Hormonal Imbalance

You might have heard people relating their disease to something called hormones. Hormones are chemical substances produced and released by the glands of your body’s endocrine system. The endocrine system consists of a group of small organs (called glands), each having a unique structure and function. The list of glands includes the pituitary, thyroid, parathyroid, pancreas, adrenal, pineal, ovary, testes, etc. The endocrine system and hormones work in collaboration to help your body grow and function properly, for example, managing your growth, metabolism, sleep, blood pressure, sugar levels, bone development, sexual development, childbirth, stress response, etc. 

Anything that disrupts this system can result in a hormonal imbalance disorder resulting in various diseases depending on the gland type involved. The most common of which is diabetes. Others are hyperthyroidism, hypothyroidism, Polycystic Ovary Syndrome (PCOS), Adrenal insufficiency, Cushing's disease, precocious puberty,  etc. 

Hormonal imbalance usually results from either underproduction or overproduction of hormones by the glands and the response of the body to them or infiltration of the gland by an infection or neoplasm. 

One more entity to be discussed with the endocrine system is the Hypothalamus, a part of the brain’s limbic system located at the brain’s base. Its role is to link the nervous system with the endocrine system via the pituitary gland. It sends signals to the pituitary gland to release or stop certain hormones.

The release of hormones is usually controlled by a feedback mechanism that works exactly like a thermostat for temperature control. Decease amounts of hormones signal the gland to release more of it, and excess of a hormone turns off its own production from the gland to keep the levels in the normal range. 

This tightly regulated system can be disrupted by any of the following events;

• Stress
• Infection of the gland
• Tumor of the gland
• Changes in the body fluid composition and minerals
• Genetic disorder
• Immune disorder
• Hypothalamus malfunctioning

Pituitary gland: The pituitary gland is also called the master gland as it controls the release of other hormones by the feedback mechanism. It is located at the base of the brain and has two parts; the anterior one is the bigger and the master one with a wide range of effects on the body functions, while the posterior part releases two hormones, oxytocin and vasopressin. Vasopressin controls the cells’ blood pressure and water content, while oxytocin contracts the uterus during delivery and lactation.

Following are the disorders of the pituitary gland;

Posterior pituitary

• Diabetes insipidus
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

  Anterior pituitary

• Hypopituitarism (or Panhypopituitarism)
• Pituitary tumors
• Pituitary adenomas
• Prolactinoma (or Hyperprolactinemia)
• Acromegaly, gigantism, dwarfism
• Cushing's disease

Pancreas: Pancreas is a gland located near the stomach. It has an exocrine part related to the digestive system and the endocrine function that releases insulin, and glucagon which have roles in glucose homeostasis. Its disorders are;

• Type 1 Diabetes
• Type 2 Diabetes
• Mature Onset Diabetes of the Young
• Insulinoma
• Glucagonoma

Thyroid gland: It is a paired gland located in front of the neck. It releases thyroid hormones that have a wide range of effects like metabolism, heart rate, physical growth, brain development, sexual development, etc. its disorders are;

• Goiter
• Hyperthyroidism
• Graves-Basedow disease
• Toxic multinodular goitre
• Hypothyroidism
• Thyroiditis
• Hashimoto's thyroiditis
• Thyroid cancer
• Thyroid hormone resistance

Parathyroid glands: They are a group of 4-5 small glands located near the thyroid gland. They release the parathyroid hormone that controls the levels of calcium and phosphate and hence bone development. Its disorders are;

• Primary hyperparathyroidism
• Secondary hyperparathyroidism
• Tertiary hyperparathyroidism
• Hypoparathyroidism
• Pseudohypoparathyroidism

Adrenal glands: These are paired glands located on the top of each kidney and have two parts, the outer cortex that releases Cortisol, Aldosterone, DHEA, and Androgenic steroids, and the inner part called the medulla that releases Epinephrine (Adrenaline) and Norepinephrine (Noradrenaline). Its disorders are;

• Adrenal Insufficiency
• Congenital Adrenal Hyperplasia
• Overactive Adrenal Glands.
• Cushing Syndrome.

Gonads: These are ovaries and testes and release sex hormones. Its disorders are;

• Menstrual function or fertility disorders
• Amenorrhea
• Polycystic ovary syndrome

The following factors can increase your risk of having a hormonal imbalance;

• Severe stress
• Complicated Surgery
• Exposure to radiations
• Family history
• Co-presence of autoimmune disorders 
• Pregnancy
• Medicines( like amiodarone and lithium for thyroid disorders)
• Chronic and infiltrative diseases ( tuberculosis)
• Cancers that can metastasize to the endocrine glands
• Some genetic disorders like hemochromatosis

The prevalence of endocrine disorders causing hormonal imbalances is 5% in the US. These include diabetes mellitus, obesity, erectile dysfunction, metabolic syndrome, osteopenia, thyroiditis. Among them, the most common is Diabetes. In 2018, 10.5% of the population of the US had diabetes. Thyroid disorders(goiter) are the next common disorder. It is prevalent in 15.7% of the world’s population, while it affects 4.7% of the population in the USA. 

Since each gland has its specific functions, the disease process thus causes specific signs and symptoms for each disorder. Generally speaking, the following symptoms should alert you, and you should consult your physician. 

• If you drink a lot of water but still feel thirsty
• You feel excessive hunger or no hunger at all
• You feel the need to pee often, more than others around you
• You feel frequent belly pain or nausea 
• You notice changes in stool habits
• You notice changes in menstruation or sexual functions
• You have started to feel more anxious, depressed, irritable, or confused
• You feel unusually tired or weak
• You are gaining or losing a considerable amount of weight
• You have tremors or a lot of sweating
• You have excess unexplained hair loss
• Unexplained darkening or patches of discoloration on the skin

Hormonal imbalance usually does not cause pronounced symptoms in the early stages. Some of the disorders are found incidentally on blood tests, imaging, or physical examination of some other illness.

History and physical examination are the initial steps followed by a combination of blood tests, urine tests, special challenging tests, genetic tests, ultrasound, radiographs, CT scans, MRI scans of the area of the gland suspected, some special scans like radioactive iodine uptake, etc., so the testing depends on the gland involved and the hormonal imbalance suspected. 

Some of the other disorders can share similar complaints like that of the endocrine disorders like;

• Chronic Fatigue Syndrome 
• Depression
• Anemia 
• Iodine Deficiency
• Lithium Nephropathy
• Obesity
• Fibromyalgia
• Tuberculosis 
• Lymphomas 
• Alcoholism
• Anorexia nervosa
• Bulimia Nervosa

Treatment for hormonal imbalance depends upon many factors like hypo-functioning or hyperfunctioning, effects on other body organs, presence or absence of causative diseases or tumors,  and the patient’s preference for the treatment option. The approach adopted is first to treat the underlying causes, then control the symptoms or growths if present, replacing the deficiencies to improve the function of the gland, surgical or minor procedures when required. Radiotherapy, chemotherapy, hormonal therapy for tumors, etc. 

Once the diagnosis is made and treatment is started, the prognosis is usually good for the hormonal imbalances involving the hypo-functioning or hyperfunctioning except for some extreme cases. Usually, the deficient hormones are replaced and the glands releasing excess hormones are removed surgically or medically controlled. The prognosis of tumors depends on the stage of diagnosis, grades, spread, etc. 

Each disorder would require you to make some changes to your lifestyle along with other treatment modalities to improve the outcome of the disease. These changes may include the following;

• Try to learn about your disease as much as possible
• Try to take the medicines and hormones regularly.
• Try to be regular for medical checkups.
• Be conscious about your family history of any disorder 
• A balanced diet replacing the deficient nutrients should be taken after being advised by a nutritionist and a doctor.
• One must remain active and perform some form of exercise. 
• Be around your friends and family members to feel supported