Diagnosis of diencephalic syndrome

It is necessary to pay attention to the peculiarities of maternal pregnancy and childbirth: hypoxia, hypotrophy, hypersensitivity and other factors contributing to the disruption of the function of the child's hypothalamic structures. It is also necessary to find out the presence of close relatives of obesity, diabetes, thyroid gland diseases, propensities to vegetative dystonia.

Physical examination

The physical development of children is characterized by high growth and an increase in BMI since the onset of puberty. Almost a third of patients have a tendency to obesity since childhood. White and pink striae on the skin of various degrees of severity are a common sign of hypothalamic dysfunction, in 21% of girls, hirsutism is observed. In 19% of patients, hyperpigmentation of the skin in the axillary region, on the neck and elbows is detected, in 34% - an increase in the thyroid gland to the I-II degree.

The course of puberty in girls is characterized by its early onset (9-10 years) and rapid weight gain for 2-4 years on the background of rapid body growth in length. The age of menarche varies from 9 to 12 years. In the vast majority of patients, violations of the menstrual cycle were recorded after 0.5-2.5 years after the onset of menstruation, basically coinciding with the age of 14-16 years.

In assessing the rates of puberty, an earlier and rapid sexual development of girls with hypothalamic dysfunction was found in comparison with contemporaries.

With a gynecological examination, the correct development of the genital organs is detected, while at the same time, almost half of the adolescents notice hyperpigmentation of the skin of the perineum and the inner surface of the hips. The condition, size and location of internal genitalia, as a rule, do not differ from the age norm.

Laboratory diagnostics

Laboratory diagnostics include:

• determination of serum levels of LH, PRL, FSH, testosterone, estradiol, DEA-S, cortisol, TSH, triiodothyronine, free thyroxine, if necessary - ACTH, as well as STH, antibodies to TPO and TG. According to the indications, daily rhythms of LH secretion, prolactin, cortisol are studied;
• determination of biochemical blood parameters characterizing the state of lipid, carbohydrate and protein metabolism;
• the determination of the level of glucose in the blood serum taken on an empty stomach. At a normal glucose level, a glucose tolerant test with a glycemic load, and with an elevated content, with a nutritional load;
• the determination of the content in the daily urine of metabolites of sex steroids.

Instrumental methods

• Radiography of the skull with a projection on the Turkish saddle, hands and wrist joints with the definition of bone age.
• EEG, EchoEG, rheoencephalography or dopplerometry of cerebral vessels.
• Ultrasound of the organs of the small pelvis, thyroid gland and adrenal glands.
• MRI of the brain, (for example, the pituitary-hypothalamic region) with contrast.

Differential diagnostics

It is necessary to carry out differential diagnostics with the disease and the syndrome of Itenko-Cushing, a brain tumor. In addition, hypothalamic dysfunction should be differentiated from metabolic-endocrine disorders on the background of insulin resistance.

Differential diagnosis is based on additional methods of investigation: MRI of the brain and adrenal glands, on the results of studying the daily rhythm of hormones and hormonal status in conditions of hormonal tests, biochemical indicators of blood.

Indications for consultation of other specialists

With dysfunction of the thyroid gland, adrenal glands or signs of hyperinsulinemia (or suspicion of them), consultation is needed in the endocrinologist, and in case of manifestations of autonomic dysfunction, thermoneurosis - in a neurologist. If a pituitary adenoma is detected, a consultation with a neurosurgeon is required.

[1], [2], [3], [4], [5], [6]