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Symposium for Patients & Caregivers. Hormonal Imbalances. Laura Knecht, MD Adult Endocrinologist Medical Director, Barrow Pituitary Center. Functions of the Hypothalamus. Secretes hormones-releasing and inhibitory effects on the pituitary gland Anti diuretic hormone (ADH) Dopamine

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Hormonal imbalances
Hormonal Imbalances

Laura Knecht, MD

Adult EndocrinologistMedical Director, Barrow Pituitary Center

Functions of the hypothalamus
Functions of the Hypothalamus

  • Secretes hormones-releasing and inhibitory effects on the pituitary gland

    • Anti diuretic hormone (ADH)

    • Dopamine

    • Oxytocin

    • Somatostatin

    • Corticotropin Releasing Hormone (CRH)

    • Thyrotropin Releasing Hormone (TRH)

    • Gonadotropin Releasing Hormone (GnRH)

    • Growth Hormone Releasing Hormone (GHRH)

Anti diuretic hormone adh
Anti Diuretic Hormone (ADH)

  • ADH (vasopressin) made in the hypothalamus

  • ADH stored in posterior pituitary gland

  • Works at kidney to resorb water

  • Reabsorbing water regulates sodium levels in the blood

  • Lack of ability to reabsorb water leads to increased thirst and urination


  • Released by the Hypothalamus

  • Travels down the pituitary stalk

  • Continuous release inhibits the release of prolactin from pituitary


  • Acts at breast for milk let-down

  • Acts at uterus to aid in contractions


  • Inhibits growth hormone release from pituitary

  • Inhibits TSH release from pituitary

Corticotropin releasing hormone crh
Corticotropin Releasing Hormone (CRH)

  • Acts at pituitary to release adrenocorticotropic hormone (ACTH)

  • ACTH acts at adrenal glands to secrete cortisol (stress hormones)

Thyrotropin releasing hormone trh
Thyrotropin Releasing Hormone (TRH)

  • Acts at thyroid to secrete TSH (Thyroid Stimulating Hormone)

  • Acts at pituitary to release prolactin

  • TSH acts at thyroid to release T4, T3 which controls metabolic activities

Gonadotropin releasing hormone gnrh
Gonadotropin Releasing Hormone (GnRH)

  • Acts at pituitary to secrete FSH (Follicular Stimulating Hormone) and LH (Luteinizing Hormone)

  • Acts at ovaries and testicles to secrete Estrogen, Progesterone, and Testosterone

Growth hormone releasing hormone ghrh
Growth Hormone Releasing Hormone (GHRH)

  • Acts at pituitary to secrete Growth Hormone

  • Growth hormone acts at liver to produce IGF-1

  • Acts at bones, muscles, cartilage

Growth hormone deficiency
Growth Hormone Deficiency

  • In children, short stature

  • Diminished muscle mass

  • Increased fat mass

  • Increased LDL

  • Increased inflammatory markers (IL-6, CRP)

  • Increased cardiac disease

  • Decreased bone mineral density

  • Diminished quality of life


  • Growth hormone deficiency

    • Recombinant human growth hormone

    • Increased muscle mass

    • Decreased fat

    • ? Improvement in bone mineral density

    • Improved quality of life


  • Causes hypogonadism

    • In women

      • Inability to ovulate

      • Oligo/amenorrhea

      • Estradiol deficiency

      • Decreased bone mineral density

    • In men

      • Testicular hypofunction

      • Infertility

      • Decreased testosterone (energy/libido)

      • Decreased bone mineral density


  • LH/FSH deficiency

    • Men - testosterone replacement if not interested in fertility

      • Cannot follow LH

      • If interested in fertility, can be treated w/ gonadotropins or GnRH, HCG

      • Check sperm count

    • Women - estradiol-progestin replacement if not interested in fertility

      • If interested in fertility, can be treated w/ pulsatile GnRH or gonadotropins

      • Effects of testosterone still being studied

Prolactin oxytocin deficiency
Prolactin/Oxytocin Deficiency

  • Inability to lactate after delivery

  • Difficulty with uterine contractions


  • Not available

  • Not indicated


  • Central hypothyroidism

  • Fatigue

  • Heat/cold intolerance

  • Decreased appetite

  • Puffy face

  • Dry skin

  • Bradycardia

  • Relaxation of deep tendon reflexes

  • Anemia


  • TSH deficiency

    • Levothyroxine (synthroid, levoxyl, unithroid, armour)

    • Normalize free T4 – mid range (TSH not helpful)

    • Treat adrenal insufficiency first

Adrenal insufficiency
Adrenal Insufficiency

  • Cortisol deficiency

  • Mild

    • Fatigue

    • Anorexia

    • Weight loss

    • Decreased libido

    • Hypoglycemia

    • Eosinophilia

  • Severe

    • Vascular collapse

    • Loss of peripheral vascular tone

    • Death


  • ACTH deficiency

    • Administer hydrocortisone

      • 20-30 mg/d in varying regimens

    • Dexamethasone/prednisone (0.5-1mg, 5-7.5mg) have longer action

      • Increase in times of stress

      • Cannot measure serum ACTH, cortisol, urinary cortisol

    • Mineralocorticoid replacement unnecessary

    • Can unmask central DI w/ polyuria

    • Can increase blood pressure, renal flow, and decrease bone mineral density

Diabetes insipidus
Diabetes Insipidus

  • Can occur prior to surgery, around time of surgery, after surgery

  • Can be temporary or permanent

Diabetes insipidus symptoms
Diabetes Insipidus - Symptoms

  • Increased thirst

    • Craving ice water

  • Increased urination

    • Every 30-60 minutes

    • Night time urination 5-6x/night

  • Increased sodium levels

    • Above upper limit of normal

Diabetes insipidus treatment
Diabetes Insipidus - Treatment

  • If intact thirst center, can drink

    • Can drink to thirst

    • Usually desire ice water

    • Avoid significantly increased sodium loads

      • Tomato juice, V8, pickles, high salt foods

Diabetes insipidus treatment1
Diabetes Insipidus - Treatment

  • If hypothalamus damaged, may not have desire to drink

    • Can schedule drinking times

    • With meals, at mid-morning (10am), mid-afternoon (3pm)

Diabetes insipidus treatment ddavp desmopressin
Diabetes Insipidus – TreatmentDDAVP (Desmopressin)

  • Oral

    • 0.1-0.2mg by mouth 2-3x/day

    • Half-life of 8-12 hours

  • Intranasal

    • 10mcg spray 1-2 sprays 2-3x/day

    • Longer half-life of 12 hours

    • More potent

    • Need to coordinate inhalation

Diabetes insipidus treatment ddavp desmopressin1
Diabetes Insipidus – TreatmentDDAVP (Desmopressin)

  • Subcutaneous

    • Rarely necessary as outpatient

    • Avoids absorption issues

  • IV

    • Avoids absorption issues

    • Used in hospital around time of surgery

A special thanks to our sponsors
A Special Thanks to our Sponsors

  • Aesculap

  • Barrow Neurological Institute @ St. Joseph’s Hospital

  • Barrow Neurological Institute @ Phoenix Children’s Hospital

  • Great Council for the Improved

  • Hope for Hypothalamic Hamartoma Foundation

    • KARL STORZ Endoskope