.
The consequences of the changed level of hormones typically have widespread effects on the body. Some of these imbalances are classified as metabolic diseases, with a common one being diabetes. Diabetes is caused by the failure of the pancreas to produce enough insulin to keep blood sugar levels normal. This has a knock-on effect of an abnormal metabolism of carbohydrates and raised blood sugar levels. In the long term, this disease has many implications on the body. High blood sugar levels can damage various tissues in the body, especially tissues in the kidney, blood vessels, and nervous system. This, in turn, can lead to many complications.
Most endocrine diseases are chronic and progress slowly. Some of these can be present from birth and are usually hereditary, while others can develop as a result of dietary habits and the body’s metabolism changing. The effects of the disease usually depend on the level of hormones in the body. Hormones are extremely powerful, and the body only needs a small amount. If there is an overproduction, the body’s chemical balance can be upset.
Endocrine diseases often lead to disturbances of endocrine glands and their hormones. It can happen when there is a change in the chemical composition of the blood or in the production of a particular hormone, an increase or decrease in the number of hormone receptors, failure of hormone negative feedback, a change in hormone metabolism or excretion by the liver and kidneys, or failure to produce one or more hormones.
4. Strategies for Prevention and Management
Prevention of endocrine-related disorders is primarily achieved through health promotion and risk reduction. This can be done not only by the reduction of public health hazards but also by modifying lifestyle. As many endocrine disorders are linked to obesity or hypertension, it is important that national strategies are developed to address dietary improvements and increased physical activity. As the majority of the population is at risk of developing an endocrine disorder, these lifestyle measures must become widespread, and care must be taken not to further stigmatize those already suffering from an endocrine disorder. Lung cancer, for example, is linked to the endocrine disorder Cushing’s syndrome.
While smoking is the major cause of Cushing’s syndrome, restricting those who already have the syndrome from treatment of their lung cancer will only further stigmatize them. In said example, the best prevention of an endocrine disorder would have been the prevention of smoking through education and governmental policy. As the number of those suffering from an endocrine disorder increases, the burden on the health service increases. What management strategies are chosen will depend on the disorder, and in many cases, acute symptoms must be treated. However, it is generally recognized that chronic endocrine disorders are most effectively managed in primary care, with an emphasis on self-care and disease management support, including lifestyle changes. The aim of all management strategies should be the improvement of functional health while minimizing the amount of stigma and psychological impact on the patient. Being chronic in nature, a major focus of management of endocrine disorders revolves around physical and psychological rehabilitation.
5. Conclusion
Hormones are important to various body functions. Endocrine disorders can disrupt hormone balance and thus affect an individual’s health. Since the endocrine system is involved in almost every physiologic process, the potential for an endocrine disruptor to affect health is considerable. Public health actions are needed. These actions should be based on the best possible evidence in science in conjunction with the societal values of fairness, an improved quality of life, and a safe and healthful environment.
The Institute of Medicine, in a 1988 report, defined public health as “fulfilling society’s interest in assuring conditions in which people can be healthy”. Applying this definition to the broad array of individuals with endocrine disorders, a large majority of whom have common health problems, many of which are preventable, it is apparent that endocrinology has a largely unrealized potential public health impact. Good scientific and epidemiological research help to reach cause and effect determinations and recommend effective interventions.
The global burden of endocrine disorders increases yearly reflecting the increasing impact of hormone disrupting chemical mixtures in the environment, known to affect health especially during development. After losing many pounds, an individual with diabetes mellitus prevents further damage to arteries limiting risk of adverse cardiovascular events. An environment with less exposure to mixtures of chemical pollutants that may have been responsible for mimicry of hormone action contributing to diabetes or its prevention may impede development of the worldwide diabetes epidemic. Primary prevention through identification, education and removal or reduction of exposure to environmental toxins at high-risk sites is one important goal.