What does the hypothalamus do and what is disrupted?
The hypothalamus is a small area at the base of the brain that connects the nervous and endocrine systems. It regulates the feeling of hunger and satiety, temperature, thirst, sleep and wakefulness, vascular tone, and through the pituitary gland controls the thyroid gland, adrenal glands and gonads. When its operation is disrupted, several systems are affected at once, so the complaints seem unrelated. Hence the characteristic picture: simultaneously problems with weight, blood pressure, cycle, mood and thermoregulation, and the severity of symptoms changes from day to day.
- Neuroendocrine form with weight gain and stretch marks
- Vegetative-vascular form with crises and pressure surges
- Thermoregulation disorders with low-grade fever
- Sleep and wakefulness disorders
- Disorders of sexual development and menstrual cycle
Causes and risk factors
Often no clear cause can be found, and the syndrome is attributed to a combination of factors. Triggering events include previous viral and bacterial infections, including neuroinfections, traumatic brain injuries, chronic stress and lack of sleep, and rapid weight gain in adolescence. Less often, the symptoms are due to structural changes - tumors and cysts of the hypothalamic-pituitary region, consequences of radiation or surgery. Therefore, when symptoms first appear in an adult, as well as headaches and blurred vision, the examination necessarily includes brain imaging.
- Previous infections, including neuroinfections
- Traumatic brain injury
- Chronic stress and sleep deficiency
- Fast weight gain
- Tumors and cysts of the hypothalamic-pituitary region
- Consequences of surgery or radiation
- Hereditary predisposition to obesity
Symptoms
The most noticeable sign is weight gain with fat deposits on the abdomen and thighs, often along with pink or whitish stretch marks on the skin. Headaches, dizziness, episodes of palpitations with a feeling of lack of air and fear, increased sweating, chilliness or hot flashes, unmotivated low-grade fever are added. The pressure rises and falls. In girls, the cycle is disrupted; in boys, delayed sexual development is possible. The mood is unstable, sleep is shallow, drowsiness and fatigue plague the day, and performance decreases.
- Rapid weight gain, fat deposition on the torso
- Pink or white stretch marks on the skin
- Headaches and dizziness
- Blood pressure surges, vegetative crises
- Increased sweating, hot flashes, chilliness
- Menstrual irregularities
- Fatigue, daytime sleepiness, anxiety
Survey
The doctor’s task is to exclude specific diseases with a similar picture. Thyroid function, prolactin, cortisol and its circadian rhythm are checked; if necessary, a dexamethasone test is performed to exclude hypercortisolism. Carbohydrate metabolism is assessed: glucose, glycated hemoglobin, glucose tolerance test if indicated, as well as lipid profile and uric acid. MRI of the brain with a focus on the pituitary gland is needed for headaches, blurred vision and persistent hormonal abnormalities. To assess pressure surges, daily monitoring is used.
- TSH and free T4
- Prolactin, cortisol, dexamethasone test if indicated
- LH, FSH and sex hormones
- Glucose, glycated hemoglobin, lipid profile
- MRI of the brain and pituitary gland
- 24-hour blood pressure monitoring
- Examination of the fundus and visual fields
Treatment and lifestyle
If a specific cause is found—a tumor, a hormonal disorder, the consequences of an injury—that is what is treated. In other cases, the basis is a change in lifestyle, and this is not a formality: losing weight even by a small amount significantly reduces symptoms, normalizes blood pressure and the cycle. They recommend eating a diet with limited fast carbohydrates, regular exercise, restoring sleep patterns, giving up energy drinks and smoking. If necessary, the doctor selects medications to control blood pressure and carbohydrate metabolism, and also helps to cope with anxiety. Teenagers need family support without pressure and reproaches.
- Treatment of the identified cause
- Gradual weight loss
- Diet with limited sugar and fast carbohydrates
- Regular physical activity
- Normalization of sleep patterns
- Control of blood pressure and carbohydrate metabolism
- Quitting energy drinks, smoking and alcohol
- Psychological support and stress management