Postkastratsionny syndrome

Description:

The Postkastratsionny syndrome develops after bilateral removal of ovaries and includes the vegeto-vascular, neuromental and exchange and endocrine disturbances caused by a gipoestrogeniya. The Postkastratsionny syndrome is called differently a syndrome of the surgical (induced) menopause. Frequency of a postkastratsionny syndrome varies from 55 to 100% depending on age of the patient by the time of operation, a premorbidal background, functional activity of adrenal glands. In general the frequency of a postkastratsionny syndrome makes 70-80%.

Symptoms of the Postkastratsionny syndrome:

The clinical picture of a postkastratsionny syndrome includes psychoemotional, neurovegetative, and also exchange and endocrine frustration.

Psychoemotional frustration can arise from the first days of the postoperative period. Manifestations are most expressed asthenic (37,5%) and depressive (40%), more rare happen phobic, paranoiac and hysterical. In formation of psychoemotional frustration play a role both hormonal changes, and a psikhotravmiruyushy situation in connection with perception of a hysterectomy as mutilating operation.

Vegetonevrotichesky disturbances form since 3-4 days after an ovariektomiya and are characterized by the mixed synpaticotonic and vagotomichesky manifestations with dominance of synpaticotonic activity. Thermal control is broken at 88% of patients and shown by heat inflows, a fever, feeling of crawling of goosebumps, there can be a bad portability of hot weather. At 45% of patients the sleep is interrupted, fear of the closed spaces is less often observed. Cardiovascular manifestations in the form of tachycardia, subjective complaints to heartbeat, gripping pains in heart and increase in systolic arterial pressure come to light at 40% of patients.

The clinical picture of a postkastratsionny syndrome is similar to that at a postgisterektomichesky syndrome, but, as a rule, more expressed and long. Involution of clinical manifestations without correction within a year occurs at 25% of patients, at patients of reproductive age is more often - in 70% of cases. It is explained by inversion of the main source of sex hormones which are adrenal glands.

Removal of ovaries during a hysterectomy causes exchange and endocrine and urogenital frustration which arise after psychoemotional and neurovegetative manifestations - in 1 year and more after operation and are most inherent to patients in a premenopauza. Gradually the frequency of obesity, a diabetes mellitus, ischemic heart disease, thrombophilia increases, the aterogennost index increases.

The hysterectomy is risk factor of an ischemic heart disease, at the same time the earlier operation is executed, the risk (by 1,5-2 times) is higher than emergence of an ischemic heart disease at young age. In the first months after operation atherogenous shifts in blood are observed: authentically the general cholesterol (by 20%), lipoproteids of low density increase (for 35%). After removal of ovaries the risk of development of a myocardial infarction increases by 2-3 times, cardiovascular diseases mortality increases.

Removal of a uterus is accompanied by higher risk of development of arterial hypertension as a result of decrease in level of the prostacyclins cosecreted by a uterus as vazodilatiruyushchy, hypotensive agents, endogenous inhibitors of aggregation of thrombocytes.

The hysterectomy promotes emergence of urogenital frustration (a dispareuniya, the dysuric phenomena, a colpitis, a prolapse) as because of hypooestrogenic exchange and trophic changes in fabrics, and because of disturbance of very tectonics of a pelvic bottom. In 3-5 years after removal of a uterus urogenital disorders of this or that expressiveness are observed at 20-50% of patients.

The hysterectomy with an adnexectomy of a uterus promotes acceleration and strengthening of processes of osteoporosis, after it annual average loss of mineral density of a bone tissue is higher, than in a natural menopause. Osteoporosis frequency at patients with a postkastratsionny syndrome is higher, than at their not operated coevals.

Allocate an easy, medium-weight and heavy pathological postkastratsionny syndrome. If necessary use additional diagnostic methods of psychoemotional, urogenital disturbances and osteoporosis.

Reasons of the Postkastratsionny syndrome:

At a postkastratsionny syndrome starting and pathogenetic a major factor is the gipoestrogeniya with plurality of manifestations inherent to it.

Disturbances in gipotalamo-pituitary area are followed by disadaptation of the subcrustal structures regulating cardial, vascular and temperature reactions of an organism as at deficit of estrogen synthesis of the neurotransmitters responsible for functioning of subcrustal structures decreases.

Substantial increase of the LG and FSG levels to corresponding to post-menopausal turns out to be consequence of decrease in level of sex hormones with cancellation of inhibin. Disorganization of adaptation processes can lead to increase in the TTG, AKTG levels. Long deficit of estrogen is reflected in a state estrogen - receptive fabrics, including urinogenital system - the atrophy of muscular and connecting tissue with decrease in amount of collagenic fibers accrues, vascularization of bodies decreases, the epithelium becomes thinner. The lack of sex hormones leads to gradual progressing of osteoporosis.

Treatment of the Postkastratsionny syndrome:

The main treatment of a postkastratsionny syndrome consists in purpose of drugs of replacement hormonal therapy. It can be begun for the 2-4th days after operation. Purpose of replacement hormonal therapy in the first days after operation prevents a postkastratsionny syndrome.

The choice of drug of replacement hormonal therapy for long reception depends on the volume of an operative measure, estimated duration of replacement hormonal therapy, a condition of mammary glands. Lack of a uterus allows to use monotherapy by estrogen, at a fibrous and cystous mastopathy use estrogen-gestagenov in the continuous mode is preferable.

To young patients (up to 40 years) which supposes prolonged use of drugs of replacement hormonal therapy, is better to appoint the combined drugs (ginodian-depot, diwine, фемостон, климонорм, a tsikloproginova, климен, трисиквенс), and if necessary the short course of monotherapy by estrogen is possible (эстродерм, a klimara, премарин, etc.). Parenteral administration (gels, plasters", intramuscular injections) excludes primary metabolism of hormones in a liver and therefore is more acceptable at long replacement hormonal therapy. Replacement of one drug by another is also possible.

To patients with the expressed psychoemotional manifestations in addition appoint tranquilizers and antidepressants in usual doses.

For prevention of metabolic disturbances along with estrogensoderzhashchy drugs of replacement hormonal therapy it is necessary to recommend a vitamin therapy course, reception of microelements. At detection of osteoporosis, in addition to replacement hormonal therapy, appoint pathogenetic therapy (calcium drugs, biphosphonates, a calcitonin, etc.). Long administration of drugs of replacement hormonal therapy with a postkastratsionny syndrome demands prevention of trombotichesky complications and observation by the mammologist from patients: mammography of 1 times in 2 years, ultrasonography of mammary glands and palpatorny survey each 6 months.

At contraindications to replacement hormonal therapy it is possible to appoint sedative drugs (a valerian, a motherwort, new Passitum, etc.), tranquilizers (Phenazepamum, Relanium, lorazepam, etc.), antidepressants (koaksit, аурорикс, Prozac, etc.), homeopathic medicines (климактоплан, климадинон, etc.).