Endocrinology - Institute

The Pituitary Center at Ichilov has specialists who address the various aspects of diagnosing and treating pituitary gland disorders, including pituitary tumors and pituitary insufficiency. Clinical discussions and teamwork among endocrinologists, neurosurgeons, neuroradiologists, neuro-ophthalmologists, and radiation therapy specialists enable the exchange of knowledge and expertise and the achievement of excellence in the treatment of pituitary diseases, positioning the Center as one of the leading centers of its kind in Israel.

The pituitary gland is located at the base of the brain, close to the optic chiasm. This gland secretes hormones that regulate many vital processes in the body, including growth, fertility, metabolic balance, maintenance of body weight, regulation of blood pressure, and electrolyte levels.

The most common conditions affecting the pituitary gland are tumors that may secrete specific hormones uncontrollably, causing syndromes resulting from elevated levels of growth hormone (acromegaly), ACTH and cortisol (Cushing's disease), prolactin (reproductive and sexual dysfunction), and TSH (hyperthyroidism). On the other hand, even tumors that do not secrete hormones may cause headaches, visual disturbances, and impaired normal hormone secretion due to their sensitive location.

Pituitary-related disorders include:

• Acromegaly: Excessive secretion of growth hormone.

• Cushing's disease: Excessive secretion of cortisol and ACTH.

• Prolactinoma: Excessive secretion of prolactin.

• Non-functioning pituitary tumor: A tumor that does not cause symptoms associated with excessive hormone secretion.

• Diabetes insipidus: Deficiency of ADH, the antidiuretic hormone responsible for water retention.

• Craniopharyngioma.

Successful treatment depends on accurate diagnosis and the development of a specific treatment plan for each disease and patient. In some cases, medication alone may be sufficient to regulate excessive hormone secretion while correcting deficient hormone levels. In other cases, surgical removal of the tumor is necessary. In such cases, evaluation and treatment by an endocrinologist before and after surgery are critical to treatment success. Treatment is fundamentally multidisciplinary and requires close collaboration among several medical specialties.

The Diabetes Unit at the Institute of Endocrinology at Ichilov includes the Diabetes Clinic and a consultation service for inpatient departments.

The Diabetes Clinic is open to all patients with type 1 diabetes, type 2 diabetes, and prediabetes.

The clinic serves as a tertiary care center for patients with complex conditions and specializes in advanced treatment methods, including glucose sensors, insulin pumps, and medication therapy. Emphasis is placed on intensive treatment, tailoring treatment goals to each patient's condition and underlying diseases, and ensuring the availability of the medical team according to patient needs.

The clinic works in full coordination with the hospital's departments and units, providing care for patients with diabetes combined with chronic or acute illnesses.

Damage to the arterial blood vessels is a leading cause of morbidity and mortality in Western populations. Structural and functional abnormalities of the arterial system may lead to conditions ranging from heart attacks, strokes, kidney disease, and reduced blood supply to the limbs to impaired brain function and sexual dysfunction.

In recent years, methods have been developed to detect changes in blood vessels long before vascular damage leads to illness or death. These methods involve a series of tests that assess blood vessel elasticity, relaxation capacity, compliance, and the speed at which pressure waves travel through the arteries.

The degree of elasticity reflects the "relative age" of the arterial system and identifies premature arterial aging, providing patients with a picture of their current vascular condition and its potential future implications. Based on this assessment, patients may receive preventive treatment aimed at reducing damage to the arterial system. Therefore, this service is also relevant for young and healthy individuals.

The examinations offered by the Institute of Endocrinology combine several diagnostic methods to provide highly reliable data on the characteristics of the arterial vascular system. These are noninvasive tests performed at rest and after fasting for at least three hours.

Many endocrine disorders, such as diabetes, hypertension, excessive hair growth, certain thyroid tumors (medullary carcinoma), and tumors of other endocrine organs, including the parathyroid glands, adrenal glands, pancreas, and pituitary gland, may develop as a result of an identifiable genetic abnormality. Detecting these abnormalities is extremely important for treatment and follow-up.

The Genetic Endocrinology Clinic at Ichilov Hospital focuses on hereditary endocrine syndromes, such as monogenic diabetes, neuroendocrine tumors, and hereditary metabolic conditions, including morbid obesity, familial dyslipidemia, bone diseases, fertility problems, and other disorders.

Genetic diagnosis can help tailor treatment and follow-up for genetic disorders such as:

• Monogenic diabetes caused by a defect in the glucokinase gene (MODY2): This condition presents as a mild form of diabetes that does not require medication due to the low risk of developing diabetic complications. Identifying this condition and distinguishing it from other forms of diabetes that require treatment is important.

• Pheochromocytoma, an adrenal gland tumor: Genetic diagnosis can help assess the risk of disease recurrence and the risk of associated conditions, such as tumors in other tissues or locations, enabling more comprehensive and appropriate patient follow-up.

Genetic diagnosis of a syndrome is also important for identifying additional family members who may be at risk of developing the endocrine disorder. Furthermore, genetic diagnosis may enable prenatal or preimplantation genetic testing in future pregnancies.

The Women's Endocrinology Clinic provides care for changes and disorders of the menstrual cycle and sex hormones in women aged 18 and older. Treatment focuses on hormonal disorders as well as associated metabolic aspects, such as changes in weight, bone density, glucose metabolism, and blood lipid levels.

It should be noted that, unlike a gynecology clinic, the Women's Endocrinology Clinic does not provide fertility treatments.

In addition, the clinic treats women during menopause, addressing the various symptoms associated with this stage of life and tailoring treatment to each woman's personal medical background.

When necessary, patients are referred for a metabolic assessment, which may include dietary consultation, calorimetry and body composition testing (assessment of the body's metabolic rate), bone density evaluation, vascular function assessment, sleep quality assessment, psychological or psychiatric treatment, and treatment at the urogynecology clinic.

The clinic aims to provide a holistic approach to women's health at this stage of life, addressing immediate needs while working to prevent future health problems.

The Endocrine Day Hospitalization Unit performs diagnostic tests for a wide range of diseases and provides complex treatments for patients requiring intravenous medication or special monitoring. The unit has four beds and is staffed by experienced nurses.

The clinic serves patients aged 18 and older with thyroid nodules requiring fine-needle aspiration, as well as patients of the Institute of Endocrinology who require a thyroid ultrasound (US) to evaluate thyroid disease, including the presence of nodules.

The clinic is unique in Israel, as ultrasound examinations are performed by an endocrinologist. Ultrasound assessment is carried out on-site and, when necessary, combined with other thyroid examinations to provide comprehensive, evidence-based care.

Patients receive an explanation of their condition during the visit and may continue treatment and follow-up at the Institute of Endocrinology. When necessary, patients are referred to the Institute for further evaluation and treatment.

The Neuroendocrine Tumors Clinic at Ichilov Hospital specializes in the diagnosis and hormonal treatment of neuroendocrine tumors, primarily those affecting the gastrointestinal tract, pancreas, chest, and adrenal glands.

Clinic Activities and Multidisciplinary Approach

• Diagnosis of neuroendocrine tumors in various locations, including the gastrointestinal tract, lungs, and adrenal glands.

• Development of follow-up plans for patients with neuroendocrine tumors.

• Treatment of neuroendocrine tumors through medication or interventions, including surgery, radiotherapy, and ablation, in collaboration with the Oncology, Imaging, Surgery, and Gastroenterology departments.

• Treatment of associated endocrine disorders, including diabetes management, hypoglycemia, hypercalcemia, hypocalcemia, phosphorus metabolism disorders, electrolyte imbalances, and other conditions.

• Identification of hereditary neuroendocrine tumors and previously undiagnosed cases among affected families, in collaboration with the Institute of Genetics.

• Detection and diagnosis of additional neuroendocrine tumors in patients with multiple endocrine gland disorders.

As part of its multidisciplinary approach, treatment and follow-up are provided in collaboration with specialists in oncology, imaging, pathology, surgery, gastroenterology, nuclear medicine, and other relevant fields.

The clinic also operates a joint Oncology-Endocrinology Clinic for Neuroendocrine Tumors, where each patient's case is regularly discussed in multidisciplinary team meetings.

The multidisciplinary team treats patients with neuroendocrine tumors referred from across Israel and abroad.

The first combined clinic of its kind in Israel was established to treat thyroid-related eye diseases associated with Graves' disease (hyperthyroidism).

Approximately 30% of patients with Graves' disease develop eye disease, with severe cases occurring in 5% of these patients. Most patients with thyroid-related eye disease have hyperthyroidism, although eye disease may also occur in patients with hypothyroidism.

Thyroid dysfunction and eye disease usually develop around the same time. However, eye disease may sometimes precede or follow the onset of hyperthyroidism by a year or more.

Patients may experience excessive tearing, sensitivity to light, and eye discomfort. More severe cases may involve double vision, blurred vision, and, in extreme cases, a risk of vision loss. Risk factors include smoking and exposure to radioactive iodine.

Patients attending the combined Graves' Ophthalmopathy Clinic are examined on the same day by a multidisciplinary team of neuro-ophthalmologists/ophthalmologists and endocrinologists. When necessary, patients are also evaluated by an oculoplastic specialist.

The Endocrinology Laboratory is part of the Institute of Endocrinology, Metabolism and Hypertension at Tel Aviv Medical Center.

The laboratory performs a wide range of routine and specialized endocrine tests using advanced technology. It is equipped with modern laboratory equipment and complies with the requirements of the Israeli ISO 9001 standard.

The Endocrinology Laboratory provides services to all hospital departments and clinics, other hospitals, health maintenance organizations (HMOs), private individuals, and research institutions.

In addition to routine clinical work, the laboratory conducts extensive clinical and basic research in various fields of endocrinology and continuously develops new methods that enable specialized testing.

Obesity has become a growing global epidemic in recent years, with obesity rates more than tripling over the past four decades. This trend is also evident in Israel, which ranks among the ten countries with the highest obesity rates.

The Obesity Clinic at the Institute of Endocrinology at Ichilov offers a range of services to address this condition.

During the initial consultation, the medical team assesses whether an underlying endocrine disorder, such as Cushing's syndrome, should be ruled out as a possible cause of obesity.

Treatment includes nutritional counseling and guidance from the Institute's dietitian, as well as physical activity assessment and recommendations provided by an exercise physiologist.

In addition to comprehensive medical evaluation and behavioral treatment, the clinic offers medications that support weight loss. When appropriate, patients may also be referred for nonsurgical weight-loss procedures offered by the Institute of Gastroenterology or, in certain cases, for bariatric surgery.

The Institute of Endocrinology at Ichilov Hospital regularly participates in international clinical trials evaluating the effectiveness of new treatments and medications, providing patients with opportunities to participate in these studies.

In addition to treating obesity itself, the Institute's physicians manage many obesity-related complications, including diabetes, hypertension, and elevated blood lipid levels, with the aim of improving patients' quality of life and life expectancy.

The clinic specializes in the diagnosis and treatment of endocrine and metabolic disorders caused by the use of new medications introduced into oncological treatment.

The Hypertension Clinic at Tel Aviv Medical Center (Ichilov) specializes in evaluating hypertension and tailoring treatment according to its underlying cause. The clinic also provides treatment for associated risk factors.

Blood pressure is the pressure exerted by circulating blood against the walls of the arteries. Blood pressure varies throughout the day in the same individual and in response to different activities.

Blood pressure is expressed using two numbers: the higher value, systolic blood pressure, represents the peak pressure within the arteries following the pumping of blood from the heart into the arteries. The lower value, diastolic blood pressure, represents the lowest pressure, measured when the heart is at rest before its next beat.

In the general population, hypertension is defined as blood pressure equal to or greater than 140/90 mmHg. In specific populations, such as patients with diabetes, kidney disease, and/or multiple risk factors, the defining thresholds are lower.

Hypertension often develops without any warning signs and may increase the risk of stroke and heart disease.

Treatment at the Hypertension Clinic includes identifying the underlying causes of high blood pressure and adjusting medication to achieve optimal blood pressure control. Patients undergo a medical history assessment and physical examination and, when necessary, are referred for laboratory tests.

The Lipid and Atherosclerosis Prevention Clinic provides diagnostic and treatment services for patients with lipid metabolism disorders and additional risk factors for atherosclerosis. Care focuses on both primary prevention (before the development of atherosclerosis and/or cardiovascular disease) and secondary prevention (after the disease has developed).

The clinic also conducts clinical research in the fields of lipid disorders and atherosclerosis.

The clinic's goals are to prevent the development and progression of atherosclerosis and cardiovascular disease by treating elevated blood lipid levels and identifying and managing additional cardiovascular risk factors.

The Clinical Research Unit at the Institute of Endocrinology collaborates with leading companies in the field of clinical research while providing patients with advanced care and treatment. All studies are supervised and monitored by the local Helsinki Committee.

The Institute of Endocrinology, Diabetes, Metabolism and Hypertension at Ichilov Hospital participates in leading international clinical studies in the fields of diabetes, obesity, and endocrine disorders through its Clinical Research Unit.

The Thyroid Center was established to provide patients with multidisciplinary care under one roof, offering immediate access to the extensive expertise of the hospital's specialists.

The Center aims to address various thyroid disorders, including structural abnormalities (enlargement of the gland, lumps, and nodules), thyroid dysfunction, benign and malignant tumors, as well as parathyroid gland disorders.

The Center treats thyroid nodules and tumors, parathyroid gland disorders, hypothyroidism (an underactive thyroid gland that does not produce sufficient hormones), and hyperthyroidism (an overactive thyroid gland that produces excessive amounts of hormones).

At the Center, patients can consult, as needed and even on the same day, with an endocrinologist, a head and neck surgeon, a radiologist for ultrasound imaging, a pathologist for biopsy, an oncologist, and nuclear medicine specialists. This multidisciplinary approach enables the development of a comprehensive treatment plan tailored to each patient's medical needs, providing high-quality care without the need to visit multiple specialists at different locations.

The Center offers a range of advanced treatments for thyroid and parathyroid disorders, including minimally invasive surgery, ultrasound-guided biopsies and fine-needle aspirations (FNA/FNB), radiofrequency ablation (RFA) to reduce benign tumors without surgical scarring, radioactive iodine therapy, and biological treatments. Patients also receive long-term medical follow-up.

The surgical team performs thyroid and parathyroid gland removal procedures for benign and malignant tumors or overactive glands, including complex surgeries to remove tumors and affected lymph nodes. When appropriate, procedures are performed using minimally invasive techniques, through the oral cavity, or under local anesthesia, with advanced intraoperative monitoring.

Gender dysphoria is a relatively common condition, and the need for appropriate, high-quality medical care for transgender women and men is increasing.

The Transgender Health Center provides holistic care delivered by leading specialists. Its goal is to offer a wide range of services under one roof and make personalized gender-affirming care accessible to every patient.

The Transgender Health Center is a unique facility and the first of its kind in Israel, specifically established to serve the transgender community.

The Center offers holistic, multidisciplinary medical care, bringing together leading specialists in endocrinology, plastic surgery, oral and maxillofacial surgery, otolaryngology (ENT), gynecology and fertility preservation, psychiatry, nutrition, and other fields.

Our goal is to provide comprehensive care under one roof, making professional, personalized treatment accessible and tailored to each individual's unique needs throughout the gender-affirmation process.

Many oncology patients experience additional medical conditions and complex health problems, some of which result from cancer treatment. Treatments such as chemotherapy, biological therapies, immunotherapy, steroids, and medications that suppress hormone secretion (used in prostate and breast cancer) may cause a variety of endocrine disorders at a significant frequency.

Endocrine disorders in oncology and hematology patients require medical intervention both during treatment and after recovery, with the aim of achieving optimal outcomes from cancer treatment.

Metabolic syndrome may result from an unhealthy lifestyle, genetic predisposition, or side effects of medications prescribed for skin diseases, inflammatory conditions, and mental health disorders. These medications are often essential and cannot be discontinued.

Metabolic syndrome increases the risk of developing diabetes and cardiovascular diseases, such as heart attacks and strokes. It may also be associated with fatty liver disease, kidney failure, and elevated uric acid levels, which increase the risk of gout. Early treatment is therefore essential to prevent the development of diabetes, obesity, cardiovascular diseases, and liver cirrhosis.

Metabolic syndrome is also common among women planning pregnancy and may lead to risks and complications for both mother and fetus if not treated before conception.

The goal of treatment is to help control the components of metabolic syndrome, prevent the development of diabetes, fatty liver disease, and damage to the heart, blood vessels, and kidneys by improving metabolic function, adopting a healthy lifestyle, and implementing preventive measures.

Osteoporosis ("porous bone") is a silent disease characterized by a reduction in bone mass and quality, resulting in an increased risk of fractures.

The Bone Diseases Clinic provides care for patients with bone and mineral disorders, including osteoporosis, calcium metabolism disorders, Paget's disease, and other conditions.

The clinic's multidisciplinary team includes specialist endocrinologists, registered nurses, dietitians, and consultants specializing in tailored physical activity.

During a clinic visit, patients undergo a comprehensive health assessment, including evaluation of fracture risk factors, bone mineral density, and laboratory tests. Based on the findings, a personalized treatment plan can be developed to prevent osteoporotic fractures.

The clinic offers specialized laboratory tests, including bone turnover markers (CTX, P1NP) and additional advanced biomarkers, enabling a more detailed assessment of the patient's condition, treatment response, and individualized treatment needs.

Patients can also receive personalized nutritional counseling from a team of clinical dietitians and guidance on appropriate physical activity.

The clinic specializes in managing severe osteoporosis and secondary osteoporosis. Treatment is also provided following fractures to improve bone quality and strength and prevent recurrent fractures.