Hypothalamic syndrome: symptoms, features in the pubertal period, treatment

Hypothalamic syndrome is a symptom complex characterized by a rapidly progressive course and a combination of vegetative, endocrine, trophic and metabolic disorders.This condition is due to the pathology of the hypothalamus.

The majority of patients with this pathology are people of reproductive age from 30 to 40 years.Women get sick much more often than men.Hypothalamic syndrome is often detected in adolescents in the puberty period( 12-15 years).Diagnosis is difficult, because the symptomatology can be "masked" for other disorders.

Table of contents: Classification Causes Symptoms of hypothalamic syndrome Diagnosis Treatment of hypothalamic syndrome and prognosis

Classification

Within the framework of modern endocrinology, an extended classification of the symptom complex is developed.

In its origin, the hypothalamic syndrome is divided into primary, secondary and mixed. Primary form develops on the background of TBI and the effects of infectious agents, and secondary often becomes a consequence of obesity.

In accordance with the prevalence of certain symptoms, the following types of syndrome are distinguished:

• neuromuscular;
• thermoregulation disorders;
• hypothalamic epilepsy;
• is neurotrophic;
• vegetative-vascular;
• metabolic and neuroendocrine disorders;
• pseudoneurosthenic( psychopathological);
• violation of drives and motivations.

In clinical practice, variants of the syndrome with prevalence of pathology of neurocirculation, hypercortisy( excess adrenocortical hormones) or constitutional obesity are considered separately.

The severity of light, medium and severe forms of pathology.

Classification of the hypothalamic syndrome by type of development includes 4 forms:

1. Stable.
2. Progressive.
3. Regressing.
4. Recurrent.

Reasons for

Note: hypothalamus is a small area in the diencephalon responsible for homeostasis, thermoregulation, metabolism, food and sexual behavior, and also for the condition of blood vessels.When the hypothalamic structures are damaged, the physiological reactions of the organism are regulated, and a vegetative crisis develops.

Possible causes of the hypothalamic syndrome include:

• chronic intoxications affecting the central nervous system;
• trauma associated with changes in hypothalamic structures;
• benign and malignant tumors pressing on the hypothalamus;
• mental overwork;
• psychoemotional stresses;
• hormonal changes during pregnancy;
• vascular pathology;
• strokes;
• Neuroinfections( viral or bacterial nature);
• osteochondrosis of the cervical region( with impaired blood supply to the brain);
• chronic somatic pathologies with autonomic component;
• individual( congenital) insufficiency of the hypothalamic region.

Neurointoxication may be due to industrial hazards( work with toxic compounds) or addictions( addiction or chronic alcoholism).

The presence of a vegetative component is characteristic for such chronic pathologies as gastric ulcer, hypertension, bronchial asthma and constitutional obesity.

Infectious diseases that can negatively affect the activity of the hypothalamus include malaria, rheumatism, as well as common influenza in the development of complications.

Symptoms of the hypothalamic syndrome

Among the manifestations of the pathology are:

• frequent headaches;
• general weakness and increased fatigue;
• increase( less often - decrease) in body weight;
• increased appetite;
• a constant sense of thirst;
• sharp mood changes;
• unmotivated sense of anxiety;
• panic attacks;
• mental exhaustion;
• finger and eyelid tremor;
• sensation of lack of air;
• increased blood pressure( arterial hypertension);
• stitching pains in the thorax( cardialgia);
• heart palpitations;
• intestinal disorders( constipation or diarrhea);
• dysmenorrhea;
• change in sexual desire( upward or downward);
• expressed meteorological dependence;
• high sensitivity to climate change;
• sleeplessness at night and drowsiness during the day;
• increased susceptibility to allergies.

Important: in adolescent puberty, the symptom complex is able to accelerate or slow down sexual development.

Symptomocomplex is often complicated by degenerative changes in the heart muscle, amenorrhea, uterine bleeding, gynecomastia and hirsutism.Possible formation of insulin resistance.

In most cases, paroxysmal manifestations of the syndrome are observed.

Patients develop vasoensular crises, characterized by a sensation of fever, a surge of blood to the face, suffocation, sweating, dizziness and general weakness.Many patients complain of discomfort in the epigastric region.Urination is usually rapid, and the volume of diuresis increases.Do not exclude hypersensitivity reactions in the form of skin rashes and angioedema.Objectively, bradycardia is detected( heart rate drops to 45-50 beats per minute).The arterial pressure drops to 80/50 mm.Gt;Art.

Sympathetic-adrenal crises develop against a background of psychoemotional overexertion, weather change, pains or periods.Paroxysms make themselves felt more often at night.The patient has trembling, numbness and cold extremities and a feeling of chill.The pulse rate increases to 100-130 beats per minute, and the BP figures rise to 180/110.Often there is hyperthermia( body temperature reaches 39 ° C).The patient experiences a feeling of anxiety and fear of death.

Note: before the beginning of sympathetic-adrenal crises are marked by the so-called."Harbingers" - general lethargy, cephalgia, unmotivated mood change and stitching pains in the heart.

The duration of the paroxysmal attack is from 15 minutes.Up to 3-4 hours.After its termination the patient longly feels weakness and fear of a new crisis.

Paroxysms can be mixed, that is, the patient has signs of sympathetic-adrenal and vaso-insular crisis.

If on a background of a hypothalamic syndrome the thermoregulation suffers, at patients the subfebrile temperature remains for a long time, and periodically it rises up to values ​​in 39-40 ° C . This phenomenon was called the hyperthermal crisis;It is quite often diagnosed in children and adolescents against the background of psychoemotional stress. For failures in the thermoregulation system, the temperature rise in the morning hours and its decrease by the evening is typical.Specialists attribute this symptom to physical and mental stress;He often develops during active school hours and takes place during rest.

Note: is one of the signs of thermoregulation disorders on the background of the hypothalamic syndrome that becomes intolerant of insufficiently comfortable( low) temperatures and chilliness.

Manifestations of drive disorders and motivations:

• change in sexual desire;
• appearance of a wide variety of phobias;
• hypersomnia( persistent drowsiness);
• behavioral disorders;
• lability of emotions;
• increased irritability;
• anger and aggression;
• tearfulness;
• is depressed.

In neuroendocrine and metabolic disorders, virtually any metabolic process can suffer.

Among their possible manifestations are:

• anorexia( refusal to eat);
• bulimia( wolfish famine);
• strong thirst;
• polyuria with decreased urine density;
• dyspepsia disorder;
• pathological changes in the thyroid gland;
• acromegaly;
• diabetes insipidus;
• hypercortisy syndrome;
• early onset of menopause.

Complications of neuroendocrine and metabolic manifestations of the hypothalamic syndrome may include ulcers of the digestive tract, dystrophic changes in the skin, muscle and bone tissue.

Diagnosis

Detection and treatment of hypothalamic syndrome is the task of endocrinologists, neurologists and gynecologists.Diagnosis is complicated by the polymorphism of manifestations of pathology.

The main criteria for verifying the diagnosis are:

• EEG;
• thermometry( axillary from 2 sides and rectal);
• analysis of the sugar curve( sample is carried out on an empty stomach and with a load, and the indicators are measured every half hour);
• three-day trial of Zimnitsky on the ratio of the volume of liquids and diuresis.

Important: for the diagnosis is conducted electroencephalography and magnetic resonance imaging of the brain and an extended laboratory study of the patient's hormonal background.EEG can detect pathological changes in the deep structures of the brain.With the help of MRI, intracranial pressure can be assessed and neoplasms and the consequences of TBI and oxygen starvation of tissues can be detected.

According to indications, doctors resort to ultrasound scanning of the endocrine system - adrenal and thyroid gland.

During the diagnosis of the hypothalamic syndrome, laboratory tests of the following hormones are made:

• thyreotropic( produced by the pituitary gland);
• of thyroxine( synthesized by the thyroid gland);
• follicle-stimulating;
• Prolactin;
• testosterone;
• is luteinizing;
• Estradiol;
• cortisol;
• adrenergic.

In daily urine, the content of 17-ketosteroids is also evaluated.

Treatment of hypothalamic syndrome and prognosis

As a rule, symptomatic therapy is performed and inhibitory or, alternatively, stimulating hormone therapy is prescribed.Its main goal is correction of disorders of hypothalamic structures.

First of all, the possible cause of violations is eliminated.Traumas and tumors are subject to appropriate treatment, and chronic foci of infection - sanation.When toxic lesions are detected, active detoxification therapy is carried out, involving the introduction of specific antidotes, saline solutions and glucose.

Alkaloids of belladonna, Phenobarbital, pyrroxane, Tofizopam, Sulpirid and agents and 3 groups of antidepressants( in particular - Amitriptyline) are shown to prevent sympathetic-adrenal paroxysms.

The fight against neuroendocrinal disorders involves the appointment of a therapeutic diet and drugs regulating the exchange of neurotransmitters( long-term course of treatment with phenytoin or bromocriptine is required).In parallel, there is a substitution, stimulating or inhibiting hormone therapy.

Syndrome of posttraumatic genesis requires the implementation of cerebrospinal puncture and the application of measures for the dehydration of the body.

Metabolic disorders are an indication for diet and vitamin therapy, as well as the appointment of an anorexant drug.

Effective agents for stimulating cerebral blood flow:

• Glycine;
• Vinpocetine;
• Pyracetam;
• B vitamins;
• hydrolyzate of the porcine brain;
• preparations of calcium.

Non-pharmacological methods include therapeutic gymnastics, various physiotherapy procedures and reflexology.

Of great importance is the normalization of weight and balneotherapy.Patients are strongly advised to adhere strictly to the optimal mode of work and rest.

Important: prevention of crises is reduced to minimizing the psychotraumatic factors and preventive administration of sedatives, antidepressants and tranquilizers.

The prognosis directly depends on the severity of the lesion of the brain area.In many cases it is possible to achieve complete clinical recovery.With an unfavorable outcome, the pathology progresses, and endocrine infertility, polycystic ovary, obesity and persistent hypertension develop. With a successful conception, obstetric and perinatal complications are not excluded.

Syndrome is often accompanied by severe neuroendocrine disorders, resulting in a decrease or disability with the establishment of III or II disability.

Plisov Vladimir, medical reviewer