Hypothalamic syndrome is a complex of endocrine, metabolic, vegetative disorders caused by the pathology of the hypothalamus. It is characterized by a change (more often an increase) in body weight, headaches, mood instability, hypertension, menstrual cycle disorders, increased appetite and thirst, increased or decreased libido. To diagnose of pathology, an extended hormonal study, EEG, MRI of the brain, if necessary, ultrasound of the thyroid gland, adrenal glands is performed. Treatment consists in the selection of effective stimulating or inhibitory hormone therapy, symptomatic treatment.
Meaning
Hypothalamic syndrome is often found in endocrinological, gynecological, neurological practice, causing difficulties in diagnosis due to the variety of forms of manifestation. Pathology develops more often in adolescence (13-15 years) and reproductive age (31-40 years), prevailing in females (12.5–17.5% of women).
The problem of the medical and social significance of this syndrome is determined by the young age of patients, the rapidly progressing course of the disease, pronounced neuroendocrine disorders, often accompanied by a partial decrease or complete disability. Syndrome causes serious violations of a woman’s reproductive health, causing the development of endocrine infertility, polycystic ovaries, obstetric and perinatal complications.
Causes
The hypothalamic part of the brain is responsible for the regulation of humoral and nervous functions that ensure homeostasis (stability of the internal environment). The hypothalamus plays the role of the highest vegetative center, regulating metabolism, thermoregulation, the activity of blood vessels and internal organs, food, sexual behavior, mental functions. In addition, the hypothalamus controls physiological reactions, therefore, with its pathology, the periodicity of certain functions is disrupted, which is expressed by a vegetative crisis (paroxysm).
The following reasons can cause disorders of the hypothalamus and the development of hypothalamic syndrome:
- brain tumors compressing the hypothalamic region;
- traumatic brain injuries with direct damage to the hypothalamus;
- neurointoxications (substance abuse, drug addiction, alcoholism, occupational hazards, environmental problems, etc.);
- vascular diseases, stroke, spinal osteochondrosis;
- viral and bacterial neuroinfections (influenza, rheumatism, malaria, chronic tonsillitis, etc.);
- psychogenic factors (stress, shock situations, mental stress);
- pregnancy and related hormonal changes;
- chronic diseases with vegetative components (bronchial asthma, hypertension, stomach and duodenal ulcers, obesity);
- constitutional insufficiency of the hypothalamic region.
Classification
Clinical endocrinology has a large number of studies on the study of hypothalamic syndrome. The results of these studies formed the basis of the modern extended classification of the syndrome.
According to the etiological principle, hypothalamic syndrome is divided into primary (due to neuroinfections and injuries), secondary (due to constitutional obesity) and mixed.
According to the leading clinical manifestations , the following forms of hypothalamic syndrome are distinguished:
- vegetative-vascular;
- thermoregulation disorders;
- hypothalamic (diencephalic) epilepsy;
- neurotrophic;
- neuromuscular;
- pseudo – neurasthenic and psychopathological;
- disorder of motivations and drives;
- neuroendocrine-metabolic disorders.
There are clinical variants of hypothalamic syndrome with a predominance of constitutional obesity, hypercorticism, neurocirculatory disorders, germinative disorders.
The severity of the manifestation of hypothalamic syndrome can be mild, moderate and severe, and the nature of development is progressive, stable, regressive and recurrent. During puberty, hypothalamic syndrome may occur with a delay or acceleration of puberty.
Symptoms
The manifestations of hypothalamic syndrome depend on the affected area of the hypothalamus (anterior or posterior) and caused neurohumoral disorders in the hypothalamic-pituitary region. The manifestations of hypothalamic syndrome are more often dominated by the following disorders:
- vegetative-vascular – 32%,
- endocrine-exchange – 27%,
- neuromuscular – 10%,
- violations of thermoregulation, etc. – 4%, etc.
Hypothalamic syndrome is manifested by general weakness, increased fatigue, physical and mental exhaustion, poor tolerance for changing meteorological conditions, tingling in the heart, a tendency to allergic reactions, unstable stool, a feeling of lack of air, emotional disorders (anxiety, panic attacks), sleep disorders, increased sweating. Tachycardia, asymmetry of blood pressure with a tendency to increase it, tremor of fingers and eyelids are objectively detected.
In most patients, hypothalamic syndrome proceeds paroxysmally (paroxysmally), more often in the form of vagoinsular and sympathetic-adrenal crises. Vasoinsular crises with hypothalamic syndrome are accompanied by a feeling of heat, a rush to the face and head, dizziness, suffocation, unpleasant sensations in the epigastrium, nausea, sinking of the heart, sweating, general weakness. There may be increased intestinal peristalsis with relaxation of stool, frequent and copious urination, repeated toilet urges. It is possible to develop allergic manifestations in the form of urticaria and even Quincke’s edema. The heart rate is reduced to 45-50 beats. in min., blood pressure decreases to 90/60-80/50 mm Hg.
Sympathetic-adrenal crises can be provoked by emotional stress, changes in weather conditions, menstruation, pain factors, etc. Paroxysms usually occur suddenly in the evening or at night, sometimes they are preceded by precursors: headache, mood changes, tingling in the heart, lethargy. During an attack, there is chills, tremors, “goose bumps”, palpitations, cold and numbness of the extremities, an increase in blood pressure to 150/100-180/110 mm Hg, tachycardia to 100-140 beats. in min. Sometimes sympathetic-adrenal crises are accompanied by an increase in temperature to 38-39 ° C, excitement, anxiety, fear of death (panic attacks).
The duration of the crisis can be from 15 minutes to 3 or more hours, after which weakness and fear of a repeat of such an attack persist for several hours. Often, with hypothalamic syndrome, crises are of a mixed nature, combining the symptoms of vagoinsular and sympathetic-adrenal crises.
Violation of thermoregulation is accompanied by the development of a hyperthermic crisis, characterized by a sudden jump in body temperature to 39-40 ° C on the background of prolonged subfebrilitis. For thermoregulatory disorders, a typical morning increase in temperature and its decrease in the evening, the lack of effect from taking antipyretic drugs. Thermoregulation disorders are more often observed in childhood and adolescence and depend on physical and emotional stress. In adolescents, they are often associated with school classes and disappear during the vacation period.
Manifestations of thermoregulatory disorders in hypothalamic syndrome can be constant chilliness, intolerance to drafts and low temperatures. Such patients are constantly wrapped up, wear clothes not according to the weather, even in warm weather they do not open windows and windows, avoid taking a bath. The disorder of motivations and drives in hypothalamic syndrome is characterized by emotional and personal disorders, various phobias, changes in libido, pathological drowsiness (hypersomnia) or insomnia, frequent mood changes, irritability, anger, tearfulness, etc.
Neuroendocrine metabolic disorders in hypothalamic syndrome are manifested by a violation of protein, carbohydrate, fat, water-salt metabolism, bulimia, anorexia, thirst. Neuroendocrine disorders can be accompanied by Cushing syndromes, diabetes insipidus with polyuria, polydipsia and low relative urine density, acromegaly, early menopause in young women, changes in the thyroid gland. There may be dystrophy of bones and muscles, skin trophic disorders (dryness, itching, bedsores), ulceration of mucous internal organs (esophagus, duodenum, stomach). Hypothalamic syndrome is characterized by a chronic or prolonged course with relapses and exacerbations.
Complications
The course of hypothalamic syndrome is most often complicated by polycystic ovarian changes, gynecomastia, menstrual cycle disorders from oligo- and amenorrhea to uterine bleeding, myocardiodystrophy, hirsutism and insulin resistance. A complication of pregnancy may be a severe form of late gestosis.
Diagnostics
The polymorphic clinic of hypothalamic syndrome presents considerable difficulties in its diagnosis. Therefore, the leading criteria for the diagnosis of hypothalamic syndrome are the data of specific tests: sugar curve, thermometry at three points, brain EEG, three-day Zimnitsky test.
Blood glucose in hypothalamic syndrome is examined on an empty stomach and with a load of 100 g of sugar, determining the glucose level every 30 minutes. With hypothalamic syndrome, the following variants of the sugar curve occur:
- hyperglycemic (an increase in glucose levels above normal);
- hypoglycemic (glucose content below normal);
- double-humped (a decrease in glucose levels alternates with a new rise);
- torpid (a small rise in glucose is fixed at one point).
Thermometry for hypothalamic syndrome is carried out at three points: both armpits and in the rectum. Thermometric disorders can be expressed in isothermia (equal to the temperature in the rectum and axillary areas, with the norm in the rectum 0.5-1 ° C higher); hypo- and hyperthermia (in the armpits the temperature is lower or higher than normal); thermal inversion (the temperature in the rectum is lower than in the armpits).
Electroencephalography reveals changes affecting the deep structures of the brain. In a three-day Zimnitsky test, the ratio of the fluid consumed and excreted, night and day diuresis changes in patients with hypothalamic syndrome. MRI of the brain in hypothalamic syndrome reveals increased intracranial pressure, the effects of hypoxia and trauma, tumor formations.
A mandatory criterion for the diagnosis of hypothalamic syndrome is the determination of hormones (prolactin, LH, estradiol, FSH, testosterone, cortisol, TSH, T4 (free thyroxine), adrenotropic hormone in the blood and 17-ketosteroids in the daily urine) and biochemical parameters for the detection of endocrine and metabolic disorders. To differentiate hypothalamic syndrome with organic damage to other systems allows ultrasound of the adrenal glands, ultrasound of the thyroid gland and internal organs. If necessary, an additional MRI or CT of the adrenal glands is performed.
Treatment
A set of measures for the treatment of hypothalamic syndrome should be carried out jointly by an endocrinologist, neurologist and gynecologist (in women). The selection of treatment methods for hypothalamic syndrome is always individual and depends on the leading manifestations. The purpose of therapy of hypothalamic syndrome is to correct disorders and normalize the function of hypothalamic structures of the brain.
At the first stage of treatment, the etiological factor is eliminated: rehabilitation of infectious foci, treatment of injuries and tumors, etc. In case of intoxication with alcohol, drugs, insecticides, pesticides, heavy metals, active detoxification therapy is carried out: intravenous saline solutions, sodium thiosulfate, glucose, saline solution, etc. are administered. For the prevention of sympathetic-adrenal crises, pyrroxane, alkaloids of belladonna + phenobarbital, sulpiride, tofizopam, antidepressants (tianeptin, amitriptyline, mianserin, etc.) are prescribed.
Neuroendocrine disorders are corrected by substitution, stimulating or inhibitory hormonal drugs, the appointment of a diet and regulators of neurotransmitter metabolism (bromocriptine, phenytoin) for up to six months. With the development of posttraumatic hypothalamic syndrome, dehydrating therapy and cerebrospinal puncture are performed. In case of metabolic disorders, diet therapy, anorexants, vitamins are prescribed.
With hypothalamic syndrome, drugs that improve cerebral circulation (piracetam, pig brain hydralizate, vinpocetine), B vitamins, amino acids (glycine), calcium preparations are prescribed. The treatment of hypothalamic syndrome includes reflexotherapy, physiotherapy, therapeutic gymnastics. In the structure of treatment of hypothalamic syndrome, an important role is assigned to the normalization of rest and work, diet, normalization of body weight, spa therapy.
Prognosis and prevention
Hypothalamic syndrome can lead to a decrease and loss of performance in cases of frequently recurring vegetative paroxysms. Such patients, taking into account their professional activity, may be assigned a disability of group III. Pronounced neuroendocrine-metabolic forms of hypothalamic syndrome can also lead to disability with the establishment of group III or II disability.
Since crises with hypothalamic syndrome, as a rule, occur at a certain time and with changes in weather conditions, significant emotional and physical overstrain, their prevention consists in the preventive use of sedatives, antidepressants, tranquilizers. Also, if possible, it is necessary to exclude factors provoking seizures, neuropsychiatric and physical exertion, work in night shifts.