Neurogenic hyperglycemia. Causes. Symptoms. Diagnostics. Treatment

Neurogenic hyperglycemia is manifested by an increase in the level of sugar in the blood. May be accompanied by a hyperglycemic coma. Hyperglycemia is usually accompanied by glucosuria. Patients often complain of thirst. Polydipsia, polyuria, itchy skin are detected.

Causes of neurogenic hyperglycemia. Neurogenic hyperglycemia, or "stress diabetes", can be caused by various factors leading to increased secretion of cortisol, glucagon, catecholamines, growth hormone, which contributes to the violation of secretion and the action of insulin. Acute changes in the regulatory hypothalamic-pituitary system are most often observed during periods of stress: hypothermia, general anesthesia, severe and extensive traumatic injuries, sepsis, extensive body burns, acute emotional stress. It can be observed with severe damage to the skull, thrombosis of cerebral vessels, encephalitis, thermal shock.

Pathogenesis of neurogenic hyperglycemia. At the heart of the pathological condition is a decrease in the level of insulin, an increase in the concentration of glucagon, catecholamines, cortisol, ACTH, growth hormone.

Decrease in insulin levels, as a rule, is the result of the previous increase in the level of contrinulsory hormones. The effect of increasing the glucose level in the blood should be called a multi-hormonal reaction. Hypothalamic control over carbohydrate metabolism is altered, which is mediated through vegetative (sympathetic activation) and neurohormonal links.

Differential diagnosis should be carried out with diabetes mellitus, hormonal disorders with excessive secretion of the contrinsular hormones within the syndrome and the Itenko-Cushing's disease, acromegaly, pheochromocytoma. Hyperglycemia can accompany a number of complex genetic syndromes, such as ataxia-telangiectasia, Laurence-Moon-Barde-Biddle syndrome, atrophic myotonia, Friedreich's ataxia, etc. Do not forget about the possibility of drug hyperglycemia in the use of potassium-releasing diuretics, counterinsulant hormones, psychotropic means.

Treatment of neurogenic hyperglycemia. An effective approach to the elimination of neurogenic hyperglycemia through the blockade of peripheral alpha-adrenergic receptors is considered effective. For this purpose, alpha-blockers are used - phentolamine, 0.025 grams 4 times a day, or pyrroxane 0.015 g 4 times a day. Both drugs increase insulin secretion, thus normalizing the blood sugar level. However, a specific therapeutic tactic is under development. Possible reception of various hypoglycemic agents.