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Patient Resources

Lipids and Endocrine Disorders

January 23, 2022

The term lipids refer to any group of fats in the blood, including triglycerides and cholesterol. Triglycerides are an important source of energy, and cholesterol is used to make vitamin D and some hormones.  

Cholesterol is a waxy, fat-like substance that is found in all cells in the body. Cholesterol is also found in foods from animal sources. The body requires only a small amount of lipids to function. If triglyceride levels are too high, the risk for pancreatitis (inflammation of the pancreas) is increased. When cholesterol levels are too high, fat is deposited in the artery walls. This can lead to heart disease and stroke.

Endocrine Connection  

Endocrine conditions such as diabetes or hypothyroidism can lead to changes in lipid levels. Hormones control every pathway for fats and proteins and are transported to support metabolism. The primary hormones involved in this process are estrogen, testosterone, insulin, cortisol, thyroid hormone, growth hormone, and glucagon. 

Abnormal lipid levels are diagnosed by a blood test called lipid panel. The lipid panel measures LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol, as well as triglycerides. 

LDL is also known as bad cholesterol. High levels of LDL cholesterol increase the risk for heart disease and stroke. HDL is known as good cholesterol. It picks up excess cholesterol in the bloodstream and is associated with a lower risk of heart disease and stroke. 

In most cases, lipid testing can be done without any changes in your daily routine. Your doctor may request that you fast for 12 hours prior to testing to avoid significant changes in lipid levels that can be affected by foods eaten. This is known as a fasting lipid profile. A non-fasting lipid profile allows patients to eat before drawing blood. This may be a preferred method for patients with diabetes who experience hypoglycemia after fasting. 

If lipid levels are high, your clinician will ask about your family history and lifestyle. Sometimes, high lipid levels or a lipid disorder may require diagnosis by a health care provider who is a specialist. Additional testing may be done to eliminate other causes of high lipids, such as thyroid disease or another endocrine condition. 

Lipid levels can change and become abnormal due to the following: 

  • Lifestyle
  • Genetics
  • Certain drugs
  • Obesity

Endocrine disease such as diabetes, hypothyroidism, hyperthyroidism, Cushing syndrome, chronic use of steroids, acromegaly, and polycystic ovary syndrome (PCOS) 

For adults with endocrine disorders, experts recommend a lipid panel to measure triglyceride levels and to calculate LDL cholesterol. A lipid panel helps determine the risk for heart disease and stroke, and helps guide decisions for treatment if the risk of heart disease and stroke is borderline, intermediate, or high. Experts recommend conducting cardiovascular risk assessment by reviewing traditional risk factors, including calculation of a 10-year risk for atherosclerotic cardiovascular disease. 

It is important to note that high cholesterol and triglycerides often have no symptoms. They can only be detected by a lipid panel. If left untreated, high cholesterol can lead to chest pain, heart attack or stroke, and high triglycerides can lead to pancreatitis. 

Common treatment options to lower lipids may include diet and exercise, and medications such as statins. Options to reduce the risk of heart disease include quitting smoking and using diet and medications to reduce LDL cholesterol, blood pressure, and glucose levels. Other recommended lifestyle changes may include weight loss, and increasing physical activity. 

  • For patients with type 2 diabetes, doctors recommend statin therapy to reduce the risk for heart disease, and 10-year risk assessment may not be needed.
  • For patients with hypertriglyceridemia (high triglycerides) with levels over 500 mg/dL, experts recommend medication, in addition to diet and exercise to prevent pancreatitis.
  • For patients with obesity, experts recommend making lifestyle changes to lower triglyceride levels, which will decrease the risk for pancreatitis. Some patients may also need medications to reduce weight, or undergo weight loss surgery.
  • For patients that undergo weight loss surgery, experts recommend scheduling an appointment with a doctor to measure the lipid panel after recovery from surgery to assess the risk for heart disease.
  • For patients with type 2 diabetes and diabetic retinopathy, experts suggest using medications called fibrates in addition to statins to reduce the progression of retinopathy.
  • For patients with Cushing Syndrome (excess cortisol levels), experts recommend therapies to lower lipid levels to reduce heart disease.

Experts recommend a fasting screening lipid panel at diagnosis to assess cardiovascular risk in women with PCOS. Lifestyle choices can help lower lipid levels in these women. Lipid-lowering medication is not advised in women with PCOS to treat elevated testosterone levels or infertility.

  • In women who have undergone menopause, experts recommend treating lipid abnormalities with statin therapy rather than hormone therapy because hormone therapy can increase the risk for cardiovascular disease.
  • For men with low testosterone levels, testosterone therapy should not be used to treat abnormal lipid levels or heart disease risk.
  • For transgender patients who have taken or are taking gender-affirming hormone therapy, traditional guidelines for assessing cardiovascular risk should be followed.
  • What should I expect during a lipid panel test?
  • What are the common goals for total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides?
  • What lifestyle changes should I make to lower my cholesterol and triglycerides?
  • Based on my endocrine conditions, which treatment method is right for me?

Developed for Patients Based on Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline.

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