Bacterial vaginosis

Manifestations of bacterial vaginosis

Diagnostics

Bacterial Vaginosis Treatment

Forecast

Bacterial vaginosis is a violation of the vaginal microecology. This is the most common condition in women of childbearing age.

The predisposing factors leading to the development of bacterial vaginosis include the following:

  • use of antibacterial drugs;
  • long-term use of intrauterine contraceptives;
  • use of preformed contraceptives;
  • previous inflammatory diseases of the urogenital tract;
  • violation of the hormonal status, accompanied by violation of the menstrual cycle;
  • changing the state of local immunity;
  • exposure to low doses of ionizing radiation;
  • stressful effects on the body.

In 60% of women suffering from bacterial vaginosis, violations of the microecology of the colon are detected (dysbiosis intestine).

Manifestations of bacterial vaginosis

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The main symptom is complaints about discharge with an unpleasant smell, which are noted by only 50% of women. Discharge is more often moderate, less often – plentiful, in some cases they may be absent altogether. Secretions in bacterial vaginosis grayish-white, uniform, without lumps, have a specific “fishy smell”, which can be permanent, absent, appear during menstruation and sexual intercourse.

The duration of these symptoms can be calculated for years. With a long current process discharge they acquire a yellowish-green color, become thicker, often resemble a curd, have the property of foam, are slightly friable and sticky, and are evenly distributed along the walls of the vagina.

Other complaints, mainly of itching and urination disorders, are rare: they may be completely absent or appear periodically. Often women with bacterial vaginosis complain of heavy menstrual bleeding, pain in the lower abdomen, adnexitis .

At the same time, in some cases in some patients do not reveal any manifestations of the disease.

Vaginal and vaginal irritation is rarely observed, which distinguishes bacterial vaginosis from candida and trichomoniasis, which are usually accompanied by severe itching.

Diagnostics

A preliminary diagnosis of bacterial vaginosis can be made already during a gynecological examination. After the inspection, a discharge of the vaginal discharge from the back of the body is taken.

The diagnosis can be made in the presence of 3 out of 4 listed symptoms:

  • the specific nature of the discharge;
  • acidity> 4.5 (normal 3.8-4.5);
  • positive aminotest ;
  • the presence of “key” cells. The so-called “key cells” are mature epithelial cells (surface layer of the vaginal epithelium), over the entire surface of which microbes are tightly and in large numbers attached.

Performing one of the 4 tests is not enough for a diagnosis.

Bacterial Vaginosis Treatment

In case of bacterial vaginosis, local therapeutic measures are considered optimal. A good therapeutic effect is indicated for drugs from the group of nitroimidazoles ( metronidazole , trichopolum , metrogyl , etc.), which are administered intravaginally in the form of tablets, tampons, or suppositories.

There are various schemes of complex treatment of bacterial vaginosis, consisting in the use of nitroimidazoles , prescribed by tablet and topical agents (1% hydrogen peroxide, antiseptic solution of tomicid , benzalkonium chloride compounds , etc.), which irrigate the vagina.

In case of tablet administration of nitroimidazoles, it is necessary to take into account the possibility of side effects such as dysfunction of the gastrointestinal tract, dizziness and headache.

In severe cases of bacterial vaginosis, the underlying principle of treatment is the use of broad-spectrum antibiotics for the purpose of general sanation of the vaginal mucosa ( clindamycin , oleandomycin , cephalosporins).

When prescribing broad-spectrum antibacterial drugs, a large number of side effects may occur, including dysbacteriosis of other cavities (intestines, etc.).

The effectiveness of the treatment of bacterial vaginosis is assessed by the disappearance of subjective manifestations, the dynamics of the clinical symptoms of the disease, the normalization of laboratory parameters. The first follow-up clinical and laboratory examination should be carried out a week after the completion of therapy, repeated – after 4-6 weeks.

During treatment and follow-up, the use of barrier methods of contraception (condoms) should be recommended.

Currently, one of the effective drugs for the treatment of bacterial vaginosis is dalacin vaginal cream, applied once a day for 3 days. The course of treatment is 3 days. One full applicator corresponds to a single dose of the drug.

Among the most frequent complications in the application of the above drugs should be noted vaginal candidiasis. For its prevention it is necessary to prescribe antifungal drugs – nystatin 2000 mg per day inside, simultaneously with the start of treatment. The most effective drug for non-pregnant women is fluconazole.At the same time, for the treatment of vaginal candidiasis during pregnancy, drugs such as clotrimazole , pimafucine , gino – mevoril , dafnedzhin , etc. are widely used .

Another effective remedy for bacterial vaginosis is the antiseptic drug Povidone – iodine ( Betadine ).

Forecast

With all of the above methods of treatment, there may be relapses that occur at different times after treatment. Apparently, this is due to the fact that antibiotic therapy, eliminating pathogens, often does not create the conditions for a sufficiently rapid recovery of beneficial bacteria.

In this regard, the complex treatment within 10 days after the main course of treatment must include such biological products as acylact, bifikol , bifidum – and lactobacterin , because of their specific action, aimed at restoring the normal ratio of lactobacilli in the vagina, and thereby preventing the frequency of recurrences of this diseases.

Dysbacteriosis

Kinds

The reasons

Symptoms of dysbiosis

Diagnostics

Treatment of intestinal dysbiosis

Consequences and prognosis

Dysbacteriosis is a qualitative and quantitative change in the normal intestinal microflora in the direction of increasing the number of symbiotic microorganisms that are not present in healthy people or are found in small quantities.

Dysbacteriosis is quite common and occurs in 90% of adults. It should be borne in mind that intestinal dysbiosis is not an independent disease, it is just a clinical and laboratory syndrome that develops against the background of the underlying disease.

A huge number of bacteria is present in the human intestine:

  • bifidobacteria;
  • lactobacillus;
  • enterobacteria;
  • conditionally pathogenic flora (bacteroids, staphylococci, streptococci, peptococci and others).

Conditionally pathogenic microorganisms are found in small numbers and peacefully coexist with the “main contingent” of the intestine. But when any factors occur, they begin to actively proliferate, which leads to the development of dysbiosis.  

Normal intestinal microflora performs a number of important functions. The main role is protective (they prevent the growth and reproduction of pathogenic and conditionally pathogenic microorganisms). Lactic, succinic and other acids that produce bifidobacteria and E. coli inhibit the growth of putrefactive and pyogenic microbes. In addition, the normal intestinal microflora promotes digestion and produces vitamins. In addition, the normal microflora contributes to the production of antibodies, that is, it has an immunizing property.

Kinds

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There are several clinical forms of intestinal dysbiosis:

Type:

  • typical ( enteritic, enterocolitis, colitis);
  • atypical.

By gravity:

  • easy;
  • medium heavy;
  • heavy

With the flow:

  • acute (up to 30 days);
  • protracted (up to 4 months): with clinical manifestations (continuous or recurrent) and without clinical manifestations;
  • chronic (more than 4 months): with clinical manifestations (continuous or recurrent) and without clinical manifestations.

The reasons

The development of dysbiosis lead to various adverse factors:

  • intensive antibiotic therapy, chemotherapy, hormone therapy;
  • acute and chronic intestinal infections;
  • abdominal surgery;
  • diseases of the digestive tract;
  • reduction of the body’s defenses under the influence of adverse factors (radiation sickness, burn disease);
  • poor nutrition, fasting, overeating;
  • avitaminosis;
  • a sharp change in the usual way of life;
  • the effect of various allergens on the body;
  • helminthiasis ( ascariasis , enterobiosis and others).

Symptoms of dysbiosis

Clinical manifestations of intestinal dysbiosis can be very diverse. They depend on the nature of the pathological changes that caused dysbacteriosis, and on individual sensitivity, the degree of specific and non-specific sensitization of the organism. Also play the role of the patient’s age, the nature and duration of the drugs used, which led to this state, the type of microbes and so on.

The clinical picture of intestinal dysbiosis is characterized by the presence of common and local signs.

Common manifestations include:

  • loss of appetite
  • fast fatiguability,
  • weight loss
  • signs of hypolivitaminosis,
  • anemia.

If there is an increase in the activity of conditionally pathogenic flora, then the symptoms of infectious intoxication join:

  • high temperature
  • dyspnea,
  • heart palpitations
  • leukocytosis and acceleration of ESR in the blood .

Local symptoms of intestinal dysbiosis include:

  • copious watery stools without pathological impurities ( enteritis ),
  • loose stools with admixture (enterocolitis),
  • when pus, mucus and blood streak appear in the stool, they speak of colitis .

A spasm of the large intestine due to its inflammation leads to constipation and increased gas formation ( flatulence ).

Abdominal pain is characteristic of all types of intestinal dysbiosis. The intensity of the pain syndrome varies and depends on the location and depth of the pathological process.

In addition, intestinal dysbiosis is characterized by allergic syndrome, which is manifested by itching of the skin and mucous membranes and an allergic rash.

Easy form

For mild enteritnogo, enterocolitica and kolitnogo dysbiosis include those cases where the chair is no more than 5 times a day, fever and inflammatory changes in the blood are not available. There is also a decrease in appetite.

Moderate form of dysbiosis

In case of an increase in stool up to 6-10 times a day, lack of appetite, continued weight loss, the development of intoxication syndrome and the manifestation of allergy, they speak of a moderate form.

Symptoms of hypovitaminosis and anemia also increase. In the event of a fever, inflammatory changes in the blood indicate an increase in the activity of conditionally pathogenic flora.

Heavy form

With stool frequency up to 10 times a day or more, fever, intestinal paresis (refuses to peristaltic ), anemia, significant weight loss, hemodynamic changes up to toxic shock should be diagnosed with a severe form of dysbacteriosis.

Diagnostics

Differential diagnosis of dysbiosis should be carried out with intestinal infections.

From laboratory methods of diagnosis, microbiological examination of feces provides real assistance, which makes it possible to identify not only the qualitative and quantitative violation of the intestinal microflora, but also to determine the sensitivity of the inoculated pathogenic and conditionally pathogenic microorganisms to antibiotics and bacteriophages.

For the study, 1 gram of feces, diluted in nat. the solution is sown on nutrient medium. A violation of the intestinal biocenosis is evidenced by the absence of growth of bifidobacteria and a sharp decrease in E. coli. In addition, an indicator of dysbiosis is the detection of bacteria such as proteus, staphylococcus, yeast-like fungi, and others.

In addition to the examination, the doctor may prescribe  gastroscopy, sigmoidoscopy, barium enema, colonoscopy and Ultrasound examination of the abdominal cavity .

Treatment of intestinal dysbiosis

The gastroenterologist, or, in his absence, a general practitioner, is engaged in the treatment of intestinal dysbacteriosis.

Treatment should begin with the elimination of the cause of the condition (if possible) and the appointment of a diet.

Diet for dysbacteriosis

First of all, when dysbacteriosis is imposed a ban on alcohol, fatty, fried, spicy and salty foods, sweets and baked goods, as well as products that enhance gas formation and putrefactive processes.

Rough fiber is also recommended not to use. In the food should be dairy products and fruits, berries and vegetables that are well absorbed in the intestines and inhibit rotting and fermentation (apricots, tomatoes without skin, blueberries, pumpkin, eggplant and others).

Drug treatment

Antibacterial therapy is prescribed for moderately severe and severe forms of dysbacteriosis.

Antibiotics are selected taking into account the sensitivity to them of the sown pathogenic microorganisms.

For example, in staphylococcal dysbacteriosis, preference is given to macrolide antibiotics (azithromycin, erythromycin), aminoglycosides (gentamicin), fluoroquinolones ( ciprolet ) and cephalosporins ( cefazolin ).

In dysbacteriosis caused by Klebsiella and citrobacter, gentamicin is indicated.

Treatment of candidal dysbacteriosis requires prescription of antifungal drugs ( flucostat ).

It is possible to replace antibiotics with nitrofuran derivatives ( furazolidone , furadonin ) or bacteriophages (for a mild disease): staphylococcal bacteriophage, proteic bacteriophage, pyobacteriophage and others.

The course of treatment with antibiotics and nitrofurans lasts 7-10 days. Bacteriophages prescribed courses for 5-7 days, at intervals of 3 days. The number of courses depends on the effectiveness of treatment.

The second step in the treatment of dysbiosis is the restoration of normal intestinal microflora.

Bacterial drugs (probiotics) include: bifikol, lactobacterin, colibacterin, bifidumbacterin, baktsibutil and others. The duration of the course of treatment with biological preparations ranges from 3 weeks to 1.5-2 months, depending on the severity of the disease.

Treatment of dysbacteriosis is complex and should include, in addition to the above, enzyme preparations ( festal , pancreatin, abomin ), vitamin complexes and immunostimulants.

Consequences and prognosis

Dysbacteriosis leads to secondary immunodeficiency, as a result of which the following diseases can develop (if there is a predisposition and provoking factors):

  • eczema;
  • bronchial asthma;
  • diabetes;
  • osteochondrosis;
  • malignant intestinal tumors and so on.

The prognosis for dysbacteriosis depends on the adequacy of therapy and the severity of the process.

In most cases, the prognosis is favorable.

Chronic gastritis

The reasons

Symptoms of chronic gastritis

Diagnosis of chronic gastritis

Treatment

Diet for chronic gastritis

Gastritis is a disease characterized by a change in the gastric mucosa and accompanied by various disorders of its basic functions.

Chronic gastritis affects 50-80% of the total adult population, and the incidence of gastritis increases with age.

The reasons

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  • Microbial: Helicobacter pylori and other microbes
  • Non-microbial: autoimmune, alcoholic, after gastric surgery, caused by anti-inflammatory drugs (for example, indomethacin, ibuprofen, aspirin, etc.) caused by chemical exposure
  • Unknown factors, incl. microorganisms.

Chronic non-atrophic gastritis in 85-90% of cases is due to the Helicobacter pylori microbe.

The development of chronic atrophic (autoimmune) gastritis is associated with genetically determined production of autoantibodies to the cells of the gastric mucosa.

The most common causes of chemical (reactive) gastritis are bile reflux from the intestines to the stomach and long-term use of certain medications.

The causes of eosinophilic gastritis are unknown, in some patients reveal   bronchial asthma ,   eczema   and other allergic diseases.

Granulomatous gastritis is found in 10% of patients sarcoidosis, 7% of patients with Crohn’s disease , with tuberculosis, mycoses, foreign bodies in the stomach.

The cause of giant hypertrophic gastritis is unknown.

Symptoms of chronic gastritis

  • Pain in the epigastric region, occurring on an empty stomach. The pains can be acute, cramping or aching, non-intensive; sometimes occur soon after eating
  • Heartburn, belching sour, less nausea, vomiting gastric contents.
  • The most frequent manifestations of gastritis in a chronic course are heaviness in the epigastric region after eating, a feeling of overeating, stomach overflow, belching food and air, an unpleasant taste in the mouth, loss of appetite flatulence, unstable chair
  • Vomiting and diarrhea; appetite is often reduced

Diagnosis of chronic gastritis

  • A general blood and urine test will help detect signs of inflammation in the body during exacerbation of chronic gastritis (tests will be normal in remission), hyperchromic anemia in chronic autoimmune gastritis.
  • Stool analysis: possible   the presence of hidden blood, as well as undigested food residues with reduced secretory activity of the stomach.
  • FGDS and biopsy specimens for histological examination. If it is impossible to perform FGDs, an X-ray examination of the stomach with barium contrast can be performed, but this is less informative.
  • The study of the secretory function of the stomach.
  • Detection of Helicobacter pylori microbe. The “gold standard” is the histological examination of biopsy specimens with their color according to certain patterns and subsequent microscopic examination. A biological method is also used (sowing a microorganism on a nutrient medium).
  • Manometry: with reflux gastritis, an increase in pressure in the duodenum up to 200-240 mm water column is detected. (in normal – 80-130 mm water column).

Differential diagnosis is carried out with gastric ulcer and duodenal ulcer, diaphragmatic hernia, esophagitis, tumors.

FGDS is crucial for clarifying the diagnosis.

Treatment

Treatment of chronic gastritis caused by H. pilory

In case of gastritis caused by the microbe Helicobacter pylori, antimicrobial therapy is used.

There are several standard treatment regimens, including

  • antibiotics
  • IPP (omez, nolpaz, pariet, emaner – substances used in the treatment of gastrointestinal diseases associated with the release of hydrochloric acid),
  • bismuth preparations (de-nol, ventrisol).

Treatment of other forms of chronic gastritis

In the absence of Helicobacter pylori and increased gastric secretory function:

  • drugs that lower the acidity of gastric juice (almagel, phosphalugel, gelusil varnish, maalox, etc.)
  • drugs that protect (envelop) the mucous membrane: sucralfate, bismuth dicitrate (also has an antimicrobial action against Helicobacter pylori).

Treatment of chronic atrophic gastritis

Drug therapy of such gastritis is carried out only in the period of exacerbation.

Replacement therapy of secretory gastric insufficiency:

  • gastric juice,
  • pepsidil
  • hydrochloric acid with pepsin,
  • acidin-pepsin (these drugs are contraindicated in the presence of erosions of the mucous membrane).

Replacement therapy with reduced pancreatic function:

  • cholezim,
  • Pancreatin + bile components + hemicellulase,
  • pancreatin,
  • Panzinorm Forte.

Phytotherapy:

  • herbal remedies that have anti-inflammatory effect – infusion of plantain leaves, chamomile, peppermint, St. John’s wort, valerian,
  • plantaglyutsid.

Preparations that improve the nutrition of tissues and enhance healing processes:

  • nicotinic acid 1% solution intravenously
  • solcoseryl
  • inosine,
  • thiamine
  • pyridoxine
  • folic acid.

Reflux gastritis treatment

The treatment is aimed at normalization of gastric motility and binding of bile acids, which is primarily achieved by diet (meals 5-6 times a day in small portions, with the exception of fried, spicy, fatty foods).

To prevent reflux into the stomach of duodenal contents, domperidone and metoclopramide are prescribed short courses. Prolonged use of these drugs is not recommended due to serious side effects from the cardiovascular system.

A relatively new drug from the prokinetic group is itopride (ganaton), it normalizes the motility of the gastrointestinal tract and reduces the flow of bile into the stomach.

For the neutralization of bile acids that have a damaging effect on the gastric mucosa, chenodeoxycholic and ursodeoxycholic are used. acids, for example, Ursosan.

Protection of the mucous membrane from bile acids – drugs that reduce the acidity in the usual daily dose (aluminum-containing antacids, for example, almagel, have the ability to bind bile acids, so they are more effective).

Diet for chronic gastritis

With low acidity prescribed diet number 2:

  • soups from cereals and vegetable, mashed soups in meat, mushroom, fish broths;
  • lean meat (minced, fried), boiled chicken, steam, stewed, fried cutlets without a rough crust, lean ham, boiled lean fish, well-soaked lean herring, black caviar;
  • milk (if it does not cause diarrhea), butter, kefir, yogurt, cream, non-sour sour cream, fresh non-sour cottage cheese, non-sharp grated cheese;
  • boiled eggs, fried omelette;
  • porridge, well boiled or pureed (buckwheat, semolina, rice);
  • flour dishes, (except for muffin), stale white bread, gray bread, lean crackers;
  • vegetables, fruits boiled, raw in the ground form; fruit, vegetable juices (also sour);
  • tea, coffee, cocoa on water with milk, marmalade, sugar. Salt to 12-15 g.
  • add vitamins C, B1, B2, PP.

Food for chronic gastritis fivefold, mainly in a puree form.

With increased acidity prescribed diet number 1:

  • pureed dairy and vegetable (except cabbage), cereal mucous soups (but not meat and not fish);
  • vegetables cooked in chopped (pureed) form or in the form of steam puddings;
  • pureed porridge with butter, milk;
  • boiled lean meat, boiled fish of low-fat varieties (cod, perch, pike), meat, fish steam meatballs, boiled chicken without skin;
  • creamy, olive, sunflower oil;
  • milk, yogurt non-sour, cream, fresh low-fat, better grated cottage cheese, non-acid sour cream;
  • soft-boiled eggs or in the form of steam omelets;
  • white stale bread, white lean pastries;
  • sweet varieties of berries and fruits, vegetable, fruit, berry juices, dogrose infusion, jelly, sweet berry compote, fruit in shabby form, sugar, jam, tea, cocoa – weak, with milk;
  • as the overall condition improves, food is given boiled, but not shabby;
  • salt limit up to 8 g;
  • add vitamins A, C, vitamins of group B.

Food is often taken 5-6 times a day, chewing it well; avoid too hot or too cold food)

Hypothalamic syndrome

Kinds

The reasons

Symptoms of hypothalamic syndrome

Diagnostics

Treatment of hypothalamic syndrome

Forecast

Hypothalamic syndrome is a complex symptom complex that develops when the hypothalamus is damaged and is characterized by endocrine, autonomic, metabolic and trophic disorders.

Hypothalamic syndrome affects people aged 31-40 years. The percentage of patients with this syndrome among women significantly exceeds the percentage of men with hypothalamic syndrome.

Hypothalamic syndrome is widespread, but not immediately diagnosed, as its symptoms may be masked as signs of other diseases.

The hypothalamus is located in the brain and is responsible for homeostasis (constancy of the internal environment), metabolic processes, thermoregulation, the state of blood vessels and internal organs, as well as nutritional, sexual and mental behavior. In the pathology of the hypothalamus, the periodicity of any functions is disturbed, which manifests itself in the form of a vegetative crisis or paroxysm.

Kinds

Depending on the prevalence of certain signs of the disease, the following forms of the hypothalamic syndrome are distinguished:

  • vegetative-vascular;
  • disturbances of thermoregulation;
  • hypothalamic (diencephalic) epilepsy;
  • neurotrophic;
  • neuromuscular;
  • violation of motivation and inclinations (including disorders of sleep and wakefulness);
  • neuroendocrine metabolic disorders;
  • psevdoneustenic or psychopathological.

In adolescence, hypothalamic syndrome occurs with a delay or acceleration of sexual development (puberty syndrome).

According to the severity of the disease emit mild, moderate and severe.

According to the course of the disease, there is a progressive course, a stable, regressing, recurrent.

The reasons

The following factors can lead to dysfunction of the hypothalamus with the development of the hypothalamic syndrome:

  • brain tumors that squeeze the hypothalamus;
  • head injuries with damage to the hypothalamus;
  • chronic brain intoxication (drug addiction, alcoholism, substance abuse, work in hazardous industries, disrupted ecology, and others);
  • vascular diseases, cerebral stroke, cervical osteochondrosis ;
  • viral and bacterial neuroinfections ( malaria , influenza, meningitis , infectious jaundice, rheumatism, chronic tonsillitis );
  • chronic stress, mental stress;
  • hormonal changes during pregnancy;
  • chronic and endocrine diseases ( bronchial asthma, hypertension, gastric ulcer, obesity );
  • constitutional failure of the hypothalamus.

Symptoms of hypothalamic syndrome

Manifestations of the hypothalamic syndrome depend on which part of the (anterior or posterior) hypothalamus is damaged. Symptoms of the syndrome may occur immediately after damage to the hypothalamus or delayed (after a few days, weeks and even years).

Vegetative-vascular form

In the development of the vegetative-vascular form of the hypothalamic crisis play a role of impaired function of the autonomic nervous system (the parasympathetic and sympathetic divisions). This form manifests itself in the form of crises.

1. During sympathoadrenal crisis, patients complain of

  • heart palpitations
  • general weakness and lethargy
  • anxiety, manifested by anxiety,
  • fear of death.

Observed

  • numbness and coldness of hands and feet,
  • pale skin
  • exophthalmos (bulging eyes),
  • dry mouth
  • thirst and chills,
  • common tremor
  • the rise in blood pressure to 150/100 – 180/110 mm Hg. Art.,
  • temperature rise to 38 degrees.

To provoke a crisis can change the weather, menstruation, emotional stress, pain. The duration of paroxysm is 15 minutes – 3 hours.

2. Vaginismular crisis is characterized

  • suffocation
  • lack of air,
  • headache
  • hot flashes to face.

Also, patients appear

  • general weakness, lethargy, drowsiness,
  • excessive sweating
  • salivation,
  • dizziness, tinnitus,
  • nausea,
  • blood pressure goes down
  • heartbeat decreases ,
  • symptoms of intestinal upset (flatulence, diarrhea) and bladder (abundant urination) join.

Allergic reactions in the form of   urticaria   or   Quincke’s edema . The attack continues 1 – 2 hours.

Thermal control disturbance

Hypothalamic syndrome with impaired thermoregulation is characterized by long subfebrile (up to 38 degrees) body temperature with its periodic increase (up to 40 degrees).

This form is more common in children and adolescents.

Along with an increase in temperature, there are signs of sympathoadrenal or mixed crises (vegetative-vascular form).

The temperature rises in the morning and normalizes in the evening. There are no obvious signs of inflammation. Changes in thermoregulation are directly related to emotional and physical stress (for example, in children, thermoregulatory changes appear in school and disappear during the holidays).

Characteristic signs of a violation of thermoregulation are constant chilliness, fear of drafts and cooling.

Violation of motivations and drives

This form of hypothalamic syndrome is characterized by emotional and personality disorders (various phobias – fears, increased or weakened sexual desire, pathological drowsiness or insomnia, frequent and sudden mood swings).

Neuroendocrine form

Such disorders are characterized by impaired protein, carbohydrate, fat and water-salt metabolism, voracity ( bulimia ) or   anorexia   (refusal to eat), thirst.

Often, neuroendocrine disorders are accompanied by Itsenko-Cushing syndromes,   diabetes mellitus , early   menopause,   acromegaly   and thyroid pathology.

Neurotrophic form

It is characterized by trophic changes (allergic rash,   trophic ulcers , itching and dry skin,   bedsores , changes in pigment metabolism), osteomalacia (softening of bones) or hardening of bones, the appearance of ulcerations in the esophagus, stomach, duodenum.

Diagnostics

Due to the numerous symptoms of the hypothalamic syndrome, its diagnosis presents certain difficulties.

Apply various tests to statement of diagnosis

  • determination of the sugar curve with a load: measurement of blood sugar on an empty stomach and after taking 100 gr. sugar glucose determination every 30 minutes
  • three-day urine sample according to Zimnitsky ,
  • measurement of body temperature at three points: in both armpits and in the rectum,
  • electroencephalography .

Shown

  • purpose   MRI of the brain   (identification   increased intracranial pressure   and tumors)
  • the study of hormones ( testosterone, prolactin, cortisol, estradiol, LH FSH, TSH, T4 , adrenocorticotropic hormone and level  17-ketosteroids in the urine ),
  • Ultrasound of the adrenal and thyroid glands
  • MRI of adrenal glands or computed tomography.

Treatment of hypothalamic syndrome

Treatment of the hypothalamic syndrome is long-lasting, in most cases life-long. Therapy depends on the leading signs and causes of the hypothalamic syndrome.

An endocrinologist, a neurologist and a gynecologist (in women) are involved in treating patients with this disease.

The first stage of therapy includes the elimination of the causative factor: the appointment of antibiotic therapy or antiviral treatment, therapy of injuries, brain tumors, and so on.

In case of exposure to a poisonous factor hypothalamic syndrome is treated with detoxification therapy ( hemodez , sodium thiosulfate, glucose, saline intravenously).

Fortifying therapy, vitamins of group B, the means improving brain blood circulation (cavinton, piracetam, cerebrolysin ), amino acids (glycine, actovegin ), calcium preparations are recommended. The treatment complex includes physiotherapy, physiotherapy, reflexology (acupuncture).

In order to prevent sympathoadrenal krizov appointed Bellataminalum, pirroksan, Grandaxinum, antidepressants (amitriptyline).

When neuroendocrine disorders (violation of lipid and carbohydrate metabolism), it is recommended to follow a diet that stimulates or inhibits hormonal drugs ( adrenocorticotropic hormone – ACTH and glucocorticoids: prednisone, dexamethasone ).

Forecast

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The prognosis for this disease is relatively favorable.

However, as a rule, the hypothalamic syndrome leads to a decrease in working ability. Such patients are assigned the 3rd, rarely 2nd group of disability. They are contraindicated for work at night, physical and mental stress.

Hypothalamic pubertal syndrome passes to 20-25 years with correct correction.

Hyperprolactinemia

Epidemiology

Classification of hyperprolactinemia

Causes and risk factors

Symptomatology

Diagnostics

Treatment

Prognosis and prevention

Hyperprolactinemia – a disease and syndrome associated with a persistent increase in the rate prolactin in the blood plasma. It is characterized by infertility, decreased libido in women and potency in men, weight gain, galactorrhea and a number of other symptoms. Treatment, depending on the root cause, is carried out conservatively or promptly.

Epidemiology

Hyperprolactinemia associated with pathological causes occurs in about 17 people per 1000 population. Mostly affected women are in reproductive age. In the general adult population, the average incidence of the disease ranges from 0.15% to 1.5%.

It is important to remember that about 25-30% of married couples visiting the clinic for infertility will end up in a group where one of the spouses has hyperprolactinemia .

Among men who mark erectile dysfunction and are being examined for this reason, the disease is detected in 0.4-20% of cases.

In women suffering from menstrual disorders caused by prolonged irrational use of hormonal contraceptives, an excess of prolactin is determined in 40-60% of cases.

In about 50-70 cases per 1 million, a pituitary tumor secreting this hormone becomes the cause of the development of hyperprolactinemia. In total, prolactinomas account for about 25% of the total number of tumors found in the pituitary gland.

Classification of hyperprolactinemia

Hyperprolactinemia is divided into two large groups: physiological and pathological.

Physiological form is a variant of the norm and does not require medical intervention. The upward fluctuation of prolactin is quite natural, for example, during pregnancy, during breastfeeding. Also, a jump in the hormone index in the bloodstream is noted in a big way.

  • after sex,
  • after nipple stimulation (for example, when breastfeeding),
  • after physical exertion
  • stress also leads to a temporary increase in prolactin levels.

Pathological hyperprolactinemia needs correction under the supervision of a physician. She may be:

  • primary, developing on the background of micro- or macroadenomas of the pituitary gland or having an idiopathic (unknown) nature;
  • secondary, developing on the background of other diseases of the endocrine nature or somatic diseases;
  • iatrogenic, that is emerging on the background of the use of certain drugs (eg, oral contraceptives).

Causes and risk factors

Pathological hyperprolactinemia is a consequence of the influence of a number of reasons. Among the factors that can lead to disease, emit:

  • diseases that can disturb the balance in the hypothalamic-pituitary system, the pituitary gland: infections (eg, encephalitis, meningitis), injuries, tumor neoplasms;
  • endocrine diseases not directly related to pituitary lesion: primary hypothyroidism type, polycystic ovary syndrome, congenital adrenal hyperplasia type, etc .;
  • severe somatic diseases: traumatic injuries of the chest, cirrhotic liver damage, chronic renal failure;
  • use of certain drugs: calcium channel blockers, estrogens , verapamil , antidepressants, etc.

Among the factors predisposing to hyperprolactinemia are the same effects as among the causes.

It is important to remember that the overproduction of prolactin inevitably leads to a violation of the emissions of FSH, LH into the bloodstream. As a result, infertility develops.

Symptomatology

Prolactin rates differ in men and women:

  • adult (not pregnant) women – 64-395mIU / l, or from 4 to 27-29ng / ml;
  • adult males – 78-380mme / l or 3-18ng / ml.

In addition, the level of prolactin in women depends on the phase of the menstrual cycle:

  • follicular – 252-504 mme / l or 4.5-33ng / l;
  • before ovulation – 361-619mu / l or 5-42ng / l;
  • luteal – 299-612 mme / l or 4.9-40ng / l.

Symptoms of hyperprolactinemia in men and women differ.

Men Women
Reduced sexual desire, erectile dysfunction (occurs from 50 to 80%) Violation of menstrual function (from 85 to 90%)
Gynecomastia (from 6 to 23%) Infertility due to anovulatory cycles (from 95 to 98%)
Insufficient severity of secondary sexual characteristics (from 2 to 21%) Galactorea (70%)
Infertility on the background of oligospermia (from 3 to 15%) Hirsurtism (male pattern) (from 20 to 25%)
Galactorrhea (from 0.5 to 8%) Acne (from 20 to 25%)

In about 15% of cases in men, hyperprolactinemia is an accidental finding that is found during examination for other reasons.

In women, the main complaint of hyperprolactinemia is galactorrhea – the release of colostrum in the absence of lactation. It can be both mild (drops appear only when pressing on the mammary gland), and strongly pronounced (full-fledged release of milk).

Among other non-specific symptoms of hyperprolactinemia , with which patients rarely go to the doctor, blaming everything for other existing diseases or fatigue:

  • disorders of the sexual spectrum;
  • moderate or pronounced obesity;
  • headaches;
  • bouts of dizziness;
  • bradycardia (slow heartbeat);
  • hypotension;
  • emotional spectrum disorders, depressive states.

The main complication of hyperprolactinemia with which patients go to the doctor is infertility. However, if the cause of an increase in the level of prolactin is a pituitary tumor, over time, the patient may experience complaints of reduced vision, up to its complete loss.

Diagnostics

Laboratory diagnosis – the main diagnosis of hyperprolactinemia . The main criterion is the determination of the level of prolactin in the patient’s serum. For this a classic blood test is taken from a vein.

According to foreign clinical recommendations, it is possible to diagnose hyperprolactinemia if a single increase in the level of the hormone was detected in the blood serum, but only if the patient is not under stress during the blood collection procedure. According to the Russian recommendations for the diagnosis is recommended to detect at least a twofold increase in the level of prolactin.

Depending on the numbers to which prolactin levels have risen, you can make approximate conclusions about the origin of hyperprolactinemia:

  • more than 10,000 iU / l – pituitary macroadenoma ;
  • more than 5,000 iU / l – pituitary microadenoma ;
  • less than 2000 mU / l – non-tumor origin of hyperprolactinemia .

For the diagnosis of pituitary tumors used   MRI of the brain.

Features of differential diagnosis

In the differential diagnosis of hyperprolactinemia , especially if it is confirmed by the analysis of blood serum, difficulties are rarely encountered. The big difficulty is to establish the reason why the level of prolactin in the body has increased. Patients examined for hyperprolactinemia are advised to evaluate the function:

  • thyroid gland;
  • the liver;
  • the kidneys.

It is also necessary to exclude a pituitary tumor, pregnancy in women, taking medications that can lead to a persistent increase in the level of prolactin in the blood. Idiopathic hyperprolactinemia is diagnosed if all somatic diseases, diseases of the endocrine system and tumors that can provoke an increase in the level of prolactin are excluded.

Treatment

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Treatment of hyperprolactinemia is carried out both conservatively and promptly. The treatment is engaged in endocrinologist. The choice of method depends on the reason for the increase in prolactin level.

Conservative methods

Conservative therapy is the basis for the treatment of hyperprolactinemia . In terms of the pathogenesis of hormone- producing pituitary tumors, it is most advisable to use dopamine antagonists. On the territory of World use Cabergolin , Hinagolide , Bromocriptine . The question of reducing the dose or completely eliminating the drugs is raised only after a remission of at least 2 years is achieved. Dopamine antagonist drugs can be used not only in the treatment of patients with pituitary tumors. They are also used for idiopathic elevation.

The conservative methods can also include the correction of somatic diseases that can lead to an increase in the level of prolactin. If necessary, the treatment of the underlying disease, the tactics chosen by the doctor depending on the nature of the disease. Correction of prolactin levels in the absence of a tumor varies greatly depending on the cause. Recovery indicator can take from several weeks if the somatic disease was detected in the early stages, up to several years, if the cause is not established or is severely neglected.

Surgical treatment

Surgical treatment is required for patients suffering from a hormone-producing pituitary tumor resistant to dopamine antagonist drugs. Adenomectomy is performed through the nasal sinuses. If the tumor is large, instead of minimally invasive surgery, transcranial removal directly through the skull is preferred . The rehabilitation period, depending on the type of operation, varies from a month to a year.

In case of pituitary tumors, therapy may be supplemented with chemotherapy and radiation treatment.

Prognosis and prevention

The prognosis for hyperprolactinemia depends on many factors. First, it is worth considering the severity of the clinical picture. The brighter it is, the more prognostic this symptom is. Secondly, they rely on the nature of the disease. Hyperprolactinemia caused by somatic diseases has a good prognosis for the treatment of the underlying pathology. With an increase in the level of prolactin due to a tumor after surgical treatment, a relapse of the disease occurs in 25-50% of cases. The most unfavorable are prolactinomas with signs of malignancy .

Specific prophylaxis for hyperprolactinemia is not developed due to the large number of factors capable of causing it.

Gynecomastia

Kinds

The reasons

Gynecomastia Symptoms

Diagnostics

Gynecomastia treatment

Complications

Prevention and prognosis

Gynecomastia (translated from the Greek language – the female breast) is a benign increase in the mammary (breast) glands in men. The size of the formations in the chest may be in the range of 1-10 cm, but, as a rule, do not exceed 4 cm in diameter.

Kinds

There are physiological and pathological gynecomastia.

The first peak of physiological gynecomastia occurs in the neonatal period (60-80%) a few days after birth. This gynecomastia is associated with the circulation of maternal estrogen in the blood, and passes on its own, within 2-4 weeks.

The second peak of the disease occurs in adolescence (12-14 years) and is due to hormonal changes in the body. Adolescent gynecomastia disappears after 6-24 months without treatment.

And the third peak occurs in old age (in men 50-80 years old), it is associated with a decrease in testosterone levels and relative hyperestrogenemia (an increase in the content of female sex hormones).

Also distinguish between false and true gynecomastia.

The false form of the disease develops as a result of the proliferation of adipose tissue (for example, in obesity or overuse of beer).

True gynecomastia is the proliferation of glandular and stromal tissues. It can be affected as one mammary gland – one-sided gynecomastia, and both – bilateral gynecomastia. In adolescents, bilateral form is more common.

The reasons

The causes of gynecomastia are quite numerous. First of all, true gynecomastia is associated with hormonal imbalance (the predominance of estrogen and / or androgen deficiency):

  • congenital hypogonadism (hypoplasia of the testes);
  • toxic, radiation or infection of the testes;
  • a testicular tumor that produces estrogens;
  • adrenal tumor (increased estrogen synthesis);
  • dysfunction of the hypothalamus (part of the brain responsible for the formation of hormones);
  • genetic diseases (Klinefelter syndrome);
  • hyperfunction of the thyroid gland (thyrotoxicosis);
  • liver diseases (cirrhosis) in which estrogens are not destroyed;
  • choriocarcinoma (a malignant tumor that synthesizes a pregnancy hormone – hCG);
  • in male athletes with a sharp cessation of physical exertion;
  • hyperprolactinemia;
  • malnutrition or hunger;
  • renal failure;
  • HIV infection (is the cause of hyperprolactinemia).

In addition, gynecomastia can be a side effect when taking the following medications:

  • spironolactone;
  • calcium channel blockers (corinfar, verapamil);
  • antihypertensive drugs (capoten, Enap);
  • antibiotics and antifungal agents (metronidazole, ketoconazole);
  • hormonal drugs in the treatment of prostate cancer;
  • drugs and alcohol;
  • cytostatics (methotrexate);
  • antidepressants and tranquilizers (Relanium).

Gynecomastia Symptoms

The following clinical picture is characteristic of gynecomastia:

the mammary gland or glands increase in size, mobile elastic formations and tenderness of the mammary glands are determined by palpation,

patients often complain of a feeling of fullness or heaviness in the chest, an increase in the nipples (swelling) and their increased sensitivity,

clear or turbid discharge from nipples.

During gynecomastia there are 3 stages:

  1. Developing (proliferating) stage – lasts about 4 months. When prescribing treatment, the mammary glands return to their original size.
  2. Intermediate stage – lasts from 4 to 12 months. At this time, maturation of breast tissue occurs, and the mammary glands practically do not return to their previous size.
  3. Fibrous stage – characterized by the appearance of mature connective tissue in the mammary gland, and the formation of fatty deposits around the glandular tissue. The fibrous stage is irreversible.

Diagnostics

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In the diagnosis of gynecomastia ultrasound of the mammary glands, axillary lymph nodes, as well as mammography and needle biopsy are used.

In addition, laboratory diagnostics are carried out, the level of hormones (testosterone, estradiol, thyroid stimulating hormone TSH, prolactin, hCG, luteinizing (LH) and follicle stimulating (FSH) hormone) is determined.

If a testicular tumor is suspected, an ultrasound of the testicles is done, and if an adrenal tumor is suspected, a CT scan is performed.

Often, patients need the advice of a surgeon, urologist, endocrinologist and therapist.

Gynecomastia treatment

Gynecomastia treatment is carried out by breast oncologists and endocrinologists.

The first step is to establish and eliminate the cause that led to the disease. Depending on the etiology of gynecomastia, the terms of treatment also differ (sometimes they reach several months). When taking drugs, a side effect of which was gynecomastia, it is enough to cancel or reduce the dose.

During the first six months of the development of the disease prefer to watch. If an independent regression of gynecomastia did not occur, conservative hormone therapy is prescribed:

  • testosterone (therapy of patients with low levels of this hormone, the elderly);
  • Clomiphene is an anti-estrogen used to stimulate ovulation in female infertility;
  • tamoxifen – estrogen receptor blocker (with severe disease and severe pain);
  • Danazol is a synthetic analogue of testosterone.

Surgical treatment is carried out in patients with suspected malignant process and with a pronounced cosmetic effect.

Mammoplasty involves the removal of breast tissue with the formation of a bed under the nipple in order to avoid zapadeniya.

Complications

The most terrible complication of gynecomastia is the malignancy (degeneration into cancer) of the tumor. In addition, emotional disorders and scarring of a long-existing tumor are not excluded.

Prevention and prognosis

The prognosis of gynecomastia in newborns and adolescents is favorable (the disease regresses itself). In other cases, the prognosis of the disease depends on the reasons that caused it and also remains favorable during surgical treatment.

Prevention of gynecomastia consists in maintaining a healthy lifestyle, careful selection of drugs that led to the development of the disease, as well as in the prevention of causes that can cause gynecomastia.

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