Departments

At Yale Medicine, our team of renowned physicians are leaders in the field of endocrinology. We specialize in understanding and treating the delicate balance of the endocrine system and the hormones that regulate essential body functions. Our physicians are also experts in the management of metabolic disease, which affects how your body processes food to create energy. We're here to provide you with advanced diagnostic and comprehensive treatment options that address these crucial hormonal and metabolic functions. Specialized care is offered in the following areas: Adrenal diseases, including adrenal masses, Cushing syndrome, hyperaldosteronism, and pheochromocytoma. Bone Center consists of a team of specialists with expertise in bone health who treat patients with bone diseases and disturbances in the metabolism of calcium and phosphorus, a mineral that helps build bones. Center for Weight Management, which offers assistance with weight and weight-related health conditions. Diabetes Center is comprised of diabetes specialists who help patients manage their diabetes and prevent long-term complications. Endocrine cancers of the thyroid and adrenal glands. Pituitary conditions and complex disorders. Thyroid diseases, including hyperthyroidism, thyroiditis, thyroid nodules, and thyroid cancer.

Our goal at the Diabetes Center is to give patients the tools necessary to successfully manage the day-to-day challenges of living with diabetes and prevent long-term diabetes complications. We provide comprehensive management and education for adults with type 1 and type 2 diabetes. We focus on lifestyle interventions and use the latest medications and technologies to improve our patients’ health. We also treat patients with: Pre-diabetes and metabolic syndrome Obesity Polycystic ovarian syndrome Lipid or cholesterol abnormalities Our nationally recognized doctors and nurse practitioners work as a team to address our patients’ needs in managing diabetes and other conditions. We understand that living with diabetes presents challenges. We focus on education and making patients their own advocates. Through the most current and state-of-the-art treatments, we will help them better manage their care. Oral Medications There are several classes of oral diabetes medications that we may prescribe if patients have type 2 diabetes. These medications differ in the way they work to reduce blood glucose levels. Frequently, oral medications from different classes are used in combination. Sulfonylureas: These drugs increase the amount of insulin produced by the pancreas. Meglitinides: These drugs rapidly increase the amount of insulin produced by the pancreas. Biguanides: Metformin is the only biguanide on the market. It is thought to work by reducing the production of glucose in the liver. Alpha-Glucosidase Inhibitors: These medications reduce the amount of glucose absorbed in the intestines. Thiazolidinediones: This agent makes the body more sensitive to insulin. Dipeptidyl Peptidase 4 inhibitors (DPP-4 inhibitors): These drugs increase the amount of insulin produced by the pancreas after a meal and reduce the amount of glucose produced by the liver. Injection Therapies There are several classes of injection therapies for diabetes. These treatments are given by an injection under the skin. The most common injection therapy is insulin, which comes in many different formulations that differ in how fast they work and how long they last. Below is a list of the different types of insulins. Technologies and Experimental Treatments Insulin Pumps: Insulin pumps were first pioneered at Yale in the 1970s. An insulin pump is an electronic, pager-sized, battery-powered device that delivers insulin continuously through a small plastic catheter under the skin. Insulin is delivered in different amounts (“basal” or “bolus” levels) during the day and controlled by the patient. While fasting, patients will administer a low level of continuous “basal” insulin to keep their blood glucose in the normal range. Prior to meals, they will determine a “bolus” of insulin based on the amount of carbohydrates in the meal. Continuous Glucose Monitoring systems (CGM): A CGM is a device that measures glucose under the skin (also known as “interstitial” glucose) every five minutes thr

Considered one of the nation’s most respected sections in endocrinology and diabetes, our team includes nationally recognized physicians, certified nurse practitioners, nurse educators, dietitians, social workers, and other caregivers. We help children and their families with the many problems that may accompany defects in the endocrine system, including diabetes, growth problems, and obesity. Yale Pediatric Endocrinology faculty are expert in the clinical management of endocrine and metabolic disorders, including: Type 1 diabetes Type 2 diabetes Obesity & weight management in children Interdisciplinary bariatric surgery clinic Lipid disorders, including hyperlipidemia and lipodystrophy General endocrine disorders Thyroid disease Parathyroid Adrenal, including congenital adrenal hyperplasia Pituitary Neuroendocrine Growth & puberty Polycystic ovarian syndrome Metabolic bone disease, including nutritional rickets & osteomalacia Interdisciplinary differences in sexual differentiation Interdisciplinary transgender program Hormonal complications of cancer and cancer treatment

We specialize in the treatment of children with type 1 diabetes, offering comprehensive care and support for patients and their families. Ourteam of physicians, nurse practitioners/certified diabetes educators, nurses, social workers, psychologists,and nutritionists is dedicated to educating and supporting children, adolescents, and parents as they cope with this disease. We place a special emphasis on technological tools, as well as clinical research that can help our patients manage their diabetes. For our teen and young adult patients who are preparing to transition to adult diabetes care and are learning to manage their diabetes on their own, we offer the Yale FORGE Ahead Bridge Diabetes Program. FORGE stands for: Form new relationships Orient to the future Reach out for support Gain new knowledge Embrace life … Ahead and Bridge We recognize that teens and young adults need a different kind of support as they prepare to manage diabetes on their own. We aim to: Better address the unique needs of teens with type 1 diabetes who are transitioning into adulthood Support efforts for patients to assume full responsibility for their own diabetes management and exercise healthy behavior. At the Bridge Clinic, patients will have a team visit with a nurse practitioner trained in both pediatric and adult diabetes, along with our clinical nutritionist and social worker. The team will help guide patients through the transition to adult care.

Obesity is a common problem that can cause fatigue, diabetes, fatty liver disease, and sleep problems, and raise the risk of many cancers. It reduces energy, and can take the pleasure out of many aspects of life. Extra weight also places stress on vital organs, including the heart, liver, and kidneys, as well as joints and the reproductive system. Although organs can work under this extra stress for a number of years, eventually they are likely to fail. Most organs lose about 80% of their capacity before symptoms are evident, and by that time, it is often too late to return them to normal function. The conditions associated with obesity are: Cancer Cardiovascular disease Diabetes Liver disease Obstructive sleep apnea Losing weight can help improve and sometimes cure many of these conditions, as well as fertility issues. Losing weight can also lead to a life with fewer medications, lower health expenses, and overall greater enjoyment. At the Yale Metabolic Health and Weight Loss Program, we offer all nonsurgical weight-loss interventions in one location. Our philosophy is to focus on health, rather than specific disease, and to tailor our care to each patient’s specific needs and goals. The first step in our care is to determine weight-loss goals. Patients may need to lose 5 to 10% of their body weight to help in the treatment of a disease. We will help patients choose from interventions that include intensive meal-replacement programs, a range of medications, or endoscopic (nonsurgical procedure) options. Sometimes, there are additional medical necessities, such as an upcoming surgery, that require a specific weight-loss goal. We will explain the advantages and disadvantages of the various options, but the choice will depend primarily on what feels right to the patient. We provide therapies under the medical supervision of obesity experts. Patients can choose from the full range of tested interventions: Lifestyle changes: Nutrition counseling goes hand-in-hand with medical management of metabolic health. Care will include a personal visit with a registered dietitian with advanced training in weight management. OPTIFAST® program: OPTIFAST® is a medically monitored weight management program that allows patients, under the supervision of a physician, to consume a low-calorie diet and receive comprehensive lifestyle education. The OPTIFAST program provides full meal replacement for 12 weeks and transitions to self-prepared “everyday” meals in conjunction with comprehensive patient education and support, to help patients achieve long-term weight loss. Medications: All medications are used as part of a comprehensive program that includes proper nutrition and a healthy lifestyle. Contrave® is a single pill that contains two medications (naltrexone and bupropion) and is taken twice a day. It will reduce appetite and can produce weight loss in the 5 to 10% range. Phentermine is taken once in the morning, and is prescribed for a few weeks.

Weight management is a complex and multi-faceted challenge that can involve a wide range of health issues, with solutions that are different for every person. The Center for Weight Management, part of Yale New Haven Health (YNHH) and Yale School of Medicine, is a multidisciplinary practice offering a comprehensive range of services for patients needing help to achieve their target weight. The center provides assistance with weight and weight-related health conditions from many different perspectives, with personally tailored solutions based on each patient’s specific needs and goals. Weight management is a lifelong journey, and we are here to help. The center brings together renowned experts in both the medical and surgical treatment of obesity, as well as in such fields as psychology, nutrition, exercise physiology, orthopaedics, endocrinology, cardiology, liver disease, and more. The center doesn’t just focus on weight management, but also on the many health outcomes associated with excess weight, such as diabetes, fatty liver disease, heart disease, joint problems, and cancer. Successful weight management can significantly improve these conditions and reduce the chance of developing them in the first place. In short, the center provides services across the entire continuum of care for weight management, including everything from dietary advice to psychological counseling, medications, endoscopic interventions, and surgery. Having all of those services under one umbrella gives us the unique ability to care for any patient with weight management needs, regardless of size or treatment options. The center also has an alliance with the YNHH Department of Pediatrics, and since obesity tends to run in families, center administrators are planning an intergenerational clinic where the entire family can receive care. Currently, the center is situated at several different locations within the health system; in 2022, all of the components of the center are scheduled to move to a single location at 8 Devine St. in North Haven. Consultations are also available via telehealth. The Center for Weight Management has three physician-directors: John Morton, MD, MPH, medical director of bariatric surgery for the Yale New Haven Health System; Wajahat Mehal, MD, PhD, director of the Yale Weight Loss Program and an expert in obesity medicine and endobariatrics; and Ania Jastreboff, MD, PhD, an adult and pediatric endocrinologist with expertise in obesity medicine and weight management. The center has a fully integrated medical and surgical team. We have approximately 20 physicians, including 12 bariatric surgeons, who together have performed about 10,000 successful surgeries (Dr. Morton alone has performed about 4,000 successful bariatric surgeries). Other members of the team include nurses, dieticians, psychologists, social workers, and an exercise physiologist, as well as the many experts on weight-related health conditions who partner with the center.

Our program, focused on adult primary care, is known for its excellence and emphasis on prevention and wellness. We efficiently manage potential medical problems as they arise, and collaborate with specialists when needed. Our practice includes internal medicine physicians, advanced nurse practitioners, a clinical psychologist, a social worker, registered-nurse patient care coordinators, licensed practical nurses, medical assistants, clerical office staff, and a practice supervisor. Our goal is to provide patients with the highest quality, personalized healthcare in the Patient-Centered Medical Home (PCMH) model of care. The PCMH model of care focuses on five areas: Building strong, collaborative health care teams that work together to meet the needs of patients Providing patient-centered care addressing the whole person, respecting patients’ values and preferences Coordinating comprehensive health care through clear communication among patients, families, caregivers, medical and behavioral health providers, hospitals, and other facilities Improving patients’ access to care, through such initiatives as expanded office hours and providing email access to electronic medical records Improving health care quality and standards by providing evidence-based care, patient and family education, and self-management support We would like to hear your direct feedback regarding your experience as a patient/family member of our clinic. Please visit the YIMA Patient/Family Comment Box to provide your feedback. Sign up for MyChart , our secure online patient portal, that gives you access to all of your Yale health information whenever you need it, wherever you may be.

We help children who are overweight or obese improve their health through a variety of strategies, including behavior and lifestyle modification. We understand that many factors can contribute to obesity, including genetics, diet, physical activity level, psychological issues, and adverse family events. Our team includes board-certified pediatric endocrinologists, advanced practice registered nurses, physician assistants, a registered dietitian, a bariatric surgeon, and an endocrinologist who specializes in diabetes and obesity management for adults and children. We work together to tailor treatment to each child and his or her family. Seventeen percent of children ages 2 to 19 in the United States are obese, according to the Centers for Disease Control and Prevention. While there is no cure for obesity, our caregivers work with children to prevent serious health complications that can accompany it, including: Prediabetes and type 2 diabetes Polycystic Ovary Syndrome (PCOS) High cholesterol Fatty liver disease When a child is referred to us—typically from a pediatrician—our first step is to do a full medical examination and check for obesity-related diseases and complications. We offer a traditional approach to weight loss through lifestyle changes, and incorporate the whole family into the process. We refer many children to Yale School of Medicine’s Bright Bodies Program in New Haven, which teaches children and their families about nutrition and encourages them to exercise. If lifestyle and behavioral modifications are not successful, medications are a potential option for children 16 and older. Our last step, if necessary, would be bariatric surgery, also for children 16 and up. There are rigid protocols for the surgery, as well as pre- and post-surgical care. Once patients turn 21, we can seamlessly transition them into an adult program for weight management.

At Yale Medicine, our experts and caregivers give comprehensive and compassionate treatment for those with end-stage liver, kidney, and pancreas organ failure who might benefit from transplantation. We offer many treatment options and hope for high-risk patients who may have been turned down for transplant elsewhere, in addition full support services. Our expert physicians specialize in anesthesiology, internal medicine, pediatrics, surgery, transplant immunology, kidney diseases, liver diseases, diabetes mellitus, and transplant surgery. Our caring, highly skilled nurses, physician assistants, nutritionists, pharmacists, social workers, and financial counselors further support your needs. Many inherited metabolic liver diseases such as Wilson's disease, Gaucher's disease, lipidosis, alpha-1 antitrypsin deficiency, hemochromatosis, tyrosinemia, and glycogen storage diseases are cured by successful liver transplantation. We specialize in genetic testing for liver diseases and treatments that provide comprehensive care for affected patients. Even though we treat some of the most seriously ill patients, our program's survival rates are consistently higher than the national average. We offer many options for advanced liver disease, including living donor and deceased donor transplantation, liver transplantation in HIV-infected individuals, and pre- and post-transplant antiviral therapy to prevent or treat recurrent hepatitis C. Through our acute liver failure program, we can transfer patients to Yale New Haven Hospital in a timely manner for transplant evaluation and medical management. In collaboration with the hospital’s Medical Intensive Care Unit, we offer innovative techniques such as hypothermia therapy for the treatment of acute liver failure. Pancreatic transplants are less common than kidney or liver transplants and are usually performed in patients with type 1 diabetes. Our physicians perform isolated pancreas transplantation, simultaneous kidney/pancreas transplantation, and pancreas transplantation following kidney transplantation. Specialized care is offered in the following areas: Combined organ transplantation including kidney, kidney/liver, and kidney/heart Comprehensive tissue typing and immune evaluation services Follow-up and psychosocial support Leading-edge treatment options for immunosuppression Liver transplantation, including adult-to-adult living donor, pediatric living donor, and other surgeries Minimally invasive living-donor kidney surgeries Robotic hepatobiliary surgery Surgical therapy of diseases of the liver and biliary systems and end-stage kidney and liver disease Telemedicine via patient portal

The Cardiovascular Disease and Pregnancy Program at Yale offers comprehensive and individualized support before, during, and after pregnancy for people with heart conditions. Our mission is to improve outcomes in pregnancy for patients with either pre-existing or newly diagnosed heart disease and ensure that pregnant patients receive appropriate and specialized risk assessment, treatment, and support. Cardiovascular disease is the number one cause of maternal mortality in the United States. While most people with pre-existing cardiovascular conditions can safely and successfully become pregnant, carry a baby to term, and breastfeed, patients with cardiovascular conditions are at higher risk of complications during pregnancy and after delivery. Pregnancy can also reveal or cause previously undiagnosed heart problems, and certain pregnancy complications can put patients at a higher risk for future cardiovascular disease. Yale’s Cardiovascular Disease and Pregnancy Program brings together cardiologists, maternal-fetal medicine specialists , nutritionists, pharmacists, lactation consultants , social workers, and family planning specialists who utilize their unique expertise to provide comprehensive patient care. Our multidisciplinary team meets regularly to create individualized care plans for each pregnant patient with heart disease. We provide care to: People with known heart disease, including congenital heart disease and acquired heart diseases, such as abnormal heart rhythms (arrhythmias), heart failure, and ischemic heart disease (coronary artery disease) People who develop cardiovascular disease or are newly diagnosed with heart disease during pregnancy (for example, peripartum cardiomyopathy) People who develop pregnancy-specific complications (including preeclampsia and related hypertensive disorders or gestational diabetes) that put them at higher risk for future cardiovascular disease Before pregnancy Contraception counseling: We provide individualized contraception counseling to patients with cardiovascular conditions to help determine the best and most reliable form of contraception for them based on a variety of factors, including specific heart conditions, interaction with other medications, and personal preferences. Comprehensive risk assessment: We provide a comprehensive risk assessment for patients with heart conditions who wish to become pregnant. We coordinate care to ensure they receive updated imaging and diagnostic studies and are on pregnancy-safe medications before they conceive. We also work closely with patients to provide nutrition and exercise guidance. Preconception counseling: We provide consultations to explore and discuss a potential pregnancy and family building. During this visit, we will answer all patient questions and develop care recommendations to support patients prior to, during, and after pregnancy. We also introduce members of the care team. During pregnancy Prenatal care management: We work wi

Fatty liver disease is a serious condition caused by stress placed on the liver from excess body weight. People with obesity, diabetes, high blood pressure, and high lipids are at high risk of developing fatty liver disease. Currently, weight loss of 7 to 10% has been shown to be the most effective way of improving fatty liver disease. Patients in our program lose weight safely and effectively through a combination of medications, endoscopic weight loss, bariatric surgery, and therapies. The Yale Medicine Fatty Liver Disease program provides a comprehensive suite of services to help manage the condition. These include: Medications: At Yale, many clinical trials are underway to test the ability of new drugs to treat fatty liver disease. Drugs under development seek to reverse the increased fat in liver cells (and the resulting inflammation and scarring), as well as the increased risk of liver cancer. Medical Weight Loss: Most weight loss medications are tablets that work by reducing appetite. Other medications mimic hormones that the body makes, and improve the body’s ability to manage extra calories. We also offer the OPTIFAST® program, which is a medically monitored weight management program that allows the patient, under the supervision of a physician, to consume a low-calorie diet and receive comprehensive lifestyle education. The typical OPTIFAST patient loses between 30 to 60 pounds in 18 to 24 weeks, and experiences a healthy decrease in blood pressure and cholesterol levels. Additionally, in clinical studies of the OPTIFAST program, about half of the people assessed had maintained enough weight loss for five years to improve their long-term health. Bariatric Surgery: Bariatric surgery is the most effective way to treat fatty liver disease, with improvement in approximately 90% of patients. Bariatric surgery can improve hepatic fibrosis and may reduce the risk of liver cancer. If patients have a body mass index (BMI) above 35, and they have fatty liver disease, they may qualify for bariatric surgery. Patients who are referred to our program will first undergo blood tests and imaging to determine whether or not they have NAFLD (nonalcoholic fatty liver disease) or NASH (nonalcoholic steatohepatitis). Once the diagnosis has been made, we will determine how serious the condition is, which helps our team develop a personalized treatment plan. We take a comprehensive approach to managing fatty liver disease—from medications to bariatric surgery—and refer severe cases to the liver cancer tumor board, if necessary.

The Endocrine Program at Smilow Cancer Hospital is one of the largest multidisciplinary endocrine programs in the country. We evaluate, diagnose, and care for patients with both cancerous and benign tumors of the thyroid, parathyroid, adrenal glands, pituitary gland, hypothalamus, and pancreas. As part of the only endocrine surgery program in Connecticut, our highly trained surgeons collaborate with specialists both at Yale and other institutions in order to provide the most comprehensive, leading-edge surgical treatment available to all of our patients. Our emphasis is on the safest and most minimally invasive surgery with the least amount of discomfort, scarring, and the fastest recovery time for every patient. The Endocrine Program is experienced in treating rare cancers, such as parathyroid carcinoma, advanced thyroid cancer, adrenal cancer, and pheochromocytoma/paragangliomas, which benefit from this multidisciplinary approach and specialized expertise. Specialized surgical expertise is essential for the management of all endocrine tumors. Some of the latest and most innovative procedures offered by our program include: Radiofrequency Ablation (RFA) is a unique, non-surgical way to treat benign thyroid lesions. Traditionally, thyroid nodules are removed surgically, which may require lifelong thyroid hormone supplementation. RFA is a safe and effective alternative to surgery that can preserve normal thyroid tissue and function and alleviate compressive symptoms. During the minimally invasive, outpatient procedure, a patient’s nodule is selectively heated and denatured using an electrode that passes through the skin. Minimally Invasive Parathyroidectomy : The removal of one or more of the parathyroid glands, which are small, pea-shaped glands located in the neck on either side of the trachea and next to the thyroid. This is performed with a focused approach, often using a gentle local anesthesia technique. This enables the patient to vocalize during surgery, ensuring the vocal cords are protected. Retroperitoneoscopic Adrenalectomy : This approach allows for direct access to the adrenal gland without the need for invasive procedures in patients deemed to have smaller tumors. This results in less scarring and pain with a quicker recovery for patients. Laparoscopic or Open Transabdominal Adrenalectomy : Based on the individual patient, and especially in the management of large adrenal tumors, either a laparoscopic or open surgical approach may be preferable. We offer several specialized approaches to enhance care in conjunction with surgery. These include: A parathyroid four-dimensional (4-D) CT Scan , an advanced imaging technique used to localize parathyroid tumors before surgery is performed Rapid PTH (parathyroid hormone) assays , which allow for real-time testing while patients are still in the operating room. Rapid PTH-assays are essential in determining if a tumor has been completely removed, or if further exploration is needed before