Cushing's Syndrome Amayambitsa Cortisol Yambiri
Cushing's syndrome ndi matenda omwe amapezeka pamene thupi limakhala ndi cortisol yambiri. Cortisol imapangidwa ndi thupi ndipo imagwiritsidwanso ntchito mu mankhwala a corticosteroid. Matenda a Cushing akhoza kuchitika chifukwa chakuti cortisol imadwalitsidwa ndi thupi kapena kugwiritsa ntchito mankhwala omwe ali ndi cortisol (monga prednisone). Pamene Cushing akudwala chifukwa chogwiritsidwa ntchito nthawi yaitali ndi mankhwala a corticosteroid, imatchedwanso hypercortisolism.
About Cortisol
Cortisol ndi hormone yaikulu ya thupi. Cortisol imabisidwa ndi adrenal glands chifukwa cha kutsekemera kwa adrenocorticotropic hormone (ACTH) ndi pituitary. Mtundu wina wa matenda a Cushing angayambe chifukwa cha kusokonezeka kwa ACTH ndi pituitary yomwe imatsogolera ku cortisol.
Cortisol imagwira ntchito zingapo, kuphatikizapo lamulo la kutupa ndi kulamulira mmene thupi limagwiritsira ntchito chakudya, mafuta, ndi mapuloteni. Corticosteroids monga prednisone, yomwe nthawi zambiri imagwiritsidwa ntchito pochizira matenda, imatsanzira zotsatira za cortisol.
Zifukwa za Cushing's Syndrome
Pali zifukwa zingapo zosiyana za matenda a Cushing.
Matenda a Cushing. Matenda a Cushing ndi amodzi omwe amachititsa matenda a Cushing omwe amapezeka pamene pituitary imatulutsa ACTH yochulukirapo, zomwe zimabweretsa kortisol yowonjezera. Izi zikhoza kuchitika chifukwa cha chotupa chopuma kapena kukula kwina.
Cash's Syndrome ya Iatrogenic. Kugwiritsa ntchito mankhwala owonjezera a mankhwala a steroid kwa nthawi yaitali kungayambitse mtundu uwu wa matenda a Cushing.
Mankhwala a steroid kapena corticosteroid mankhwala amagwiritsidwa ntchito pochita zinthu zambiri zotupa, kuphatikizapo mphumu, lupus, nyamakazi ya nyamakazi, ndi matenda opatsirana (IBD) . Nthaŵi zina, amalembedwa pa mlingo waukulu komanso kwa nthawi yaitali.
Matenda Achimuna Amtundu. Pomaliza, chifukwa china, ngakhale chosazolowereka, chimayambidwa mwachindunji ndi chotupa pa gland adrenal.
Mitundu imeneyi imayambitsa cortisol, yopanda mphamvu ya ACTH kuchokera kumtundu wa pituitary. Pamene chotupacho chili mu adrenal imodzi chabe, cortisol yochulukirapo yowonjezera ingayambitse kuti adrenal gland isayambe kuphulika ndi kuchepa.
Zizindikiro za Cushing's Syndrome
Zizindikiro za matenda a Cushing angaphatikizepo zotsatirazi:
- ziphuphu
- Buffalo hump (mafuta owonjezera omwe amatsatiridwa kumbuyo kwa khosi)
- miyeso yapamwamba ya shuga
- ludzu lalikulu
- kutopa
- kuwonjezeka kwambili
- mutu
- kuthamanga kwa magazi
- hirsutism (kukula kwakukulu kwa tsitsi)
- kusintha kwa msambo
- kunenepa kwambiri kuzungulira thunthu
- malingaliro a maganizo monga kusasinthasintha, kusokonezeka, nkhawa, mantha
- kuzungulira, nkhope yonse (yotchedwa mwezi nkhope)
- khungu amasintha
- kutambasula pamimba, mikono, mabere, matako, ndi ntchafu (yotchedwanso striae)
- kufooka
Pakhoza kukhala zizindikilo zina za chikhalidwe ichi chomwe sichimaperekedwa pamwambapa. Ndikofunika kuwona dokotala ali ndi nkhaŵa zirizonse za zizindikiro za matenda a Cushing.
Kuzindikira kwa Cushing's Syndrome
Pali zochitika zosiyana, monga mwezi wapakati ndi njuchi, zomwe zimakhala pakati pa anthu omwe ali ndi matenda a Cushing. Ngati dokotala akukayikira Cushing, pambuyo pa mbiri yakale, kuyezetsa thupi, ndi ntchito yamagazi, adzayesa kuyesa magazi ndi mkodzo kuti aone kuchuluka kwa cortisol yomwe ilipo m'thupi.
Ngati masitepewa ali pamwamba, dokotala akhoza kulamula mayeso omwe amatchedwa test dexamethasone. Izi ndi mayeso pamene steroid ya m'kamwa yotchedwa dexamethasone imaperekedwa ndipo mayeso a magazi ndi mkodzo amachotsedwa kachiwiri kuti ayese kortisol ndi ma hormonal ena. Mayesero ambiri akhoza kulamulidwa ngati mayesero oyambirirawa abwereranso ndi zotsatira zomwe zikusonyeza kuti matenda a Cushing angakhale odetsa nkhawa.
Dokotala akhoza kupita ku njira yoyezetsa yowonjezereka ngati kuyang'ana koyamba kumasonyeza kuti izi ndi zofunika. Ngati chikuwoneka kuti ndicho chifukwa cha Cushing's, mayesero ena omwe angapangidwe akuphatikizapo CT scan kapena MRI .
Pamene kuyesedwa kungawoneke ngati ntchito yambiri kapena zosokoneza, nkofunika kutsatira ndikukwaniritsa mayeso onse omwe adokotala amamuuza.
Chithandizo cha Cushing's Syndrome
Matenda a Cushing ndi othandizidwa kwambiri pozindikira chomwe chikupangitsa kuchuluka kwa cortisol ndikuchichotsa.
Matenda a Cushing. Kuchita opaleshoni kawirikawiri ndi njira yoyamba yothandizira odwala matenda a Cushing. Kuchotsa chotupacho komanso nthawi zina zonsezi, kudzera mu njira yotchedwa transsphenoidal resection (kumbuyo kwa mphuno) ndi kafukufuku wamatenda nthawi zambiri amafunikira. Ngati nthenda yonseyo iyenera kuchotsedwa, zowonjezerapo za cortisol, chithokomiro, ndi mahomoni ogonana ayenera kuperekedwa. Ngati opaleshoni ikutsutsana kapena chotupa sichingachotsedwe, mankhwalawa akhoza kugwiritsidwa ntchito kuchepetsa chotupacho. Ngati chotupacho chikupezeka kuti chiri ndi mankhwala oopsa , chemotherapy kapena radiation angapangidwe kuti athe kuchepetsa chiopsezo chobwezera. Pali mankhwala ochiritsira omwe angapezeke pochiza matenda a Cushing, kuphatikizapo Pasireotide (Signifor) ndi Mifepristone (Korlym).
Matenda a Iatrogenic Cushing. Ngati matendawa akuyambitsa mankhwala, ndi bwino kuyamba kumwa mankhwala, kuyang'aniridwa ndi dokotala, kuchotsa steroid yowonjezera. Ndikofunika kuti pang'onopang'ono kuchepetsa kuchuluka kwa corticosteroid kumatenga masabata kapena miyezi. Mankhwala osiyana kapena mlingo angapezedwe kukhala chithandizo choyenera kwambiri kwa vutoli. Ndikofunika kutsatira malangizo mwatchutchutchu, monga momwe steroid sizingatheke mosayembekezereka, koma iyenera kuti ikhale yochepa.
Ngati ma steroid sangathe kuimitsidwa, kapena ngati atenga nthawi yaitali kuti awaletse, mankhwala ena angaperekedwe kuti athetse zizindikiro zina za matenda a Cushing. Zina mwa zinthu za matendawa zomwe zingafunikire chithandizo ndi mankhwala ena ndi kusintha kwa zakudya zikuphatikiza shuga wamagazi komanso cholesterol. Kuchepetsa chiopsezo cha zophulika ndi mankhwala omwe amachiza matenda a mitsempha kungakhale kofunikira. Pankhani ya kupanikizika kapena nkhawa, kutumiza kwa katswiri wa zaumoyo kuchipatala kungakhale kothandiza.
Chidziwitso Chochokera
Pankhani ya matenda a Cushing, anthu ambiri amachira atatha opaleshoni. Zizindikiro zina za matendawa zingapitirize opaleshoni, monga matenda oopsa, koma izi zimatha kusamalidwa ndi mankhwala. Ngati opaleshoni sizingatheke, palinso mankhwala ochiritsira omwe angathe kuchepetsa zotsatira za kuchuluka kwa cortisol.
Cushing's syndrome ndi chiopsezo chotenga mankhwala a steroid, koma si zachilendo. Kugwiritsidwa ntchito kwa steroids komanso pangozi yomwe ingakhalepo potsata phindu liyenera kukambidwa ndi dokotala. Matenda a Cushing akhoza kuchiritsidwa pochepetsa kuchepetsa kuchuluka kwa steroids, komanso pochiza zizindikiro zina. Cholinga chanu nthawi zonse ndikutenga odwala mankhwala osokoneza bongo mofulumira komanso mosatetezeka.
> Zotsatira:
> Margulies, P. "Adrenal Matenda - Cushing's Syndrome: Mfundo Zofunikira Kumudziwa." National Adrenal Diseases Foundation. 2017.
> Ma Institutes of Health. "Cushing's Syndrome." National Institute of Diabetes ndi Digestive and Kidney Diseases (NIDDK) Apr 2012.
> Sharma ST, Nieman LK. "Cushing's syndrome: mitundu yonse, kuzindikira, ndi chithandizo." E ndocrinol Metab Clinic North Am . 2011 Jun 40: 379-391, viii-ix. lembani: 10.1016 / j.ecl.2011.01.006
> Sharma ST, Nieman LK. Cushing's Syndrome: Zosiyanasiyana, kuzindikira, ndi chithandizo. "Endocrinol Metab Clinic North Am. 2011; 40: 379-391. lembani: 10.1016 / j.ecl.2011.01.006