POSTKASTRATSIONNY SYNDROME (Latin post after + castratio castration; syndrome; synonym kastratsionny syndrome) — the symptom complex which is developing after the termination of endocrine function of testicles at men and ovaries at women in the reproductive period and characterized by specific exchange and endocrine, psychological and other disturbances. The syndrome caused by the termination of endocrine function of gonads (or their hypofunction) in the dopubertatny period, carries the name eunuchoidism (see).
The Postkastratsionny syndrome at men
the Postkastratsionny syndrome at men is result traumatic, operational or beam castrations (see), and also destructions of testicular fabric owing to acute and hron, infectious diseases.
P.'s pathogeny of page at men is caused by dysfunctions of hypothalamic, endocrine and neurovegetative regulatory systems (see. Autonomic nervous system , Gipotalamo-gipofizarnaya system ) in response to sudden loss of endocrine function of testicles.
Patofiziol, disturbances at P. pages are characterized by the sharp tension of systems hypothalamus (see), activating gonadotropic function hypophysis (see), the main result of it is the increased allocation gonadotropic hormones (see). Other systems of hypothalamic regulation, and first of all are involved in process sympathoadrenal system (see). Falloff of concentration androgens (see) in blood it is shown by a row specific endocrine obkhmennykh disturbances. Sexual desire at many men after castration remains for a long time. Sometimes there is even an ability to sexual intercourse owing to preservation of the corresponding mechanisms in c. N of page.
The phenomena of a demaskulinization of a phenotype belong to the pathoanatomical changes caused by castration: change of character of pilosis, reduction of volume of muscles, redistribution of adiposities in hypodermic cellulose on eunuchoid type, progressing of obesity owing to loss of anabolic and zhiromobilizuyushchy action of androgens. Development of osteoporosis of various localization is observed. The thyroid gland in the postkastratsionny period decreases, fabric of pancreatic islands (islets of Langerhans) increases, note acceleration of regressive processes in a pinus (an epiphysis of a brain).
To the earliest a wedge, to P.'s manifestations by the village vegetovascular disturbances belong. Patients complain of «inflows» (the sudden feeling of heat which is often followed by face reddening), the increased perspiration, feeling of shortage of air, an asthma, sometimes a fever, paresthesias, dizzinesses, a heart consciousness at normal pulse. Quite often tranzitorny hypertensia comes to light.
Later a wedge, P.'s manifestations by the village are connected with development of a number of disbolism. Patients complain of physical weakness, decrease in working capacity, weakening of a muscle tone. Obesity with a typical adiposity in hypodermic cellulose on hips and in hypogastric area develops (in a hypogastrium). Skin becomes secretion of sebaceous glands, thin, dry and wrinkled because of decrease, and oppression of anabolic processes in connecting fabric. Ostealgias, especially in tubular appear from behind osteoporosis. Neurotic manifestations (irritability, sleep disorders, phobias) note pages, specific to P. When castration is made at late age, P. is shown by page not so clearly, metabolic and vegetovascular disturbances are less expressed.
P.'s diagnosis of page at men is made on the basis of the characteristic symptoms given the anamnesis taking into account emergence.
The main method of treatment of P. of page at men is replacement therapy by androgens. Treatment by drugs of sex hormones of the prolonged action — sustanony, Testoenatum, etc. is most extended; drugs of short-term action and peroral drugs (methyltestosterone, Testobromlecithum) are less effective. Duration and intensity of replacement therapy by androgens depend on expressiveness of manifestations of androgenic insufficiency and age of the patient. The main contraindication for an androgenotera-piya is the prostate cancer. There is a method of operational allotransplantation of testikul on a vascular leg which was still not widely used. The complex of treatment of P. of page depending on a wedge, symptoms includes treatment sedative, cardiovascular, hypotensive and others medicinal to means and.
P.'s forecast of page at men depends on specific features of the patient. In most cases it is possible to reduce vegetovascular and neurotic manifestations gradually. Endocrine and exchange disturbances at P. villages demand a long replaceable androgenoterapiya.
P.'s prevention by the village consists in the prevention and treatment inf. defeats of testicles (see. Orchitis ), and also in ensuring antiactinic protection on production, in X-ray departments, etc.
the Postkastratsionny syndrome at women
the Postkastratsionny syndrome at women is characterized by development defined a wedge, a symptom complex with vegetovascular, psychological and exchange and endocrine disturbances against the background of the termination of endocrine function ovaries (see) in the reproductive period. According to literature, P.'s development by page is observed in 60 — 80% of cases after operation of removal of ovaries. At every 4th woman after removal of ovaries observe a heavy current of P. of page with vegetovascular disturbances during 2 — 5, sometimes 5 — 10 years.
The pathogenetic mechanism P. of page at women can be explained with decrease in contents estrogen (see) in an organism owing to removal of ovaries or increase in secretion of gonadotropic hormones. At the same time there are data indicating that not at all women with such hormonal disturbances P. of page develops. It suggests that in P.'s formation by the village at women the large role is played by reaction of closed glands on caused by castration hypoestrogen-miyu. It is established that Glucocorticoid function of bark of adrenal glands at patients with a severe form of P. of page decreases and increases at improvement of a state. Studying of excretion catecholamines (see) showed relative increase in excretion adrenaline (see) at all women after castration that demonstrates moderate activation at them sympathoadrenal system. Development of a postkastratsionny syndrome is followed by increase in function of a thyroid gland and expansion of peripheral vessels, especially in distal departments of extremities.
Patofiziol, P.'s features of page at women after operational castration are characterized by a certain dependence between a wedge, P.'s current of page and the nature of the changes registered on electroencephalograms (EEG). At patients with an easy current of P. of page insignificant decrease in amplitude of the dominating alpha waves and emergence of slow waves like tet is usually observed. At patients with a long and heavy current of P. of page (more than 20 «inflows» a day) falloff of quantity of alpha waves is observed and the beta asset - nost therefore curve EEG takes a flat form that indicates sharp excitement of subcrustal structures of a brain and increase of the activating influence of a reticular formation of a mesencephalon on bark of a great brain increases; thus, in patol, process not only subcrustal educations, but also bark of a great brain are involved. Various extent of involvement in patol, process of subcrustal structures of a brain, according to EEG, is caused by premorbidal features of the women subjected to operational castration.
In the course of adaptation at women after castration Glucocorticoid function of cortical substance (bark) of adrenal glands increases, function of a thyroid gland decreases, the tone of peripheral vessels raises, the insignificant hypoglycemia develops at moderately and activation of sympathoadrenal system.
On roentgenograms of a skull of women from P. the village is possible to find changes of bones of a skull in the field of a dorsum sellae and back wedge-shaped shoots (the back inclined shoots, T.). Extent of these changes depends on weight and duration of a postkastratsionny syndrome.
Patients with an easy current of P. have a page and after rather recently made operation of castration thinning of a back wall of the Turkish saddle and an insignificant hyperostosis of back wedge-shaped shoots is observed. The expressed decalcification of the Turkish saddle is found in patients with a severe form of P. of page along with a hyperostosis of back wedge-shaped shoots.
On roentgenograms of bones of a calvaria from three after castration find a hyperostosis of an occipital bone in each two women. The considerable hyperostosis (thickness of an occipital bone of 14 mm and above at norm 8,2 ± 1,22 mm) is observed usually at patients, at to-rykh P. the page proceeds with the expressed diencephalic pathology, considerable obesity and a hypercholesterolemia.
P. is frequent the page at women is characterized by an atrophy of an epithelium of a mucous membrane of a vagina and uterus, reduction of the sizes of a uterus, small vulvar lips and a clitoris. At the expense of an atrophy of a ferruterous parenchyma mammary glands decrease (often visually they seem increased, however it is result of obesity).
The wedge, picture P. of page can be various depending on age of the patient, premorbidal features of the personality and the nature of compensatory reactions of an organism. The heavy current of a postkastratsionny syndrome is observed at patients with weakened by gipotalamo-pituitary and sympathoadrenal systems which are not capable to put the certain compensatory mechanisms necessary for normalization of a homeostasis in action.
P.'s symptom complex of page consists in emergence of vegetovascular disturbances («inflows» — feeling of heat, face reddening, perspiration; heartbeat, headaches, pains in heart, dizzinesses), paresthesias, psychological disturbances, exchange and endocrine disturbances (obesity, atherosclerosis, a hypercholesterolemia, osteoporosis), joint pains and extremities. These symptoms at P. of page can meet in various combinations and to be various intensity.
Very often in the postkastratsionny period the hypertension, and at the women operated after 45 years develops, it develops in 3 times more often than at women, the Crimea operation of castration was made up to 45 years.
The most constant and typical complaint at P. of page are «inflows». Therefore the frequency and intensity of «inflows» are conditionally considered as an indicator of expressiveness of P. of page. «Inflows» usually appear in 3 — 4 weeks after operation of removal of ovaries and usually reach the maximum expressiveness in 2 — 3 months after operation. They can be followed by perspiration, heartbeat, feeling of shortage of air, sensation of fear, sometimes subconscious state with spasms and dizziness. «Inflows» amplify at night, in hot season, at nervous excitement and after hot tea or coffee.
P.'s diagnosis of page usually comes easy, it is put on the basis of data of the anamnesis on operation of removal of ovaries and emergence approximately in 1 month after operation of «inflows».
It is reasonable to begin treatment of patients with a severe form of P. of page from first months after operation. It shall be directed to activation of compensatory reactions of an organism, normalization of a functional condition of the highest departments of a brain controlling reactions of adaptation of an organism.
Patients with P. of page (both to women, and men) should recommend physiotherapeutic treatment (see below), and also drugs of calcium and glutaminic to - you, drugs with tranquilizing action (Frenolonum, meprobamate, Seduxenum, Elenium, Valium, Tazepamum on 0,5 — 1 tablet 2 — 4 times a day within 1 — 2 month, injections of oryzamins, B6, S, PP and intramuscular introduction of 2% of solution of novocaine within 20 — 25 days.
In the absence of effect of the carried-out therapy women with P. of page should appoint on 1/4 — 1/2 tablets of Infecundinum or Bisecurinum during 1 week, then 1/4 tablets during the subsequent 2 weeks with a break in 2 weeks. Further breaks shall be increased to 3 — 4 weeks and more. The repeated course of treatment is recommended to be carried out only during the resuming of frequent «inflows». Use of synthetic progestins (see) in combination with tranquilizers and fortifying therapy strengthens therapeutic effect. The good effect can be gained at purpose of a premarin on 0,3 — 0,625 mg a day within 20 days with the subsequent use of any progestins (5 — 10 mg) or Pregninum (on 30 mg) daily within 6 — 8 days. At nek-ry patients good results are yielded by an electroanalgesia.
P.'s forecast of page at women depends on premorbidal features of patients, a condition of gipotalamo-pituitary and sympathoadrenal systems, age, in Krom castration was made. At sick therapy adequate to a state improvement of health occurs quickly enough.
Mental changes at a postkastratsionny syndrome
the Castration made at mature age at the persons which are psychologically prepared for need of an operative measure, especially at men can not cause mental changes which would affect working capacity or demanded the special help, but more often castration reproduces a picture of a climax (see. Menopausal syndrome ).
At P. by page at men psychological frustration — tearfulness, irritability, sleep disorders, a depression, the general weakness etc. — are connected not only with hypothalamic pathology and disturbances of exchange, but also with manifestation of a demaskulinization. Decrease or disappearance of erections and a sexual potentiality, reduction of pilosis, etc. provoke development of psychological manifestations. At women with P. psychological frustration (tearfulness, irritability, the general weakness, bystry fatigue, sleeplessness, a memory impairment) observe page more than at a half of patients. Idiosyncrasy of psychological frustration at women after removal of ovaries is development of the asthenic syndrome expressed in various degree.
At the women subjected to operation of removal of ovaries aged 45 years are younger, psychological frustration are noted more often and they proceed heavier.
In a wedge, a picture of mental changes at P. as page into the forefront psychogenic reactions — the reactive conditions of various depth caused by the fact and circumstances of castration can act. These states represent the depressive frustration sometimes arising periodically; such frustration are more rare are mixed alarming and depressive or depressive and hypochiondrial and depressive senestopatiche-skimi.
The picture of mental changes at P. of page can also reflect reaction of the personality to castration, to medical and social effects of castration (decrease in sexual desire, impossibility to have children, signs of a hirsutism at women etc.) because the intellectual sphere of patients remains in many cases rather safe.
Treatment of the mental deviations caused by castration, symptomatic. In these cases use antidepressants, small tranquilizers, hypnagogues. The psychotherapy against the background of the corresponding replacement hormonal therapy figures prominently.
The physical therapy at a postkastratsionny syndrome
by physiotherapeutic methods is recommended to begin Treatment as soon as possible, i.e. in the first months after castration. Patients with an easy current of P. of page for the purpose of stimulation of zashchitnoprisposobitelny reactions of an organism can apply therapy by microwaves of centimetric or decimeter range on area of adrenal glands. It is desirable to combine physical therapy with the all-tempering and tonic procedures: walks in the fresh air to lay down. gymnastics, balneotherapy (rubdown, washing or douche by cool water, rain shower or sulfur, pine, sagy, sea, hloridnonatriyevy baths).
The patient with a heavy current of P. of page treatment is carried out in two steps. At the first stage recommend all listed above procedures. At the second stage appoint galvanization (see) — endonasal, cervical and front, on collar area; novocaine - or magnesium electrophoresis on collar area (see. Electrophoresis, medicinal ) it is possible to combine with massage of this area, alternating on days or on the same day in 30 — 90 min. after an electrophoresis or in 2 — 3 hours before it.
At frequent, exhausting «inflows» use is recommended electrosleep (see), 10 — 12 procedures on a course (repetition of a course in 4 — 6 months), the central electroanalgesia across Persianinov — to Kayetrubin, the expressed therapeutic effect the cut allows to lower medicinal load of an organism of the patient. At a repeated course of treatment the balneoterapiya — oxygen, nitric, carbonic, pearl bathtubs is desirable. To women with P. of page 45 years are more senior radonic or iodine-bromine bathtubs are useful.
Dignity. - hens. treatment should be carried out in the conditions of the climatic zone usual for the patient.
Treatment by physical factors does not exclude simultaneous or consecutive (an independent course) use of hormonal drugs, and also psychotropic pharmaceuticals.
Bibliography: Vartapetov B. A. Postkastratsionnaya a disease and the neyrogor-monalny mechanism of its emergence» in book: Physiology and pathology of endocrine system, under the editorship of V. P. Komissaren-co, etc., page 85, Kharkiv, 1965; Gynecologic endocrinology, under the editorship of K. N. Zhmakin, page 436, M., 1980; Grollman A. Clinical endocrinology and its physiological bases, the lane with English, M., 1969; Dilman V. M. Aging, climax and cancer, L., 1968; To in and - E. I rubbed. Hormonal diagnosis and therapy in obstetrics of pi of gynecology, M., 1967; Manuylova I. A. Neuroendocrinal changes at switching off of function of ovaries, M., 1972; To Milk Sh. Therapy of endocrine diseases, the lane from Romanians., Bucharest, 1969; Rosen V. B. Fundamentals of endocrinology, M., 1980; The Guide to clinical endocrinology, under the editorship of V. G. Baranov, JI., 1977; Savchenko O. N. Hormones of an ovary and gonadotropic hormones, JI., 1967; Starkova H. T. Fundamentals of clinical andrology, M., 1973; Teter E. Hormonal disturbances at men and women, the lane with polsk., Warsaw, 1978; In 1 e u 1 e of M. of Endokrino-logische Psychiatrie, Stuttgart, 1954; Endocrine causes of menstrual disorders, Symposium on gynecologic endocrinology, ed. by T. R. Givens, Chicago, 1978; The menopause, guide to current research and practice, ed. by R. J. Beard, p. 86, a. o., Lancaster, 1976; Textbook of endocrinology, ed. by R. H. Williams, Philadelphia, 1974.
I. V. Golubeva, I. A. Manuylov (gin.); D. D. Orlovskaya (psikhiat.), I. F. Perfilyeva (hens.).