Hormone Disorders (Endocrine Disorders)

What hormones do

Hormones are chemical messengers released by endocrine glands into the bloodstream. They control metabolism, growth, blood sugar, blood pressure, fluid balance, sleep, mood, sexual development and reproduction. The pituitary gland at the base of the brain acts as a master controller, directing the thyroid, adrenal glands, ovaries and testes, under instruction from the hypothalamus.

Common signs of hormonal imbalance

• tiredness or low energy
• unexplained weight gain or loss
• feeling unusually hot or cold
• sweating or hot flashes
• fast or slow heartbeat
• excessive thirst and urination
• mood changes, anxiety or depression
• changes in sleep
• irregular, heavy or absent periods
• low libido, erectile dysfunction, infertility
• hair thinning or excess hair growth
• acne, dry skin, darkening of skin folds
• changes in face, hands or feet size

Many of these have other causes, so blood tests are needed to confirm a hormone problem.

Common hormone disorders

Diabetes

Diabetes is the most common endocrine disorder. Type 1 is an autoimmune loss of insulin; type 2 involves insulin resistance. Symptoms include thirst, frequent urination, tiredness and blurred vision.

Thyroid disorders

• Hypothyroidism: tiredness, weight gain, feeling cold, constipation, dry skin, low mood, heavy periods.
• Hyperthyroidism: weight loss, heat intolerance, palpitations, tremor, anxiety, loose stools.
• Thyroid nodules and goiter.

Reproductive hormone disorders

• Polycystic ovary syndrome: irregular periods, excess hair, acne, insulin resistance.
• Menopause and perimenopause: falling estrogen causing hot flashes, sleep problems and vaginal dryness.
• Primary ovarian insufficiency before 40.
• Hypogonadism in men: low testosterone causing low libido, fatigue and reduced muscle mass.

Adrenal disorders

• Cushing syndrome: too much cortisol, often from long-term steroid medicines; weight gain around the middle, round face, purple stretch marks, high blood pressure and sugar.
• Addison's disease: too little cortisol and aldosterone; fatigue, weight loss, low blood pressure, darkened skin.
• Primary aldosteronism: high blood pressure, sometimes low potassium.
• Pheochromocytoma: episodes of headache, sweating and palpitations with high blood pressure.

Pituitary disorders

• Pituitary tumors: usually benign; may overproduce hormones (prolactin, growth hormone, ACTH) or press on the gland and optic nerves.
• Acromegaly: too much growth hormone in adults, enlarging hands, feet and facial features.
• Hyperprolactinemia: missed periods, milky nipple discharge, low libido.
• Diabetes insipidus: lack of ADH, causing large volumes of dilute urine and thirst.

Calcium and bone hormone disorders

• Hyperparathyroidism: high calcium, kidney stones, bone thinning, fatigue.
• Hypoparathyroidism: low calcium, cramps, tingling.

Causes

• autoimmune disease (type 1 diabetes, Hashimoto's thyroiditis, Graves' disease, Addison's disease)
• tumors, usually benign
• genetic conditions
• medicines, especially steroids and some cancer treatments
• infection, injury or surgery affecting glands
• obesity and insulin resistance
• aging and menopause

Diagnosis

1. History and examination.
2. Blood tests: glucose and HbA1c, TSH and free T4, cortisol, sex hormones, prolactin, IGF-1, calcium and parathyroid hormone, electrolytes.
3. Timing matters: cortisol and testosterone are usually measured in the morning; some female hormone tests depend on the menstrual cycle day.
4. Dynamic tests: stimulation tests (such as the ACTH stimulation test) or suppression tests (such as the dexamethasone suppression test).
5. Imaging: ultrasound of the thyroid, CT of the adrenals, MRI of the pituitary.

Saliva hormone tests and broad "hormone panels" sold directly to consumers are often unreliable and can be misleading.

Treatment

• Replace missing hormones: insulin, levothyroxine, hydrocortisone, estrogen, testosterone.
• Reduce excess hormones: antithyroid medicines, medicines that block prolactin or cortisol production, radioactive iodine.
• Surgery or radiation for tumors.
• Lifestyle: weight management and exercise improve insulin resistance and PCOS.

An endocrinologist specializes in diagnosing and managing these conditions.

Frequently asked questions

What are the signs of a hormonal imbalance?

Common signs include tiredness, unexplained weight change, feeling too hot or cold, mood changes, sleep problems, irregular periods, low libido, hair or skin changes, and increased thirst or urination. Because these are nonspecific, blood tests are needed to confirm a hormone problem.

What is the most common hormone disorder?

Diabetes is the most common endocrine disorder worldwide. Thyroid disorders, particularly underactive thyroid, and polycystic ovary syndrome in women are also very common.

How do I test for a hormonal imbalance?

See your doctor, who will choose blood tests based on your symptoms, such as thyroid function, blood sugar, sex hormones, prolactin or cortisol. Some tests need to be taken at specific times of day or cycle. Imaging may follow if a gland problem is suspected.

Can hormonal imbalance cause weight gain?

Yes. Hypothyroidism, Cushing syndrome, PCOS, insulin resistance, low testosterone and menopause can all contribute to weight gain. However, most weight gain is not caused by a hormone disorder, so testing is targeted to symptoms.

Can hormonal imbalances be cured?

Some can be cured, for example by removing a hormone-producing tumor. Many, such as diabetes, hypothyroidism and Addison's disease, are lifelong but can be controlled very well with medication, allowing a normal life.