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Diabetes is sometimes called a "silent disease," and is characterized by the fact that it does not cause serious symptoms on its own. However, if it progresses unnoticed, it can lead to three major complications (neuropathy, retinopathy, and nephropathy), each of which can have serious consequences such as foot gangrene (and sometimes foot amputation), blindness, and kidney failure. It has also become clear that diabetes is a particularly significant risk factor for large blood vessel complications such as cerebral infarction and myocardial infarction. In order to prevent these complications, our department aims to not only manage blood sugar, but also other risk factors such as high blood pressure and hyperlipidemia.
While hospitalization for diabetes treatment and education typically consists of a two-week course, we customize treatment plans to suit each patient's condition. For patients admitted due to poor blood sugar control, we actively administer temporary intensive insulin therapy for approximately one week during their hospital stay, combined with diet and exercise therapy, to improve glucotoxicity (a vicious cycle of hyperglycemia). Many patients are then discharged home after returning to oral medication. For patients who do not improve with temporary insulin therapy and require insulin treatment after discharge, we have a system in place where doctors and nurses work together to provide consistent support during and after their hospitalization. Regarding insulin initiation, we also offer a short-term hospitalization plan that utilizes a three-day weekend for insulin initiation. For patients who are unable to stay in the hospital, we also offer outpatient insulin initiation. However, a short-term inpatient stay is ideal to help patients understand diet and exercise therapy, master injection techniques, and learn how to manage hypoglycemia.
Diabetes treatment drugs continue to improve, and we hope to establish the best possible treatment based on these advances.
Dietary therapy is extremely effective and essential for the treatment of diabetes, and self-management of exercise therapy and drug therapy is also important. Medical staff from a variety of professions will support you in your recovery so that you can manage your diabetes well, prevent complications, and live a healthy daily life. Nurses in the outpatient department also provide guidance on recovery, with a particular focus on foot care. Please feel free to consult with us.
In cases of thyrotoxicosis, we differentiate between hyperthyroidism (primarily Graves' disease) and destructive thyroiditis (primarily painless thyroiditis). Most cases of Graves' disease are treated with antithyroid drugs, with surgical or isotope therapy being selected for refractory cases. We also specialize in treating women with Graves' disease who wish to have children. For hypothyroidism, we begin treatment with the minimum dose of thyroid hormone preparation, taking into account the patient's age, duration of disease, and presence of comorbidities, and gradually increase the dose to determine the maintenance dose. In cases of nodular goiter, we perform a qualitative diagnosis using thyroid ultrasound and aspiration cytology. In cases of thyroid cancer, we check for local invasion and distant metastasis using CT, MRI, and scintigraphy before requesting surgical treatment. Most cases of thyroid disease can be treated on an outpatient basis, but hospitalization is required for the treatment of Graves' ophthalmopathy with a combination of steroid pulse therapy and orbital radiation therapy, and for Graves' disease accompanied by complications (infection, heart failure, etc.).
We aim to provide medical care for a wide range of endocrine diseases, including those of the pituitary gland, parathyroid gland, adrenal gland, and gonads.
We also accurately diagnose many endocrine disorders (pituitary gland disease, adrenal gland disease, Graves' disease) that lead to secondary diabetes, as well as "incidentalomas" of the adrenal, pituitary, and thyroid glands, early on, and consider surgical options, resulting in referrals to urology, neurosurgery, and otolaryngology. It has also been reported that primary aldosteronism (5-10%) exists among cases of "essential hypertension," and we have actually experienced cases of primary aldosteronism with normal renin and normal serum potassium. Even in the absence of hypokalemia or hyporenemia, more aggressive screening for secondary hypertension is becoming necessary. Furthermore, "hypoglycemia" and "hypophosphatemia" are often caused by endocrine disorders that are easily overlooked, such as insulinoma and tumor-induced osteomalacia, respectively.
Diabetes is a disease in which blood sugar levels rise due to a lack of insulin, a hormone that lowers blood sugar levels.
Type 1 diabetes is a type in which the cells that secrete insulin are destroyed, resulting in a drastic reduction in the amount of insulin in the blood.
If you suddenly experience symptoms such as increased thirst, increased urine output, or weight loss, you should suspect this disease. Treatment mainly involves supplementing with insulin injections, but just like with type 2 diabetes, dietary therapy is also important.
Our hospital has many diabetes care educators on staff who can provide accurate advice on dietary therapy, insulin injections, and other aspects of the overall treatment of type 1 diabetes patients.
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both.
Prolonged high blood sugar can cause complications in various organs, including the eyes, kidneys, nerves, heart and blood vessels.
Type 2 diabetes develops when a predisposition to reduced insulin secretion, multiple genetic predispositions, and environmental factors such as overeating, obesity, lack of exercise, and stress, as well as aging, are combined. While some cases are asymptomatic and are discovered incidentally during a health check, others present with classic hyperglycemic symptoms such as dry mouth, polyuria, polydipsia, and weight loss.
The goal of treatment is to prevent complications and maintain a high quality of life. By understanding the patient's characteristics, we maintain blood sugar levels close to normal using oral medications and insulin, based on dietary and exercise therapy. Systemic management of blood pressure, lipids, etc. is also important.
Our department works in teams with specialists and diabetes care instructors (nurses, nutritionists, pharmacists, and exercise therapists) to achieve results in helping patients achieve their goals.
Thyroid hormone secretion is regulated by thyroid-stimulating hormone (TSH) secreted by the pituitary gland.
TSH stimulates the thyroid gland by binding to the TSH receptor on the thyroid cell membrane. Graves' disease is a disease in which autoantibodies against this TSH receptor are produced, resulting in unlimited stimulation of the thyroid gland.
When thyroid hormones are secreted in excess, metabolism increases, causing symptoms of thyroid poisoning such as palpitations, tachycardia, sensitivity to heat, sweating, trembling hands and feet, weight loss despite appetite, and fatigue.
The neck appears slightly swollen due to goiter. Eye symptoms such as exophthalmos may also occur. Diagnosis is confirmed by these symptoms, measurements of thyroid hormones and TSH receptor antibodies, and thyroid scintigraphy.
Treatment begins with antithyroid drugs, and depending on the circumstances, surgery or isotope therapy may be performed. It is important to differentiate between other diseases that can cause thyrotoxicosis, such as painless thyroid disease.
The overwhelming majority of hypothyroidism is caused by primary hypothyroidism due to chronic thyroiditis (Hashimoto's disease).
A deficiency of thyroid hormones causes a slowdown in metabolism, leading to symptoms such as sensitivity to cold, dry and flaky skin, bradycardia, constipation, a hoarse voice, slow speech, constipation, and a tendency to fall asleep easily.
The person's movements become sluggish, they feel reluctant to do anything, and they appear depressed. The face, limbs, and legs become swollen, making them appear older than their age. The thyroid gland may become enlarged or shrunken and unable to be felt.
These symptoms often come on slowly and go unnoticed by the individual or their family.
The diagnosis is confirmed by measuring thyroid hormone levels.
Treatment involves supplementing thyroid hormones, which dramatically improves symptoms. A small dose is started and gradually increased to determine the maintenance dose. Lifelong supplementation is required. In cases of secondary hypothyroidism caused by diseases of the pituitary gland or other conditions, supplementation with adrenal hormones is essential at first, and differentiation is extremely important.
If you can feel a lump below your Adam's apple in your neck, and it moves upward when you swallow, it is likely a lump in the thyroid gland.
A thyroid gland with such a nodule is called a nodular goiter. There may be one nodule (single) or two or more (multiple). If it is large, you may notice it yourself, but it is often pointed out during a medical checkup or general examination.
If the nodule is a lump of flesh, it is called a solid tumor, and if it is liquid, it is called a cyst. Most nodules are benign adenomas, cysts, or adenomatous goiters, but it is not uncommon for them to be cancerous (relatively well-differentiated cancers, especially papillary carcinomas).
In many cases, diagnosis can be made by palpation, thyroid ultrasound, and aspiration cytology.
We perform this routinely at the outpatient level in our department, and when surgery is necessary, we refer it to the ENT department, with good results.
Just above the waist, near the kidneys, there are a pair of hormone-producing organs called the adrenal glands.
When the adrenal glands produce too much of the hormone cortisol, it can lead to a condition called Cushing's syndrome.
Causes include a tumor in the adrenal gland, a tumor in the pituitary gland which controls the hormones of the adrenal gland, or a malignant tumor in an organ other than the pituitary gland, so it is important to determine the cause.
This disease is suspected when symptoms include obesity with a protruding belly but thin limbs, a swollen, red face, and acne, or when diabetes or high blood pressure worsens.
Treatment mainly involves identifying the cause of the aforementioned disease and working with specialist departments to remove the tumor. As a general hospital, our hospital is well-suited to treating such diseases.
One of the diseases that can treat high blood pressure through surgery is pheochromocytoma.
The adrenal glands are located above each kidney in a cap-like shape. The inside of the adrenal glands is called the adrenal medulla, which secretes hormones such as adrenaline and noradrenaline. A tumor in this tissue is called a pheochromocytoma. This tumor may be present in some patients with high blood pressure.
If you experience sudden attacks of symptoms such as headache, palpitations, chest tightness, anginal pain, excessive sweating, nausea/vomiting, tremors, and facial pallor, you should suspect this disease.
Diagnosis is made by measuring adrenaline, noradrenaline, and their metabolic products in the blood and urine.
Once the tumor is confirmed by abdominal CT scan or scintigraphy, we request laparoscopic tumor removal from the urology department, with good results.
One of the diseases in which high blood pressure can be cured by surgery is primary aldosteronism.
The outer part of the adrenal gland is called the adrenal cortex, which secretes hormones such as cortisol and aldosterone.
When cells that produce aldosterone form tumors (often adenomas) and secrete excess aldosterone, sodium accumulates in the body and potassium is excreted in the urine, resulting in hypertension accompanied by hypokalemia.
This disease is called primary aldosteronism. If a patient with high blood pressure experiences symptoms such as muscle weakness, excessive drinking and urination, quadriplegia, and cramps, this disease should be suspected. It is diagnosed by measuring aldosterone and renin levels under certain conditions.
Once the tumor is confirmed by abdominal CT scan or scintigraphy, we request laparoscopic tumor removal from the urology department, with good results.
The previous idea was that primary aldosteronism should be screened for by hypertension, hypokalemia, hyporenemia, and hyperaldosteronemia, but there have been a series of reports showing that even in the absence of hypokalemia, screening for hyporenemia and hyperaldosteronemia will result in the discovery of nearly 10% of "essential hypertension," and it has been confirmed that this is almost the same in Japan.
In the future, this disease is expected to play an important role in screening for secondary hypertension.
When a child grows into an adult, growth hormone produced by the pituitary gland plays an important role in increasing height. However, if more growth hormone is produced than necessary after reaching adulthood, it can lead to a disease called acromegaly.
In most cases, this disease is caused by a pituitary tumor. It should be suspected when symptoms include swelling of the hands and feet, making rings and shoes no longer fitting, thickening of the nose and lips, or worsening of diabetes or high blood pressure.
Treatment mainly involves surgically removing the pituitary tumor in cooperation with neurosurgeons, but drug or radiation therapy may also be added if necessary.
Our hospital is equipped with the latest radiation therapy equipment called the X-Knife, and we look forward to making use of it in the future.
There are various types of hormones in the blood that regulate the body's functions, and the pituitary gland is the control center for these hormones.
Hypopituitarism is a condition in which the pituitary gland does not function properly and stops producing hormones that the body needs.
Symptoms vary depending on which hormone levels are particularly reduced, but if you experience symptoms such as fatigue, sensitivity to cold, loss of appetite or sex drive, or no menstruation, you should suspect this disease.
Treatment mainly involves supplementing the missing hormones, but at the same time, we investigate whether the cause of the pituitary gland's malfunction may be a brain tumor or other condition, and if necessary, we work with neurosurgeons to provide treatment.
There are four miliary-sized parathyroid glands behind the thyroid gland, which secrete parathyroid hormone (PTH), which is important for calcium metabolism. A disease in which excessive PTH is secreted from these tumors (mostly adenomas) is called primary hyperparathyroidism.
It is often discovered by chance due to high calcium levels in a blood test, but it can also be diagnosed as a result of urinary tract stones or bone disease.
If a tumor is found by ultrasound or scintigraphy, an ENT specialist will be consulted to perform surgery to remove it. A disease in which the parathyroid glands are destroyed by autoimmune mechanisms or other factors, resulting in insufficient secretion of PTH, is called idiopathic hypoparathyroidism. If sensory abnormalities such as numbness in the limbs, tonic convulsions, epileptic seizures, or cataracts occur at a relatively young age, this disease may be the cause, and serum calcium and PTH will be measured.
Once the diagnosis is confirmed, treatment involves active vitamin D and calcium supplements.
This refers to hypofunction of the adrenal glands, small organs located above the kidneys. There are idiopathic and secondary causes, and in the past, tuberculosis-related cases were more common among the latter, but recently the former, autoimmune-related cases, have been increasing.
It is divided into primary (causes in the adrenal gland itself), and secondary/tertiary (causes in the superior pituitary gland or hypothalamus). The former is screened for by low serum cortisol levels and high ACTH levels, but care must be taken with blood sampling conditions (morning fasting, after rest). The latter may be due to isolated ACTH deficiency or an organic disease of the pituitary gland (tumor, inflammation, etc.).
Symptoms and abnormal test findings include hypoglycemia, hyperkalemia, hypotension, and loss of appetite, but acute cases can lead to shock, and it is a disease that must be included in the differential diagnosis as a cause of shock of unknown cause. Clinically, the most common cause is so-called iatrogenic acute adrenal insufficiency, which occurs when steroids administered as treatment are suddenly discontinued.
This can also occur with topical steroids, so caution is required.
See the section on hypopituitarism.
This is a disease in which there is a selective deficiency of ACTH (adrenocorticotropic hormone) secreted by the pituitary gland.
It was previously considered rare, but has now been discovered to be a fairly common disease. In addition to hypoglycemia, symptoms of adrenal insufficiency such as weight loss, low blood pressure, and hyperkalemia appear. It is not uncommon for the cause to be lymphocytic hypophysitis, which is based on autoimmunity.
Symptoms improve rapidly with the administration of corticosteroids, so early diagnosis is important.
It is a tumor of the pancreatic beta cells that secrete insulin. Most are benign, but sometimes they can be malignant.
This is a disease that must be differentiated in cases of hypoglycemia, but blood insulin levels are often not necessarily high, and a special test called a selective intravenous calcium infusion test is required for a definitive diagnosis.
If left untreated, hypoglycemia can cause personality changes and there have been many reported cases where the condition is treated as a psychiatric illness, so if psychiatric symptoms occur, screening for hypoglycemia is essential.
Recently, with the widespread use of diagnostic imaging (CT, MRI, ultrasound), there have been an increasing number of cases in which tumors in the adrenal gland are discovered by chance during diagnostic imaging performed for other reasons. These are collectively called "adrenal incidentalomas."
This is not a diagnostic name, and the most common final diagnosis is non-functioning adrenocortical tumor, but in fact there are many cases where a small amount of cortisol is autonomously secreted, which is called subclinical Cushing syndrome.
Other tumors include adrenal ganglioneuroma, (including normal blood pressure) pheochromocytoma, aldosterone-producing tumor (primary aldosteronism), and various other tumors. There are two indications for surgery: 1) when malignancy is suspected, and 2) when hormone secretion is active, but in the case of 2), there is debate as to what level of activity is considered active, and the indication for surgery must be thoroughly considered through detailed examinations.
This is the most common type of malignant thyroid tumor. Early diagnosis and treatment can often result in a complete cure. Compared to other malignant tumors, it grows more slowly (so much so that it is evaluated by a 10-year survival rate instead of a 5-year survival rate), and the clinical course is relatively good.
The 10-year survival rate at our ENT department is a respectable 96.4%. Total thyroidectomy is the rule, and postoperative radioiodine therapy (oral administration) may be required if necessary. However, there are many cases of long-term recurrence and metastasis, so regular checkups (such as thallium thyroid scans) are necessary even after treatment.
If a thyroid tumor is found, it is absolutely necessary to rule out the disease using FNA (fine needle aspiration), but just because a one-time test shows that the tumor is benign does not mean that you can be at ease; a tumor may be discovered later, so regular follow-up is necessary.
This refers to cases where bones become brittle and the risk of fracture increases, or when a person has already suffered a fracture (especially a spinal fracture). As people age, their backs become bent and they become shorter, which is due to spinal compression fractures associated with osteoporosis.
When caused by aging, most cases occur after menopause, but they can also be classified as secondary.
Secondary causes include diabetes (mainly type 1), alcohol, and smoking, while typical endocrine diseases include primary adrenal hypertension, Graves' disease, hypogonadism, and Cushing's syndrome (including iatrogenic).
When osteoporosis is diagnosed, these diseases must be ruled out. Diagnostic methods for bone density quantification include qCT, D(E)XA, and ultrasound, but DXA is the most accurate and allows for subtle treatment decisions. Treatments can be broadly divided into those that suppress bone resorption and those that promote bone formation, and the majority of drugs currently approved for insurance coverage are considered to be the former.
Unlike osteoporosis, this condition refers to a condition in which bone mineralization is impaired and normal bone formation cannot occur.
In children, it is called rickets. The mechanisms of osteomalacia can be divided into 1) vitamin D deficiency, 2) vitamin D metabolic insufficiency or resistance, 3) hypophosphatemia, and 4) renal tubular damage. Causes of 1) include post-gastrectomy and chronic renal failure, and 4) Fanconi syndrome. 2) is a rare hereditary disease in Japanese people called vitamin D resistance, and tumor-induced osteomalacia, including 3), is attracting attention. This disease occurs mainly when some hormone is secreted from mesenchymal tumors, causing increased excretion of phosphorus into the urine and resulting in hypophosphatemia.
Our hospital's Diabetes and Endocrinology Department offers outpatient services such asDiabetes Care Support Nurse OutpatientWe also provide group education and weekend classes for hospitalized patients, as well as a variety of nutritional guidance sessions.
The seminars are held every Wednesday from 2:00 PM in Conference Room 6 on the 5th floor (previously Conference Room 1). Participation is free. Participants from outside the hospital are also welcome. Lecturers rotate among doctors, nurses, nutritionists, pharmacists, and physical therapists. Doctors from each specialty will also give talks on "complications." A three-month schedule is posted in the internal medicine outpatient clinic, and pamphlets are also available.
Ultrasound, CT, MRI, thermography, linear accelerator, bone density measurement device (DXA), etc.
