endocrinologist-dr-jonathan-cohen-services

Diabetes

Type 1, 2 and GDM

Broadly speaking there are 3 types of diabetes. Type 1 diabetes is an auto-immune condition, whereby one’s own immune system attacks the cells in the pancreas, called Beta-cells, that produce insulin. Consequently, the body does not produce insulin and so treatment of type 1 diabetes centres around insulin replacement. Type 2 diabetes is a more encompassing condition, has a slower onset, and is largely related to weight, lifestyle and genetics. It is the type of diabetes that attracts the most attention in the media. The goals of managing type 2 diabetes are not just glucose control, but a wholistic approach to vascular risk reduction. Gestational diabetes is a relative of type 2 diabetes, that occurs only in pregnancy, and largely resolves post pregnancy. A comprehensive approach, in conjunction with diabetes educators, and using the latest technology is used to assist in management.

Insulin Pumps

Insulin pump technology is evolving rapidly, together with continuous glucose sensors. Insulin pumps are mostly, but not exclusively, utilised by patients with type 1 diabetes, to provide greater flexibility with diabetic management and improved diabetic control. I am able to facilitate the commencement and ongoing management of insulin pumps with my highly experienced pump educator team, and the technology associated with it, to make this a seamless transition.

Thyroid Disease

Dysfunction or disorders of the thyroid are incredibly common, particularly for women. For reasons incompletely known, the incidence of these disorders are increasing. The thyroid produces thyroid hormone which is the regulator of one’s metabolism. The most common thyroid conditions include auto-immune thyroid disease, thyroid nodules, goitres and thyroid cancers. A simple set of blood tests will often establish the broad type of condition and different forms of imaging may augment that. Most treatments for thyroid disease are well established.

Andrology – male hormonal disorders

Andrology is a specialized area of endocrinology that I am passionate about and in which I completed my fellowship. It involves the evaluation and treatment of males with either reproductive or fertility issues caused by diminishing male hormone, testosterone production or function. Andrology is is an emerging area of endocrinology, and the research into male hormonal disorders, as well as the scientific evidence about available treatments, is rapidly evolving. Treatment of andrology disorders requires careful evaluation of each patient to establish the cause, reversibility, and the potential benefits of any intervention. Tests will often include blood work, imaging and for fertility assessment, a semen sample.

Reproductive Disorders

Endocrinologists can assist in a number of female hormone disorders. The most common, PCOS (Polycystic Ovarian Syndrome) is a multi-faceted condition requiring an approach that often involves an initial clinical evaluation, which supported by blood tests and imaging, and is then treated with lifestyle intervention and at times medication. Because the diagnosis of PCOS can be at times difficult or can mimic other conditions, a careful evaluation is always required. Other female hormonal disorders which I manage include issues during peri-menopause and fertility evaluation.

Osteoporosis

As the name suggests, osteoporosis deals with porous or thin bones. Osteoporosis treatment seeks to reduce the risk of a fracture or broken bones in an individual that may be at high risk of breaking a bone without much force. It is a condition that tends to be associated with age affecting up to 1:2 women over the age of 60 and 1:3 men as they advance in age. Apart from advancing age, there are also many other medical conditions which can contribute to osteoporosis. A combined approach of lifestyle interventions, exercise and medications are used in the treatment of osteoporosis.

Pituitary Disease

At the base of the brain and deep behind the back of the nose, the small pituitary gland is the control centre of the major hormones in the body. With the advent of high grade imaging such as MRI, small defects or benign growths on the pituitary are more easily detected and the diagnosis of pituitary disorders is increasing as a result. A variety of different clinical syndromes can arise from pituitary disorders, depending on whether a particular hormone is produced in excess, whether there is a reduced capacity of one of the regulating hormones to do it’s job, or whether there is an inactive growth incidentally picked up. A set of blood tests, at times urine and saliva tests, and MRI imaging may be used depending on the suspicion of a problem.

Parathyroid Disease

Hyperparathyroidism is the most common cause of parathyroid dysfunction but may have a number of different causes which will determine how it’s treated. Parathyroid hormone produced from the parathyroid glands largely regulates blood calcium levels in conjunction with the bones, kidneys and gut. This will often be tested if an array of non specific symptoms are being investigated or if incidentally one’s blood calcium level is low or high. Calcium is important for bone health and muscle and nerve function. Depending on the cause, sometimes medication is used, and at times surgery. Tests involved will often include blood, urine evaluation, bone testing and detailed neck imaging.

Adrenal Disease

Adrenal conditions are fairly rare. Most adrenal disorders involve incidental adrenal growths or the suspected over or under activity of one of the three main adrenal hormones – cortisol, aldosterone and adrenaline. The most common reasons you will be referred to an endocrinologist for evaluation of an adrenal disorder include a change in your body shape, difficulties with controlling high or low blood pressure, or abnormalities with salts in the blood.