Elena Christofides, MD, explains how surgery, radiation, traumatic brain injuries, inflammation, and other factors may contribute to acquired hypothalamic obesity.
Transcript
So the hypothalamus, which is in the center of the brain, controls all the signals in your body for energy, for hunger, for temperature regulation, sleep-wake cycle, even in controls fight-or-flight reactions, and because of its location in the center of the brain can be somewhat difficult to identify when there’s a disturbance there.
So the most obvious acquired hypothalamic obesity patients have an injury due to surgery, such as a surgery on the pituitary gland or surgery on the hypothalamus or, for instance, on the blood vessels around that area or the lining of the brain in that area.
And that is a, you know, convenient timeline. You know, you were normal before surgery, and now you’re not normal after surgery. So it’s very distinct and kind of obvious to everyone around because you had surgery.
The most difficult acquired hypothalamic obesity situations occur when the injury is silent, nonsurgical, or not associated with any changes structurally on an MRI. Right? So an MRI is an imaging scan of the brain, really good for assessing the tissue of the brain, whereas the CT scan is much better at assessing the bone structures of the head.
So let’s say you had an injury; you had an accident; you had a CT scan in the emergency room, and they say, “OK, it’s all good.” All they’re really looking for is to make sure that your bones are intact and you don’t have any sudden or acute bleeding in the brain. That’s the job of the CT scan in, say, an emergency room situation. It isn’t good for any of the tissue of the brain. The tissue of the brain is too soft. So you have to have an MRI.
But again, if the injury is silent, let’s say you had radiation treatment to the brain. Let’s say you had a traumatic brain injury. The most common traumatic brain injuries are concussions, whiplash, closed head trauma, whether they be from accidents like a skating accident, a skiing accident, a car accident, or violent trauma on your person.
These are scenarios where you can damage the very delicate structures of the soft part of the brain, which is the hypothalamus. And you’re not going to see anything on a scan like an MRI.
So you can also get injury from things like inflammation or infection or injury from, say, even medications potentially. Maybe you had seizure history and some of the seizure medicines have caused tissues.
The problem with assessing acquired hypothalamic obesity is sometimes the injury is obvious, but the majority of the time it is not obvious and requires careful consideration about what might have happened to you before you showed up with these concerns.
So understanding that the soft tissue of the brain can be very delicate. And think of it like Jell-O. You try to grab Jell-O with your hand. It’s going to pour through your hand. Sometimes it’s stiffer Jell-O; sometimes it’s not so stiff. And that’s not easily seen on a scan. So the injuries are sometimes obvious and sometimes less so.
