The Power Of Hormones: Why "Hormonal Background" Does Not Exist

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The Power Of Hormones: Why "Hormonal Background" Does Not Exist
The Power Of Hormones: Why "Hormonal Background" Does Not Exist
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Endocrinology remains one of the most mystified fields of medicine. This is manifested both in the number of legends about endocrine diseases (for example, about diabetes mellitus), and in the demonization of the "power of hormones" over a person, when hormonal disruptions 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 fails, something terrible will happen. Let's figure out how things really are.

Text: Evdokia Tsvetkova, endocrinologist, postgraduate student of the Department of Endocrinology, P.M. I.M.Sechenova, author of the telegram channel

about evidence-based endocrinology "Endonnost"

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Abstract painting

There are many terms in medicine, but the phrase "hormonal background" definitely does not apply to them. In the minds of those who use this phrase, all hormones in the human body, like pieces of a puzzle, take some "right" place, hold on to each other and form a single canvas - and if you put it together somehow, the picture will not come out. In reality, the totality of hormones produced can be rather compared to abstract painting, so this puzzle cannot be “rebuilt” and corrected. There is simply no treatment aimed at "normalizing hormonal levels".

Hormones are produced by endocrine glands - endocrine glands. Unlike the glands of external secretion, they do not have a duct for secretion, so that it goes directly into the bloodstream. Endocrine glands are the thyroid and pancreas (the pancreas also has an exocrine part, which is responsible for digestion), adrenal glands, sex glands (testicles or ovaries), parathyroid glands, pineal gland and hypothalamic-pituitary complex.

In addition to the glands of the endocrine system, the body has many special scattered cells that can produce hormones. The concept of their existence was put forward by the English pathologist and histochemist Everson Pearce in the late 1960s. He designated these cells with the abbreviation APUD - Amine Precursor Uptake and Decarboxylation - according to the main process taking place in them: "absorption and decarboxylation of the amine precursor." This means that they absorb molecules - precursors of active biological substances and turn them into these very substances. Thanks to Peirce's concept, it was possible to revise and expand the existing ideas about hormonal regulation. More than sixty types of cells of the APUD system have now been identified, located in a wide variety of organs and tissues, including the gastrointestinal tract, organs of the urinary and respiratory systems, skin and adipose tissue.

In other words, the human body is a giant factory with billions of cells - production sites. Each released hormone plays different roles on different scenes - 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 20 to 28 hours) are called circadian. Periods of sleep and wakefulness, eating behavior, thermoregulation, and the functions of the endocrine and reproductive systems obey these rhythms. A number of hormones - including glucocorticosteroids (they play important roles in stress management, inflammation, immune defense, metabolism), growth hormone (on which the growth of children and the metabolism of adults depend), mineralocorticoids (which affect water-salt metabolism), sex hormones (determining secondary sexual characteristics and reproductive function) - are produced in different ways at different times of the day; this is called impulse secretion. The secretion of hormones into the blood has peaks and troughs, so our abstract picture is a plexus of zigzags and wavy lines.

The hypothalamus controls the circadian system.The master timer is daylight, which acts indirectly through the retinal receptors. In addition to light, the function of timers is performed by meal time, planned physical activity and a number of social factors. If the mechanisms that maintain circadian rhythms are disrupted, metabolic diseases such as obesity or diabetes mellitus can develop. Shift work schedules, fast time zone changes on long flights, or excess artificial lighting can contribute to such disruptions.

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Endocrine system diseases

If everything is in order, then the hormones are produced as much as the body needs. If somewhere there was a "breakdown", then this is the history of a specific disease, and not "background disturbance". Endocrine diseases are associated with a lack or excess of secretion of one or another hormone: a lot of thyroid hormone (thyroxine) - hyperthyroidism, little - hypothyroidism, little pancreatic hormone insulin (or it does not work well) - diabetes mellitus, little sex hormones - menstrual irregularities and so on.

Of course, this does not mean that hormones do not depend on each other in any way. So, with hypothyroidism, there will be little thyroxine produced by the thyroid gland, but a lot of thyroid-stimulating hormone (TSH) produced by the pituitary gland. The pituitary gland, through a negative feedback mechanism, receives information about the lack of thyroxine in the blood and struggles to stimulate the thyroid gland with the help of TSH. So it turns out that in the results of the blood test, we see an increase in TSH and a decrease in T4. And sometimes - at the subclinical stage - only an increase in TSH.

Experts know how hormones interact with each other, and the concept of "hormonal background" is not used. Most often it can be heard from doctors of other specialties or from patients, and it means "I do not understand what is wrong with you (me)." Attempts to become your own therapist, "prescribe" tests and "direct" yourself to an endocrinologist are understandable, but unsafe. Evaluation of the entire "hormonal profile" can lead not only to unnecessary waste, but also to overdiagnosis.

For example, if a woman comes to the laboratory and expresses a desire to “pass the hormonal profile,” prolactin will appear in the list of hormones. The level of this hormone in the blood can be increased for a variety of reasons: due to emotional or physical stress, taking certain medications, sex on the eve of blood sampling. In the results of a blood test, prolactin is elevated, there are suspicions of prolactinoma (pituitary tumor), this causes stress in the patient, leads to additional examinations, and then it turns out that everything is in order. The stress and cost of time and money could have been avoided if tests had been prescribed as indicated from the outset.

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. It is believed that if a person is very tired, then his thyroid gland does not work well - but most people with a complaint 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, with which an endocrinologist is often consulted, is weight gain or loss. Contrary to popular belief, there are not many diseases in endocrinology that lead to weight gain. These include hypothyroidism and hypercortisolism (excess 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 in a number of additional signs: an increase in blood pressure, characteristic changes in appearance.

Weight loss can be associated with excess thyroid hormones. Or, for example, with the 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 splitting the available energy reserves are activated. There is even a poetic expression that diabetes is "hunger in the midst of abundance." But in any of these cases, there will be additional signs: with diabetes mellitus, frequent urination and thirst may disturb, hyperthyroidism is characterized by increased emotional lability and rapid heartbeat, or even heart rhythm disturbances, in case of adrenal insufficiency, weight loss is accompanied by nausea, vomiting, weakness, decrease pressure. All these manifestations can manifest themselves in various combinations and constitute a characteristic clinical picture. Separately, even 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 disease and the need for screening. There are specialized questionnaires that identify risk factors, you can fill them out on your own and take with you to your appointment. In the questionnaire on diabetes mellitus, for example, risk factors can be noted: the presence of relatives with diabetes mellitus, body mass index above 25 kg / m22, age over forty-five, high blood pressure, sedentary lifestyle, and so on. These are again very nonspecific signs, but if a high score is scored, then it is worth discussing this with your doctor.

Glucose screening is recommended for people over forty-five who are overweight or obese. Measurement of bone density (densitometry) to rule out osteoporosis, which is more common in women, is always done if a high risk has been identified using the FRAX calculator, and from fifty-five years old, this examination is desirable for all women. Screening for thyroid hormones 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 volumetric formation that can be detected by touch.

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