Treatment for 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.

Indications for hospitalization

• No effect from outpatient treatment within 6 months.
• The need for a detailed examination of circadian hormonal rhythms.
• Study of hormonal levels in conditions of hormonal tests.
• The need for complex intensive treatment, especially for patients with severe somatic (endocrine and neurological) symptoms.
• Disease progression.

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.

Drug treatment

Prescribe drugs that improve cerebral circulation and bioelectrical activity of the brain: carbamazepine orally (0.2 mg) 1/2 tablet per day for 3-4 weeks, then 1/2 tablet at night for 4-6 weeks and 1/4 tablet at night for 4-6 weeks or phenytoin (diphenin) 1/2 tablet per day for 3-4 weeks (the duration and dose of the drug are selected taking into account the dynamics of the EEG once every 20-30 days); ginkgo biloba leaf extract (ginkgo biloba) orally 1 tablet 3 times a day. 1-2 months or piracetam orally 1 tablet 2 times a day, 1 month.

Dehydrating effect: spironolactone orally 25-50 mg once a day, 2-4 weeks or acetazolamide orally 1 tablet 2 times a day, 3-4 weeks (mainly for patients with intracranial hypertension).

Vitamin therapy: pyridoxine intramuscularly 1.0 mg once a day, 15 injections every day, thiamine intramuscularly 1.0 mg once a day, 15 injections every day. Multivitamins orally 1 tablet 2 times a day, 1 month.

Hormone therapy: dydrogesterone orally 10 mg 2 times a day from the 16th day of the menstrual cycle for 10 days 1-6 months or progesterone (utrogestan) 100 mg 3 times a day from the 16th day of the menstrual cycle for 10 days to prevent bleeding. Microdose combined oral contraceptives (COCs) ethinyl estradiol + gestodene orally 20 mcg/75 mcg once a day from the 1st to the 21st days of the menstrual cycle, 3-6 months, ethinyl estradiol + desogestrel orally 20 mcg/150 mcg once a day from the 1st to the 21st days of the menstrual cycle, 3-6 months, usually with developing polycystic ovaries.

Surgical treatment

Surgical treatment is not used.

Indications for consultation with other specialists

The development of signs of thyroid dysfunction, adrenal dysfunction or hyperinsulinemia in a patient requires consultation with an endocrinologist, and in the case of manifestations of vegetative dysfunction, thermoneurosis - a neurologist. If a pituitary microadenoma is detected, a neurosurgeon consultation is required.

Approximate periods of incapacity for work

The period of incapacity for work is 2-3 weeks during the inpatient treatment period or intensive treatment on an outpatient basis.

Further management

Patients with various menstrual cycle disorders and hypothalamic dysfunction should be regularly, almost constantly monitored and receive maintenance courses of treatment, the intensity and frequency of which depends on the course of the disease.

Information for patients

Strict adherence to sleep and rest regimen, diet, dosed physical activity to stabilize normal body weight, regular monitoring by the attending physician and compliance with all his/her instructions. Consultation with the attending physician in cases of any deviations from the usual state of health (in addition to scheduled visits).

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

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