For your hormonal balance: At PAN Klinik, you benefit from modern endocrinology and diabetology through the collaboration of all specialties – ensuring precise diagnostics and individually tailored therapies. Feel free to contact us to schedule an appointment.
In our private endocrinology practice, we diagnose and treat hormonal disorders as well as diseases of hormone-producing glands. Endocrinology is a major specialty within internal medicine and also forms part of other medical disciplines, such as gynaecology with its subspecialties of gynaecological endocrinology and reproductive medicine.
Endocrinology deals with hormonal disorders and diseases of the internal glands. Hormones are messenger substances that are produced in specialised cells of the pituitary gland (hypophysis), the thyroid gland, the parathyroid glands, the adrenal glands, the islet cells of the pancreas, the sex glands (gonads) and other organs such as the gastrointestinal tract. Hormones influence our lives in many different ways. They regulate the water balance, blood pressure, length growth, sexual maturation and numerous metabolic processes such as bone metabolism or sugar metabolism. Disorders of these processes can be caused by a deficiency (insufficiency) or an excess (excess) of certain hormones, for example. Accordingly, endocrinology deals with a variety of diseases. The symptoms can be non-specific and therefore difficult to attribute to a disease.
As hormones are involved in regulating many processes in the body and can exert their effects in virtually every organ, there is hardly any area of medicine that is not influenced by them. Accordingly, endocrinology deals with a wide range of medical conditions. Some of these are common diseases such as osteoporosis (a skeletal disorder characterised by reduced bone mass and an increased risk of fractures) or diabetes mellitus (a condition associated with elevated blood glucose levels). In addition, there are also many rare and very rare disorders. The symptoms caused by hormonal imbalances can often be very non-specific and may therefore be difficult to attribute to a particular condition.
Individually tailored to the underlying causes as well as to your personal needs, we treat disorders and diseases affecting all endocrine organs:
Learn more about diseases of the adrenal gland in detail:
Hashimoto’s thyroiditis is an autoimmune disease characterised by chronic inflammation of the thyroid gland caused by cellular and antibody-mediated immune processes. The condition is named after the Japanese physician Hakaru Hashimoto (1881–1934), who first described it in 1912. It is also known as autoimmune thyroiditis, struma lymphomatosa Hashimoto, or chronic lymphocytic thyroiditis. It is the most common autoimmune disease in humans, and women are affected more frequently than men (approximately 3–4 per 1,000 women per year).
Two forms can be distinguished. In the hypertrophic form, which is less common in Germany (classical Hashimoto’s thyroiditis), the thyroid gland is enlarged (goitre). In chronic atrophic autoimmune thyroiditis, destruction of thyroid cells leads to shrinkage (atrophy) of the thyroid tissue. A characteristic finding in Hashimoto’s thyroiditis is the presence of TPO autoantibodies, whereas thyroglobulin antibodies are considered less specific. Because TPO antibodies can also be detected in people with otherwise normal thyroid function, their presence alone does not necessarily mean that treatment is required. Thyroid scintigraphy is usually not necessary.
As the disease progresses, thyroid function may become increasingly impaired and the gland may no longer be able to provide sufficient thyroid hormone for the body. This results in hypothyroidism (an underactive thyroid), which can be treated by taking thyroid hormone replacement. Treatment is initiated depending on thyroid hormone levels and the overall clinical situation (for example, in cases of a desire to conceive). Manifest hypothyroidism (with reduced levels of the free thyroid hormones fT4 and fT3) should generally always be treated. There is currently no causal therapy because it would require direct intervention in the immune system. The benefit of selenium therapy remains controversial.
Hashimoto’s thyroiditis may occur together with other autoimmune diseases, such as pernicious anaemia, and more rarely Addison’s disease or type 1 diabetes mellitus. A familial predisposition to such autoimmune diseases has also been observed.
Postpartum thyroiditis, also known as post-partum thyroiditis, is an autoimmune disease of the thyroid gland that can occur within one year after childbirth. Estimates of its frequency vary widely; older studies in Germany reported a prevalence of around 2.0%. More recent research suggests that the condition may be considerably more common.
The course of the disease may be biphasic or triphasic. Initially, there is often a phase of hyperthyroidism (overactive thyroid), which may later progress to hypothyroidism (underactive thyroid). In between, thyroid function may temporarily return to normal (euthyroidism). For many mothers, the symptoms are difficult to interpret because they may be hard to distinguish from the general changes that occur after the birth of a child (such as disturbed sleep or fatigue). Symptoms of hyperthyroidism—such as palpitations, increased sweating and nervousness—may later be followed by symptoms of hypothyroidism, including depression, reduced performance, dry skin and intolerance to cold.
Treatment of the hyperthyroid phase (with antithyroid medication) is usually not required, although beta-blockers may occasionally be used. Thyroid function can recover over time; however, about one third of affected women develop permanent hypothyroidism.
De Quervain’s thyroiditis is an inflammatory disease of the thyroid gland that is often accompanied by pain and general symptoms. Other names for this condition include subacute thyroiditis or granulomatous thyroiditis. The exact cause of the disease is not fully understood. Viral triggers are suspected, as De Quervain’s thyroiditis is often preceded by an infection of the upper respiratory tract and shows a seasonal pattern. During a fine-needle biopsy of the thyroid gland, multinucleated giant cells can typically be detected. Overall, the condition is relatively rare (approximately 4.9 cases per 100,000 people per year). Women between the ages of 40 and 50 are most commonly affected. Typical symptoms include a general feeling of illness, elevated body temperature and pain in the neck region. The pain may also radiate to the ears or the jaw. In addition, clinical signs of hyperthyroidism may occur, as this often accompanies De Quervain’s thyroiditis. Treatment consists of pain medication and, if necessary, corticosteroids. After the disease subsides over a period of several weeks to months, thyroid function often recovers.
Riedel’s thyroiditis, also known as Riedel’s struma, was named after its first describer, the surgeon Bernhard Riedel, in 1896. It is a very rare condition in which fibrous connective tissue grows into the thyroid gland, leading to hardening of the gland. For this reason, it is also referred to as “Riedel’s woody thyroid” or invasive fibrosing thyroiditis. The disease may cause local symptoms such as compression of the trachea, difficulty swallowing and other related problems. If the thyroid gland is destroyed by the fibrosing process, hypothyroidism may develop (in approximately 30–40% of cases). Another possible consequence is damage to the parathyroid glands, which can lead to hypoparathyroidism. Middle-aged women are most commonly affected. Riedel’s thyroiditis may occur in association with other fibrosing diseases, such as retroperitoneal fibrosis.
Nodular goitre refers to the formation of nodules within the thyroid gland. The development of thyroid nodules is particularly favoured by iodine deficiency and genetic predisposition. A distinction is made between nodular goitre with a single nodule and multinodular goitre with two or more nodules. This must be distinguished from diffuse goitre, which is an enlargement of the thyroid gland without the formation of nodules. Thyroid nodules are very common. In Germany, it is estimated that every fourth to fifth adult has one or more thyroid nodules. In the Papillon study, nodular changes were detected in 23.1% of participants, and 11.9% had thyroid nodules larger than 1 cm. Extrapolated to the total population, this corresponds to approximately 8 million people in Germany.
An important part of the diagnostic process is follow-up monitoring by thyroid ultrasound, although many benign nodules also show gradual growth over time. To distinguish between benign and malignant thyroid changes, technetium scintigraphy (Tc scintigraphy) is used in addition to ultrasound examination. If nodules appear suspicious on ultrasound and are “cold” on scintigraphy, a fine-needle biopsy of the thyroid gland may be performed to determine whether thyroid surgery is necessary. In unclear cases, MIBI scintigraphy may also be considered. Tumour markers are generally not available for primary diagnosis, with the exception of calcitonin in the relatively rare C-cell carcinoma.
Study data estimate that about 2.4% of people have a cold thyroid nodule. Applied to the total population, this would correspond to around 2 million people nationwide in Germany. In contrast, approximately 4,000 to 6,000 new cases of thyroid cancer are diagnosed each year, about 30% of which are so-called papillary microcarcinomas with a very favourable prognosis.
In one study involving 387 patients who underwent fine-needle biopsy over a three-year period, surgery could be avoided in many cases. The biopsy results were negative for tumour cells in 84.9% of cases and positive for malignancy in 3.8%. A further 8.5% of biopsies showed indeterminate findings and 2.7% were considered suspicious. Based on the biopsy results, thyroid surgery was recommended for 56 patients (14.5%), of whom 38 actually underwent surgery. Tissue samples after surgery were available for 81 patients. In cases with normal cytology, no malignant tumour was found (100% benign findings, with one incidental papillary microcarcinoma on the non-biopsied side). In cases with indeterminate or suspicious cytology, thyroid carcinoma was found in 17% and 33% of cases respectively. When cytology was positive (malignant cells detected), 92% of patients had a malignant thyroid tumour. Overall, fine-needle biopsy of the thyroid gland is a reliable method for assessing whether suspicious thyroid nodules are benign or malignant.
In thyroid autonomy, part of the thyroid gland no longer follows the normal regulatory mechanisms that control the production of thyroid hormones. One or more nodules (unifocal or multifocal autonomy) or the entire thyroid gland (diffuse autonomy) may be affected. Thyroid autonomy is mainly a disease of older age and is rare in people under 40 years. The diagnosis is based on thyroid hormone levels and thyroid scintigraphy. In Tc scintigraphy, “hot” or “warm” nodules can be detected. In cases of diffuse autonomy, overall uptake of the radionuclide is increased. Typically, latent or manifest hyperthyroidism (overactive thyroid) is present. If the increased hormone production in the autonomous areas is balanced by reduced hormone production in the rest of the thyroid gland, this is referred to as compensated autonomy. If hyperthyroidism develops, medical treatment is initiated depending on the laboratory findings. As a rule, the intake or administration of iodine should be avoided. The treatment of choice is radioiodine therapy, although thyroid surgery may also be considered in certain cases.
Malignant thyroid tumours are the most common endocrine malignancies. Overall, however, they account for only about 1% of all malignant tumours in humans. Several different tumour types are distinguished:
The most common group of thyroid carcinomas are the differentiated thyroid carcinomas (60–85%). They usually have a very good prognosis. Treatment generally consists of thyroid surgery and, in more advanced tumour stages, radioiodine therapy. In some patients, treatment with higher doses of thyroid hormone (TSH-suppressive therapy) is required. Very small papillary carcinomas discovered incidentally during thyroid surgery (papillary microcarcinomas) represent a special subgroup and often do not require intensive follow-up treatment. Nevertheless, follow-up monitoring with ultrasound examinations is always recommended. Measurement of thyroglobulin as a tumour marker is only useful after complete removal of the thyroid gland, but it then serves as a reliable parameter for follow-up monitoring.
C-cell carcinoma, also known as medullary thyroid carcinoma (MTC), does not arise from the thyroid hormone-producing cells but from the C cells of the thyroid gland. This tumour type accounts for 3–5% of thyroid carcinomas. These tumours may occur sporadically or run in families, either as an isolated disease (FMTC) or as part of multiple endocrine neoplasia (MEN 2A or 2B). A tumour marker for C-cell carcinoma is calcitonin. Treatment usually consists of surgical removal. Radioiodine therapy cannot be used because these tumours are unable to store iodine. In recent years, new therapeutic approaches have been developed, including the use of tyrosine kinase inhibitors, which show promising results.
In rare cases, the thyroid gland may also be the site of metastases (secondary tumours from other cancers), for example from renal cell carcinoma.
Find detailed information about adrenal gland disorders:
Primary adrenal insufficiency, also known as Addison’s disease, is a disorder of the adrenal glands that leads to a deficiency of glucocorticoids and mineralocorticoids. It is therefore an underfunction of the adrenal glands resulting in a lack of two very important hormones.
The most common cause is autoimmune adrenalitis, which leads to a gradual destruction of the adrenal cortex and is often associated with other autoimmune diseases. Due to the non-specific nature of the symptoms – such as weakness, weight loss and hypotension (low blood pressure) – months or even years may pass before a diagnosis is made. If left untreated, a life-threatening condition with shock and severe electrolyte imbalance may occur, known as an Addisonian crisis. The diagnosis is established through hormone testing and confirmed by additional examinations such as the ACTH test. Treatment of Addison’s disease consists of lifelong replacement of the missing glucocorticoids and mineralocorticoids. The glucocorticoid dose must sometimes be significantly increased during periods of physical or severe psychological stress in order to prevent an Addisonian crisis.
Regular endocrinological follow-up is advisable in order to prevent treatment errors. The occurrence of additional autoimmune diseases must be recognised early and treated accordingly. Examples include autoimmune thyroiditis (autoimmune hypothyroidism), type 1 diabetes mellitus, or pernicious anaemia (autoimmune vitamin B12 deficiency). Adrenal insufficiency may also occur as part of so-called polyglandular autoimmune syndromes.
Autoimmune adrenalitis must be distinguished from an acquired weakness of the adrenal glands caused by long-term treatment with glucocorticoids (steroids or cortisone preparations). When such medications are taken at higher doses over a prolonged period, the adrenal cortex may become suppressed. The tissue is no longer required and gradually shrinks because the hormones normally produced there are supplied externally as tablets, infusions or topical preparations. This process is known as atrophy. Whether this occurs depends on the type of glucocorticoid, its potency (relative strength), and the duration of treatment. A rough guideline is the so-called Cushing threshold dose.
In cases of uncertainty, hormone tests or stimulation tests should be performed to determine whether such adrenal insufficiency is present. If it is diagnosed and the underlying therapy can be discontinued, temporary replacement therapy with hydrocortisone may be necessary until the adrenal glands are able again to supply the body with this vital hormone on their own.
Cushing’s syndrome refers to the symptoms caused by an excess of glucocorticoids. This may be due to tumours of the adrenal gland or the pituitary gland (hypophysis). However, the most common cause is treatment with glucocorticoids (cortisone preparations). Over time, an excess of glucocorticoids can lead to significant health problems.
Symptoms include unexplained weight gain, central obesity, a rounded “moon face”, thin skin, the appearance of bluish stretch marks on the skin and muscle weakness. Diabetes mellitus, osteoporosis and high blood pressure may occur, and there is also an increased tendency to develop thrombosis and infections. Establishing the correct diagnosis is often difficult. If a cortisol-producing tumour of the adrenal gland or pituitary gland is confirmed, treatment usually consists of surgical removal of the responsible tumour, although medication may sometimes also be used. After surgery, a pronounced withdrawal of cortisone frequently occurs, which requires close monitoring and follow-up treatment.
In cases of exogenous Cushing’s syndrome (caused by medication), it may be possible—after consultation with the treating physicians—to attempt to reduce the cortisone dose. However, this depends on the underlying reason for the therapy and on the severity of the condition for which glucocorticoid treatment is required.
Primary hyperaldosteronism is a disorder of the adrenal glands caused by autonomous (i.e. unregulated and independent) overproduction of aldosterone. Aldosterone is one of the body’s key hormones responsible for regulating salt and water balance as well as blood pressure. Excess production of this hormone can lead to high blood pressure, which may be accompanied by low potassium levels (hypokalaemic hypertension).
Diagnosis is not always straightforward, as hormone levels must be interpreted while taking blood pressure medications into account. In addition, confirmatory tests such as a saline loading test or a fludrocortisone suppression test are often required. It is also necessary to distinguish between the possible causes of primary hyperaldosteronism. These may include aldosterone-producing tumours of the adrenal gland (Conn’s adenoma) or increased production throughout the entire adrenal cortex (so-called bilateral adrenal hyperplasia).
Malignant aldosterone-producing tumours are fortunately extremely rare. In many cases, precise localisation and diagnosis of hyperaldosteronism require adrenal vein sampling, a procedure that allows blood to be collected separately from each adrenal vein. If an aldosterone-producing tumour is clearly identified, it is usually removed surgically. In some cases, however, treatment with medication alone may also be sufficient.
A mass of the adrenal gland that arises from the adrenal medulla and produces catecholamines is referred to as a phaeochromocytoma. Catecholamines (noradrenaline and adrenaline) are hormones that regulate blood pressure and mediate reactions of the sympathetic nervous system. An excess of catecholamines usually leads to high blood pressure or hypertensive crises. Headaches and excessive sweating are also common symptoms of a phaeochromocytoma. Other possible symptoms include a rapid pulse (tachycardia), weight loss and visual disturbances.
Although such tumours are a relatively rare cause of high blood pressure, a phaeochromocytoma should be considered in certain situations: when high blood pressure occurs at an unusually early age, when blood pressure remains poorly controlled despite treatment with several antihypertensive medications, when characteristic accompanying symptoms occur (such as a pale face during episodes of high blood pressure), or when a mass of the adrenal gland is detected. Phaeochromocytomas are more common in certain hereditary conditions such as multiple endocrine neoplasia type 2 (MEN-2) or neurofibromatosis type 1 (NF-1).
Most phaeochromocytomas arise in one of the two adrenal glands, but such tumours may also occur outside the adrenal glands (extra-adrenal). The majority of phaeochromocytomas are benign, although in some cases they may spread and form metastases. Catecholamine-producing tumours of the sympathetic paraganglionic tissue are referred to as paragangliomas, and these may also occur more frequently in families.
Diagnostic evaluation includes laboratory tests of blood and urine, and in some cases special tests such as the clonidine suppression test may be required. If these investigations suggest the presence of a phaeochromocytoma, imaging techniques are used, such as ultrasound, CT or MRI of the adrenal glands, or nuclear medicine procedures such as MIBG scintigraphy.
If a phaeochromocytoma is confirmed, or if there is a family history of such tumours, genetic testing is generally recommended. Treatment consists of surgical removal of the tumour. However, careful medical preparation is essential beforehand, as otherwise serious complications—such as severe blood pressure crises—may occur during the operation.
An adrenal incidentaloma refers to an adrenal mass that is discovered incidentally. Such findings are relatively common. Depending on the definition used and the age of the patients, the prevalence of these masses is estimated to be between 0.4% and 4.4%. In most cases, they represent benign changes. However, certain groups of patients have a higher risk of malignant disease. In many cases, imaging techniques such as CT or MRI allow a reliable assessment of whether the lesion is benign.
Because the adrenal glands produce several hormones (including cortisol, aldosterone and catecholamines), some of these masses may lead to hormone overproduction. Depending on which hormone is produced in excess, the condition may present as Cushing’s syndrome, primary hyperaldosteronism or phaeochromocytoma. Possible indications of a hormone-producing process include high blood pressure, diabetes mellitus or other symptoms such as weight gain. For this reason, measuring adrenal hormone levels is an important part of the diagnostic evaluation.
Many adrenal incidentalomas, however, are hormonally inactive, meaning they do not produce excess hormones. Whether an adrenal incidentaloma needs to be surgically removed depends mainly on its size, its dignity (that is, whether it is assessed as benign or malignant), and its hormonal activity.
Adrenocortical carcinoma is a rare malignant tumor of the adrenal cortex. Depending on the type of tumor, it may produce excess hormones, or it may remain asymptomatic and be discovered incidentally during imaging examinations. Possible signs include hormonal abnormalities, high blood pressure, unexplained weight changes, or the detection of an adrenal mass.
Diagnosis requires a comprehensive hormonal evaluation combined with appropriate imaging studies. Further treatment is coordinated closely with specialists from different medical disciplines. Depending on the findings, surgical removal of the tumor may be recommended.
Congenital adrenal hyperplasia (CAH) is an inherited disorder affecting hormone production in the adrenal cortex. It is caused by an enzyme deficiency that results in reduced production of certain hormones while increasing the production of others. Depending on the severity of the condition, symptoms may appear in early childhood or may not become apparent until adulthood. An endocrinological evaluation includes a detailed medical history, specialized hormone testing, and, if necessary, additional diagnostic procedures. Treatment is tailored to the individual form of the condition and usually involves long-term endocrinological care.
Learn more about the endocrine causes of high blood pressure:
Hormonal disorders that cause elevated blood pressure are referred to here. These are mainly due to excessive production of cortisol, aldosterone or catecholamines. The corresponding conditions include Cushing’s syndrome, primary hyperaldosteronism and phaeochromocytoma. In some cases, thyroid dysfunction or primary hyperparathyroidism may also lead to high blood pressure or worsen existing hypertension.
Although these causes of high blood pressure are relatively rare, they should be considered particularly in the following situations:
The MVZ PAN Institute is affiliated with PAN Klinik at Neumarkt. The Department of Internal Medicine – Endocrinology works in close collaboration with the many neighbouring specialties represented here. Under one roof, endocrinologists, gynaecologists and reproductive medicine specialists, urologists, neurosurgeons, nuclear medicine specialists, radiologists, human geneticists, nutrition specialists and psychologists work closely together.
Hormones & fertility
Do you have questions about fertility or gynaecology? Then our colleagues at the MVZ PAN Institut will be happy to assist you.
Hormones & Endometriosis
Do you have questions about the diagnosis and treatment of endometriosis? Then you are in the best hands at our certified endometriosis centre.
An endocrinological assessment may be advisable if a hormonal or metabolic disorder is suspected or if abnormal laboratory results have already been identified. We are also happy to advise you individually if you are experiencing unexplained symptoms such as unexpected weight changes or osteoporosis.
During your first visit, we will take the time to discuss your symptoms, medical history, and any previous findings in detail. Together, we will determine which diagnostic steps are appropriate and develop an individualized treatment plan.
Please bring any recent laboratory results, medical reports, ultrasound or MRI findings, and a list of your current medications. Existing medical records help us assess your condition more efficiently and avoid unnecessary duplicate examinations.
This depends on the examinations planned. If fasting blood tests are required, we will inform you when your appointment is scheduled.
Our practice is part of the interdisciplinary Hormone Center Cologne. Under one roof, specialists in endocrinology, diabetology, gynecology, reproductive medicine, nuclear medicine, radiology, urology, cardiology, and other medical disciplines work closely together. This enables many medical questions to be assessed quickly through interdisciplinary collaboration.
Yes. Many hormonal and metabolic disorders affect several organ systems. When necessary, we coordinate diagnostics and treatment closely with specialists at the PAN Klinik and the MVZ PAN Institut to ensure comprehensive care.
You can reach us by phone at +49 221 2776-403, by email at endokrinologie@pan-klinik.de, or conveniently online via Doctolib.
Our Endocrinology and Diabetology Practice is a private medical practice. We treat privately insured patients as well as self-paying patients. Patients with statutory health insurance are also welcome to book an appointment as self-paying patients. We will gladly provide information about the consultation process and the expected costs in advance.
No. In most cases, you do not need a referral to make an appointment at our private practice.
The scope of the diagnostic work-up depends on your individual medical needs. Many laboratory tests and initial diagnostic procedures can be carried out promptly. Once the results are available, we will discuss them with you in detail and determine the next steps together.
Hormonal and metabolic disorders often affect several organ systems at the same time. At the Hormone Center Cologne, specialists from different disciplines work closely together. This allows for short communication paths, coordinated diagnostics, and a treatment approach that considers the patient as a whole.
Specialist in Internal Medicine, Endocrinology and Diabetology
Education
Professional career
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Specialist in Internal Medicine, Endocrinology, Diabetology and Metabolic Medicine
Education
Professional career
Professional qualifications
Memberships
Contact
Private Practice for Endocrinology and Diabetology at PAN Klinik am Neumarkt
5th floor at the PAN Prevention Center
Zeppelinstr. 1 / Neumarkt Gallery
50667 Cologne
In cooperation with PAN Klinik am Neumarkt and the MVZ PAN Institut
Contact/Appointments
0221 2776-403endokrinologie@pan-klinik.deBook via Doctolib
You are also welcome to use our contact form for appointment requests and prescription inquiries.
Consultation hours/Appointments
Private and self-payers
Monday – Friday
8:00 am – 2:00 pm
and by appointment
Your Doctors
Dr Georg Mansmann
Specialist in Internal Medicine, Endocrinology and Diabetology
Prof. Dr Dirk Müller-Wieland
Specialist in Internal Medicine, Endocrinology, Diabetology and Metabolic Medicine
