Chiari-Frommel Syndrome

Chiari-Frommel syndrome is a chronic galactorrhea, amenorrhoea and the growing reproductive organs hypotrophy. This pathology for a long time was attributed to postpartum consequences. However, later the disease was also found in nulliparous patients: the syndrome developed as a result of severe stress, malignant tumors of the pituitary gland, and also after prolonged intake of hormonal preparations.

[1], [2]

Causes of the chiari-Frommel syndrome

The exact cause of the syndrome is not fully understood. One of the causes of Chiari-Frommel syndrome is the increased release of prolactin by cells of microscopic pituitary tumors (microadenomas). However, the disease can be caused by any damage to the hypothalamus or pituitary gland, which affects the production of prolactin.

[3], [4], [5], [6],

Pathogenesis

The pathogenesis of the syndrome is explained by a functional failure of prolactin production. Such a malfunction can occur due to pregnancy (due to the natural increase in pituitary lactotrophs), as a result of tumors of the pituitary gland. Accelerate the development of the disease such factors:

• long lactation period;
• complicated pregnancy (with the threat of miscarriage, with gestosis);
• long-term use of hormonal contraceptives.

Most scientists tend to consider the Chiari-Frommel syndrome as a damage to the hypothalamus with subsequent endocrinological disorders. The possibility of pressure on the hypothalamus by the tumor process is also not excluded.

[7], [8], [9]

Symptoms of the chiari-Frommel syndrome

The first signs of Chiari-Frommel syndrome can appear at the age of 17-35 years. This often occurs after the end of breastfeeding, when a woman discovers lactorrhea (abnormal milk secretion) and amenorrhea (absence of menstruation). Also, the syndrome can occur and without any connection with pregnancy.

In most cases, the patient develops symptoms that indicate damage to the diencephalic zone:

• change in body weight (in one direction or another);
• pain in the head;
• dizziness, tiredness;
• hypopigmentation of the areola;
• increased hair growth;
• discontinuation of menstruation;
• sleep disorders;
• mood instability, capriciousness;
• hyperhidrosis;
• weakening of sexual desire, etc.

At medical examination, atrophy of the reproductive organs is revealed to a varying degree, including thinning of the mucous tissues and endometrium. Some patients have no visual changes.

[10], [11], [12]

Complications and consequences

Chiari-Frommel syndrome develops as a result of a breakdown in the main regulatory link - the hypothalamus. Those cellular structures that are responsible for the production of regulatory hormones are destroyed. This occurs in the absence of a logical decrease in the function of the pituitary gland. As a result, the uncontrolled pituitary gland overproduces prolactin - a hormone that activates lactation. What are the consequences of these violations?

• Simultaneous decrease in the production of estrogens.
• Failure of FSH and LH products.
• Malfunction of the monthly cycle with no ovulation.
• Atrophic processes in the ovaries and external genital organs.
• Changes in behavior, psyche and neurovegetative system.

All these consequences are interrelated and sooner or later lead to such a complication as infertility - the inability to conceive a child.

[13], [14], [15], [16], [17]

Diagnostics of the chiari-Frommel syndrome

Diagnosis of such a disease as Chiari-Frommel syndrome is based on several factors:

• on information obtained during a patient interview (for example, a recent pregnancy or abortion);
• on characteristic signs of the disease;
• on the results of additional studies.

Instrumental diagnosis is the conduct of radiographic examination, or MRI of the Turkish saddle (location of the pituitary and hypothalamus). Ultrasonography of the pelvic organs and mammary glands can also be prescribed.

Laboratory studies are cytological and histological analyzes of scrapings from the walls of the vagina and cervix. In addition, patients donate blood from the vein to the amount of hormones FSH, LH, prolactin, estradiol, progesterone, releasing hormones.

The diagnosis of Chiari-Frommel syndrome is made if an increase in the amount of prolactin is detected simultaneously with a general decrease in the hormonal background in the body. Additional signs should be:

• atrophy of mucous tissues;
• absence of ovulation;
• an increase in the Turkish saddle, or the presence of tumors in the nearby zone.

[18], [19], [20]

Differential diagnosis

Differential diagnosis is performed with a disease such as fibrocystic mastopathy. With prolonged lactation against a worsening of visual functions, one can suspect a tumor process in the brain (for example, the pituitary adenoma).

Treatment of the chiari-Frommel syndrome

Chiari-Frommel's syndrome is relatively successful in treatment. The scheme of therapy directly depends on the factor that triggered the development of the disease.

In case the pathology appeared due to damage to the cells of the hypothalamus, the treatment is carried out with preparations containing hormones. With a prolonged course of the syndrome with severe atrophy of tissues, treatment becomes more complex and combined.

Infertility, resulting from the Chiari-Frommel syndrome, is not subjected to separate treatment, since after normalization of the function of the hypophysis-hypothalamus, the childbearing function will recover itself.

In advanced cases, lifelong use of certain medicines may be required.

Patients diagnosed with the disease have the following therapies.

Medicines that inhibit the production of prolactin:

• Bromocriptine is a stimulant of dopamine receptors. The drug is prescribed from 5 to 10 mg per day, the duration of therapy - up to 8 months. Do not use Bromocriptine with low blood pressure, with arrhythmia. The drug is incompatible with the reception of alcoholic beverages.

Hormones:

• Puregon is a recombinant follicle-stimulating hormone. The drug is used in the form of subcutaneous and intramuscular injections, according to an individual scheme. Use Puregon can only be under the supervision of a doctor, since the risk of developing ovarian hyperstimulation is high;
• Menogon is a human menopausal gonadotropin containing FSH and LH. Menogon is not used in estrogen-dependent tumors. The average dosage of the drug is 1-2 ampoules per day. The dose is prescribed by the doctor, observing the response of the ovaries to treatment.

Preparations containing ovarian hormones:

• Estrogel is a gel with estradiol. The drug is applied to the skin in the abdomen, in an amount of 2.5 g once a day. Do not use in the presence of estrogen-dependent neoplasms;
• Krinon is a vaginal preparation with progesterone content. Standard use 1 dose of Krinon on a certain day of the cycle daily, according to an individual scheme.

Vitamins and complex preparations, for maintenance of reproductive function:

• Aevit - contains large doses of vitamins A and E. Take 1 capsule once a day, immediately after meals. The duration of treatment is determined by the doctor. The drug is not prescribed for thyrotoxicosis, as well as for patients with an increased likelihood of developing thromboembolism.
• Vitamin E zentiva is an antioxidant drug that regulates the sexual sphere. Usually appoint 1 capsule 400 mg per day. Long-term use of vitamin E in large doses can disrupt the metabolism of thyroid hormones.

The physiotherapy treatment of Chiari-Frommel syndrome can include:

• endonasal electrophoresis with a complex of B vitamins is an effective procedure that facilitates the conduct of drugs in the brain and the posterior surface of the eyeball;
• transcerebral therapy is a physiotherapy method, often used to relieve functional CNS disorders. It can include procedures such as electrosleep, transcranial electroanalgesia, amplipulse therapy, transcerebral ionization;
• galvanic collar - use of a DC electric current of low voltage.

Physiotherapy is not used for proven tumor processes in the brain.

Homeopathy is an effective treatment and support of sexual function without pronounced side effects. At the discretion of the doctor, the following homeopathic medicines may be prescribed:

• Cyclodinone - a combination of phyto-drugs, normalizing the hormonal background in the body. Standard take 40 caps., Or 1 tablet once a day in the morning, before breakfast. The minimum continuous course of therapy is 90 days. Before using the drug, you need to make sure that there are no allergies to its components.
• Ovariamine is a cytamine with an estrogen-like effect. The drug is taken as prescribed by the doctor, from 1 to 9 tablets per day. Duration of treatment - 2 weeks. Side effects when taking Ovariamin is not observed.
• Ovarium compositum is a homeopathic solution for injections, which is actively used for failures in the pituitary-ovarian relationship. The drug is administered intramuscularly, 1 ampoule, from one to three times a week.
• Climakt Hel - sublingual tablets that activate the function of the appendages and normalize the work of the anterior part of the hypothalamus and the pituitary gland. Take 1 tablet three times a day. The drug has virtually no contraindications (the only contraindication is an allergy);
• Conium plus - homeopathic multicomponent granules, which are used sublingually (under the tongue) for 8 pcs. Up to 5 times a day. The course of therapy - up to 2 months. Contraindications: age to 18 years, a tendency to allergies.

When detecting tumor processes in the pituitary gland, surgical treatment is prescribed. Surgical intervention can be supplemented by radiotherapy, the introduction of radioactive iodine, cobalt, etc.

In the postoperative period, hormone replacement treatment is indicated, and, if necessary, restoration of metabolic processes.

Alternative treatment, as an independent type of therapy, with Chiari-Frommyl syndrome is not used. However, it can be successfully combined with the main treatment prescribed by a doctor, provided that all of its prescriptions are observed. It should be borne in mind that some medicinal herbs can influence the hormonal background, so their reception must necessarily be agreed with the doctor.

• At the very beginning of the disease, an equal mixture of pureed pumpkin seeds, natural honey and sesame seed, ground ginger root and primrose plant can help. The mixture is taken 4 times a day for 1 tsp.
• In case of malfunctions in the pituitary system, a 10% bug infusion is very helpful, which can be purchased at the pharmacy. The drug is diluted in water in the proportion of 10 drops of medicine per 100 ml of water.
• With the Chiari-Frommel syndrome, the hemlock infusion in olive oil helps, which is used for instillation into the nose. There are also good reviews of 10% alcoholic hemlock tincture, which is taken inwards, starting with 1 drop and gradually adjusting the dosage to 40 drops, adding 1 drop every day. After 40 days begin to reduce 1 drop, gradually reducing the dose to a minimum.
• Benefits in the syndrome of Chiari-Frommel brings infusion on mountain ash, sage, valerian, plantain and melissa. Each component should take 1 tbsp. L., pour boiling water and drink before each meal of 100 ml.
• It is also recommended to add tea flowers of chamomile, marigold, oregano, goritsvet and cudweed. This drink should be consumed half an hour before meals.

Herbal treatment implies the regular use of the following plants in the preparation of beverages:

• Leonurus - grass, which has a pronounced cardiotonic and regulating effect;
• Valerian - rhizome with a therapeutic neuroregulatory and vasodilating properties;
• lemon balm - leaves that have a capillary-stimulating, antispasmodic property. Reduces the tone of smooth muscles;
• St. John's wort - grass with a multifaceted therapeutic effect. Serves as a catalyst for intracellular processes, regulates metabolism;
• cones of hops - a plant with a neurotropic effect. Regulates metabolic processes;
• fruits of hawthorn - a plant rich in flavonoids, organic acids, carotenoids, fatty oils, glycosides, etc .;
• elderberry - reduce the permeability of the walls of blood vessels, relieve inflammation and swelling, restore the function of vital organs;
• Passiflora is a tropical plant successfully used for menopausal and menstrual disorders.

Prolactin production is inextricably linked with the amount of progesterone in the blood. Therefore, with the permission of the doctor, it is possible to take preparations from plants with progestagenic action. These are herbs such as raspberry leaves, medicinal cuff, sacred vitex, meadow chamber, goose goatee.

Prevention

Specific prevention of Chiari-Frommel syndrome does not exist, since the pathogenesis of the disease has not yet been fully explored. General preventive measures can be the possible impact on the development of primary disorders that provoke secondary hyperfunction of the pituitary-hypothalamus system.

In this regard, preventive measures include:

• prevention of complications during pregnancy and childbirth;
• avoiding stressful stress on the body, creating a positive psychological environment at home and at work;
• protection against all possible craniocerebral injuries;
• prevention of hormonal failures.

Unfortunately, there are no measures to prevent the primary overproduction of prolactin.

[21], [22], [23]

Forecast

The prognosis of the disease depends on the cause of the pathological synthesis of the hormone prolactin, as well as on the chosen method of treatment. So, with successful correction of hormonal disorders, the syndrome passes without a trace, and a woman may well become pregnant and give birth to a child. In some cases, taking hormonal drugs can last a lifetime.

When detection of tumor processes in the pituitary gland, the prognosis depends only on the effectiveness of the operative and restorative treatment performed.

The above therapy techniques that combine the lactation-blocking effect of estrogens and physiotherapy regulating the pituitary-hypothalamic relationship lead to a steady improvement in the condition of patients with a disease such as Chiari-Frommel syndrome.

[24], [25], [26], [27]