This is the third in a series of articles on the basics of endocrinology. Hormone problems can occur if a gland makes too little or too much of a particular hormone. In my last article I discussed what happens when hormones are too low, such as with hypothyroidism, menopause or type 1 diabetes. But, problems can also occur when hormones are too high. In the most general terms, too much hormone is referred to as a “hyper’” state. When hormones are too low, it is referred to as “hypo.”
One of the most common states of hormonal excess is too much thyroid hormone, also known as hyperthyroidism. The thyroid gland produces thyroid hormones, responsible for the general activity of the body. When thyroid hormones are too high, the all the body’s functions are sped up. The heart beats faster, bowels work more quickly and people tend to complain of anxiety, nervousness, insomnia and weight loss. The opposite is true when thyroid hormone levels are low, known as hypothyroidism.
Another example of an elevated hormone state is a condition known as Cushing’s Syndrome. Here, the adrenal gland pumps out excess amounts of the hormone cortisol. High cortisol levels result in many symptoms, the most well-known is weight gain. This condition can cause massive weight gain and is often missed by doctors because it is so rare. But, I’ll tell you that I have seen many patients with Cushing’s Syndrome, and it is not rare if you are the one that has the condition. Other symptoms of cortisol excess include acne, depression, insomnia and stretch marks. If you have these symptoms, you may have to convince your doctor to test you for excess cortisol production.
Testing can be tricky. This is because normally, cortisol is produced in variable amounts throughout the day. Therefore, the timing of the testing is really important. Cortisol is higher in the morning and lower at night. One of the better tests for cortisol measures at midnight, when it is supposed to be at its lowest point. The same test, done in the morning, is meaningless, though. Another good test for cortisol is a 24 hour urine collection because it measures all the cortisol produced in one day. If you have Cushing’s Syndrome, the treatment is usually surgery on either the pituitary gland or the adrenal gland, so it is not a diagnosis to be treated lightly.
Another reason hormones can be high is that the hormone itself is not working properly. The body tries to compensate by making more hormones. This is generally known as hormone “resistance.” The symptoms of hormone resistance are usually similar to having low hormones. Insulin resistance, for example, is associated with high insulin levels, but causes diabetes, similar to people who don’t make enough insulin. The end result is the same, either the body does not make insulin or it makes insulin but it doesn’t work properly. The treatments for hormone deficiencies and hormone resistance can vary; sometimes the same, sometimes different. Measuring hormones is an important way endocrinologists determine what is going on in the body.