Dietary supplements for hypothalamic or pituitary hypofunction

As of now, there is no high-level evidence-based medical evidence to support that dietary supplements can cure organic hypothalamic or hypopituitarism. Only some people with functional hypothalamic dysfunction can use specific dietary supplements as an auxiliary means of lifestyle adjustment under the guidance of professionals, and they must not replace standard hormone replacement therapy as the core plan.

I met a 28-year-old patient with Sheehan Syndrome in the emergency department before. After giving birth to a child, hemorrhage caused ischemic necrosis of the pituitary gland. She could live a normal life as long as she took hydrocortisone and levothyroxine sodium regularly. She was afraid of gaining weight from taking hormones, so she secretly stopped taking the medicine. She spent more than 2,000 yuan to buy three sets of dietary supplements claimed to "activate the pituitary gland and repair the hypothalamus." Within three months of taking them, her whole body became swollen and she felt faint even when she stood. When they were delivered, her cortisol level was so low that it was undetectable, and she almost had an accident. I looked through the unopened supplements she brought. The first three ingredients on the list were vitamin C, maltodextrin, and microcrystalline cellulose. To put it bluntly, they were the crumbs of a multivitamin sold at a high price.

In fact, it is easy to understand when comparing the hypothalamus-pituitary axis to the headquarters of the endocrine system: if the neurons and secretory cells in the headquarters have been completely necrotic due to surgery, radiotherapy, ischemia, and congenital development problems, it is equivalent to the collapse of the building. No matter how much "nutritional supplies" you send, it is impossible to build the building back out of thin air. The downstream organs should be given. The "command" hormone still cannot be released. At this time, it is better to supplement whatever is missing - if the adrenal gland function is insufficient, supplement hydrocortisone, if the thyroid axis is broken, supplement levothyroxine sodium, and if gonadal function is affected, supplement estrogen and progesterone/testosterone. This is a standard protocol that has been agreed upon by the global endocrinology community for decades, and there is nothing to discuss.

Of course, not all related abnormalities can be eliminated by supplements. There are also many targeted explorations in the field of functional medicine. For example, in some cases, the headquarters house did not collapse, but the people inside stayed up late for three to five years in a row, were in a state of high pressure and stress every day, and collectively went on strike to take advantage of the situation - such as hypothalamic amenorrhea caused by long-term dieting and excessive exercise, and functional hypotension induced by continuous high pressure. In patients with gonadal hormone hypogonadism, there is no structural abnormality in the pituitary MRI. In this case, appropriate supplementation of ingredients such as magnesium, B vitamins, ashwagandha, and rhodiola rosea, along with sleep adjustment and stress relief, can indeed bring many people back to their hormonal rhythms slowly. I met a 32-year-old Internet programmer before who slept less than 4 hours a day while working on a project for half a year. The sex hormones luteinizing hormone and testosterone were found to be below the threshold for men of childbearing age. He was afraid that taking exogenous testosterone would affect his own secretion, so he found a functional medicine doctor to adjust his work and rest, and supplemented with magnesium, vitamin D and ashwagandha. After more than three months of review, the hormones returned to the normal range. But it must be made clear that most of these studies are currently observational results with small samples, and there is no real evidence from large-sample randomized controlled trials. Moreover, the premise must be to rule out organic diseases first. If there are already problems such as pituitary tumors and pituitary necrosis, no matter how many supplements you take, it will be useless.

Many people think that supplements are “natural and have no side effects”, but this is not the case. For example, for patients who already have adrenal insufficiency, taking supplements that claim to "increase cortisol" will increase the burden on the already fragile adrenal glands, and in severe cases may induce adrenal crisis. ； There are also some people who blindly supplement selenium and vitamin E. If they take too much, they will lose their hair and damage their liver function, which is not worth the loss.

The first step is to find problems related to hypothalamic or pituitary function. The first step is to go to the endocrinology department of a regular hospital to take an MRI and do a hormone stimulation test. First, distinguish whether it is organic or functional. The hormones that should be supplemented should be kept up with first. Don't use your own body as a guinea pig with the hope that "supplements can cure the problem". If you really want to try supplements as an auxiliary, you must first explain clearly to your attending doctor what you are taking to avoid conflict with conventional treatment. This is the most responsible thing for you.