Publisher Summary This chapter focuses on the role of human hypothalamus in metabolic and epidemic disorders Various clinical observations illustrate the importance of hypothalamic mechanisms for governing satiety and hunger In Diencephalic syndrome or hypothalamo-optic-pathway glioma, emaciation of the entire body is found in infancy and childhood Lesions in the ventromedial hypothalamic area cause increased appetite and obesity, whereas tumors in the lateral hypothalamic area (LHA) may cause anorexia Additionally, hypercortisolism in Cushing's syndrome or due to corticosteroid therapy may cause obesity accompanied by depression, hypertension, and circadian disturbances Uncommon, intractable hypothalamic obesity syndrome occurs after cranial insults, which is often coupled with other hypothalamo–pituitary disturbances that may exacerbate obesity, such as growth hormone deficiency or hypothyroidism In disorders of eating and metabolism, there is frequent hypothalamic comorbidity in terms of mood, sleep and rhythm disorders due to the intense hypothalamic interconnectivity and integrative mechanisms These symptoms often occur in an episodic way and generally have a different prevalence for the sexes Circadian and seasonal fluctuations and sleep disorders may also point to the involvement of the suprachiasmatic nucleus (SCN) in symptom expression

The human hypothalamus in metabolic and episodic disorders.

A 74-year-old man developed fever, somnolence, hyponatremia, and life-threatening sinus bradycardia for three weeks. He showed a slight elevation of lymphocyte count and protein level in the cerebrospinal fluid. A brain CT scan revealed a diffuse low density area around the hypothalamus which was identified as a high intensity signal by flair MR imaging. Marked sinus bradycardia developed with no abnormality in the echocardiograph or cardiac enzymes. Over the next 6 weeks he became alert and normal sinus rhythm resumed. The results of endocrine tests were compatible with hypothalamic insufficiency with partial hypopituitarism and the syndrome of inappropriate secretion of ADH.

https://www.jstage.jst.go.jp/article/internalmedicine1992/40/8/40_8_805/_pdf

Hypothalamic Encephalitis with Bradycardia

A case of hypothalamic encephalitis proved by postmortem examination is reported. The patient was a three-year-old Chinese boy who had complained of obesity for one year and fever for half a year. Three days after admission to a hospital, the patient suddenly died of allergic reaction to intramuscular penicillin, without additional complaints. Autopsy revealed severe bilateral outfall of neurons in the ventromedian hypothalamic nuclei with diffuse hyperplasia of astrocytes and some glial nodules consisting chiefly of oligodendroglias and perivascular cuffing. Similar changes were noticed in hypothalamus at the level of optic chiasm, but the posterior hypothalamic nuclei and lateral hypothalamic nuclei were intact. This article provides significant data for the study of hypothalamic function.

Huang Kw

Papers

Hypothalamic encephalitis with oligodendrocytic glial nodules. Case report of a Chinese boy.