Connective tissue dysplasia as a risk factor for adnexal torsion in adolescent girls

Abstract

the state of somatic and reproductive health of adolescent girls is an actual problem
 both throughout the world and in Ukraine. Connective tissue dysplasia, a group of congenital pathol-ogies of connective tissue with insufficient or abnormal development of collagen structures, which
 leads to disruption of the structure and functional disorders of various organs and tissues, was foundto be widespread among patients of the pubertal period. More often there are undifferentiated forms
 of connective tissue dysplasia, characterized by clinical polymorphism: pathology of the musculo-skeletal system, autonomic dysfunction syndrome, gynecological pathology, among which adnexal
 torsion attracts special attention, and more. The aim of the study was to explore the manifestations ofconnective tissue dysplasia and neurological disorders as risk factors for adnexal torsion, with the aimof improving the clinical and diagnostic approaches to the management of adolescent girls with thisgynecological pathology. Based on informed consent, inclusion and exclusion criteria, 42 adolescentgirls aged 14-17 years old with a history of adnexal torsion (the clinical group) and 30 healthy peers(the control group) took part in the study. To achieve the set goals, anthropometric, general clinical,echographic and radiological methods, the study of the neurological status were used. In the courseof the study, it was found that signs of connective tissue dysplasia were found in 16 (38.1%) of the
 examined adolescents of the clinical group and in 3 (10%) of the control groups (p<0.05). In particu-lar, scoliosis of the I-II degree was diagnosed in 14 (33.3%) adolescents of the clinical group, which
 was more than 3 times higher than the similar indicator in the control group - 3 (10%) (p<0.05). Inaddition, dolichostenomelia and arachnodactyly were observed in adolescents with connective tissuedysplasia, on average, 1.5 times more often. Flat feet was diagnosed 3 times more often in the clinicalgroup (in 13 patients (30.9%)) compared to the control group (in 3 patients (10%)) (p<0.05). At thesame time, some patients had a combination of several pathologies disorders of the musculoskeletal
 system. Thus, scoliosis and flat feet were simultaneously diagnosed in 9 (21.4%) adolescents of theclinical group and only in 2 (6.6%) adolescents in the control group (p<0.05). External developmentalanomalies in connective tissue dysplasia were quite often combined with developmental anomalies ofinternal organs: gallbladder kink was found in 5 (11.9%) patients, nephroptosis - in 2 (4.7%) patients,mitral valve prolapse - in 3 (7.1%) patients of the clinical group, which is associated with the same
 origin and laying of a number of systems in embryogenesis. The surveyed adolescents of the clini-cal group had complaints of an asthenic nature associated with autonomic imbalance, namely: rapid
 heartbeat - in 16 (38.1%), headache - in 12 (28.5%), poor tolerance of moderate physical activity - in7 (16.6%), increased fatigue - in 9 (21.4%) , sweating – in 7 (16.6%) patients. All adolescent girlswere prescribed complex treatment, taking into account the type of autonomic regulation, the severityof clinical and functional disorders that characterize autonomic dysfunction. Thus, as a result of thestudy, a high prevalence of undifferentiated forms of connective tissue dysplasia was established inpatients with a history of adnexal torsion and in most cases was accompanied by the development ofpathology of the musculoskeletal system, structural and functional disorders of the internal organs,and manifestations of autonomic dysfunction syndrome. Connective tissue dysplasia, as one of theestablished predictors of adnexal torsion, can act as an important prognostic marker and providean opportunity to prevent and timely diagnose the abdominal pain syndrome and its complicationscaused by this gynecological pathology.