In Conversation with Doctors

 

Raging Hormones : Not just a saying

by Associate Professor Dr. Jeyakantha Ratnasingam, Consultant Endocrinologist

The pituitary normal gland (highlighted red)

Raging Hormones: Body’s Natural Response or Medical Condition?

People with very volatile mood are often said to have raging hormones. Hormones are chemicals produced by glands, that send messages to different parts of your body. The hormone system mimics a postal network and without hormones, your body will not be able to function. The many hormones in your body are controlled by a master gland situated at the bottom of the brain, called the pituitary gland. The pituitary gland ensures hormones are in check, because either excess or decreased hormone levels lead to problems.

Pregnant women, women with pre-menstrual syndrome and teenagers are often said to have raging hormones that affect their mood and behaviour. However, these changes are mostly natural and do not mean you suffer from a medical condition that require treatment. Hormonal changes that occur in these conditions are mild and reversible, making it “natural” and often no treatment is required.

Besides mood, hormones also play a crucial role in controlling body weight, hunger and satiety, temperature, heart rate, water and salt balance as well as the immune system. There are several medical conditions that cause hormone levels to rage out of control and are often ignored because of its subtle presentation. Although rare, these conditions could lead to multiple problems if ignored.

A. Cushing’s Syndrome- Raging Cortisol

When to suspect ?

Cortisol is an important hormone that ensures your body can cope with stress adequately, but excessive amounts of this hormone is deleterious, and is called Cushing’s syndrome. If you have unexplained weight gain that happens abruptly and generalized weakness or easy bruising with purplish red stretch marks on your belly, you will need to be tested for cushing’s syndrome. Cushing’s syndrome is a condition in which either your pituitary gland or the adrenal glands that are situated above the kidneys produce too much cortisol hormones. These are growths that are non – cancerous but still lead to problems including worsened diabetes, high blood pressure and osteoporosis if not treated.

How is it confirmed ?

This condition can be detected by doing urine and blood tests to measure levels of cortisol in your body. Often you may also require either a pituitary MRI or CT scan of the adrenals to look for the exact source of the excessive cortisol.

How is it treated ?

Surgical removal of the tumour is the most effective way in controlling and curing Cushing’s syndrome. Pituitary surgeries these days are done with guidance of a scope via the nostrils, and the tumour usually can be completely removed through the nostrils without any scars. If the source of cushing’s syndrome is from the adrenal glands then the adrenal tumor can also be removed as well using minimally invasive techniques. Patients with cushing’s will require long term follow up even after surgery as there is a modest chance of relapse of disease.

B.Prolactinoma- Raging Prolactin

                                                         An MRI revealing a large pituitary tumour  (circled area)

What are the symptoms?

Women with absent or irregular periods or difficulty conceiving a child need to be investigated for prolactinoma. Prolactin is a hormone for breast milk production, that is present in both men and women. Prolactinomas are benign tumours that secrete too much prolactin This tumour arises from the pituitary gland and sometimes can enlarge to also cause headaches and visual problems. Although uncommon, in men it may cause loss of sex drive and erectile dysfunction.

How is it confirmed ?

Prolactinomas can very easily be diagnosed with blood test to measure prolactin levels. If found to be elevated, a pituitary MRI will also be required to assess the size and extent of this tumour.

How is it treated ?

The good news is that prolactinomas are the only pituitary tumours that can be treated and cured with medications alone, without any surgery. The medications can quickly shrink the size of the prolactinoma tumour and bring down hormone levels to normal. This often occurs by 3 months and you will regain your normal periods or be able to conceive usually after 6 months or so of commencing treatment.

 C. Acromegaly – Raging Growth Hormone

                                                                        Subtle facial changes that happen in acromegaly

When to suspect ?

Acromegaly is often missed because the bodily changes that occur are usually very subtle and occur over 5 to 10 years. As an adult, if you experience enlargement of feet or hands, like if you are not able to fit your shoes or rings anymore you need to seek medical advice to for acromegaly. Often acromegaly patients also have headaches and impaired vision because these tumours are large. Just like the other conditions, acromegaly tumours arise from the pituitary and secrete too much growth hormone. It can also cause facial changes that makes you look different due to overgrowth of jaw and forehead. In children, it may cause rapid growth, making the child abnormally tall for his age. If left untreated it may cause multiple complications including heart failure, poorly controlled diabetes, arthritis and increased risk of certain cancers.

How is the diagnosis made ?

Acromegaly is confirmed by blood tests and also your doctor will need to get an imaging of your pituitary using an MRI.

How is it treated ?

Acromegaly is effectively treated with surgical removal of the pituitary tumor that can be done using endoscope via the nasal route, similar to cushing’s disease surgery. 70% of these tumours can be completely removed but some may require additional treatment with medications or radiotherapy if there is regrowth or residual tumour. You will need lifelong follow up with your doctor to monitor levels of growth hormone and perform scans to monitor for regrowth of these tumours.

D. Hyperthyroidism- Raging Thyroid

What are the symptoms ?

Thyroid gland is a little butterfly shaped gland in the centre of your neck. Excess thyroid hormones or hyperthyroidism can make you lose too much weight suddenly, experience palpitations, heat intolerance, tremors and irritability. This conditions often occurs from excess antibodies within your body that stimulate the thyroid gland to produce too much hormones and is called Grave’s  Disease. Sometimes it occurs from an enlarged thyroid (goiter) with nodules within it.

Who is at risk ?

Normally hyperthyroidism run in the family, most commonly amongst women in the same family. It may also be associated with other autoimmune disorders such as rheumatoid arthritis.

How is it treated ?

Hyperthyroidism can be treated with medications such as carbimazole or propylthiouracil that block excess thyroid hormone. Sometimes you may also need extra medications to control your heart rate. It is important not to stop treatment without your doctor’s advice and often medications need to be continued for one to two years. Your doctor will monitor your blood thyroid levels every 2-3 months. Some patients who are difficult to control may require radio-active iodine therapy or surgical removal of the thyroid gland.

Besides the described conditions, there are several other hormonal excess diseases that are rare such as excess parathyroid hormones (hyperparathyroidism) that cause high blood calcium levels and phaeochromocytoma that is a condition of excessive adrenaline hormones that cause uncontrolled blood pressure.

The key message is that raging hormones are not just a saying. Although in many circumstances it is related to natural changes, it could also mean an underlying disease. If such a valid suspicion is not raised and one does not seek medical help, we may miss a morbid and maybe fatal condition of excess hormone. Clearly, there is no chemistry in our body without hormones, but too much is definitely harmful.