Hypothalamic dysfunction

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It is an alteration of a relatively small part of the brain called the hypothalamus, which although integrated into the nervous system has an endocrine function. In this way it exercises control over the pituitary gland and regulates many bodily functions. Keeping the balance of bodily functions, in such a way is the regulator of:
Appetite and weight
Body temperature
Childbirth
Emotions, behavior, memory
Growth
Breastfeeding
The balance of salt and water
Sexual desire or libido
The cycle of sleep and wakefulness and what is called the circadian rhythm (that is, the differences between day and night).
The pituitary gland or hypophysis is a small gland at the base of the brain. It is just below the hypothalamus its function depends on it: in what refers to the posterior pituitary lobe, also known as neuropituitary produces oxytocin that acts as a neuromodulator in the central nervous system modulating social behaviors, sexual patterns and parental behavior .
In women, oxytocin is also released in large quantities after distention of the uterine cervix and vagina during childbirth, as well as in the ejection of breast milk in response to stimulation of the nipple by sucking the baby, thus facilitating childbirth and lactation.
It also produces vasopressin or antidiuretic hormone (ADH), Vasopressin is a peptide hormone that controls the reabsorption of water molecules by concentrating urine and reducing its volume in the renal tubules, thus affecting tubular permeability.
Vasopressin is released mainly in response to changes in serum osmolarity or blood volume increasing peripheral vascular resistance and in turn blood pressure. It receives its name because it plays a key role as homeostatic regulator of fluids, glucose and salts in the blood.
In relation with the anterior lobe receives some “releasing factors” now considered true hormones (TRH, ACTH-RH, FSH-RH, LH-RH, GH-RH, etc.)

The pituitary gland in turn controls:

The adrenal glands
The ovaries
The testicles
The thyroid gland

-Causes:

There are many causes for hypothalamic dysfunction. The majority are surgery, brain trauma, tumors and radiation.
Nutrition problems such as eating disorders (anorexia), extreme weight loss.
Problems in the cerebral blood vessels, such as aneurysm, pituitary apoplexy, subarachnoid hemorrhage
Genetic disorders such as Prader-Willi syndrome, familial diabetes insipidus, Kallmann syndrome, 1 in 20,000 males
Infections and inflammation
Stress: The emotional etiology plays a great role, since the hypothalamus is probably one of the essential centers of emotions.
The toxic substances of the environment, especially chemicals, act as disruptors of the hypothalamic pituitary testicular (HHT) axis and are of estrogenic action (xenoestrogens) or antiandrogens.
This environmental contamination is responsible for qualitative and quantitative changes in the spermiogram currently, which are little known by the patient and the doctor, and therefore difficult to identify, although they are practically ubiquitous, ranging from our clothing to the food chain.
There is also gonadotrophic hypothalamic dysfunction: patient with hypogonadotropic hypogonadism of post-pubertal appearance in which testosterone decreases, LH and FSH diminished, however, there is a normal gonadotrophic and testosterone response to clomiphene, gonadotrophic insufficiency is ruled out and there is hypothalamic dysfunction , transient, would be the equivalent in women to hypothalamic amenorrhea that responds to clomiphene.
Morbid obesity with sleep apnea, which produces a hypothalamic dysfunction generated by the alteration of REM sleep and stimuli originated in the adipose tissue by aromatization of androgens to estrogens.
In men with hypogonadotropic hypothalamic functional hypogonadism, without being able to perform a progesterone test, as is the case of women, to help differentiate the degrees of commitment of gonadotropin-releasing hormone (GnRH).
It is considered that the clomiphene test could differentiate between a milder hypothalamic dysfunction (increase in testosterone with clomiphene), a more serious one, such as hypothalamic insufficiency (without an increase in testosterone with clomiphene).
The hypothalamic factor causing alteration of the hypothalamic-pituitary-ovarian axis has been known since ancient times, in women and it is called hypothalamic amenorrhea to the picture in which, excluding all organic and functional cause, can respond to progesterone (hypothalamic dysfunction) or not respond (hypothalamic insufficiency).
In the male only in recent years has been considered the existence of hypogonadotropic hipotámico functional hypogonadism, secondary to systemic disease, endocrinopathy or idiopathic (no apparent cause).
The male hypothalamus is sensitive to psychological or metabolic stress factors that have an impact just as the female was wrong, being sensitive to intense exercise, diet, and stress. Clomiphene may be useful in the diagnosis and possibly in the treatment of some cases of hypothalamic dysfunction.
-Symptoms of dysfunction:
Symptoms are usually due to hormones and brain signals that are lacking. In children, there may be growth problems, either too much or too little. In older children, puberty occurs too early or too late.
The symptoms of tumors can include headache or loss of vision.
The symptoms of hypothyroidism can be constant feeling of cold, constipation, fatigue or weight gain among others.
Symptoms of low adrenal function can be fatigue, weakness, loss of appetite, weight loss and lack of interest in other activities.
Sexual dysfunctions

-Test and exams:

Blood or urine tests may be ordered to determine hormone levels, such as:

Cortisol
Estrogens
Growth hormone
Pituitary hormones
Prolactin
Testosterone
Thyroid hormone
Sodium and potassium
Osmolality of blood and urine

Other possible exams include:

Injections of hypothalamic hormones, followed by blood samples at regular intervals after stimulation with GnRH to see the response of LH and FSH, analogs are also used as procrin or decapeptyl, stimulus test with basal TSH and after TRH and so on.
Magnetic resonance with contrast or brain CT
Ocular examination of the visual field (if there is a tumor)

-Treatment:

Treatment depends on the cause of hypothalamic dysfunction:
In case of a tumor, medication, surgery or radiation may be needed.
For hormonal deficiencies: it is necessary to replace the hormones that are diminished or absent, taking medications. Many causes of hypothalamic dysfunction can be treated. Most of the time you can replenish hormonal deficiencies.
The complications of hypothalamic dysfunction depend on the cause and the hormones affected.

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