Faces of shock. What you need to know about the drug dexamethasone

Relative infertility or the inability to conceive for certain reasons is caused by many factors, one of which may be an excess of male hormones in a woman’s body. For hyperandrogenism, drugs are prescribed that suppress their excessive number. Dexamethasone when planning pregnancy is one of these medications.

Dexamethasone when planning pregnancy

Dexamethasone is a hormonal drug that is often prescribed to women who are trying in vain to become pregnant. What kind of medicine is this? Many patients, reading the annotation for it, are horrified by the number of possible side effects and begin to look for additional information. Now they are worried about whether the prescription is justified in their case, whether it harms the body and the unborn baby (the drug is also prescribed to pregnant women), why does the instructions say nothing about taking it during pregnancy and preparing for it?

Indeed, among the numerous indications in the instructions for Dexamethasone, only one concerns bearing a child - eclampsia (toxicosis of the second half of pregnancy). Medical professionals say that, unfortunately, the instructions for Dexamethasone are outdated and do not describe its frequent use in endocrinology, gynecology and obstetrics. On the contrary, the instructions indicate that it is contraindicated during pregnancy, which misleads many, because in fact it is precisely during pregnancy that it is prescribed.

Dexamethasone is a synthetic analogue of adrenal hormones. It is he who has the power to restore the balance of his own kind in the human body. By interfering with disrupted hormone metabolism in the body, it reduces the formation of male sex hormones. Here we smoothly come to our main question. Hyperandrogenism is a phenomenon when an increased amount of male hormones (androgens) in a woman’s body often leads to infertility, and in the case of pregnancy, to the threat of failure or, in fact, to a miscarriage. The constant supply of Dexamethasone regulates the level of hormones in the body, and conception becomes possible. After a woman manages to become pregnant, the drug is not discontinued, but its dose is adjusted and continued for some time, and sometimes until childbirth. Experts say that you should not be afraid of possible complications, since when preparing for pregnancy, the dose of the drug is not large, but the hormonal disorders for which Dexamethasone is prescribed are much more dangerous than taking it. Keep in mind that all side effects of the drug are described for those cases when the patient takes 5-6 or more tablets per day. A dosage of ¼ tablet, which is usually prescribed during the planning or pregnancy stage, cannot in any way cause serious negative consequences.

To assess the level of androgens, a special analysis is performed - 17KS, the essence of which is the determination of 17 ketosteroids in the patient’s blood. If the level is elevated, then the doctor will prescribe Dexamethasone for successful conception.

If your doctor has prescribed this remedy for you, then you should know the following. Dexamethasone takes part in metabolism, including fat. The effect of the drug on fat metabolism is that the production of fatty acids in the body increases, cholesterol levels in the blood increase, and fat mass increases. Moreover, women begin to gain weight mainly in the upper part of the body. When reading these lines, you shouldn’t roll your eyes in horror and think about where to hide the recently purchased package of pills. Practice shows that many women do not experience weight fluctuations at all. A greater chance of increasing in volume exists among those who are genetically prone to being overweight.

It would also be useful to know that while taking Dexamethasone, the body needs additional amounts of potassium and calcium, since these substances are actively eliminated from the body, creating their deficiency.

Another effect of the drug is inhibition of the immune system. And since the production of active substances that protect the body is suspended, be prepared for exposure to infectious diseases.

Keep in mind that this medicine is prescribed ONLY by a doctor and only after performing the necessary tests! Unauthorized treatment with the drug is unacceptable! The doctor will prescribe the dosage and treatment regimen based on the test results and the individual characteristics of each individual patient.

It is very important to take Dexamethasone without missing a dose, and at exactly the same time. Medical professionals usually advise taking it early in the morning after a meal so that one of the side effects, a negative effect on the gastrointestinal tract, does not occur.

Dexamethasone when planning pregnancy

Infertility in women can be caused by a number of factors, including an excess of male hormones - hyperandrogenism. In this case, the doctor may prescribe dexamethasone when planning pregnancy , as well as during pregnancy. Unfortunately, the instructions for this synthetic drug are far from complete and are largely outdated, so patients are frightened by many side effects and a lack of information regarding indications for use.

Dexamethasone is a tablet that is prescribed during replacement therapy for insufficient secretion of hormones from the adrenal cortex.

This is a potent medicine that can have a serious effect on the hormonal levels of the expectant mother and fetus. It is taken only if there are significant health problems. Therefore, you can take dexamethasone strictly according to the instructions of your gynecologist and for a short course.

Negative reviews about dexamethasone found on the Internet are usually associated with the fact that women do not take the drug.

Rules of application

The level of required dosage is calculated by the attending physician strictly individually. At the beginning of the therapeutic course, Dexamethasone is usually prescribed in high dosages - 10-15 mg per day. For subsequent maintenance therapy (after achieving the desired effect), the volume of the drug is reduced to 3 mg per day.

• allergic reactions and asthmatic phenomena - 2 mg of medication for seven days;
• to normalize the functionality of the adrenal cortex with increased volumes of male hormones, 1.5 mg per 24 hours.

A woman is under strict medical supervision during pregnancy and during Dexamethasone therapy to avoid the development of negative reactions and possible overdoses. The drug has been used by official medicine for many years, and experts can easily determine the initial symptomatic manifestations of non-standard reactions of the body to the administration of the drug.

The development of negative reactions can be avoided with the correct dosage and constant monitoring of hormonal levels. The correct dosage regimen begins with the maximum amount with a gradual decrease in the positive effects of the therapy.

Signs of hyperandrogenism

Every woman's body produces a small amount of male hormones. Increased secretion of androgens leads to infertility or miscarriage due to external skin defects (acne), obesity, cycle disruptions, and male pattern hair growth.

The instructions for the medicine almost do not mention pregnancy and the preparatory stage (except for eclampsia or toxicosis in the later stages). However, doctors sometimes prescribe dexamethasone when planning pregnancy. In fact, the drug is indeed often used not only in endocrinology, but also in gynecology and obstetrics, if external signs (excessive hair growth, cycle disorders, acne) and a blood test for 17 ketosteroids show an excess of androgens.

Thus, dexamethasone is appropriate for the following conditions:

• infertility (lack of children during a year of active attempts to conceive) due to hyperandrogenism;

high risk of miscarriage, also associated with hormonal imbalance (this could be a miscarriage, frozen pregnancy);

• the risk of premature delivery due to the same reasons;
• threat to the life of the woman bearing the child (severe allergies, autoimmune pathologies, rejection reactions if the body perceives the fetus as hostile due to immunological failures).

Recommendations for use

Important! In each individual case, a doctor should give strict recommendations on the use of dexamethasone, but general information regarding the rules for taking this drug will help a woman navigate and avoid an overdose. At the planning stage, ¼ tablet per day is enough in the course prescribed by the doctor to get rid of hormonal disorders. Then you can continue taking the drug, but in an adjusted dosage.

In the later stages, it is enough to take dexamethasone for several days to prepare the baby’s lungs for premature birth. If you follow the instructions of your gynecologist, you don’t have to worry about side effects, and the benefits of taking the drug will significantly exceed the harm from those health problems that excess androgens can cause in a woman planning to conceive.

It is advisable to take the drug in the morning after meals at the same time to avoid gastrointestinal upset - the most likely side effect. If you notice other negative effects, stop taking it immediately.

It is forbidden to self-medicate and interrupt the course of therapy.

Effects of dexamethasone on the body

The effect of dexamethasone on the body is ambiguous. In moderate doses, this powerful hormonal drug promotes conception and intensively replenishes the lack of adrenal hormones, inhibiting the secretion of androgens. When the drug regimen is violated or its prescription is unjustified, health problems arise.

Dexamethasone to open baby's lungs

Dexamethasone is used during advanced pregnancy (28-37 weeks) to accelerate the maturation of the baby's lungs when there is a risk of premature birth. Typically, 2-3 days of use of glucocorticosteroids is enough for the maturation of the fetal lungs, and in the event of labor, the born child in most cases is capable of independent breathing. There are no negative consequences from short-term use of dexamethasone in a newborn baby. Very rarely, with long-term use during a long period of pregnancy, it is possible to develop atrophy of the adrenal cortex in a child, but this condition is corrected with special treatment.

You cannot do without the help of hormones even in difficult situations that threaten the life of a pregnant woman. Dexamethasone is used for acute allergic reactions, for example, anaphylactic shock or Quincke's edema, for severe shock of various etiologies, as well as for exacerbation of autoimmune diseases existing in a pregnant woman. These are quite rare cases.

The use of dexamethasone requires valid medical indications, both when planning pregnancy and during it, but in difficult situations this medicine is irreplaceable, as it performs the most important task of preserving the life of the future person!

Journalist, graduated from the school of medical journalism, collaborates with the Media Institute of Public Health. Specializes in the following topics: obstetrics, gynecology, reproductive medicine, urology, psychology

source

Operating principle

Dexamethasone belongs to the class of glucocorticosteroid hormones and was artificially created by chemists in the mid-20th century. It is a substitute for a natural steroid and is prescribed if the balance of adrenal hormones is disturbed. Among the reasons for this phenomenon are even benign or malignant tumors and hereditary predisposition.

It is not the high level of male sex hormones in itself that is dangerous, but the fact that it leads to other reproductive health problems:

• polycystic ovaries;
• miscarriage of an existing pregnancy;
• premature birth.

When planning pregnancy, dexamethasone is prescribed when it is necessary to correct the functioning of the adrenal cortex. In general, corticosteroids have many functions:

• anti-inflammatory;
• antiallergic;
• immune suppression;
• regulation of metabolism;
• anti-shock

and many others.

The issue of dexamethasone dosage should be decided only by gynecologists and endocrinologists. They should also determine the duration of taking the drug. As a rule, small doses are used for hyperandrogenism.

This steroid, entering the body, suppresses the increased production of adrenocorticotropic hormone by the adrenal glands. After all, it is metabolized into male sex hormones, of which there are too many. Thus, dexamethasone acts as a protective barrier and prevents the adrenal cortex from creating conditions that prevent the occurrence and development of normal pregnancy.

What is dexamethasone and how does it work?

This glucocorticosteroid hormone was first produced artificially in 1957. Dexamethasone is able to replace its natural analog produced by the body, so it is often prescribed for hormonal imbalance caused by disruption of the adrenal cortex. This deviation can be caused by hereditary factors and neoplasms.

Here are the dangers of exceeding the norm of male sex hormones in a woman’s body:

1. During pregnancy, premature or difficult labor may occur.
2. Miscarriage may occur.
3. Numerous cysts may appear in the ovaries (polycystic ovary syndrome).

A high level of male hormones in a woman’s body leads to infertility (impossibility of conception).

When planning pregnancy, dexamethasone is prescribed to normalize the functioning of the adrenal cortex, which is involved in the formation of hormones. In addition, this wonderful drug has other beneficial properties, namely:

• anti-allergenic;
• anti-inflammatory;
• immunosuppressive;
• anti-shock.

Dexamethasone can also be prescribed to regulate the metabolic process, to suppress the body's immune defense, and in many other treatment regimens. The use of this hormonal drug is quite widespread in medicine.

When planning a child

In gynecology for infertility, before prescribing the drug, it is necessary to clearly differentiate the reason for the increase in male sex hormones, in particular testosterone. After all, not only the adrenal glands produce the hormone, but also the ovaries and even adipose tissue in a certain dose. The task of doctors is to determine the source of excessive hormone synthesis.

In addition, it is important to identify whether testosterone enters the blood in free or bound form. The hormone in free form has a greater negative effect on the female body than when bound to certain proteins.

Although it is not entirely correct to call testosterone an enemy: although it is called male, women also need it in a certain amount. From it, female sex hormones are synthesized, so necessary for health, beauty and good mood.

Dexamethasone is prescribed to relieve conditions that prevent the onset and further development of pregnancy. With hyperandrogenism, one of the common phenomena is menstrual irregularities. Menstruation may be absent for a long time, irregular, and scanty. This is exactly how excess testosterone affects women. Accordingly, ovulatory function suffers, and conception becomes impossible under such conditions.

Another common manifestation of the disease is polystosis ovaries (PCOS). In this case, many small cysts filled with liquid form on their surface, and the egg cannot break through such a membrane and come out. With polycystic ovary syndrome on dexamethasone, the ovulation process is corrected quite quickly if this disease is the only cause of infertility. Doctors note a high pregnancy rate.

Effect on ovulation

The entire process of ovulation is controlled by a whole cocktail of substances that begin to be released at the appropriate time, their level constantly changes depending on the specific task. If one of the hormones is released in excess or insufficient quantities, it affects the others. As a result, the egg does not mature or it occurs at the wrong time. Or she cannot break through the barrier created by too high levels of male hormones.

Dexamethasone in this case is a temporary solution to the problem. It eliminates harmful factors and allows ovulation to take place. But it does not eliminate the cause of adrenal cortex dysfunction.

Tolerance and contraindications

Like any hormone, dexamethasone has a general effect on the body. This often means that along with the benefits of the pills, there may also be harm:

1. Increase in blood cholesterol levels and body weight. Moreover, fat accumulates on the arms and shoulders, torso and face. This steroid is actively involved in fat metabolism, so as its amount increases in the body, lipids will also increase.
2. Reduced protective properties of the body. Dexamethasone is known to have an immunosuppressive effect. This is the basis of his fight against autoimmune diseases. During use, an increase in the number of colds is possible.
3. Reducing the content of potassium and calcium ions. You may need to take additional supplements of these minerals on your doctor's advice.
4. As glucose levels increase, it is important to monitor your diet and avoid consuming excess sugars and starch from food.
5. Nervousness, mood swings, anxiety.
6. Increased blood pressure. You should be attentive to the work of the heart.
7. Phenomena from the digestive system: nausea, pain.

In the case of infertility correction, the dosage of dexamethasone is chosen to be very small; as a rule, it does not cause noticeable consequences for the body. This drug is used in situations where the harm from its absence is even greater than the possible side effects.

Contraindications and side effects

Dexamethasone is not suitable for everyone. In some cases, some complications and side effects may develop:

1. Decreased immunity . This property of dexamethasone is even useful in some diseases. For example, this hormone is used in the treatment of autoimmune diseases. A dangerous consequence of decreased immunity is the body’s greater susceptibility to the negative effects of viruses and bacteria. In a simple way, you can easily catch a cold, since the body’s immune defense will be suppressed.
2. Sudden mood swings , nervousness and anxiety.
3. Increased cholesterol. This steroid hormone is also involved in the process of fat metabolism. Therefore, with prolonged use of dexamethasone, weight gain is possible. Moreover, adipose tissue will grow in certain areas of the body (shoulders, face, torso and arms).
4. Increased blood pressure. This dangerous complication requires an immediate physician decision on the need to continue dexamethasone therapy.
5. Increased blood sugar levels . Too much sugar can lead to various diseases. Therefore, when treating with dexamethasone, you need to adhere to a diet and control the amount of sweets in your diet.
6. Nausea (sometimes vomiting).
7. Abdominal pain.
8. Decreased calcium in the body . To prevent such a complication, an additional vitamin and mineral complex of drugs is prescribed. A decrease in calcium in the body leads to weakness and fragility of bone tissue.

When treating infertility, the dose of dexamethasone should be small.
A small dose of this hormone is almost impossible to lead to the development of the complications described above. The main thing for the patient is to follow the prescribed dose and course of treatment. The drug should be taken at the same time (after meals) to achieve the maximum therapeutic effect. This way you can avoid nausea.

If you follow all the doctor's instructions, dexamethasone will be tolerated easily and without complications.

Should I continue taking it if I become pregnant?

If pregnancy occurs, the doctor usually recommends continuing to take dexamethasone. The duration of the course will be determined only by the doctor based on clinical manifestations and tests. Since one of the consequences of hyperandrogenism is the danger of early birth with immature fetal lungs, in some cases dexamethasone is prescribed until the end of pregnancy or the course must be repeated at a certain period within several days. This drug will allow the child's lungs to mature.

The duration of the course of dexamethasone is also determined by the gender of the unborn child. If there is a female fetus in the uterus, then the course is smoothly completed. If the mother has a son, the doctor may decide to continue the course in order to protect the pregnancy from testosterone, which additionally enters the mother’s bloodstream from the boy.

Dexamethasone when planning pregnancy

Dexamethasone when planning pregnancy is a hormonal tablet drug that is effective for infertility caused by hyperandrogenism. An excess of male hormones in a woman’s body leads to male-pattern hair growth, obesity, acne, menstrual irregularities, infertility, and early termination of pregnancy. A synthetic medicine is prescribed to restore the balance of adrenal hormones that suppress the hypersecretion of androgens.

Dexamethasone is indicated both during planning and after conception in small doses, strictly determined by the doctor. However, reviews of it are mixed, since the instructions for the tablets list many side effects, and, according to experts, they are far from complete and do not include many indications for the use of the drug for endocrine and gynecological disorders.

After conception has taken place, the drug is not discontinued, but is continued to be taken at an adjusted dose for some time, sometimes until childbirth.

Reasons for prescribing for pregnant women

A strong hormonal agent is used quite often in gynecology. There must be serious reasons to use it:

1. Possible development of spontaneous birth before the scheduled date - the drug accelerates the maturation of the baby’s pulmonary system. The need is associated with the insufficiency of the fetal pulmonary system - until the 36th week the lungs are not capable of independent functionality. If the baby is likely to be born prematurely, the specialist prescribes the drug as a safety net.
2. Hyperplasia or enlargement of the adrenal cortex - the drug is prescribed for the entire period of gestation to suppress the growth of unwanted cells and control their numbers. A parallel property of the medication is to enhance the ability of the pregnant woman’s body to resist pathogenic microflora that penetrates it.
3. Development of a pathological type of antibodies causing autoimmune diseases. Excessive activity of the immune system is expressed in attempts to reject the fetus - the body perceives the baby as a foreign object and enters into a fight with it. The pharmacological agent suppresses the unstable functioning of the immune system, reducing the risk of spontaneous abortion. The pattern of the disorder is similar to the development of erystoblastosis - incompatibility of the group and Rh factor in the blood of the mother and fetus.
4. A sharp change in the general hormonal background with a predominance of male hormones - in most cases, the disease is a congenital form. The drug helps maintain hormone levels at a certain value, preventing a miscarriage from occurring.

Indications for use

1. Infertility and the risk of early pregnancy loss

The indication for the use of this drug is hyperandrogenism and associated infertility, as well as the risk of miscarriage, frozen pregnancy and other pathologies in the early stages of gestation. To assess the likelihood of successful conception, the doctor prescribes a special test, with the help of which 17 ketosteroids are determined in the patient’s blood. If elevated androgen levels are detected, the woman is prescribed Dexamethasone. But you cannot take it uncontrollably without taking tests for steroid hormones and without consulting with an experienced specialist. Like any other hormonal drug, Dexamethasone in doses exceeding the norm greatly affects the hormonal levels of the woman and fetus, so it is prescribed only in particularly difficult cases when non-hormonal drugs are powerless. If you take the medicine no more than a quarter of a tablet per day, you don’t have to worry about side effects.

2. Probability of premature birth

Dexamethasone is also taken in later stages (at 28-37 weeks) to open the baby’s lungs if there is a risk of premature birth. But you don’t need to take the medicine for long – 3 days is enough.

3. Threat to the life of a pregnant woman

In rare cases, the drug is prescribed to the expectant mother if there is a threat to her life due to a severe allergic reaction (Quincke's edema, anaphylactic and shocks of other etiologies), autoimmune diseases, fetal rejection due to malfunctions of the immune system.

Effect of the drug on body functions

Dexamethasone normalizes hormonal levels, as a result of which the egg matures on time and ovulation occurs. At the time of conception, the endometrium reaches the required thickness, thus creating favorable conditions for fertilization and consolidation of the fertilized egg.

Dexamethasone affects metabolism, in particular, it increases the production of fatty acids. As a result, cholesterol increases and fat mass increases. Moreover, a woman’s upper body gains weight primarily. But fluctuations in body weight are not observed in all patients. Those who have a genetic tendency to gain weight are more susceptible to such changes.

It is worth considering that taking Dexamethasone leads to the leaching of potassium and calcium, so the deficiency of these elements should be compensated.

Also, the effect of the drug is manifested in inhibition of the function of the immune system, so the body becomes susceptible to infectious diseases.

Admission rules

The dosage and treatment regimen are prescribed individually, based on test results and the characteristics of the individual patient’s body. It is very important to strictly adhere to the indicated time for taking Dexamethasone. Experts usually recommend taking the tablet with water early in the morning after breakfast to avoid the most likely side effect - negative effects on the gastrointestinal tract.

Reviews from women indicate that Dexamethasone generally has a beneficial effect on the possibility of conception and the course of pregnancy. Many mothers were able to get pregnant and carry a healthy baby to term by taking pills prescribed by their gynecologist. Even patients with one or two unsuccessful pregnancies or infertility, having started taking Dexamethasone, conceived at the next ovulation.

According to reviews, the hormonal drug helps with anembryonia, missed abortion, a history of miscarriages and other problems with pregnancy associated with hormonal imbalance.

Usually, when a woman manages to become pregnant with the help of Dexamethasone, the doctor advises taking it in small doses and in the early stages of pregnancy, if there are no side effects.

Reasons for negative reviews

Naturally, there are also mixed reviews about Dexamethasone. Some visitors to women's forums associate their problems with pregnancy (premature birth) and pathologies in the fetus with the use of Dexamethasone throughout pregnancy. At the same time, they confirm that it was possible to conceive with the help of this drug, but there were accompanying deviations that could also affect the course of the process. In this case, it should be noted that you cannot take hormonal medicine for so long. The maximum course of treatment is 7–10 days. Not a single gynecologist will recommend taking these hormone-containing pills for such a long course.

Side effects

Dexamethasone when planning pregnancy hypothetically has many side effects. But this is associated with uncontrolled or excessive use of the drug. A gynecologist will never prescribe a dose higher than necessary, so a woman should not voluntarily increase the daily dosage of the drug and change its dosage regimen in order to avoid negative reactions from the nervous, cardiovascular, digestive, endocrine systems, as well as problems with the eyes, skin and metabolism substances.

Side effects were observed in cases where the patient took 5-6 tablets per day. But during the period of planning pregnancy or bearing a child, a quarter of a tablet is usually prescribed, so serious negative consequences are excluded.

Dexamethasone is a powerful drug that helps when other medications do not produce the desired effect. But there is no need to be afraid of using Dexamethasone - with proper administration and monitoring of the patient’s condition, the likelihood of complications developing is minimal.

List of side effects

Read this list carefully, but not in order to stop taking the drug, but in order to notice the slightest negative changes in the body in time and avoid an overdose:

• signs of nervous system disorder (increased excitability or disorientation, insomnia, hallucinations, euphoria or, conversely, depression;
• various manifestations of allergies;
• high intracranial and intraocular pressure, migraine, dizziness;
• sudden fainting or loss of vision;
• glaucoma, eye infections;
• increased blood pressure;
• acne, dermatitis, increased sweating;
• heart failure, thrombosis, other pathologies in the functioning of the heart and blood vessels, flushing of the face;
• nausea, vomiting, insatiable appetite or decreased appetite, pancreatitis, hiccups;
• swelling, increased body weight, especially in the upper part of the body (more often in people predisposed to obesity);
• cycle failures;
• diabetes, Itsenko-Cushing syndrome;
• slow wound healing;
• striae;
• decreased immunity.

Tips for safe use

Dexamethasone when planning conception will not lead to dangerous consequences if the following rules are observed.

1. Take tablets in a safe dosage and only after testing for hormones.
2. Do not use expired medications.
3. Stop taking at the first sign of discomfort.
4. Take Dexamethasone regularly, always at the same time (in the morning after meals), and do not allow unauthorized breaks.
5. The drug has immunosuppressive properties, so beware of any infections, stay away from public places during seasonal epidemics of ARVI, strengthen the immune system with the help of vitamins (natural and synthetic), immunomodulators.
6. Try not to eat fatty or fried foods, reduce your consumption of flour products, so as not to gain excess weight, and avoid increasing cholesterol.
7. Because Dexamethasone removes potassium and calcium from the body, replace it regularly with food.
8. Once conception has taken place, the doctor may also recommend taking Dexamethasone to maintain the pregnancy, and sometimes the drug is prescribed in the last trimester. In such cases, it is important to strictly adhere to the specialist’s recommendations and under no circumstances increase the daily dose.

Contraindications

The only absolute contraindication to the use of Dexamethasone is allergies.

Relative contraindications to the use of Dexamethasone:

1. Viral, bacterial or fungal infections in the active phase.
2. Conditions accompanied by immunodeficiency.
3. Conducted or planned vaccination.
4. Since Dexamethasone promotes the removal of calcium from the body, it should not be used for osteoporosis.
5. Ulcerative processes of the digestive organs.
6. Hypertension, heart failure.
7. An increase in blood glucose levels under the influence of Dexamethasone requires constant monitoring of the patient's condition in the presence of diabetes mellitus.
8. High degree of obesity.
9. Convulsive states.
10. Disorders of the functions of the hypothalamic-pituitary-adrenal system at any level.
11. Open-angle form of glaucoma.