Conditions

We specialize in the following conditions

Thyroid Disease

Hashimoto’s Thyroiditis

Hashimoto’s Thyroiditis is the most common thyroid disorder affecting up to 15% of women and one quarter as many men. It is an autoimmune condition that interferes with thyroid function. In the case of Hashimoto’s thyroiditis, immune cells mistakenly attack healthy thyroid tissue, causing inflammation of the thyroid. This inflammation, also known as chronic lymphocytic thyroiditis, often leads to an under active thyroid gland (hypothyroidism). Initial symptoms can be mild, progressing slowly over time as the chronic thyroid damage leads to a drop in thyroid hormone levels in the patients blood. Thyroid hormones control how the body uses energy, and can have a broad range of symptoms as thyroid hormones affect nearly every organ in the body. A combination of factors including heredity, sex and age may determine the patient’s likelihood of developing the disorder.

Graves Disease

Graves Disease (Basedow’s Disease) Graves’ disease is a autoimmune illness that causes the thyroid gland to overactive, producing too much thyroid hormone, called hyperthyroidism. Normally, thyroid function is regulated by a hormone released by the pituitary gland at the base of the brain. The antibody associated with Graves’ disease, thyrotropin receptor antibody (TRAb), acts like the regulatory pituitary hormone. Effectively TRAb overrides the normal regulation of the thyroid, causing an overproduction of thyroid hormones. The progression of the disease varies, in some cases it may even present an alternating pattern of relapse and remission. Left untreated Graves Disease can cause eye changes, and complications such as heart disease and bone loss.

Hyperthyroidism

Hyperthyroidism is a condition in which the thyroid gland is overactive and makes excessive amounts of thyroid hormone. The thyroid gland is an organ located in the front of your neck and releases hormones that control your metabolism (the way your body uses energy), breathing, heart rate, nervous system, weight, body temperature, and many other functions in the body. Hyperthyroidism increases metabolism, and can cause disturbed sleep, palpitations, tremor, sweats, weight loss, and increased frequency of bowel movements. It may result from Graves’ disease, from an autonomously functioning thyroid nodule, or it may be a temporary result of subacute thyroiditis.

Hypothyroidism

Hypothyroidism is a condition in which the thyroid gland is under active and makes inadequate amounts of thyroid hormone. The thyroid gland is an organ located in the front of your neck and releases hormones that control your metabolism (the way your body uses energy), breathing, heart rate, nervous system, weight, body temperature, and many other functions in the body. Hypothyroidism causes a slowing of metabolism, with fatigue, weight gain, dry skin, hair loss, brittle nails, and constipation. It most frequently results from Hashimoto’s disease.

Thyroid Nodules and Thyroid Cancer

Thyroid Nodules Thyroid nodules, or growths in the thyroid, are very frequent, affecting up to half of people by the age of 60. Many of them are benign, but some are malignant, and may require a needle biopsy for diagnosis.

Thyroid Cancer is a case where the typical thyroid nodule is malignant, and replicate or spread to other tiisues and organs. There are 4 main types of thyroid cancer, and some are more common than others.

Thyroid cancers vary in aggressiveness by type:
– Papillary and/or mixed papillary/follicular thyroid cancer (85%) grows slowly and spreads locally.
– Follicular and/or Hurthle cell thyroid cancer (10%) is more likely to metastasize to distant sites than Papillary.
– Medullary thyroid cancer (3%) is uncommon and more aggressive than papillary or follicular types.
– Anaplastic thyroid cancer (1%) is rare and more aggressive than papillary or follicular types.

Fast and accurate diagnosis is critical to treatment and management of thyroid cancers.

Bone and Calcium Problems

Osteoporosis

Osteoporosis is a condition where the hard, dense material that forms bone becomes porous, and bones become weaker and subject to fracture. Osteoporosis takes place across years, with no symptoms, gradually progressing to the point where a fracture is imminent. Osteoporosis, with increased risk of fractures and skeletal deformity, can result from hormonal problems such as decreased ovarian or testicular function, or disease of the parathyroid glands, adrenals, thyroid, or pituitary gland. It can also occur because of nutritional deficiency such as inadequate intake of calcium and vitamin D, or an effect of medications such as steroids or chemotherapy agents.

Hypocalcemia

Hypocalcemia (elemental calcium) is a condition that increases neuromuscular irritability manifested as numbness and tingling, particularly of the distal extremities, however, most patients are asymptomatic. Longstanding hypocalcemia due to hypoparathyroidism can result in calcification of the basal ganglia and other intracerebral calcifications, cataracts, dermatological manifestations including dry, puffy skin, and coarse, brittle and sparse hair.

Hyperparathyroidism

Hyperparathyroidism is a condition where the parathyroid produces too much hormone resulting in bone releasing calcium into the blood. This released calcium is a cause for osteoporosis and the elevated blood calcium leads to increased urinary excretion of calcium causing kidney stones. There can also be muscle, bone, and joint pain, and impairment of cognitive function.

Female Reproductive

Irregular Periods or Absent Periods

Irregular Periods or Absent Periods can involve either abnormalities within the uterus (like uterine fibroids) or external conditions that are more difficult to diagnose. Irregular or absent periods can result from PCOS, or diseases of the thyroid, adrenals or pituitary gland. It can also be caused by systemic illnesses.

Adult Acne and Hirsutism

Adult Acne and Hirsutism can be caused by increased male hormone levels originating from the ovaries or adrenal glands, or by increased sensitivity to seemingly normal levels of hormones. Skin specialists and primary care doctors often recommend that women with acne that is resistant to antibiotics see an endocrinologist. An endocrinologist will work to confirm the acne is not a symptom of polycystic ovary syndrome, a common disorder in young women.

Female Hair Loss

Female Hair Loss (androgenetic alopecia) Is hair loss that is the result of exposure to male hormones in a genetically susceptible person. Scalp hair loss can be caused by problems with the ovaries, adrenals, thyroid, or pituitary gland. There are treatments available after confirming the hair loss is a hormonal issue. Careful evaluation is required as hair loss can also result from nutritional deficiencies, systemic illnesses, and medication effects.

Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is caused by an imbalance of reproductive hormones, creating problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be. PCOS can cause irregular or absent periods, increased male hormone effects such as acne, hirsutism, and scalp hair loss, and increased weight.

Low Desire, Sexual Dysfunction

Low Desire, Sexual Dysfunction is a condition in which there is a low desire to engage in sexual activity. Treatment of sexual dysfunction depends on the cause of the condition. Low desire and sexual dysfunction can be caused by problems with the testicles, adrenals, thyroid, or pituitary glands. It can also result from systemic illnesses such as diabetes, kidney and liver disease, infections, and medication effects. For some men, adopting a healthier lifestyle, such as exercising regularly, eating a healthy diet, getting enough sleep, reducing stress, and/or limiting alcohol, can help resolve the problem. Common causes of low libido include:

Medications (SSRI antidepressants; medications that reduce testosterone levels, such as those taken for prostate cancer)
Excessive alcohol use or recreational drug use
Systemic illness (such as chronic lung, heart, kidney and liver failure, cancer)
Low testosterone (male hypogonadism)
Depression
Relationship problems
Erectile dysfunction (ED)

Male Reproductive

Hypogonadism

Hypogonadism also called Low Testosterone, is a condition where the testes produce an abnormally low level of testosterone. Although testosterone levels never reach zero (as estrogen levels do in women during menopause), low testosterone levels men to experience symptoms such as fatigue, low sex drive, and loss of muscle mass. Hypogonadism, can either be primary, resulting from testicular damage, or secondary, caused by pituitary or hypothalamic disease.

Primary Hypogonadism is also known as primary testicular failure, and it is caused by a problem in the testicles. These problems can include:

Injury to the testicle: This can be from trauma, testicular cancer, or radiation or chemotherapy to treat testicular cancer. This trauma can affect testosterone production.
Klinefelter syndrome: Males should have one X chromosome and one Y chromosomes—those are the sex chromosomes that determine gender. In Klinefelter syndrome, there are 2 or more X chromosomes in addition to the Y chromosome, and this can lead to abnormal testicle development (and then this can affect testosterone production).
Undescended testicles: Sometimes, testicles do not descend prior to birth—they’re supposed to descend from the abdomen (where they develop) to the scrotum . If the testicles don’t descend in early childhood, it could affect testosterone production.

Secondary Hypogonadism is caused by a problem with the pituitary or hypothalamus glands. Those are glands that give a signal to the testicles to make testosterone, so if something affects them, testosterone production can be affected. Conditions that can cause secondary hypogonadism include:

Pituitary disorders: For example, a pituitary tumor can affect the release of hormones that tell the testes to make testosterone. Therefore, testosterone production can be deficient.
Medications: Certain medications, including opioids used for severe pain, chemotherapy and steroids, can affect testosterone production.
Type 2 diabetes: Having type 2 diabetes can raise your risk of developing male hypogonadism.
Aging: Older men have lower testosterone levels because testosterone production decreases over time.

Sexual Dysfunction

Erectile Dysfunction (ED)

Erectile dysfunction (ED), or Impotence, is the inability to consistently initiate or keep an erection long enough to have satisfactory sex. Erectile dysfunction (ED) is a disorder with multiple etiologies, which may be psychogenic and/or organic in origin. Among the organic causes of ED are diseases of the endocrine system, including hormone imbalance, Low testosterone, high prolactin, diabetes mellitus, and abnormal thyroid hormone levels.

Pituitary Disease

Acromegaly

Acromegaly is caused by a pituitary tumor that produces excess growth hormone (GH). It most commonly affects middle-aged adults and can result in serious illnesses or premature death.

Pituitary Adenoma

Pituitary Adenoma is a growth or tumor on the pituitary that can put pressure on nearby structures, such as the nerves that connect the eyes to the brain, and cause symptoms. A large adenoma can also obstruct normal pituitary cells and keep them from working properly, leading to a condition called hypopituitarism. This condition can cause low blood pressure, tiredness, and changes in your sex drive and function. It can also make you feel less able to manage stress.

Prolactinomas

Prolactinomas are benign tumors of the pituitary gland that produce excessive amounts of the hormone prolactin. Prolactinomas are most common pituitary disorder, appearing in 50% of cases. In women, excess prolactin causes irregular or absent periods, inappropriate milk production, and infertility. In men, excess prolactin can cause sexual dysfunction and infertility. Symptoms can result from too much prolactin in the blood (hyperprolactinemia) or pressure from the tumor on surrounding tissues (if the tumor is large).

Hyperpituitarism

Hyperpituitarism is a condition due to the primary hypersecretion of pituitary hormones, it typically results from a pituitary adenoma

Hypopituitarism/Panhypopituitarism

Hypopituitarism and Panhypopituitarism, If the pituitary is not producing one or more of these hormones, the condition is called hypopituitarism. If all the hormones produced by the anterior pituitary are decreased, the condition is called panhypopituitarism. Hypopituitarism is most often caused by large benign tumors of the pituitary gland, or of the brain in the region of the hypothalamus.

Adrenal Disease

Cushing’s Disease

Cushing’s Disease refers to a pituitary adenoma that produces excess ACTH, which stimulates cortisol secretion by the adrenal glands located above each kidney. Patients with Cushing’s disease have progressive weight gain, muscle weakness, easy skin bruising, impotence (in men), irregular periods (in women), and depression. Patients also have high blood pressure, diabetes, and osteoporosis. Sometimes called hypercortisolism, may be caused by the use of oral corticosteroid medication. The condition can also occur when your body makes too much cortisol on its own.

Treatments for Cushing syndrome can return your body’s cortisol production to normal and noticeably improve your symptoms. The earlier treatment begins, the better your chances for recovery.

Addision’s Disease

Addison’s Disease is a disorder in which the adrenal glands do not produce enough of the hormones cortisol and aldosterone. Addison’s disease is caused by an autoimmune response, in which the body’s immune system assaults its own organs and tissues. Cortisol helps the body respond to stress, including the stress of illness, injury, or surgery. It also helps maintain blood pressure, heart function, the immune system, and blood glucose (sugar) levels. Aldosterone affects the balance of sodium and potassium in the blood, which in turn controls the amount of fluid the kidneys remove as urine, which affects blood volume and blood pressure.

Diabetes

Insulin Resistance

Insulin Resistance Diabetes affects over 10% of the US population, and results from insulin resistance in 90% of patients. Onset in these patients is in middle life, with increased weight from poor diet and decreased exercise, and is treated with oral medications. Insulin lack is the cause of illness in 10% of diabetic patients, and requires insulin treatment. Prediabetes, or metabolic syndrome, affects a much larger proportion of the US population and increases the likelihood of progressing to overt diabetes. Even before diabetes is apparent, this condition increases risk of heart attack, stroke and other diabetic complications.

Metabolic Syndrome

Metabolic Syndrome is a cluster of conditions (increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels) that occur together, increasing your risk of heart disease, stroke and diabetes.

Weight Loss Medicine

Obesity and Weight Loss

Being overweight or obese predisposes an individual to many medical problems including diabetes, high blood pressure, heart disease, stroke, depression and some types of cancer. In the United States, the frequency of these conditions is increasing at epidemic rates.

Dr. Anbar Ahmad and the Experts at North Georgia Endocrinology work closely with dietitians, exercise physiologists, behavioral therapists and bariatric surgeons as part of the Comprehensive Weight Loss Center to help patients achieve realistic weight-loss goals and improve health.

Diagnosing Obesity

Obesity is diagnosed using a formula based on height and weight called the body mass index (BMI). Several online BMI calculators are available. Higher BMIs are associated with greater risk of health problems. A normal BMI is 18.5 to 24.9. Adults with a BMI of 30 or more are considered obese. Measuring waist circumference can also be helpful in determining risk of obesity-related diseases.

While many people have a genetic predisposition to obesity, the multidisciplinary team can identify other causes and monitor for complications. These secondary conditions, which frequently have endocrine causes, can be identified through a careful medical history, physical exam, blood tests, saliva tests and X-rays, if needed.

Secondary causes of obesity include:

Hypothyroidism and hyperthyroidism
Cushing syndrome/Cushing’s disease
Insulinoma
Brain trauma or brain tumors
Medications
Sleep disorders
Rare congenital obesity syndromes, including:
- Prader-Willi syndrome
- Bardet-Biedl syndrome
Lipodystrophy syndromes (abnormal deposits of fat tissue), including:
- Congenital generalized (no fat on the body since birth)
- Familial partial (fat only in certain areas)
- Acquired generalized (diffuse loss of fat)
- Acquired partial (loss of fat only in certain areas)
- Acquired lipodystrophy in HIV-infected patients

The specialists at North Georgia Endocrinology will work to find the best treatment options for you and your condition. Schedule an appointment with Dr. Anbar Ahmad to find a treatment plan that works for you.

Transgender

Transgender Health

Gender dysphoria is the stress and anguish that a person feels when the gender they identify with is incongruent with their biological sex. There are many forms of gender expression that can range from dressing differently to hormone therapy to gender reassignment surgery. Our priority is to provide a safe space to help you in your transition. We will work with you to find the therapy that works for you, and we will support you every step of the way.