Hypothalamic disease
Introduction
Introduction to hypothalamic diseases Hypothalamic disease is a group of diseases caused by multiple causes of hypothalamic function, mainly characterized by endocrine dysfunction and autonomic dysfunction. The hypothalamus is both a high-level autonomic nervous system and a highly functional high-level endocrine center. The hypothalamus and pituitary functions, gonadal activity, thermoregulation, appetite control and water metabolism are closely related. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: precocious puberty hyperthyroidism amenorrhea
Cause
Causes of hypothalamic diseases
First, congenital
(a) Growth hormone deficiency (with or without other hormone deficiency).
(B) Luteinizing hormone (LH) and follicle stimulating hormone (FSH) deficiency.
(C) sexual naive - retinitis pigmentosa - sexual dysplasia syndrome (Laurence-Moon-BiedIe syndrome)
Second, the tumor
(1) Hypothalamic craniopharyngioma, pineal tumor, meningioma, optic glioma, and other internal tumors.
(B) the pituitary on the tumor.
Third, infection with encephalitis, tuberculosis, syphilis.
Fourth, granuloma
Sarcoidosis, Hand-Schuller-Christian disease, eosinophilic granuloma, multisystemic granuloma.
V. Vascular lesions
Postpartum pituitary dysfunction, carotid or intracranial aneurysm, subarachnoid hemorrhage, pituitary apoplexy, cerebral arteriosclerosis, cerebral embolism, cerebral hemorrhage.
Sixth, mechanical oppression
Hydrocephalus for a variety of reasons.
Seven, iatrogenic
Radiation therapy, neurosurgery.
Eight, trauma
Traumatic brain injury.
Nine, functional
Neurological vomiting, polyphagia, anorexia, amenorrhea, impotence, hypothyroidism, and adrenal insufficiency.
Prevention
Hypothalamic disease prevention
Caused by congenital causes, such as growth hormone deficiency (with or without other hormone deficiency), luteinizing hormone (LH) and follicle stimulating hormone (FSH) deficiency and sexual naive-retinal retinitis - sexual dysplasia Laurence-Moon-BiedIe syndrome, taking alternative treatments to actively treat the primary disease.
For tumors and vascular lesions, such as craniopharyngioma, pineal tumor, meningiomas, optic glioma, saddle tumor; hypoplasia of the anterior pituitary, carotid or intracranial aneurysm, subarachnoid Bleeding, pituitary apoplexy, cerebral arteriosclerosis, cerebral hemorrhage, hydrocephalus of various causes, early detection and early treatment is the key.
Strive to prevent infection and craniocerebral trauma, avoid encephalitis, tuberculosis, syphilis.
Complication
Hypothalamic disease complications Complication , early maturing, hyperthyroidism, amenorrhea
Gonado, thyroid, adrenal gland and other endocrine gland hormone secretion disorders, triggering a series of corresponding clinical symptoms, such as growth and development disorders, sexual dysfunction or loss, immunity and emergency power decline.
Symptom
Hypothalamic disease symptoms Common symptoms Incompetent expression slow male precocious hair loss shedding thinning cyanial cortical dysfunction sleepiness bulimia directional disorder
First, endocrine dysfunction
(1) Insufficient secretion of pituitary hormones: It is more common in pituitary stalk injury approved by various reasons. When the pituitary stalk is blocked, any pituitary hormones other than PRL may be deficient or insufficient, and there are common diabetes insipidus and high Hypogoninism has hypogonadal function, in addition, it can cause hypothyroidism, adrenal insufficiency, and decreased growth hormone (GH) secretion. The basic and kinetic tests of pituitary hormones in this group of diseases are characterized by low secretion. Give a proper amount of released hormone to give a good response.
(2) excessive secretion of pituitary hormone: excessive secretion of CRH is the cause of Cushing: disease, excessive secretion of GHRH, leading to acromegaly, early secretion of excessive GnRH caused by pituitary gonadotropin (Gn Premature release can lead to precocious puberty, congenital cystic fibrosis syndrome (AIbright syndrome) can be combined with precocious puberty, increased secretion of TRH can cause hypothalamic hyperthyroidism.
(3) Hormone rhythm secretion disorder: The daily rhythm of ACTH secretion may disappear due to certain hypothalamic diseases and Cushing's syndrome; other hormones GH and PRL secreted by the rhythm and hormone LH secreted by the rhythm and FSH can lose the inherent rhythm of secretion due to hypothalamic diseases.
(D) abnormal puberty development: the disease in the posterior hypothalamus can eliminate the inhibition of Gn secretion from the pituitary, leading to adolescent precocious puberty, conversely, hypothalamic disease can also cause puberty delay.
Second, hypothalamic symptoms
(1) Obesity: The patient loses its function due to the loss of appetite and obesity due to the loss of function in the satiety center of the ventral nucleus. Obesity can be the outstanding and only manifestation of this disease. The body weight of obese patients can often continue to increase, causing this phenomenon. The reason is not clear.
Prade-WiIIi: Syndrome is due to hypothalamic dysfunction, significant obesity, polyphagia, diabetes, dull expression, hypogonadism and small hands and feet, in sexual naive-retinal retinitis - polycephalic deformity syndrome, obesity is also One of the prominent symptoms.
(2) Anorexia and weight loss: When the ventral lateral nuclear diet is damaged, it can cause anorexia and weight loss. In severe cases, it is dyscrasia, muscle weakness, hair loss, and severe dysfunction of the anterior pituitary.
(3) Abnormal sleep: 1 narcolepsy, the most common, each episode lasts for several minutes to several hours, it is difficult to resist, 2 deep sleep can last several days to several weeks, can wake up to eat, urinate, Then fell asleep, 3 episodes of bulimia bulimia, sustainable sleep for hours to days, waking up after bulimia, more obesity, 4 nights of intractable insomnia.
(D) body temperature regulation disorders: low body temperature and higher body temperature more common, hypothalamic hypothermia depends on the influence of environmental humidity, patients with cold lack of political party compensation mechanism, high body temperature is not effective for antipyretics.
(5) The regulation of water balance: the damage of the upper nucleus can cause diabetes insipidus. If the thirst center of the hypothalamus is involved, it can cause a decrease in fluid intake, which can lead to dehydration and an increase in serum sodium and chlorine. Corrected by supplementation with fluid and vasopressin.
Third, other
(1) Headache and visual field defects: more related to the nature of hypothalamic diseases, headaches and visual field defects caused by hypothalamic diseases are more than pituitary diseases.
(B) behavioral abnormalities: the hypothalamic ventrolateral nucleus and preoptic area lesions can produce behavioral and mental abnormalities, patients have more behavioral movements, and even sit still all day long, often accompanied by disorientation, moodiness, hallucinations.
(C) autonomic symptoms: sweating or less sweat, hand and foot cyanosis, pupil dilated or reduced, or both sides of different sizes, blood pressure is unstable.
Examine
Hypothalamic disease examination
Endocrine examination should routinely measure the function of the gonads, thyroid gland, adrenal gland and pituitary. If necessary, kinetic tests should be performed to determine the level of hypothalamic-pituitary-endocrine gland dysfunction.
X-ray cranial plain film, gas brain, cerebral angiography, head CT, magnetic resonance, cerebrospinal fluid biochemical assay, cytology and EEG can be used as appropriate.
Diagnosis
Diagnosis and diagnosis of hypothalamic diseases
There are many causes of hypothalamic diseases, and the performance is also diverse. Sometimes it is difficult to diagnose. It is necessary to consider the medical history in detail, combine various examinations, and carefully exclude the relevant diseases before considering the disease, and try to find out the cause.
Endocrine examination should routinely measure the function of the gonads, thyroid gland, adrenal gland and pituitary. If necessary, kinetic tests should be performed to determine the level of hypothalamic-pituitary-endocrine gland dysfunction.
X-ray cranial plain film, gas brain, cerebral angiography, head CT, magnetic resonance, cerebrospinal fluid biochemical determination, cytology and EEG can be used as appropriate to confirm the diagnosis and identify the cause.
Distinguish between various simple obesity, anorexia and weight loss, abnormal temperature regulation of sleep, and regulation of water balance.
