Endocrine disorders refer to any disease state that is associated with abnormal hormone secretion.  There are several different types of endocrine disorders, all of which can have a profound effect on the sufferer.  All endocrine disorders are essentially caused by the over production or under production of hormones, resulting in structural or functional changes in the body.  Endocrine disorders can have a serious impact on other organ systems and should be evaluated as to their effects on these systems. 

General Evaluation  

     Because of the nature of endocrine disorders, an evaluation of a person with such an impairment can be very complex.  Not only must you try to understand the endocrine disorder itself, you must also be aware of at least some of the many ways these diseases can interact and worsen other medical conditions.  Because of the system overlapping effect of most endocrine disorders, we will list and discuss some of   the specific considerations for common endocrine diseases.

Diabetes mellitus
Pituitary disorders
Parathyroid disorders 
Thyroid disorders
Hypoglycemia
Adrenal disorders
 

Diabetes Mellitus:  

     Diabetes is not only the most common endocrine disorder seen by SSA, it is also one of the most common diseases suffered in the United States.  This single disorder alone has an array of medically destructive side effects that can greatly complicate a claimant's condition.

     Diabetes is a secretion disorder of cells located in the pancreas which are responsible for the secretion of insulin.  Insulin is a hormone which acts to reduce the concentration of sugar in the blood.

    This abnormal secretion of insulin causes a variety of vascular manifestations such as changes in vessel walls, atherosclerosis and nerve destruction.  These manifestations then cause further destruction to the organs being fed by the diseased vessels or nerves.

     Diabetes can and often does affect the eyes, kidneys, heart, blood vessels, nerve fibers and more.  The common signs and symptoms of diabetes mellitus are high blood sugar, frequent urination, thirst, hunger, weight loss, ketoacidosis (abnormal amount of ketones in blood) leading to poor appetite, nausea, air hunger, coma and death.

     There is no cure for diabetes, but it can be treated.  Treatment seems to slow the destructive effects of the disease, but does not necessarily prevent later complications.

     Let us concentrate our attentions on the more common manifestations of diabetes mellitus.  The first diabetic effect we will consider is a condition or symptom known as peripheral neuropathy.   Essentially, peripheral neuropathy is a condition of nerve injury.  This condition is manifested by decreased sensory or motor capabilities in the affected limb.  This condition is most often seen to affect the lower extremities.  The patient may complain of poor sensory perception, tingling sensation, poor healing and pain in the involved limb.

     Peripheral vascular changes may also be present in a person suffering from diabetes.   These symptoms are manifested by possible discoloration of the limb, coolness, pain, poor or delayed healing, ulcers and other signs common to poor circulation to an extremity (arm or leg).

     Diabetic retinopathy is a condition in which the underlying diabetic disorder has affected the blood vessels of the eye, causing destruction to the retina of the eye.  The visual destruction caused by the diabetic condition may be neurological or circulatory.

     Retinopathy can affect both the blood vessels and the nerves of the eye.  In either case, the claimant may experience bleeding in the eye or damage to the optic nerve causing a decrease in vision which can lead to blindness.

     When evaluating a person with a history of diabetes, always check for additional symptoms of visual disturbance, poor circulation, delayed healing, and sensory or motor interference due to nerve damage.  Think of diabetes as a complicating factor to any other impairment the claimant may have.

     Incidentally, there are two types of diabetes.  Diabetes mellitus is the most commonly seen and also causes the most serious symptoms and end organ damage.  There is also diabetes insipidus which has its own collection of symptoms.  Both diabetes mellitus and insipidus can have a serious effect on a claimant's ability to perform work.  If you run into these disorders, your Merck or other medical text will explain its most commonly seen symptoms.

Pituitary Disorder:

     The pituitary gland located in the brain secretes a number of extremely important hormones.  If a malfunction of this gland occurs, it will cause either an abnormal increase or decrease in the amount of hormone secreted.  The pituitary gland has two parts referred to as the anterior and posterior segments or lobes.

     Malfunction of the anterior lobe, causing a decrease in the secretion of its hormones, will primarily affect the sexual organs in both males and females.  If this condition occurs in children, it can cause dwarfism due to a decrease in the secretion of GH or growth hormone.  An increase in the secretion of hormones from the anterior lobe of this gland can cause gigantism and other growth abnormalities. Young children are especially affected by disorders of the pituitary gland.

     Abnormal secretion from the posterior lobe of the pituitary gland can cause a disorder known as diabetes insipitus, which is distinctly different from diabetes mellitus.   If you encounter a pituitary disorder, usually the medical evidence will list the effects the disorder is having on the individual.

     Do not waste your time trying to understand which hormone is or is not being secreted.   Concentrate your attentions on the reported effects the disorder is having on the claimant.  You will not have a problem finding the restrictive aspects of the disorder because the medical evidence or the claimant will tell you. 

Thyroid disorders:

     A thyroid gland disorder, like all endocrine gland disorders, will either show abnormally high or low secretion of hormones it produces.  Hyperthyroidism, or a condition of increased secretion of thyroid hormone, can cause symptoms of goiter, fast heart rate, tremor, enlarged eyeballs, weakness and insomnia.

     A hyposecretion, or decreased secretion of thyroid hormone, can cause symptoms of obesity, memory problems, decreased intellectual functioning, gradual changes in personality and even psychosis.  In evaluating this condition you must keep in mind the overt effects it is having on the claimant.  If the claimant shows symptoms of memory loss for example, use this symptom (memory loss), to reduce the claimant's RFC from a psychological standpoint.

Adrenal disorders:

     Disorders of the adrenal gland will cause either increased or decreased secretion of its hormones.  Increased secretion can cause symptoms of weakness, fatigue, low blood pressure, weight loss, dehydration, small heart and an abnormal heartbeat.

     Increased secretions can cause disease complexes such as Cushing's syndrome and adrenal virilism or masculization.  If you come upon these disorders, it is simple enough to look them up in your Merck Manual or any other medical text you care to use.  The claimant and the medical evidence will supply most of the restrictive symptoms to you.  Describe the restrictive effects of the symptoms on the claimant, and show how those restrictions would interfere with the claimant's ability to work.