Hypothalamic syndrome – a complex of the endocrine, exchange, vegetative frustration caused by hypothalamus pathology. It is characterized by change (more often increase) body weights, headaches, instability of mood, hypertensia, the violation of a menstrual cycle increased by appetite and thirst, strengthening or decrease in a libido. For diagnostics of a hypothalamic syndrome the expanded hormonal research, brain EEG, MRT, in need of ultrasonography of a thyroid gland, adrenal glands is conducted. Treatment of a hypothalamic syndrome consists in selection the effective stimulating or inhibiting hormonal therapy, performing symptomatic treatment.
Hypothalamic syndrome – a complex of the endocrine, exchange, vegetative frustration caused by hypothalamus pathology. It is characterized by change (more often increase) body weights, headaches, instability of mood, hypertensia, the violation of a menstrual cycle increased by appetite and thirst, strengthening or decrease in a libido. The forecast depends on weight of damage of a hypothalamus: from a possibility of an absolute recovery before progressing of a disease (development of the expressed obesity, a persistent hypertension, infertility etc.).
Pathology of hypothalamic area often meets in endocrinological, gynecologic, neurologic practice, causing difficulties in diagnostics because of variety of forms of manifestation. The hypothalamic syndrome develops in teenage more often (13-15 years) and reproductive (31-40 years) age, prevailing at female persons (12,5–17,5% of women).
The problem of the medical and social importance of a hypothalamic syndrome is defined by young age of patients, quickly progressing course of a disease, the expressed neuroendocrine violations which are quite often followed by partial decrease or full disability. The hypothalamic syndrome causes serious violations of reproductive health of the woman, causing development of endocrine infertility, a polikistoz of ovaries, obstetric and perinatal complications.
Reasons of development of a hypothalamic syndrome
The hypothalamic department of a brain is responsible for regulation of the humoral and nervous functions providing a homeostasis (stability of the internal environment). The hypothalamus carries out a role of the highest vegetative center regulating a metabolism, thermal control, activity of blood vessels and internals, food, sexual behavior, mental functions. Besides, the hypothalamus operates physiological reactions therefore at its pathology frequency of these or those functions is broken that is expressed by vegetative crisis (paroxysm).
To cause violations of activity of a hypothalamus and development of a hypothalamic syndrome the following reasons can:
- the brain tumors squeezing hypothalamic area;
- craniocereberal injuries with direct injury of a hypothalamus;
- neurointoxications (toxicomania, drug addiction, alcoholism, production harm, ecological trouble etc.);
- vascular diseases, stroke, osteochondrosis of cervical department of a backbone;
- viral and bacterial neuroinfections (flu, rheumatism, malaria, chronic tonsillitis, etc.);
- psychogenic factors (stresses, shock situations, intellectual loadings);
- pregnancy and hormonal reorganizations interfaced to it;
- chronic diseases with vegetative components (bronchial asthma, a hypertension, stomach ulcers and a duodenum, obesity);
- constitutional insufficiency of hypothalamic area.
Classification of a hypothalamic syndrome
The clinical endocrinology contains a large number of researches on studying of a hypothalamic syndrome. Results of these researches formed the basis of modern expanded classification of a syndrome.
By the etiologichesky principle the hypothalamic syndrome is subdivided on primary (owing to neuroinfections and injuries), secondary (owing to constitutional obesity) and mixed.
On the leading clinical manifestations allocate the following forms of a hypothalamic syndrome:
- thermal control violations;
- hypothalamic (dientsefalny) epilepsy;
- pseudo-neurotic and psychopathological;
- disorder of motivations and inclinations;
- neyroendokrinno-exchange frustration.
Allocate clinical options of a hypothalamic syndrome with prevalence of constitutional obesity, a giperkortitsizm, neurocirculator violations, germinativny frustration.
Weight of manifestation of a hypothalamic syndrome can be an easy, average and severe form, and the nature of development – progressing, stable, regressing and recuring. In the pubertatny period the hypothalamic syndrome can proceed with a delay or acceleration of puberty.
Symptoms of a hypothalamic syndrome
Manifestations of a hypothalamic syndrome depend on a zone of damage of a hypothalamus (forward or back departments) and the caused neurohumoral frustration in gipotalamo-hypophysial area. In manifestations of a hypothalamic syndrome the following violations prevail more often:
- vegetovascular – 32%,
- endocrine and exchange – 27%,
- neuromuscular – 10%,
- thermal control violations, etc. - 4% etc.
The hypothalamic syndrome is shown by the general weakness, increased fatigue, physical and mental exhaustion, bad shipping of change of weather conditions, prickings in heart, tendency to allergic reactions, an unstable chair, feeling of shortage of air, emotional frustration (alarm, attacks of panic fear), sleep disorders increased by perspiration. Objectively tachycardia, asymmetry of arterial pressure with tendency to its increase, a tremor of fingers and a century come to light.
At the most part of patients the hypothalamic syndrome proceeds paroksizmalno (pristupoobrazno), is more often in the form of vagoinsulyarny and simpatiko-adrenalovy crises. Vazoinsulyarny crises at a hypothalamic syndrome are followed by feeling of heat, inflow to a face and the head, dizziness, suffocation, unpleasant feelings in an epigastriya, nausea, sinking heart, perspiration, the general weakness. The strengthened intestines vermicular movement with ease of a chair, the speeded-up and plentiful urination, repeated desires in a toilet can be observed. Development of allergic manifestations in the form of a small tortoiseshell and even Quincke's hypostasis is possible. Heart rate urezhatsya till 45-50 . in min., HELL decreases to 90/60-80/50 mm of mercury.
Simpatiko-adrenalovy crises at a hypothalamic syndrome can be provoked by emotional pressure, change of meteoconditions, periods, painful factors, etc. Paroxysms usually arise suddenly in the evening or at night, sometimes they are preceded by harbingers: a headache, change of mood, a pricking in heart, slackness. During an attack the fever, a tremor, "goose-pimples", heartbeat, a cold snap and a sleep of extremities, rise HELL to 150/100-180/110 mm of mercury appears., tachycardia to 100-140 . in min. Sometimes simpatiko-adrenalovy crises are followed by temperature increase to 38-39 °C, excitement, concern, fear of death (the panic attacks).
Duration of crisis can be of 15 min. till 3 and more o'clock then for several hours weakness and fear of repetition of a similar attack remains. Often at a hypothalamic syndrome crises have the mixed character, combining symptoms of vagoinsulyarny and simpatiko-adrenalovy crises.
Violation of thermal control at a hypothalamic syndrome is followed by development of the hyper thermal crisis which is characterized by sudden jump of body temperature to 39-40 °C against the background of a long subfebrilit. For thermoregulatory violations typically morning temperature increase and its decrease by the evening, lack of effect of reception of febrifugal medicines. Disorders of thermal control are more often observed at children's and youthful age and depend on physical and emotional pressure. At teenagers they are quite often connected with school lessons and disappear during the vacation period.
As manifestations of thermoregulatory violations at a hypothalamic syndrome the constant chill, intolerance of drafts and low temperatures can serve. Such patients constantly muffle up, wear clothes not on weather, even in warm time do not open a window leaf and a window, avoid to take a bath. Disorder of motivations and inclinations at a hypothalamic syndrome is characterized by emotional and personal violations, various phobias, change by a libido, pathological drowsiness (gipersomniya) or sleeplessness, frequent change of mood, irritability, anger, tearfulness etc.
Neyroendokrinno-obmennye frustration at a hypothalamic syndrome are shown by violation of proteinaceous, carbohydrate, fatty, water-salt exchange, bulimia, anorexia, thirst. Neuroendocrine violations can be followed by Itsenko-Cushing's syndromes, not diabetes with a polyuria, a polidipsiya and low relative density of urine, an akromegaliya, an early climax at young women, changes in a thyroid gland. Dystrophy of bones and muscles, violations skin traffic (dryness, an itch, decubituses), ulcerations of mucous internals can be observed (a gullet, a 12-perstny gut, a stomach). The chronic or long current with a recurrence and aggravations is characteristic of a hypothalamic syndrome.
Complications of a hypothalamic syndrome
The current of a hypothalamic syndrome most often is complicated by polycystous changes of ovaries, a ginekomastiya, violations of a menstrual cycle from oligo-and amenore to uterine bleedings, a miokardiodistrofiya, a girsutizm and insulin resistance. At a hypothalamic syndrome the severe form of a late gestoz can be a pregnancy complication.
Diagnostics of a hypothalamic syndrome
The polymorphic clinic of a hypothalamic syndrome presents considerable difficulties in its diagnostics. Therefore as the leading criteria of diagnostics of a hypothalamic syndrome serve data of specific tests: a sugar curve, thermometry in three points, EEG of a brain, three-day test of Zimnitsky.
Blood glucose at a hypothalamic syndrome is investigated on an empty stomach and with loading of 100 g of sugar, determining glucose level every 30 minutes. At a hypothalamic syndrome the following options of a sugar curve meet:
- hyper glycemic (rise in level of glucose is higher than norm);
- hypoglycemic (content of glucose is lower than norm);
- dvugorbovy (decrease in level of glucose alternates with new rise);
- torpedo (small raising of glucose is fixed in one point).
The thermometry at a hypothalamic syndrome is carried out in three points: both axillary hollows and in a rectum. Thermometric violations can be expressed in an isothermie (to equal temperature in a rectum and axillary areas, at norm in a rectum is 0,5-1 °C higher); hypo - and a hyperthermia (in axillary hollows temperature is lower or higher than norm); thermoinversions (temperature in a rectum is lower, than in axillary hollows).
The electroencephalography reveals the changes affecting deep structures of a brain. In three-day test across Zimnitsky at patients with a hypothalamic syndrome the ratio of the drunk and emitted liquid, a night and day diuresis changes. By the brain MRT method at a hypothalamic syndrome the increased intra cranial pressure, consequences of a hypoxia and injuries, tumoral educations comes to light.
Obligatory criterion of diagnostics of a hypothalamic syndrome is definition of hormones (Prolactinum, LG, an estradiol, FSG, testosterone, cortisol, TTG, T4 (a free tiroksin), adrenotropny hormone in blood and 17 ketosteroids in daily urine) and biochemical indicators for identification of endocrine and exchange violations. Allows to differentiate a hypothalamic syndrome with organic defeat of other systems ultrasonography of adrenal glands, ultrasonography of a thyroid gland and internals. If necessary it is in addition carried out by MPT or KT of adrenal glands.
Treatment of a hypothalamic syndrome
The complex of actions for treatment of a hypothalamic syndrome has to be carried out by joint efforts of the endocrinologist, neurologist and gynecologist (at women). Selection of methods of treatment of a hypothalamic syndrome is always individual and depends on the leading manifestations. The purpose of therapy of a hypothalamic syndrome is correction of violations and normalization of function of hypothalamic structures of a brain.
At the first stage of treatment carry out elimination of an etiologichesky factor: sanitation of the infectious centers, treatment of injuries and tumors etc. At intoxications alcohol, drugs, insecticides, pesticides, heavy metals carry out active dezintoksikatsionny therapy: salt solutions, sodium thiosulphate, glucose, physiological solution, etc. are intravenously entered. For prevention of simpatiko-adrenalovy crises belladonna alkaloids + phenobarbital, , to tofizopa, antidepressants are appointed (, , , etc.).
Neuroendocrine violations are corrected by the replaceable, stimulating or braking hormonal medicines, purpose of a diet and regulators of neuromediator exchange (, ) a course before half a year. At development of a post-traumatic hypothalamic syndrome carry out dehydrating therapy, a tserebrospinalny puncture. At violations of exchange the dietotherapy, anoreksant, vitamins is appointed.
At a hypothalamic syndrome the means improving brain blood circulation (piracetam, a hydrolyzate of a brain of pigs, ), group B vitamins, amino acids (glycine), calcium medicines are appointed. Include reflexotherapy, physiotherapy, remedial gymnastics in treatment of a hypothalamic syndrome. In structure of treatment of a hypothalamic syndrome the important part is assigned to normalization of the mode of rest and work, a diet, normalization of body weight, a kurortoterapiya.
Forecast and prevention of a hypothalamic syndrome
The hypothalamic syndrome can lead to decrease and loss of working capacity in cases of often repeating vegetative paroxysms. To such patients taking into account their professional activity disability of the III group can be established. Sharply expressed neyroendokrinno-exchange forms of a hypothalamic syndrome can also lead to disability with establishment III or II groups of disability.
As crises at a hypothalamic syndrome, as a rule, arise in certain time and at changes of meteoconditions, considerable emotional and physical retension, their prevention consists in the warning reception of sedatives, antidepressants, tranquilizers. It is also, whenever possible, necessary to exclude the factors provoking attacks, psychological and physical activities, work during night shifts.