Endocrinology remains one of the most mystified fields of medicine. This is manifested in the number of legends about endocrine diseases (for example, diabetes), and in the demonization of the “power of hormones” over a person, when hormonal imbalances are blamed for a variety of conditions. It is believed that there is a certain “hormonal background” that should work like a metronome, and if it malfunctions, something terrible will happen. Let's figure out how things really are.
Text: Evdokia Tsvetkova,
Endocrinologist, postgraduate student of the Department of Endocrinology, PMGMU named after. I. M. Sechenova, author of the telegram channel
about evidence-based endocrinology "Endonews"
Abstract painting
There are many terms in medicine, but the phrase “hormonal balance” definitely does not apply to them. In the minds of those who use this phrase, all the hormones in the human body, like pieces of a puzzle, occupy some “right” place, hold on to each other and form a single canvas - and if you put it together somehow, then the picture won’t come out. In reality, the totality of hormones produced can be rather compared to an abstract painting, so it is impossible to “reassemble” and correct this puzzle. There is simply no treatment aimed at “normalizing hormonal levels.”
Hormones are produced by endocrine glands - endocrine glands. Unlike the exocrine glands, they do not have a duct to secrete secretion, so it goes directly into the bloodstream. The endocrine glands are the thyroid and pancreas (the pancreas also has an exocrine part, which is responsible for digestion), adrenal glands, gonads (testes or ovaries), parathyroid glands, pineal gland and hypothalamic-pituitary complex.
In addition to the glands of the endocrine system, the body has many special isolated cells that can produce hormones. The concept of their existence was put forward by the English pathologist and histochemist Everson Pierce in the late 1960s. He designated these cells with the acronym APUD - Amine Precursor Uptake and Decarboxylation - after the main process that occurs in them: “the uptake and decarboxylation of an amine precursor.” This means that they absorb molecules - precursors of active biological substances and convert them into these same substances. Thanks to Pierce's concept, it was possible to revise and expand existing ideas about hormonal regulation. More than sixty types of cells of the APUD system have now been identified, located in a variety of organs and tissues - including the gastrointestinal tract, organs of the urinary and respiratory systems, skin and tissue.
In other words, the human body is a gigantic factory with billions of cells - production areas. Each secreted hormone plays different roles on different stages - for example, insulin increases the penetration of glucose from the blood into cells, stimulates the formation of glycogen from glucose in the liver and muscles, enhances the synthesis of fats and proteins, promotes the transport of potassium ions into cells, suppresses the activity of enzymes that break down glycogen and fats, and so on.
Circadian swing
Physiological processes in the human body are synchronized with the rotation of the Earth around its axis. Rhythms with a period of about a day (usually from 20 to 28 hours) are called circadian. These rhythms govern periods of sleep and wakefulness, eating behavior, thermoregulation, and the functions of the endocrine and reproductive systems. A number of hormones - including glucocorticosteroids (they play important roles in dealing with stress, inflammation, immune defense, metabolism), growth hormone (on which the growth of children and the metabolism of adults depends), mineralocorticoids (which affect water-salt metabolism ), sex hormones (which determine secondary sexual characteristics and reproductive function) - are produced differently at different times of the day; this is called pulsatile secretion. The secretion of hormones into the blood has peaks and valleys, so our abstract picture is a tangle of zigzags and wavy lines.
For example, if a woman comes to the laboratory and expresses a desire to “take a hormonal profile,” prolactin will appear on the list of hormones. The level of this hormone in the blood can be elevated for a variety of reasons: due to emotional or physical stress, taking certain medications, or having sex the day before a blood test. In the results of a blood test, prolactin is elevated, suspicions arise about prolactinoma (pituitary tumor), this causes stress in the patient, leads to additional examinations, and then it turns out that everything is fine. Stress, time and expense could have been avoided if tests had been ordered according to indications from the very beginning.
Weakness and weight gain
As a rule, the first manifestations of endocrine diseases are nonspecific, and in most cases the first symptom is weakness. True, it is characteristic of many other conditions that are not related to the endocrine system. There is an opinion that if a person is very tired, then his thyroid gland is not working well - but most people who complain of weakness do not have hypothyroidism. In addition, thyroxine affects the entire body, and its deficiency has many clinical masks: depression, infertility, anemia, and so on.
Another nonspecific manifestation that is often addressed to an endocrinologist is weight loss. Contrary to popular belief, there are not many diseases in endocrinology that lead to weight gain. These include hypothyroidism and hypercortisolism (excess of glucocorticoid hormones) - but they are characterized by a small increase, no more than ten kilograms. If we are talking about a significant increase in body weight, then most often the cause is not an endocrine disease. And the same hypercortisolism will manifest itself with a number of additional signs: increased blood pressure, characteristic changes in appearance.
Weight loss may be due to excess thyroid hormones. Or, for example, with decompensation of diabetes mellitus: there is a lot of glucose in the blood, but it does not enter the cells due to a lack of insulin and the processes of breakdown of existing energy reserves are activated. There is even a poetic expression that diabetes mellitus is “hunger among plenty.” But in any of these cases there will be additional signs: with diabetes mellitus, frequent urination and thirst may be a concern; hyperthyroidism is characterized by increased emotional lability and rapid heartbeat, or even heart rhythm disturbances; with adrenal insufficiency, weight loss is accompanied by nausea, vomiting, weakness, and decreased pressure. All these manifestations can appear in various combinations and form a characteristic clinical picture. Separately, even to a specialist, they do not say anything about the exact diagnosis.
"Just in case"
An endocrinologist is not a screening specialty. The main doctor in every person’s life should be a therapist - it is with him that you can discuss the risk of diseases and the need for screening. There are specialized questionnaires that identify risk factors; you can fill them out yourself and take them with you to your appointment. In a diabetes questionnaire, for example, risk factors can be noted: having relatives with diabetes, a body mass index above 25 kg/m2, age over forty-five years, high blood pressure, a sedentary lifestyle, and so on. These are again very non-specific signs, but if the score is high it is worth discussing this with your doctor.
Glucose screening is recommended for people over forty-five years of age who are overweight or obese. Bone density measurements (densitometry) to exclude osteoporosis, which is more common in women, are always carried out if a high risk has been identified using the FRAX calculator, and from the age of fifty-five this examination is desirable for all women. Thyroid hormone screening is mandatory in the first trimester of pregnancy. But ultrasound of the thyroid gland is not a screening method at all and is prescribed by a doctor only if there is a mass formation that can be detected by touch.
Traditionally they say that androgens are male sex hormones, and estrogens and progestins are female. This is true, and different hormones dominate in different sexes. It is important to emphasize here: women also produce certain amounts of androgens. And in the bodies of men there is a certain amount of estrogens and progestins.
Androgens in women
Androgens in women are produced in the ovaries and adrenal glands. They affect the rate of bone formation, increase muscle mass, and affect libido and mood. They don’t make themselves known until there are too many of them. This condition is called hyperandrogenism. This problem occurs frequently. Up to 15 percent of women of childbearing age suffer from excess male hormones.
Symptoms of androgen excess in women
A common symptom of excess is hirsutism. The appearance of hair in places where it usually does not grow. Hair appears on the face, chest, stomach, inside the thighs and back.
In addition to excess hair, excess male hormones can lead to:
- male pattern baldness - on the crown and temples
- seborrhea
- changing the timbre of the voice to a lower one
- menstrual irregularities
- problems with conception
In case of severe excess, virilization may develop. This is manifested by an enlargement of the clitoris, a clear decrease in the timbre of the voice and the formation of muscles typical of a male silhouette. Hyperandrogenism can lead to many problems.
Excess androgens in women and PCOS
One of the most common causes of hyperandrogenism is polycystic ovary syndrome (PCOS). In the case of this disease, excessive production of male hormones occurs due to several reasons. There is an increase in the concentration of luteinizing hormone (LH), which stimulates the production of androgens in ovarian cells. Insulin secretion increases. Which in PCOS is already produced above normal. It stimulates ovarian cells to produce male sex hormones. There may be menstrual irregularities, overweight or obesity. Insulin resistance and impaired fertility.
Excess testosterone and ovarian tumors
Excess male hormones can cause the appearance of a hormonally active ovarian tumor. Symptoms of excess develop very quickly. Therefore, it is important to get tested as quickly as possible if symptoms appear. Especially young women aged 20-30 years.
Ovarian tumors can lead to a significant increase in the amount of androgens in the female body. In these cases, the previously mentioned virilization is not uncommon. Various neoplasms have the ability to produce male sex hormones - ovarian adenocarcinoma and Krukenberg tumor.
Excess male hormones and adrenal disease
Hormonal imbalance can be caused by diseases of the adrenal glands. Here the cause may be congenital adrenal hypertrophy. Also changes that appear throughout life. Adrenal tumor, pituitary tumor causing excess ACTH and corticotropin.
Other reasons
Excess androgens may be due to other reasons. Due to menopause. This symptom may occur especially during the initial period of cessation of menstruation. The concentration of estrogen in the female body drops sharply. This can lead to quantitative androgen dominance.
Other reasons:
- Acromegaly- excess amount of growth hormone (GH).
- Hyperprolactinemia, which may result from a prolactin-producing pituitary adenoma.
- Overactive thyroid function.
Excess hormones can result from taking certain medications. For example, in the case of women taking danazol and progestogens.
Diagnostics: testosterone levels in women
It is necessary to undergo a gynecological examination. Especially if the potential cause of excess androgen is PCOS or an ovarian tumor.
It is important to perform hormonal tests. The concentration of free testosterone is determined. The normal level of free testosterone in women is less than 8.5 ng/ml. However, performing this test alone will not answer the question of what led to the appearance of excess androgens. To do this, you need to perform other tests:
- adrenal hormones
- prolactin
- estradiol
- SHBG (sex hormone binding globulin)
- thyroid hormones
Diagnosing a woman with androgen excess may take some time, but it is very important. Finding the cause is critical because it is the cause that needs to be treated, not the symptom.
Treatment of hyperandrogenism
Treatment of excess androgens in women is closely related to the cause that led to this condition. In the case of PCOS - two-component birth control pills. In patients with this disease who are not planning to have children, treatment may include the use of antiandrogen drugs. In the case of hormonally active tumors - be it ovarian, adrenal or pituitary - the mainstay of treatment is surgical removal of the changes.
In some patients, despite an accurate diagnosis, the cause of hirsutism can be found. In this case, the only option is to remove unnecessary hair. For this reason, some patients suffering from hirsutism decide to use permanent hair removal methods - laser.
Hormones are partners of the nervous system; together they control all processes in the body. While the endocrine system is doing its job properly, people only remember it after violent emotional outbursts: “hormones are acting up.” But if any hormone begins to be produced in insufficient or excessive quantities, it is always noticeable. True, it is not always possible to immediately understand that the cause of these symptoms is an endocrine disorder.
Increased irritability
Frequent changes of emotions, internal tension - if these symptoms haunt you every day, it may be due to hormonal imbalances.
First of all, it is worth checking the thyroid hormones - triiodothyronine (T3) and thyroxine (T4), as well as thyroid-stimulating hormone (TSH) - it is produced by the pituitary gland and controls the function of the thyroid gland.
Increased irritability and sleep disturbances are possible symptoms of hyperthyroidism, a condition in which the thyroid gland produces too much thyroid hormone. It occurs more often in women than in men. Other possible symptoms: weight loss, rapid and intense heartbeat, rhythm disturbances, sweating, trembling of the hands and fingers. Women may experience menstrual irregularities. Sometimes ophthalmopathy develops - redness, dryness and discomfort in the eyes occur, they become bulging, bright light causes pain.
The effect of female sex hormones on the emotional state is quite complex and not always unambiguous.
Still from the movie "Fight Club"
Weakness and increased fatigue
As a rule, reduced performance, a constant desire to sleep and a “squeezed lemon” state are attributed to irregular working hours, lack of sleep and stress. You just need to have a good rest, sleep - and your condition will return to normal. This is often true, but if the problem is hormonal imbalances, rest will not help.
Chronic fatigue can be a symptom of hypothyroidism, a condition where the thyroid gland produces too little hormone. A person is typing, his face becomes puffy, his skin becomes dry, his voice becomes hoarse. The pulse slows down, memory deteriorates, constipation and muscle pain bother you. Cholesterol levels increase in the blood.
Normal testosterone levels are important for vitality in men. With its deficiency, fatigue quickly sets in, mental performance decreases, weight increases, libido decreases and erection deteriorates.
The lack of stress hormones produced in the adrenal glands also has a negative impact on overall well-being. The person becomes lethargic, feels very tired even after sleep, the mood becomes depressed, and concentration decreases. Chronic excess of and similar substances causes irritability and sleep disturbances. If stress hormone levels fluctuate greatly, these symptoms alternate.
Panic attacks, anxiety and depression
These diseases are usually considered to be purely psychiatric. They are treated with antidepressants, anti-anxiety drugs, and psychotherapy. However, we should not forget about hormones; sometimes endocrine disorders play an important role.
For example, depression that is not controlled with antidepressants may be a symptom of undiagnosed hypothyroidism. , on the contrary, is more common in people with hyperthyroidism. Women are sometimes treated without success for panic attacks and anorexia caused by elevated thyroid hormone levels.
Still from the cartoon “Puzzle”
Sex hormones also play a role. The risk of mental health disorders increases during puberty, premenstrual syndrome, pregnancy, and male and female menopause. Depression in men can develop against the background of low testosterone levels or high estrogen levels.
The development of depression, increased anxiety and insomnia is facilitated by an imbalance of stress hormones that are produced in the adrenal glands - adrenaline and cortisol.
Bone pain and brittle bones
As a person ages, their bones inevitably become less strong. Sometimes the process happens too quickly - this phenomenon is called osteoporosis. Bones become weak and brittle. I am worried about pain, my spine is deformed, and a minor injury can lead to a serious fracture.
Osteoporosis is especially susceptible to menopausal women, which occurs due to decreased estrogen levels. Female sex hormones support the activity of osteoblasts - cells that form new bone tissue. Near the thyroid gland there are parathyroid glands, they secrete parathyroid hormone, which reduces the calcium content in the bones, suppresses the formation of bone tissue, and increases its destruction. Too much activity of the parathyroid glands also contributes to the development of osteoporosis. The risk also increases with excessive thyroid function, dysfunction of the adrenal glands, and the pituitary gland.
Still from the film “The Tomboys from Timpelbach”
Obesity
A person’s weight depends on three factors: diet, physical activity and heredity. In other words, it is important how many calories enter the body and how quickly they are burned. Some people eat a lot but remain slim, others quickly gain weight with small errors in their diet. The prevalence of obesity is growing worldwide: in Russia it affects 15 to 30% of adults.
Endocrine, that is, caused by disruption of the endocrine glands, obesity is rare - in about 5% of cases. This cause can be suspected if there is a strong increase in weight, despite following a diet and physical activity, if there are some other symptoms characteristic of endocrine diseases.
Body weight increases with a decrease in the level of sex hormones (male and female menopause), hypothyroidism. When adrenal hormones are produced in excess, a condition known as Cushing's syndrome develops.
A lot of fat is deposited on the body and face, and the arms and legs look thin, blood pressure rises, heart problems arise, immunity decreases, and blood levels increase.
Obesity, headaches, increased blood pressure, underdevelopment of the genital organs and secondary sexual characteristics, frequent mood swings are possible manifestations of hypothalamic syndrome, which
5447
Publication date: August 11, 2011
Hyperthyroidism is a condition in which the thyroid gland produces too much thyroid hormone. The condition is often called “overactive thyroid.”
The thyroid gland is an important organ of the endocrine system. It is located in the front of the neck. The gland produces the hormones thyroxine (T4) and triiodothyronine (T3), which control the body's use of energy. This process is called metabolism. Hyperthyroidism occurs when the thyroid gland produces too much hormone over a short (acute) or long (chronic) period of time. Many diseases and conditions can cause problems, including:
- Accumulation of large amounts of iodine
- Graves' disease
- Inflammation (of) the thyroid gland due to a viral infection or other reasons
- Benign growths of the thyroid gland or pituitary gland
- Tumors of the testicles or ovaries
Other symptoms that may occur with this disease:
- Sticky skin
- Weakness
- Nausea and vomiting
- Protruding eyes (exophthalmos)
- Fast heartbeat
- Skin redness
A physical examination may reveal an enlarged thyroid gland, tremors, hyperactive reflexes, or a rapid heartbeat. Systolic blood pressure may be high. Subclinical hyperthyroidism is diagnosed by abnormal blood levels of thyroid hormones, often in the absence of any symptoms. Blood tests are also done to determine thyroid hormone levels.
Treatment depends on the cause and severity of symptoms. Treatment includes:
- Antithyroid medications
- (which destroys the thyroid gland and stops excess hormone production)
- Beta blockers, such as propranolol, are used to treat some symptoms, including rapid heartbeat, and anxiety.
Prospects (forecast)
Hyperthyroidism is usually treatable and only rarely life-threatening. Some of its causes may go away without treatment. Hyperthyroidism caused by Graves' disease usually gets worse over time. It has many complications, some of which are serious and affect quality of life.
Possible complications
- Cardiopalmus
- Stagnant
- There is an increased risk of developing osteoporosis if hyperthyroidism is present for a long time
Complications after surgery.
Estrogen is the primary female hormone responsible for development, regulation of the reproductive system and gender characteristics such as breast growth and the menstrual cycle.
It is very important to control it and maintain it at a normal level, because in excess it can cause cancer. We talk about the symptoms that appear when there is an excess of estrogen in women.
Causes of Excess Estrogen Production
There are two ways to naturally increase estrogen levels, during puberty and pregnancy. But it can also happen for other reasons, such as environmental or nutritional reasons.
Nowadays, it is not difficult to increase estrogen levels since this hormone is present in foods that have been treated with toxic pesticides, herbicides and growth hormones. Be careful when buying products in the supermarket, check their description and where they were produced.
There may be other causes related to lifestyle: excessive consumption of alcohol and drugs, heart disease, diabetes, obesity and high blood pressure, stress.
Pay close attention to these symptoms and don't hesitate to contact your doctor if you find anything that worries you. If you have high estrogen levels, you may feel:
1. Swelling and pain in the chest
Many women experience changes in their breasts during their menstrual cycle and pregnancy. If you experience breast pain or notice that your breasts are more inflamed than usual, this may be due to high estrogen levels.
2. Mood changes
Estrogen affects your mental state and emotions. These feelings will remind you of the symptoms of premenstrual syndrome. You may feel depressed or anxious, and you will experience mood swings for no good reason.
3. Fibrous bundles in the chest
If you have too much estrogen, your breasts may become lumpy. This can create sensitivity and be painful. Don't hesitate to see your doctor immediately if you find lumps in your breasts.
4. Hair loss
This is usually a problem for men, but when the body produces too much estrogen, hair may fall out more than usual.
5. Weight gain
If you don't eat too much or spend time on the couch 24/7 but notice that you've gained weight, it could be a sign of excess estrogen.
6. Irregular menstrual cycle
This should be an important signal for a woman, especially if her menstrual cycle has always been very regular, but suddenly becomes erratic.
7. You feel exhausted
If you have trouble sleeping, you may feel tired. This is fine. But if you notice that you're more tired than usual and your lifestyle hasn't changed, it may be a sign that you need to monitor your hormone levels.
8. Sleep problems
Excess estrogen can also cause sleep problems. You may be too active and unable to sleep, or you may feel constantly sleepy.
