Idiopathic edema

Idiopathic edema (synonyms: primary central oliguria, central oliguria, cyclic edema, insipid antidiabet, psychogenic, or emotional, edema, in severe cases - Parkhon syndrome). The overwhelming majority of patients are women of reproductive age. Before the beginning of the menstrual cycle of cases of the disease is not registered. In rare cases, the disease can make its debut after menopause. Single cases of the disease in men are described.

[1], [2], [3], [4], [5], [6], [7]

Causes of idiopathic edema

The name "idiopathic edema" indicates an unknown etiology of this suffering. It should be noted the leading role of emotional stress, prolonged use of diuretics and the presence of pregnancy at the beginning of idiopathic edema. These etiological factors seem to contribute to the decompensation of the constitutionally caused defect of the central regulating element of water-salt balance.

[8], [9], [10], [11]

Pathogenesis of idiopathic edema

To date, the pathogenesis of the disease is not fully understood. It is believed that the disease is based on hormonal dysregulation of a central character. A significant role is played by increased secretion of the antidiuretic hormone along with an increase in the sensitivity of the renal tubules to this hormone. The role of excessive secretion of aldosterone is also noted. The role of estrogens in the form of violation of the cyclic rhythm of estrogen secretion with relative hyperestrogenia in the second phase of the menstrual cycle due to the lack of progesterone has been revealed. A number of researchers point to the pathogenetic role of the orthostatic factor and the role of increased fluid fluid transudation from the vascular bed. The hormonal dysfunction underlying the disease is a consequence of the disruption of the central mechanisms of regulation of water-salt balance, mainly of the hypothalamic-pituitary component.

Symptoms of idiopathic edema

The main symptoms of idiopathic edema are periodic swelling with oliguria. The swelling is soft and mobile, most often located on the face and paraorbital areas, on the hands, on the forelegs, legs and ankles. Possible and hidden swelling. Clinical manifestations vary depending on the severity of the disease: it occurs as a mild form with minor edema of the face and ankles, and a severe form in which pronounced swelling is prone to generalization. When generalizing swelling, their distribution depends on the force of gravity. So, upon awakening, swelling is more often localized on the face, after adopting a vertical position and by the end of the day they fall on the lower parts of the body.

Depending on the clinical course, there are two forms of manifestation of the disease - paroxysmal and permanent. Some predominance of paroxysmal form is reflected in the name of this syndrome - periodic, or cyclic, swelling. Paroxysmal form of the disease manifests itself as periodic swelling with oliguria and high relative density of urine, which are followed by periods of polyuria, when the body is freed from excess water. Periods of oliguria, as a rule, are long - from several days to a month. Then they can be replaced by periods of polyuria, as a rule, more short-term. The duration of polyuria can be calculated in hours, when up to 10 liters of urine is released during a half-day, and by days, when within a week the amount of excreted urine is 3-4 liters daily.

Cycles of the disease (oliguria - polyuria) appear at various intervals. Factors provoking the onset of a puffy attack can be emotional stress, heat, premenstrual period (second, luteal phase of the cycle), pregnancy, food change, climatic conditions. In the permanent phase of idiopathic swelling, swelling is permanent, monotonous, and not periodic. With severe clinical course at the height of edema with increasing body weight due to fluid, as a rule, more than 10 kg can develop symptoms of water intoxication. They are manifested by headache, dizziness, shortness of breath, adynamy, confusion. The period of recession of edema with strongly expressed polyuria can be manifested by symptoms of dehydration. In the period of a more prolonged polyuria, general weakness, decreased appetite, thirst, vegetative manifestations are typical, usually in the form of tachycardia, a sensation of cardiac disruptions, cardialgia. Thirst is an obligate sign of the disease and along with oliguria the main mechanism of edema formation.

A positive water balance with a fluid retention in the body leads to a rapid increase in body weight. The fluctuations in body weight with and without edemas range from 1 to 14 kg. A rapid increase in body weight of 1 kg or more per day necessarily indicates a fluid retention in the body, rather than an increase in fat content. This is an important diagnostic feature, which should be remembered, since with hidden swelling patients often complain of obesity with periods of rapid fluctuations in body weight.

Often idiopathic edema is combined with other neuro-metabolic-endocrine disorders: obesity, impaired function of the sexual glands in the form of amenorrhea or oligomenorrhoea, hirsutism, bulimia, decreased sexual desire, sleep disturbances. Emotional-personality disorders, as a rule, are represented brightly in the form of asthenic-hypochondriacal disorders. Vegetative disorders - obligate signs, manifested by permanent and paroxysmal disorders. Permanent vegetative disturbances are extremely diverse: there may be increased dryness and increased moisture of the skin, both marked decrease, and a significant increase in blood pressure, tachycardia, sweating, a decrease in skin temperature. Paroxysmal autonomic disorders are detected only with pronounced psychopathological manifestations and can be both sympatoadrenal and mixed in nature.

Neurological examination, along with radiographic and electroencephalographic, does not reveal any pathognomonic signs. Diffuse microsymptomatics, signs of dysraphic status are revealed.

On radiographs of the skull, compensated intracranial hypertension, hydrocephalic shape of the skull, frontal hyperostosis are often determined. EEG is extremely diverse: along with normal bioelectrical activity of the brain, there are often signs of involvement in the process of upper-stem brain structures. On the fundus there is a retinal dystonia with a tendency to narrow the small arteries. It should be remembered that at the height of intensive swelling (an increase in body weight of up to 10 kg), on the fundus there may be stagnant phenomena that completely disappear when the edema disappears or significantly decreases.

Differential diagnosis of idiopathic edema

The diagnosis of idiopathic edema syndrome is made by the elimination of other pathological conditions that can contribute to fluid retention in the body (heart failure, kidney pathology, cirrhosis with ascites, narrowing of venous and lymphatic vessels, dysproteinemia, allergic and inflammatory diseases, hypothyroidism).

[12], [13], [14], [15], [16], [17]

Treatment of idiopathic edema

Treatment of idiopathic edema should begin with the elimination of diuretics, especially the chlorothiazide series. It is recommended to follow a diet with salt restriction for a long time. A positive effect gives the use of large doses of veroshpiron - up to 6-9 tablets per day. In a number of cases, the use of bromocriptine (parlodel) in 1/2 tablet (1.25 mg) 3-4 times a day for half a year has a positive effect. A significant place among therapeutic measures is taken by differentiated psychotropic therapy, carried out in individually selected doses depending on the severity of psychopathological manifestations.

It is often necessary to combine drugs with antidepressant and neuroleptic effect. Of the antipsychotics, preparations like Mölleril (sonapax), terenaline, antidepressants - pyrazidol, amitriptyline, azafen are preferred. From vegetotrophic agents, an anaprilin with a dose of 40-60 mg divided into 4 doses has a positive therapeutic effect. The main principle of therapy is its complexity.