Endocrinology Treatments and Services

We use diagnostic tests and procedures to:

  • Measure the levels of various hormones in a patient's body
  • Learn if the endocrine glands are working correctly
  • Determine the cause of an endocrinological problem
  • Confirm an earlier diagnosis

We have expertise in all endocrinological treatments, including common procedures and cutting-edge technologies.

Diagnostics tests and procedures

These are some of the diagnostic tests and procedures we use.

24-hour urine collection test

In this test, the patient's urine is collected over a 24-hour period, and tested for the amount of hormones in the urine. We use 24-hour urine collection tests to measure the levels of various hormones in a patient's body.

If a doctor suspects a patient may have Cushing's syndrome, a condition in which the adrenal glands produce too much cortisol, the doctor will test the collected urine for cortisol. More than 50 to 100 micrograms of cortisol a day for an adult suggest the patient may have Cushing's syndrome. The urine collection is done at home.

ACTH stimulation test

ACTH (adrenocorticotropic hormone) is a hormone made by the pituitary gland that tells the outer part of the adrenal gland to produce hormones such as cortisol. An ACTH stimulation test measures levels of cortisol in your blood before and after you are given a synthetic form of ACTH.

This test can help a doctor tell if a patient's adrenal and pituitary glands are normal. It is often used when a doctor suspects a patient has an adrenal gland disorder, such as Addison's disease.

Bone density test

This test uses X-rays to show if a person's bones have lost tissue and minerals. It is a common test for evaluating osteoporosis, a condition which causes bones to become less dense and weaken. The most common, and accurate, bone density test is dual X-ray absorptiometry.

A doctor may recommend a bone density test for anyone at risk for osteoporosis, even if the person has no symptoms of the condition. The National Osteoporosis Foundation recommends that any woman 65 or older has a bone density test. Early detection of osteoporosis can help keep the condition from getting worse.

CRH stimulation test

A CRH stimulation test measures levels of cortisol in your blood before and after you are given a synthetic form of CRH (corticotropin-releasing hormone). This test can help a doctor determine what is causing a drop or rise in a patient's adrenal hormones. CRH is a naturally-occurring hormone that causes the pituitary gland to secrete the hormone ACTH. ACTH tells the outer part of the adrenal gland to produce hormones such as cortisol.

The test is often used when a doctor suspects a patient has too few or too many adrenal hormones, caused by a disorder such as Cushing's syndrome. The way a patient's cortisol levels respond to the test can tell a doctor if the problem is with the pituitary glands, the hypothalamus, or the adrenal glands.

Dexamethasone suppression test

This test can help a doctor learn the cause of a patient having high levels of the hormone cortisol. The doctor gives the patient dexamethasone, a synthetic version of cortisol, and checks the patient's urine to see how his or her body responds.

This test is often used when a doctor suspects that a patient has too many adrenal hormones, caused by a disorder such as Cushing's syndrome. The way a patient's cortisol levels respond to the test can tell a doctor if the problem is due to a pituitary tumor, or another cause.

Fine-needle aspiration biopsy

In fine-needle aspiration biopsy, a doctor uses a small needle to remove a sample of cells from a thyroid nodule (a lump or growth on the thyroid gland). The sample is then sent to a lab to determine whether the nodule is malignant (cancerous).

A doctor may order fine-needle aspiration biopsy to tell if a thyroid nodule is benign (non-cancerous) or malignant (cancerous). The procedure is almost completely accurate in diagnosing a malignancy. It can eliminate the need for other tests, such as ultrasound or a thyroid scan.

Five-day glucose sensor test (for diabetes)

This test uses a small sensor and an electronic recorder to monitor the blood sugar (glucose) levels of patient with diabetes. The test allows a doctor to find patterns in a patient's blood sugar levels, and discover ways to prevent episodes of hypoglycemia (low blood sugar).

A doctor most often recommends a five-day glucose sensor test if he or she suspects that a patient has episodes of dangerously low blood sugar levels (hypoglycemia). The test can measure blood sugar levels at night, when a patient is unable to do manual tests.

Oral glucose tolerance test

This test helps a doctor diagnose diabetes. It is often used to check for gestational diabetes, a condition that some women develop during the late stages of pregnancy. The test measures a person's ability to process glucose, the sugar that is used by the body as fuel. After the patient drinks a glucose solution, the doctor checks the patient's blood sugar levels several times over a period of hours.

A shorter glucose challenge screening test evaluates pregnant women for gestational diabetes. This is usually done between the 24th and 28th week of pregnancy. If the results of the screening test show that a woman might have gestational diabetes, a doctor will recommend the longer oral glucose tolerance test.

Semen analysis

Semen analysis is a test, or a series of tests, that checks the health of a man's sperm. It is used to help diagnose why a couple is having trouble getting pregnant.

Semen analysis can help a doctor learn if infertility is caused by the man's body producing no sperm, too few sperm, or defective sperm that die before the woman's egg can be fertilized. The test may also be used after a man has had a vasectomy (sterilization surgery) to make sure his semen contains no sperm.

Thyroid scan

A thyroid scan is an image made of the thyroid gland after you have swallowed a small amount of radioactive iodine. Because the thyroid naturally uses iodine to produce some of its hormones, it absorbs the radioactive substance. This substance emits energy and allows the image to be made. The image will show if the thyroid gland is enlarged and overactive. Thyroid scans are often used to diagnose hyperthyroidism, and to investigate thyroid nodules.

TSH blood test

Thyroid stimulating hormone (TSH) is made by the pituitary gland. It normally stimulates the thyroid to produce its hormones. In hypothyroidism, TSH is not used by the thyroid, and its levels remain high in the blood. A TSH blood test checks for increased levels of this hormone.

A TSH blood test is a common and important test for diagnosing hypothyroidism, a condition in which the thyroid gland produces fewer hormones than the body needs.


These are some of the treatments we specialize in.

Biphosphonate therapy (for osteoporosis)

Bisphosphonates are used to both prevent and treat osteoporosis in postmenopausal women. These drugs help slow the loss of bone density, and so reduce the risk of spinal and hip fractures. Alendronate (Fosamax) and risedronate (Actonel) are two kinds of biphosphonates.

If a bone density test, X-ray, or other diagnostic test shows that you have osteoporosis, your doctor may prescribe bisphosphonates to preserve the density of your bones. Biphosphonates are also used to treat other bone diseases, such as Paget's disease.

Insulin pump

Insulin pumps are the closest substitute available to your body's making and delivering its own insulin. The Diabetes Program at Dartmouth Hitchcock Medical Center in Lebanon offers pumps to patients with diabetes. Learn more about the Insulin Pump Program.

Male hormone replacement therapy

In male hormone replacement therapy, a man is given testosterone, the hormone responsible for developing the male sex organs and producing male characteristics such as facial hair and muscularity. Male hormone replacement therapy is most often used to correct the symptoms of male hypogonadism, a condition in which a man's body makes very little testosterone.

Parathyroid hormone therapy (for osteoporosis)

Parathyroid hormone therapy uses Teriparatide (Forteo), a synthetic form of the hormone produced by the parathyroid glands (PTH). This drug stimulates new bone growth. It is used to treat osteoporosis in people who are at high risk of fractures, most often postmenopausal women.

A doctor may recommend parathyroid hormone therapy for a patient who has already had bone fractures due to osteoporosis, who has dangerously low bone mass, and who has not responded to other treatments.

Pituitary hormone replacement therapy

In pituitary hormone replacement therapy, a patient takes hormones to replace the hormones not being produced by the pituitary gland. These hormones include ACTH, TSH, anti-diuretic hormone (ADH), sex hormones, prolactin, and growth hormone.

This therapy is used to treat hypopituitarism, a condition in which the pituitary gland is not producing one or more of its hormones, or is producing them at lower than normal levels.

Radioactive iodine therapy

Radioactive iodine therapy is used as a treatment for hyperthyroidism, if anti-thyroid medication or surgery to remove part of the thyroid gland hasn't cured the condition. In radioactive iodine therapy, a patient swallows a small amount of a radioactive substance to destroy part or all of the thyroid gland, and make it unable to produce thyroid hormones. The treatment is safe, and has been used for over 50 years.

One dose of radioactive iodine treatment cures hyperthyroidism 80% or more of the time. This therapy is also used to treat thyroid nodules that produce excessive amounts of thyroid hormone. A doctor will sometimes recommend radioactive iodine therapy as a treatment for thyroid cancer, after a patient's thyroid gland has been removed by surgery. The treatment ensures that no thyroid tissue remains after surgery

Thyroid hormone replacement therapy

In thyroid hormone replacement therapy, a patient takes a synthetic form of thyroid hormones to raise low levels of these hormones. These low levels are caused by an underactive thyroid gland. This therapy is used to treat hypothyroidism, a condition in which a person's thyroid gland does not produce enough hormones. It is also used to control the growth of a goiter (enlarged thyroid gland), or thyroid nodules.