Approach to the patient with acquired hypothalamic syndrome

The hypothalamus integrates signals from the body and the environment and coordinates homeostatic responses in multiple physiologic processes, including water balance, stress response, temperature regulation, energy balance, feeding behavior, sleep-wake cycles, and reproduction. Endocrinologists care for individuals for whom hypothalamic injury, whether from tumors, their treatment, or other causes, impairs pituitary hormone production and secretion. The extent of other symptoms in affected individuals is also influenced the extent of hypothalamic injury. "Acquired hypothalamic syndrome" refers to this broader collection of problems attributable to hypothalamic injury, variably including not only pituitary hormone deficiencies, but also hypothalamic obesity (or rarely, diencephalic syndrome), sleep and circadian disruption, temperature dysregulation, and behavioral issues (including memory problems and impulse control). Our goal is to present a pragmatic guide to the multidisciplinary, collaborative evaluation and management of hypothalamic syndrome.