4. Circadian Rhythm Control o The hypothalamus (especially the suprachiasmatic nucleus) is the brain’s “clock.” o Dysregulation here can explain early-morning cortisol spikes, disrupted sleep, and AM anxiety symptoms you’ve described before. 꾆 What Happens if Something Presses on the Hypothalamus Because it’s such a small structure surrounded by critical pathways, even a small lesion, cyst, or growth can cause broad symptoms. Possible effects and preciously Amy’s Symptoms include: • Hormonal irregularities (mimicking pituitary disorders like Cushing’s, even if tests look “normal”). • Autonomic disturbances : sudden changes in heart rate, dizziness, sweating, or feeling faint. Amy’s Autonomic disturbances occur between 2 and 5 AM • Sleep-wake disruption : unusual cortisol surges, nighttime awakenings, or early-morning panic. Amy’s symptoms occur between 2 and 5 AM • Balance/coordination issues : nearby structures also integrate with movement control. Amy who has always had terrific balance now suffers balance issues 꾆 Why Another MRI Could Matter • Lesions in this area can be small or slow-growing, sometimes missed or overlooked on earlier imaging. • A repeat MRI, ideally with high-resolution pituitary/hypothalamic protocol , and thin slice may reveal subtle changes. • a cystic lesion of the left hypothalamus measuring 5x4mm, with mild mass effect upon the left mamillary body could be significant for Amy and it could finally explain Amy’s mix of unexplained systemic symptoms (endocrine, autonomic, circadian).
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