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Diencephalic syndromes

Diencephalic syndromes are a lesion of the vegetative formations of the diencephalic region of the brain, which are the highest centers of regulation and integration of the endocrine glands. Diencephalic syndromes are accompanied by impaired metabolism and function of the endocrine glands.

The etiology of syndromes is different, and their clinical characteristics are not determined by etiological factors. Among the latter, the most important are infections (mainly secondary - influenza, rheumatism, brucellosis, malaria), intoxication, skull injuries, tumors of the third ventricle, brain, childbirth, abortion, menopause. Pronounced and persistent diencephalic syndromes can also be caused by psychogenic.

N. I. Grashchenkov distinguishes among diencephalic syndromes neuroendocrine, neurodystrophic, vegetative-vascular and neurological.

Patients have irritability, mental asthenia, discomfort in the heart, rectum, genital organs. The formula of a dream is broken, excessive drowsiness is often noted. Observed heart rhythm disorders, intestinal motility. Thermoregulation changes due to localized perspiration. As a result, it is often marked subfebrile.

When autonomic diencephalic syndromes should be stressed their parishness and polymorphism of seizures with the obligatory appearance of hunger or thirst and imperative desires for urination and defecation. Most often, the attacks begin with hyperemia of the upper half of the body, replaced by pallor of the skin. Appears hyperhidrosis, the feeling of hunger. Disorders of the trophism are noted with dry skin, the appearance of scarlet bands in the pelvic girdle, less often in the shoulder girdle and mammary glands.

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Diencephalic endocrine syndromes can be expressed in the form of changes in the function of one or more endocrine glands.

In the development of the disease Itsenko - Cushing (see) and adiposogenital pituitary dystrophy (see) lesions of the diencephalic region play an important role. Disorders of the hypothalamic region can also lead to the development of hypopituitarism (see) and psychogenic anorexia (see). Diabetes insipidus (see) is usually caused by a violation of the activity of the diencephalic region, primary or secondary, as a result of the influence of a pituitary tumor on the diencephalic region.

Damage to the midbrain is also noted in Laurens — Mun-Bardé – Bidle, Schulz – Hand – Christian syndromes, frontal hyperostosis and other hereditary family diseases and degenerative neuroendocrine disorders, and lipodystrophy (see).

In clinical practice, secondary diencephalic lesions of the thyroid gland are found. They are characterized by increased accumulation of radioactive iodine by the thyroid gland. It is slightly lower at the beginning of the disease. Diencephalic thyrotoxicosis occurs 4–6 months after infection, intoxication or injuries of the skull and are characterized by headaches, dizziness, vomiting, large tremor of the scale, impaired water metabolism, occasionally obesity, small size of the thyroid gland, low effectiveness of thyrostatic drugs.

When diencephalic hypothyroidism revealed unequal severity of individual signs of the disease. The introduction of thyroid-stimulating hormone in such cases leads to an increase in the accumulation of radioactive iodine in the thyroid gland, unlike primary hypothyroidism, in which it does not change the nature of the accumulation.

There are cases of Addison's disease of diencephalic-pituitary origin, for which, unlike the primary lesion of the adrenal glands, less pronounced melasma is characteristic. hypotension and emaciation, easier (without adrenal crises) course, good effect as a result of the use of adrenocorticotropic hormone of the pituitary gland.

Quite often, diencephalic syndromes disrupt sexual function. In men, impotence develops, in women - amenorrhea. Reduced sexual desire.

Treatment . Recommended anti-inflammatory therapy (penicillin 6-8 million units per course, biomitsin, tetracycline); resolving therapy (biochoinol, 2–3 g every two to three days, for a course — 30.0–40.0); the introduction into the vein of a 40% glucose solution and into the muscles of a 20% aqueous solution of sulphate magnesia; radiotherapy for 50–70 p at intervals of 1-2 days (for a course of 200 r) in combination with dehydrating agents (5% ammonium chloride solution, novurit), use of sedatives and tranquilizers; nasal ion galvanization; symptomatic hormone therapy; diet therapy.

The disability in patients with endocrine forms of diencephalic pathology is often preserved.