The two most important structures in neuroendocrinology are the hypothalamus and the pituitary gland . Both are located in the brain and control vital functions from there.
Among other things, the hypothalamus is responsible for
- Hunger,
- thirst,
- a healthy day-night rhythm,
- body temperature and
- balanced blood pressure.
All these matters are regulated by the increased or decreased release of correspondingly controlling hormones .
The hormones produced in the hypothalamus are not distributed throughout the body via the bloodstream like the hormones produced by other organs. Instead, the hypothalamic hormones act on the pituitary gland, also known as the pituitary gland, which is located below the hypothalamus, by regulating the release of hormones by the pituitary gland.
These pituitary hormones then control a wide range of bodily functions, from the thyroid gland to the adrenal glands and milk production in the female breast.
Neuroendocrinologists are medical specialists who specialize in the treatment of diseases that have their origin in a malfunction of the neuroendocrine system. This can be caused by brain tumors or brain injuries, for example. The neuroendocrine focal points include, for example
- Tumors such as pituitary adenoma (benign tumor of the pituitary gland), multiple endocrine neoplasia type I (co-occurrence of benign pituitary tumors and benign parathyroid tumor)
- Disturbed hormone production(hormone insufficiency) after craniocerebral trauma
- Thyroid and parathyroid disorders such as hyperthyroidism (overproduction of thyroid hormone), hypothyroidism (insufficient supply of thyroid hormone), hypoparathyroidism (reduced calcium levels mostly due to reduced parathyroid hormone production from the parathyroid glands)
- Adrenal disorders such as hypercortisolism (Cushing's syndrome; increased cortisol production), hypocortisolism (Addison's disease; adrenal cortex hypofunction), hyperaldosteronism (Conn's syndrome; overproduction of aldosterone in the adrenal cortex)
- Metabolic disorders such as hypercalcemia syndrome (increased calcium levels mostly due to increased calcium release from the bones) and osteoporosis, diabetes mellitus (diabetes), adiposity (obesity)
- Disorders of sex hormone production such as PCO syndrome
- Hormonal problems in psychiatric illnesses
- Sexual development disorders and transsexualism
The doctor begins with a comprehensive medical history, i.e. questioning the patient about their symptoms, lifestyle, medication intake and medical history or that of their direct relatives. This is followed by a physical examination. Both give the doctor initial indications as to whether a hormonal disorder is the cause of the patient's symptoms.
This is usually followed by laboratory tests to determine the levels of various hormones in the blood(hormone levels, hormone diagnostics). These endocrinological laboratory diagnostics usually provide a fairly accurate picture of whether the underlying disorder lies inside or outside the brain and which disorder might be present.
Endocrinological function tests, such as stress tests (e.g. oral glucose tolerance test), stimulation tests and inhibition tests, can be used to further investigate or narrow down the suspected malfunction. This involves administering certain hormones or substances to the patient and observing the body's reaction.
Imaging procedures such as CT, MRI or ultrasound can be used to visualize pathological changes in the endocrine glands and brain. MRI, for example, can be used to visualize pituitary tumors very well.
The causes of neuroendocrinological disorders are manifold. Doctors generally differentiate between hypofunction and hyperfunction. In the case of hypofunction, too few or no hormones are produced, meaning that all the regulatory circuits controlled by this hormone are affected. In the case of hyperfunction, there is a pathologically increased secretion, usually due to structural changes in the tissue. All disorders can affect just one specific hormone or several.
Under certain circumstances, neuroendocrine hypofunction is caused by a genetic defect and is therefore congenital. The therapy consists of administering the missing hormones in order to prevent the resulting impairments. Depending on which genetic defect is involved, the therapy may only be necessary temporarily or for life. The same applies if tissue has been destroyed by an accident or an operation and therefore no longer produces sufficient hormones.
The cause of neuroendocrine hyperfunction of the pituitary gland is usually a tumor. In most cases, this is a benign tumor whose treatment depends primarily on its size and growth. If the tumor increases rapidly in size, surgery is usually the best solution. This also applies to hypophysitis, an inflammation of the pituitary gland. Under certain circumstances, however, drug therapy may also be sufficient.
Last but not least, neuroendocrinologists are important contacts in the context of transsexual gender reassignment. They monitor and control the hormone therapy and ensure that the change in sex hormones is as gentle as possible on the body and without any incidents.
Neuroendocrinologists often have a specialist qualification in internal medicine and endocrinology and diabetology. However, they may also have completed other specialist training, such as a specialist in neurology and, if necessary, additional further training in the field of neuroendocrinology.
If surgical interventions are required, the treating physicians are usually either specialists in neurosurgery (for interventions in the brain) or specialists in general surgery or visceral surgery.
After completing a medical degree, a doctor licensed in Germany can complete specialist training. Depending on the specialization, this requires five to six years of work, during which a specified number of diagnostic procedures and therapies must be carried out.
This gives the neuroendocrinology expert in-depth knowledge in all areas of the diagnosis and treatment of neuroendocrine diseases.
