Diencephalic syndrome with menstrual disorders in adolescents

Diencephalic syndrome is a symptom complex caused by polyglandular dysfunction with disruption 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 Hypothalamic dysfunction, not elsewhere classified.
• E24.8 Other conditions characterized by Cushingoid syndrome.
• G93.2 Benign intracranial hypertension.
• G93.4 Encephalopathy, unspecified.
• I67.4 Hypertensive encephalopathy.

Epidemiology

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

Screening

To diagnose hypothalamic dysfunction in the context of preventive examinations, the method of total assessment of the numerical values of disease symptoms in girls with menstrual cycle disorders can be used. A girl whose total coefficient of clinical signs exceeds 1.1 should be referred for in-depth examination and diagnosis clarification.

List of correction factors for the main symptoms of hypothalamic dysfunction in girls with menstrual cycle disorders

Clinical symptoms	Coefficient
Obesity (body mass index 30 or more)	0.7
White stretch marks on the skin	0.3
Skin stretch marks of burgundy or pink color	0.7
Hirsutism	0.4
Enlarged thyroid gland	0.3
Headaches	0.6
Dizziness and fainting	0.3
Increased fatigue, weakness	0.4
Sweating	0.2
Irritability, tearfulness, low mood	0.1
Increased appetite, bulimia	0,1
Blood pressure fluctuations	0,1
Subfebrile temperature	0.5
Skin hyperpigmentation	0.2
Drowsiness	0.2

Classification

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

• by etiology:
  • primary (arising as a result of trauma and neuroinfections);
  • secondary (obesity related);
  • mixed.
• according to the clinical course:
  • with a predominance of obesity;
  • with a predominance of symptoms of hypercorticism (hypecortisolism);
  • with a predominance of neuroendocrine disorders;
  • with a predominance of neurocirculatory disorders.
• by severity of the disease:
  • light;
  • average;
  • heavy.
• by the nature of the process:
  • progressive;
  • regressive;
  • recurrent.

Causes of diencephalic syndrome

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

• intrauterine hypoxia and fetal malnutrition;
• birth injuries;
• pathology of the second half of pregnancy (preeclampsia of I-III severity), accompanied by fetoplacental insufficiency and the threat of termination of pregnancy in the mother;
• long-term foci of infection (chronic tonsillitis, bronchitis, acute respiratory viral infections).

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. The leading signs are:

• obesity;
• the presence of purple stretch marks on the skin (striae);
• vegetative disorders:
• tension headaches or migraine-type headaches;
• fluctuations in blood pressure and orthostatic collapse;

Symptoms of diencephalic syndrome

Laboratory diagnostics of diencephalic syndrome includes:

• determination of the serum levels of LH, PRL, FSH, testosterone, estradiol, DHEA-S, cortisol, TIT, triiodothyronine, free thyroxine, and, if necessary, ACTH, as well as STH, antibodies to TPO and TG. According to indications, the daily rhythms of LH, prolactin, and cortisol secretion are studied;
• determination of biochemical blood parameters characterizing the state of lipid, carbohydrate and protein metabolism;
• determination of the glucose level in fasting blood serum. If the glucose level is normal, a glucose tolerance test with a glycemic load is performed, and if the level is elevated, a food load is performed;
• determination of the content of sex steroid metabolites in daily urine.

Diagnosis of diencephalic syndrome

Treatment goals for diencephalic syndrome

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

Non-drug treatment

• Sanitation of infection foci.
• Normalization of sleep and rest patterns.
• 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 according to Shcherbak, etc.).
• Balneotherapy.

Treatment of diencephalic syndrome

Forecast

Long-term persistent course, with relapses. With long-term (at least 0.5-1 year) treatment, restoration of the menstrual cycle is possible in 60% of patients. A prognostically unfavorable sign is the progression of hirsutism and insulin resistance.

Prevention of diencephalic syndrome

• Normalization of body weight.
• Timely sanitation of infection foci.
• Increasing the body's adaptive capabilities.
• Normalization of sleep and rest patterns.
• Measured physical activity.

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