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Hypothalamic dysfunction

HypothalamusHypothalamus

Hypothalamic syndromes

Definition

Hypothalamic dysfunction is a problem with part of the brain called the hypothalamus. The hypothalamus helps control the pituitary gland and regulates many body functions.

Causes

The hypothalamus helps keep the body's internal functions in balance. It helps regulate:

Appetite and weight
Body temperature
Childbirth
Emotions, behavior, memory
Growth
Production of breast milk
Salt and water balance
Sex drive
Sleep-wake cycle and the body clock

Another important function of the hypothalamus is to control the pituitary gland. The pituitary is a small gland at the base of the brain. It lies just below the hypothalamus. The pituitary, in turn, controls the:

Adrenal glands
Ovaries
Testes
Thyroid gland

There are many causes of hypothalamic dysfunction. The most common are:

Surgery
Brain injury
Brain tumors
Radiation treatment to the brain

Other causes include:

Nutrition problems, such as eating disorders (anorexia), extreme weight loss
Blood vessel problems in the brain, such as aneurysm, pituitary apoplexy, subarachnoid hemorrhage
Genetic disorders, such as Prader-Willi syndrome, familial diabetes insipidus, Kallmann syndrome
Infections and swelling (inflammation) due to certain immune system diseases

Symptoms

Symptoms are usually due to the hormones or brain signals that are missing. In children, there may be growth problems, either too much or too little growth. In other children, puberty occurs too early or too late.

Tumor symptoms may include headache or loss of vision.

If the thyroid is affected, there may be symptoms of an underactive thyroid (hypothyroidism). Symptoms may include feeling cold all the time, constipation, fatigue, or weight gain, among others.

If the adrenal glands are affected, there may be symptoms of low adrenal function. Symptoms may include fatigue, weakness, poor appetite, weight loss, and lack of interest in activities.

Exams and Tests

Your health care provider will perform a physical examination and ask about your symptoms.

Blood or urine tests may be ordered to determine levels of hormones such as:

Cortisol
Estrogen
Growth hormone
Pituitary hormones
Prolactin
Testosterone
Thyroid
Sodium
Blood and urine osmolality

Other possible tests include:

Hormone injections followed by timed blood samples
MRI or CT scans of the brain
Visual field eye exam (if there is a tumor)

Treatment

Treatment depends on the cause of the hypothalamic dysfunction:

For tumors, surgery or radiation may be needed.
For hormonal deficiencies, missing hormones need to be replaced by taking medicine. This is effective for pituitary problems and for salt and water balance.
Medicines are usually not effective for changes in temperature or sleep regulation.
Some medicines may help with problems related to appetite regulation and weight gain.

Outlook (Prognosis)

Many causes of hypothalamic dysfunction are treatable or reversible. Most of the time, missing hormones can be replaced.

Possible Complications

Complications of hypothalamic dysfunction depend on the cause.

BRAIN TUMORS

Permanent blindness
Problems related to the brain area where the tumor occurs
Vision disorders
Problems controlling salt and water balance

HYPOTHYROIDISM

Heart problems
High cholesterol

ADRENAL INSUFFICIENCY

Inability to deal with stress (such as surgery or infection), which can be life threatening by causing low blood pressure

SEX GLAND DEFICIENCY

Heart disease
Erection problems
Infertility
Thin bones (osteoporosis)
Problems breast feeding
Problems with uterine contractions during delivery

GROWTH HORMONE DEFICIENCY

High cholesterol
Osteoporosis
Short stature (in children)
Weakness

When to Contact a Medical Professional

Contact your provider if you have:

Headaches
Symptoms of hormone excess or deficiency
Vision problems

Prevention

If you have symptoms of a hormonal deficiency, discuss replacement therapy with your provider.

References

Giustina A, Allora A, Frara S, Spina A, Mortini P. The hypothalamus. In: Melmed S, ed. The Pituitary. 5th ed. Philadelphia, PA: Elsevier; 2022:chap 9.

Weiss RE. Neuroendocrinology and the neuroendocrine system. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 204.

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Review Date: 5/12/2023

Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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