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Treatment of diencephalic syndrome

Alexey Portnov, medical expert
Last reviewed: 19.10.2021

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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.

Indications for hospitalization

Absence of the effect of outpatient treatment for 6 months.
The need for a detailed survey of circadian rhythm hormones.
The study of the hormonal background in the conditions of hormonal tests.
The need for complex intensive treatment, especially for patients with severe somatic (endocrine and neurological) symptoms.
Progression of the disease.

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.

Medication

Assign drugs that improve cerebral circulation and bioelectric activity of the brain: carbamazepine inside (0.2 mg) 1/2 tablets a day 3-4 weeks, then 1/2 tablets at night 4-6 weeks and 1/4 tablets at night 4 -6 weeks or phenytoin (diphenine) 1/2 tablets a day 3-4 weeks (duration and dose of the drug is selected taking into account the dynamics of the EEG 1 time in 20-30 days); ginkgo biloba leaves 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 inside 25-50 mg once a day, 2-4 weeks or acetazolamide inside 1 tablet 2 times a day, 3-4 weeks (mostly patients with intracranial hypertension).

Vitaminotherapy: 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 inside 1 dragee 2 times a day, 1 month.

Hormonotherapy: dydrogesterone inside 10 mg twice a day from the 16th day of the menstrual cycle 10 days 1-6 months or progesterone (morning) at 100 mg 3 times a day from the 16th day of the menstrual cycle for 10 days in order to prevent bleeding. Microdosed combined oral contraceptives (COC) ethinylestradiol + gestodene inside 20 mcg / 75 mcg once a day from the 1st to the 21st days of the menstrual cycle, 3-6 months, ethinylestradiol + desogestrel inside 20 mcg / 150 mcg once a day from the 1st to the 21st days of the menstrual cycle, 3-6 months, usually with the emerging polycystic ovaries.

Surgery

Surgical treatment is not used.

Indications for consultation of other specialists

Formation in the patient of signs of dysfunction of the thyroid gland, adrenal glands or hyperinsulinemia requires consultation of the endocrinologist, and in case of manifestations of autonomic dysfunction, thermoneurosis is a neuropathologist. When a pituitary microadenoma is detected, a neurosurgeon's consultation is required.

Approximate terms of incapacity for work

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

Further management

Patients with various disorders of the menstrual cycle and hypothalamic dysfunction should be regularly, almost constantly observed and receive supportive 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, diet, metered exercise to stabilize normal body weight, regular observation by the attending physician and the performance of all its prescriptions. Consultation with the attending physician in cases of any deviations from the usual state of health (in addition to programmed visits).

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

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.