MBB II Diencephalon: hypothalamus

Diencephalon:
Hypothalamus

© Dr. Andrii Shmarhalov, MD, PhD,

Associate Professor
MBB II © Dr. Andrii Shmarhalov, 2022 Hypothalamus
MBB II © Dr. Andrii Shmarhalov, 2022 Hypothalamus

The hypothalamus is a division of the diencephalon that

subserves three systems:
➔ the autonomic nervous system,
➔ the endocrine system, and
➔ the limbic system.

The hypothalamus helps to maintain homeostasis

MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus

● The medial preoptic nucleus regulates the release of gonadotropic

hormones from the adenohypophysis. It contains the sexually
dimorphic nucleus, the development of which depends on
testosterone levels.
● The suprachiasmatic nucleus receives direct input from the retina.
It plays a role in the regulation of circadian rhythms.
● The anterior nucleus plays a role in temperature regulation. It
stimulates the parasympathetic nervous system. Destruction results
in hyperthermia.
MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus

The paraventricular nucleus:

● Synthesizes antidiuretic hormone (ADH), oxytocin, and

corticotropin-releasing hormone.
● It gives rise to the supraopticohypophyseal tract, which projects to the
neurohypophysis.
● It regulates water balance (conservation) and projects directly to the
autonomic nuclei of the brain stem and all levels of the spinal cord.
● Destruction results in diabetes insipidus.

The supraoptic nucleus synthesizes ADH and oxytocin (similar to the

paraventricular nucleus).
MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus

● The dorsomedial nucleus, when stimulated in animals, results in

savage behavior.
● The ventromedial nucleus is considered a satiety center. When
stimulated, it inhibits the urge to eat. Bilateral destruction results in
hyperphagia, obesity, and savage behavior.

● The arcuate (infundibular) nucleus contains neurons that produce

factors that stimulate or inhibit the action of the hypothalamus. This
nucleus gives rise to the tuberohypophysial tract, which terminates in
the hypophyseal portal system of the infundibulum (medium eminence).
It contains neurons that produce dopamine (i.e., prolactin-inhibiting
factor).
MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus

● The mamillary nucleus receives input from the hippocampal

formation through the postcommissural fornix. It projects to the
anterior nucleus of the thalamus through the mamillothalamic tract
(part of the Papez circuit). Patients with Wernicke’s encephalopathy,
which is a thiamine (vitamin B1) deficiency, have lesions in the
mamillary nucleus. Lesions are also associated with alcoholism.
● The posterior hypothalamic nucleus plays a role in thermal
regulation (i.e., conservation and increased production of heat).
Lesions result in poikilothermia (i.e., inability to thermoregulate).

● The lateral hypothalamic nucleus induces eating when stimulated.

Lesions cause anorexia and starvation.
MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus
MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus

MAJOR FIBER SYSTEMS OF THE HYPOTHALAMUS

● The fornix is the largest projection to the hypothalamus. It projects from the
hipocampal formation to the mamillary nucleus, anterior nucleus of the thalamus,
and septal area. The fornix then projects from the septal area to the hippocampal
formation.

● The medial forebrain bundle traverses the entire lateral hypothalamic area. It
interconnects the orbitofrontal cortex, septal area, hypothalamus, and midbrain.

● The mamillothalamic tract projects from the mamillary nuclei to the anterior
nucleus of the thalamus (part of the Papez circuit).

● The stria terminalis is the major pathway from the amygdala. It interconnects the
septal area, hypothalamus, and amygdala.
MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus

MAJOR FIBER SYSTEMS OF THE HYPOTHALAMUS

● The supraopticohypophysial tract conducts fibers from the supraoptic and par-
aventricular nuclei to the neurohypophysis, which is the release site for ADH and
oxytocin.

● The tuberohypophysial (tuberoinfundibular) tract conducts fibers from the arcu-

ate nucleus to the hypophyseal portal system.

● The hypothalamospinal tract contains direct descending autonomic fibers. These

fibers influence the preganglionic sympathetic neurons of the intermediolateral cell
column and preganglionic neurons of the sacral parasympathetic nucleus.
Interruption above the first thoracic segment (T-1) causes Horner’s syndrome.
MBB II © Dr. Andrii Shmarhalov, 2022 Nuclei of the Hypothalamus
MBB II © Dr. Andrii Shmarhalov, 2022 Hypothalamus: functions
MBB II © Dr. Andrii Shmarhalov, 2022 Hypothalamus: functions
MBB II © Dr. Andrii Shmarhalov, 2022 Hypothalamus: clinical cases

● DIABETES INSIPIDUS, which is characterized by:

○ polyuria and polydipsia, is the best-known hypothalamic
syndrome.
○ It results from lesions of the ADH pathways to the posterior lobe
of the pituitary gland.

● The syndrome of inappropriate ADH secretion is usually caused

by lung tumors or drug therapy (e.g., carbamazepine,
chlorpromazine).
MBB II © Dr. Andrii Shmarhalov, 2022 Hypothalamus: clinical cases

CRANIOPHARYNGIOMA is a congenital tumor that originates from remnants

of Rathke’s pouch.
● This tumor is usually calcified.
● It is the most common supratentorial tumor in children and the most
common cause of hypopituitarism in children.

● Pressure on the chiasma results in bitemporal hemianopia.

● Pressure on the hypothalamus causes hypothalamic syndrome (i.e.,
adiposity, diabetes insipidus, disturbance of temperature regulation, and
somnolence).
MBB II © Dr. Andrii Shmarhalov, 2022 Hypothalamus: clinical cases

PITUITARY ADENOMAS account for 15% of clinical symptomatic intracranial

tumors.

● They are rarely seen in children.

● When pituitary adenomas are endocrine-active, they cause endocrine
abnormalities (e.g., amenorrhea and galactorrhea from a prolactin-
secreting adenoma, the most common type).

● Pressure on the chiasma results in bitemporal hemianopia.

● Pressure on the hypothalamus may cause hypothalamus syndrome.