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Metabolic Effects of Hypothalamic Dysfunction

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Advanced Practice in Endocrinology Nursing

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Abstract

The hypothalamus is a very small, key regulator of endocrine, metabolic, and behavioral functions. The hypothalamus controls the release of 8 major hormones by the pituitary and is involved in temperature regulation, control of food and water intake, sexual behavior and reproduction. Hypothalamus neuronal bodies that produce factors controlling the pituitary are clustered in different nuclei which have specific functions. The clinical syndrome will depend on the location and extent of the underlying lesion. The lesion may be very small and only affect specific hypothalamic nuclei. The lateral hypothalamus contains the thirst center and controls thirst. Neurons from the supraoptic and PVN of the hypothalamus terminate in the posterior pituitary and control the release of ADH (antidiuretic hormone) which then acts on the kidneys to prevent loss of water. Osmotic sensors in the hypothalamus work with ADH to maintain water metabolism.

Destruction of the VMN in hypothalamus induces hyperphagia, hyperinsulinemia, and weight gain. The same neurons in the hypothalamus express high levels of leptin and ghrelin receptors. Hypothalamic damage can result in “leptin resistance,” which means a decreased sensitivity to leptin and resulting in an inability to detect satiety despite high energy stores. Ghrelin is known as the “hunger hormone” and is mainly produced by the stomach. Circulating ghrelin is increased under fasting and reduced after refeeding. When the hypothalamus is damaged and disturbances in energy expenditure and appetite-regulation occur, a syndrome of severe weight gain ensues, termed “hypothalamic obesity.” Hypothalamic obesity can occur as a consequence of acquired anatomic hypothalamic damage including various types of hypothalamic tumors, inflammatory diseases, head injury, cranial radiotherapy, and cerebral aneurysm.

Childhood onset craniopharyngioma (CP) is a rare intracranial tumor that frequently affects hypothalamic/pituitary regions. CP patients suffer from increased morbidity, primarily due to hypothalamic damage. Understanding the central role of the hypothalamus in the regulation of feeding and energy metabolism is important in the care of the patients with hypothalamic disorders. The care should be conducted by experienced multidisciplinary teams, with the nurse as a key team member.

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Abbreviations

ALL:

Acute lymphoblastic leukemia

ACTH:

Adrenocorticotropin hormone

ADH:

Antidiuretic hormone

ARC:

Arcuate nucleus

AGRP:

Agouti-related peptide

CO:

Childhood onset

CRH:

Corticotropin-releasing hormone

CRT:

Cranial radiotherapy

CP:

Craniopharyngioma

DMN:

Dorsomedial nucleus

GnRH:

Gonadotropin-releasing hormone

GH:

Growth hormone

GHRH:

Growth hormone releasing hormone

HT:

Hypothalamus

INF:

Infundibular nucleus

NPY:

Neuropeptide Y

PVN:

Paraventricular nucleus

PWS:

Prader–Willi syndrome

TRH:

Thyrotropin-releasing hormone

VMN:

Ventromedial nucleus

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Authors and Affiliations

  1. Department of Oncology, Skane University Hospital, Lund, Sweden

    Cecilia Follin

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  1. Cecilia Follin
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Correspondence to Cecilia Follin .

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Editors and Affiliations

  1. School of Health Sciences, City, University of London, London, UK

    Sofia Llahana

  2. Department of Oncology, Skåne University Hospital, Lund, Sweden

    Cecilia Follin

  3. Northwest Pituitary Center Oregon Health and Sciences University, Portland, OR, USA

    Christine Yedinak

  4. Churchill Hospital, University of Oxford, Oxford, UK

    Ashley Grossman

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Follin, C. (2019). Metabolic Effects of Hypothalamic Dysfunction. In: Llahana, S., Follin, C., Yedinak, C., Grossman, A. (eds) Advanced Practice in Endocrinology Nursing. Springer, Cham. https://doi.org/10.1007/978-3-319-99817-6_13

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  • DOI: https://doi.org/10.1007/978-3-319-99817-6_13

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  • Online ISBN: 978-3-319-99817-6

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