TRUELLYa — ZhYuNYo the SYNDROME
(N. A. Troell, the Swedish doctor; R. M of Junet, the Swiss therapist) — the clinical syndrome which is characterized by an acromegalia, a toxic craw (usually nodal), diffusion giperostozokhm bones of a calvaria and disturbances of carbohydrate metabolism. The syndrome was described independently from each other by Zhyune and Truell in 1938. T. —. by page it is found only in women.
Pathogeny of T. —. page it is not clear. Believe that the diffusion hyperostosis (see) bones of a skull is connected with increase in secretion of somatotropic hormone (see) and hormones of a thyroid gland (see Thyroxine, Triiodothyronine).
At T. —. pages are found a thickening of bones of a skull (their thickness reaches 15 — 20 mm), increase in the sizes of a front share of a hypophysis (see) or emergence in it eosinophilic adenoma, existence of a craw, as a rule, nodal and multinodal (see the Craw sporadic). The pancreas and, in particular, its insular device are usually not changed.
Complaints of patients to a headache, often constant and intensive, most often in occipital area, change of a shape of a face, increase in the sizes of a nose, superciliary arches, ears, language, extremities, irritability, sometimes weight loss, and also the thirst which is combined with a polyuria are characteristic. As a rule, at patients with T. —. villages note a xeroderma and mucous membranes. Body weight changes slightly, observe weight loss more often. Are characteristic decrease in tolerance to carbohydrates of most of patients or a diabetes mellitus (see a diabetes mellitus). Changes of a thyroid gland (see) are characterized by development of a toxic craw with typical a wedge, a picture (see the Craw diffusion toxic). Sometimes at patients with T. —. villages observe an amenorrhea (see) though this symptom is connected rather with a menopause (see) as in most cases of T. —. the page is found in women 45 years are more senior.
The diagnosis is based on a combination typical a wedge, signs and is confirmed by results rentgenol. researches of a skull (see the Acromegalia, radiodiagnosis of an acromegalia; The Hypophysis, radiodiagnosis), scannings (see) a thyroid gland with definition of its functional activity, and also researches of carbohydrate metabolism (see). Sometimes for specification of the diagnosis measure the content in blood of somatotropic hormone and thyroxine.
The differential diagnosis carry out with an acromegalia (see) and a syndrome of Morganyi (see Morganyi a syndrome).
Symptomatic treatment. As a rule, operation of a strumectomy (see the Craw diffusion toxic, surgical treatment) in connection with existence of a nodal craw and radiation therapy of adenoma of a hypophysis is necessary (see the Hypophysis, radiation therapy of tumors). In the presence of signs of the increased intracranial pressure (see) carry out dehydrational therapy (see).
The forecast for life at the corresponding treatment favorable.
Bibliography: Junet R. M of Histopatho-logie du squelette acromegalique et ses modifications sous l'influence de l'hyperthy-roidisme, Geneva, 1938; it, L’hype-rostose diffuse de la voute cranienne chez l’acromegaliqe hyperthyroidien syndrome de Troell — Junet, Ann. Endocr. * (Paris), t. 15, p. 461, 1954; Troell A. Concept of thyrotoxicosis, its pathologic, anatomy and therapy, Svenska LakT., v. 35, p. 131 1, 1938; it,
Thyreotoxiko-gen — einiges tiber Therapie, pathologische Anatomie und Krankheitsbegriff, Arch, klin. Chir., Bd 194, p. 347, 1939.
A. G. Mazowiecki.