Pre-existing or new onset medical conditions in pregnancy have a significant impact on maternal, fetal and neonatal morbidity and mortality. The prevalence of medical conditions in pregnancy is rising because of increasing maternal age, with women more likely to have acquired medical disorders such as diabetes mellitus, and hypertension.
It is important to manage endocrine conditions (such as diabetes mellitus, obesity, thyroid disorders, pituitary and adrenal disorders, and calcium disorders) well to mitigate maternal, fetal and neonatal risks. Treating pregnant mothers require a unique approach, with special consideration about the safety of investigations and drug therapy during pregnancy and breastfeeding. There is a need for collaboration with the obstetricians during the course of pregnancy for optimal medical management.
Endocrine conditions in pregnancy:
Men’s Health Clinic is a subspecialty clinic within SGH Endocrinology that focuses on the evaluation and management of testosterone related conditions.
Men across lifespan may face health issues that are driven by or associated with abnormal testosterone production.
These may be related to reproductive disorders, including delay or incomplete puberty (in adolescents or young adults), impaired sexual function, subfertility, and late-onset hypogonadism (popularly labelled as andropause in older men).
Affected men may also experience a myriad of non-reproductive symptoms resulting in a poor quality of life, in particular mood swings, low energy level, inability to concentrate, sleep disturbances, and decrease in muscle bulk and strength.
Furthermore, metabolic disorders are closely linked to testosterone deficiency (hypogonadism). As such, affected men may suffer from abnormal blood glucose (diabetes), a greater fat-to-lean mass body composition (increased adiposity and sarcopenia) and low bone mineral density (osteoporosis).
Specialised clinical evaluation is therefore necessary to establish the diagnosis of hypogonadism and its underlying cause, as well as the presence of any other hormonal disorders (e.g. thyroid, prolactin), associated medical conditions and complications.
Treatment of hypogonadism and associated conditions is multi-faceted due to its complexity. In selected patients, multidisciplinary care is delivered together with physicians and health care providers from other specialities.
Testosterone replacement therapy (TRT) plays a central role in addressing the symptoms and complications. The mode of TRT may differ between individuals depending on the etiology and goals of treatment.
In general, TRT aims to replace blood testosterone level to within that of normal physiological range, along with personalised titration according to age and co-existing medical conditions. Regular monitoring during treatment further ensures the safety of patients.