The power of hormones: Why "hormonal background" does not exist
Endocrinology remains one of the most mystifiable areas of medicine. This is manifested in the number of legends about endocrine diseases (for example, diabetes mellitus), and in the demonization of the “power of hormones” over a man, when it is hormonal disruptions that are blamed for a variety of conditions. It is believed that there is a certain "hormonal background" that should work as a metronome, and if something goes wrong, something terrible will happen. We understand how things really are.
Text: Evdokia Tsvetkova, endocrinologist, postgraduate student, Department of Endocrinology, PMGMU them. I. M. Sechenov, author of the telegram channel on endonocrinology "Endonews"
Abstract painting
There are a lot of terms in medicine, but the phrase "hormonal background" definitely does not apply to them. In the view of those who use this phrase, all the hormones in the human body, like puzzle fragments, occupy a certain "right" place, hold each other and form a single canvas - and if you collect it somehow, then the pictures will not work. In reality, the totality of the hormones produced can rather be compared with abstract painting, therefore it is impossible to “reassemble” and correct this puzzle. There is simply no treatment aimed at "normalizing hormonal levels".
Hormones produce endocrine glands - endocrine glands. Unlike the external secretion glands, they do not have a duct for secretion, so that it enters 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, epiphysis 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 Pierce in the late 1960s. He designated these cells by the abbreviation APUD - Amine Precursor Uptake and Decarboxylation - according to the main process occurring in them: "absorption and decarboxylation of the amine precursor". This means that they absorb the molecules - the precursors of active biological substances and turn them into these very substances. Thanks to the concept of Pierce, it was possible to revise and expand the existing ideas about hormonal regulation. More than sixty types of cells APUD-system, located in a 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 secreted hormone plays different roles in different scenes - for example, insulin increases the penetration of glucose from the blood into the 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 the cells, inhibits the activity of enzymes that break down glycogen and fats, and so on.
Circus Swings
The 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. Sleep and wakeful periods, eating behavior, thermoregulation, and endocrine and reproductive system functions are subject to these rhythms. A number of hormones - including glucocorticosteroids (they play important roles in working with stress, inflammation, immune defense, metabolism), growth hormone (which affects the growth of children and adult metabolism), mineralocorticoids (which affect water-salt metabolism ), sex hormones (determining secondary sexual characteristics and reproductive function) - are produced at different times of the day in different ways; this is called pulsed secretion. The secretion of hormones in the blood has peaks and lows, so our abstract picture is a interweaving of zigzags and wavy lines.
The circadian system is controlled by the hypothalamus. The main timer is daylight, which acts indirectly through retinal receptors. In addition to light, the function of timers is performed by meal times, planned physical activities and a number of social factors. If the mechanisms that maintain circadian rhythms are disrupted, metabolic diseases such as obesity or diabetes can develop. Contribute to such violations can work schedule for shifts, quick change of time zones during long flights or an excess of artificial lighting.
Endocrine 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 story of a particular disease, and not a "background violation". Endocrine diseases are associated with a lack or excess of secretion of a hormone: a lot of thyroid hormone (thyroxin) - hyperthyroidism, a little - hypothyroidism, a little pancreatic hormone insulin (or it does not work well) - diabetes, a little sex hormones - violation of the menstrual cycle and so on.
Of course, this does not mean that hormones do not depend on each other. So, in hypothyroidism there will be a little thyroxin produced by the thyroid gland, but a lot of thyroid stimulating hormone (TSH) produced by the pituitary gland. The pituitary gland, through its negative feedback mechanism, receives information about the lack of thyroxin in the blood and is struggling to stimulate the thyroid gland with 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 "hormones" 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 happening with you (me)." Attempts to become one's own physician, “assign” tests and “direct” yourself to an endocrinologist are understandable, but not safe. Evaluation of the entire "hormonal profile" can lead not only to unnecessary expenses, but also to overdiagnosis.
For example, if a woman comes to the laboratory and expresses a desire to “donate a hormonal profile,” prolactin will appear on the hormone list. 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 taking blood for analysis. In the results of the blood test, prolactin is elevated, there is a suspicion of prolactin (pituitary tumor), it causes stress in the patient, leads to additional examinations, and then it turns out that everything is in order. Stress and time and cost could have been avoided if tests had been assigned from the very beginning according to indications.
Weakness and weight gain
As a rule, the first manifestations of endocrine diseases are non-specific, and in most cases the first symptom is weakness. True, it is characteristic of many other states that are not related to the endocrine system. It is believed that if a person gets very tired, then the thyroid gland does not work well - but most people do not have a complaint of weak hypothyroidism. In addition, thyroxin acts on the entire body, and its deficit has many clinical masks: depression, sterility, anemia, and so on.
Another non-specific manifestation often referred to by an endocrinologist is weight gain or weight loss. Contrary to popular belief, there are not too many diseases in endocrinology, leading to weight gain. These include hypothyroidism and hypercorticism (an excess of glucocorticoid hormones) - but they are characterized by a small increase, not more than a dozen kilograms. If we are talking about a significant increase in body weight, then most often the cause is not endocrine disease. Yes, and manifest the same hypercortisolism will be a number of additional signs: increased blood pressure, characteristic changes in appearance.
Weight loss may be associated with an excess of 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 splitting the available energy reserves are activated. There is even a poetic expression that diabetes is a "hunger among the abundance." But in any of these cases there will be additional signs: diabetes can be aggravated by frequent urination and thirst, hyperthyroidism is characterized by increased emotional lability and heart palpitations, and even heart rhythm disorders, with adrenal insufficiency, weight loss is accompanied by nausea, vomiting, weakness, decrease pressure. All these manifestations can manifest themselves in various combinations and form a characteristic clinical picture. Individually, even to a specialist they do not say anything about an accurate diagnosis.
"Just in case"
An endocrinologist is not a screening specialty. The main doctor in the life of every person should be a therapist - it is with him that the risk of disease and the need for screening can be discussed. There are specialized questionnaires that identify risk factors, you can fill them out yourself and take them with you to the reception. In the questionnaire on diabetes mellitus, for example, risk factors can be noted: the presence of relatives with diabetes mellitus, the body mass index is above 25 kg / m2, age over forty-five, high blood pressure, sedentary lifestyle, and so on. This is again very non-specific signs, but if you score a high score, you should discuss it with your doctor.
Glucose screening is recommended for people over the age of forty-five years of age in the presence of overweight or obesity. Measurement of bone density (densitometry) to exclude osteoporosis, which women are more often exposed to, is always performed if a high risk was detected using the FRAX calculator, and since fifty-five years of age this examination is desirable for all women. Screening of 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 volume of education that is detected by touch.
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