Diencephalic syndrome with menstrual irregularities in adolescents

Diencephalic syndrome is a symptom complex caused by polyglandular dysfunction with disturbance of metabolic and trophic processes, the menstrual cycle and accompanied by disorders of the cardiovascular and nervous systems.

Synonyms: diencephalic syndromes, neuroendocrine dysfunction, hypothalamic dysfunction.

ICD-10 code

• E23.3 Dysfunction of the hypothalamus, not elsewhere classified.
• E24.8 Other conditions characterized by Cushing's syndrome.
• G93.2 Benign intracranial hypertension.
• G93.4 Unspecified encephalopathy.
• I67.4 Hypertensive encephalopathy.

Epidemiology

It is known that hypothalamic dysfunction develops in girls more often than in young men (131.3 and 61.5 per 1000 people, respectively), and occurs in 20-32% of girls with menstrual irregularities.

Screening

For the diagnosis of hypothalamic dysfunction in conditions of preventive examinations, it is possible to apply the method of total estimation of numeric values of the symptoms of the disease in girls with menstrual cycle disorders. A girl whose total coefficient of clinical signs exceeds 1.1 should be sent for in-depth examination and clarification of the diagnosis.

The list of correction factors of the main symptoms of hypothalamic dysfunction in girls with menstrual irregularities

Clinical symptoms	Coefficient
Obesity (body mass index of 30 and more)	0.7
Stripes stretch the skin in white	0.3
Strips stretch the skin of burgundy or pink color	0.7
Hirsutism	0.4
Thyroid enlargement	0.3
Headache	0.6
Dizziness and fainting	0.3
Increased fatigue, weakness	0.4
Sweating	0.2
Irritability, tearfulness, decreased mood	0.1
Increased appetite, bulimia	0.1
Blood Pressure Fluctuations	0.1
Subfebrile condition	0.5
Hyperpigmentation of the skin	0.2
Drowsiness	0.2

Classification

There is no international standard classification of hypothalamic dysfunction. In our country, the classification of the hypothalamic syndrome of the pubertal period proposed by Tereshchenko (1996) is used:

• on etiology:
  • primary (arising from injuries and neuroinfections);
  • secondary (associated with obesity);
  • mixed.
• on the clinical course:
  • with a predominance of obesity;
  • with a predominance of symptoms of hypercortisy (hypercortisolism);
  • with a predominance of neuroendocrine disorders;
  • with a predominance of neurocirculatory disorders.
• on the severity of the disease:
  • light;
  • average;
  • heavy.
• by the nature of the process:
  • progressing;
  • regressing;
  • recurrent.

Causes of diencephalic syndrome

Among the etiological factors of hypothalamic dysfunction, particular importance is given to the adverse effects on the child of the following indicators:

• intrauterine hypoxia and fetal hypotrophy;
• birth trauma;
• pathology of the second half of pregnancy (pre-eclampsia I-III severity), accompanied by fetoplacental insufficiency and threat of termination of pregnancy in the mother;
• long-existing foci of infection (chronic tonsillitis, bronchitis, SARS).

What causes diencephalic syndrome?

Symptoms of diencephalic syndrome

Clinical manifestations of hypothalamic dysfunction are very diverse both in the combination of symptoms and in the intensity of their manifestation. Leading features:

• obesity;
• presence of crimson streaks on the skin (striae);
• vegetative disorders:
• tension or migraine headaches;
• fluctuations in blood pressure and orthostatic collapse;

Symptoms of diencephalic syndrome

Laboratory diagnosis of diencephalic syndrome includes:

• determination of serum levels of LH, PRL, FSH, testosterone, estradiol, DEA-C, cortisol, TIT, 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.

Diagnosis of diencephalic syndrome

The goals of treatment of diencephalic syndrome

Normalization of the central regulatory mechanisms of the reproductive system, the normalization of metabolic changes, the restoration (formation) of the regular menstrual cycle.

Non-drug treatment

• Sanitation of foci of infection.
• Normalization of sleep and rest.
• Diet and normalization of body weight (with subsequent consolidation of the achieved effect for at least 6 months).
• Acupuncture.
• Physiotherapy (endonasal calcium electrophoresis, galvanization of the collar zone by Shcherbak, etc.).
• Balneotherapy.

Treatment of diencephalic syndrome

Forecast

Prolonged persistent flow, with relapses. With a long (at least 0.5-1 year) treatment, the recovery of the menstrual cycle is possible in 60% of patients. Prognostically unfavorable sign is the progression of hirsutism and insulin resistance.

Prevention of diencephalic syndrome

• Normalization of body weight.
• Timely sanation of foci of infection.
• Enhancement of adaptive capabilities of the body.
• Normalization of sleep and rest.
• Dosed physical activity.

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