I-Cushing's Syndrome ibangelwa yiCortisol engaphezulu
I-Cushing's syndrome yintlupheko eyenzekayo xa umzimba uphawula kwi-cortisol enkulu. I-Cortisol ikhiqizwa ngumzimba kwaye isetyenziswe kwizidakamizwa ze-corticosteroid. I-Cushing's syndrome iyakwenzeka okanye mhlawumbi ngenxa yokuba i-cortisol iyenziwa ngaphezu komzimba okanye ekusebenziseni iziyobisi ezine-cortisol (njenge-prednisone). Xa i-Cushing's syndrome ibangelwa ukusetyenziswa kwexesha elide lemithi ye-corticosteroid, ikwabizwa ngokuba yi-hypercortisolism.
Malunga neCortisol
I-Cortisol iyimfuneko enkulu ye-hormonone yomzimba. I-Cortisol ifihliwe yi-adrenal glands ekuphenduleni ukufihla kwe-horrenone ye-adrenocorticotropic (ACTH) yi-pituitary. Enye ifom ye-Cushing's syndrome ingabangelwa kukugqithisa kwe-ACTH nge-pituitary ekhokelela kwi-cortisol engaphezulu.
I-Cortisol inemisebenzi emininzi, kubandakanywa nomthetho wokuvuvukala nokulawula indlela umzimba usebenzisa ngayo i-carbohydrat, amafutha kunye nama-proteins. Ii-Corticosteroids ezifana ne-prednisone, ezisoloko zisetyenziselwa ukunyanga izimo ezivuthayo, ukulinganisa imiphumo ye-cortisol.
Izizathu zeCushing's Syndrome
Kukho izimbalwa ezimbalwa ezahlukahlukeneyo ze-Cushing's syndrome.
Izifo zeCushing. Isifo sikaCushing sisinye sezizathu eziqhelekileyo zesifo seCushing esenzekayo xa i-pituitary ikhupha i-ACTH engaphezulu, ikhokelela ekortisol eyengeziwe. Oku kunokubangela ukuba i-tumor isifo okanye enye ukukhula.
Iatrogenic Cushing's Syndrome. Ukusetyenziswa kwamanyango aphezulu amayeza e- steroid ixesha elide kunokubangela le fomu ye-Cushing's syndrome.
Iziyobisi ze-Steroid okanye izidakamizwa ze-corticosteroid zisetyenziselwa ukunyanga iimeko ezininzi ezivuthayo, eziquka i-asthma, i-lupus, i-rheumatoid arthritis, kunye nesifo sesibindi (IBD) . Kwezinye iimeko, zichazwe kumaxabiso aphezulu kunye nexesha elide.
I-Adrenal Gland Tumor. Ekugqibeleni, enye imbangela, nangona ingaqhelekanga, ibangelwa ngqo kwi-tumor kwi-adrenal glands.
Ezi ntlobo zezidumbu zibangele amanqanaba aphezulu e-cortisol, ezizimeleyo ze-ACTH ukuveliswa kwi-pituitary gland. Xa i-tumor iphela kwi-adrenal gland eyodwa, inani elingaphezulu lee-cortisol elivelisiweyo linokubangela ukuba i-adrenal gland ingathinteki iqalise ukunyuka kwaye ihlaziye.
Iimpawu zeCushing's Syndrome
Iimpawu neempawu ze-Cushing's syndrome zingaquka oku kulandelayo:
- intsimbi
- I-Buffalo hump (amafutha athile afakwe emva kwentamo)
- amazinga e-glucose ephakamileyo
- ukoma okunzulu
- ukukhathala
- ukwanda kwamanzi
- intloko
- igazi elonyukayo
- i-hirsutism (ukukhula kancinci kweenwele)
- ukutshintsha kwexesha
- ukugqithisa kwinqanaba elijikelezayo
- iimpawu zengqondo ezifana nokungazinzi kwemizwa, ukuxinezeleka, ukuxhalaba, ukuphazamiseka
- Ujikeleze ubuso obusisigxina (owaziwa njengenyanga)
- utshintsho lwesikhumba
- Ukwelula amanqaku kwisisu, iingalo, amabele, izikhwelo kunye namathanga (okubizwa ngokuba yi-striae)
- ubuthathaka
Kukho ezinye iimpawu kunye neempawu zalo mqathango ezingagqitywanga ngasentla. Kubalulekile ukubona ugqirha nangayiphi na ingxaki malunga neempawu ze-Cushing's syndrome.
Ukuxilongwa kweCushing's Syndrome
Kukho iimpawu ezibonakalayo ezibonakalayo, njengobuso benyanga obujikelezayo kunye ne-buffalo hump, eziqhelekileyo phakathi kwabantu abane-Cushing's syndrome. Ukuba ugqirha ugxeka uCushing, emva kwembali yomsebenzi, ukuhlolwa ngokomzimba, kunye nomsebenzi wegazi oluyisiseko, uya kulandelela iimvavanyo zegazi kunye nomchamo ukulinganisa inani le-cortisol ekhona emzimbeni.
Ukuba loo mazinga aphakamileyo, ugqirha unokuyalela uvavanyo olubizwa ngokuba yi-dexamethasone yokunyanzeliswa kovavanyo. Olu luvavanyo apho i-steroid yomlomo ebizwa ngokuba yi-dexamethasone inikwe kwaye iimvavanyo zegazi kunye nomchamo zithathwa kwakhona ukulinganisa i-cortisol nezinye i-hormone ze-adrenal. Uvavanyo oluninzi luyalelwe ukuba ngaba le mvavanyo yokuqala ibuya neziphumo ezibonisa ukuba i-Cushing syndrome ingaba yinkxalabo.
Udokotela angashenxisa kwinkqubo yokuvavanya kakhulu xa ukuhlolwa kokuqala kubonisa ukuba oku kuyimfuneko. Ukuba isifo sikhankanywa njengesisombululo seCushing, ezinye iimvavanyo ezinokuthi zenziwe zibandakanya i- CT scan okanye i- MRI .
Nangona uvavanyo lubonakala lufana nomsebenzi omningi okanye lukhuni, kubalulekile ukulandelelana nokugqiba zonke iimvavanyo ezenziwa ngugqirha.
Unyango lweCushing's Syndrome
I-Cushing's syndrome iyaphathwa kakuhle ngokuqaphela oko kubangela amazinga aphezulu e-cortisol kwaye ayisuse.
Isifo sikaCushing. Utyando luqhelekileyo unyango lokuqala kumagulane anesifo sikaCushing. Ukususwa kwe- tumor ye- pituitary kunye ngamanye amaxesha yonke i-pituitary gland, ngokusebenzisa inkqubo ebizwa ngokuba yi-transsphenoidal resection (emva kwempumlo) nge-neurosurgeon idla ngokuyimfuneko. Ukuba yonke i-pituitary imele isuswe, i-cortisol, i-thyroid kunye ne-hormone yesondo iya kufuneka inikwe. Ukuba utyando lunqatshelwe okanye i-tumor ayikwazi ukususwa, unyango lwamayeza lungasetyenziselwa ukunciphisa isisu. Ukuba i-tumor ifumaneke ukuba iyingozi , i-chemotherapy okanye i-radiation inokumiselwa ukunciphisa umngcipheko wokuphindaphinda. Kukho unyango lwezokwelapha olukhoyo ukunyangwa kwesifo sikaCushing, kuquka iPasireotide (Signifor) kunye neMifepristone (Korlym).
Iatrogenic Cushing's syndrome. Ukuba i-syndrome ibangelwa yimithi enqunyiwe, kuyona nto ingcono ukuqala ukuyifaka imithi phantsi, igqithwe ngugqirha, ukususa i-steroid engaphezulu. Kubalulekile ukunciphisa ngokukhawuleza inani le-corticosteroid ethathwe kwiiveki okanye kwiinyanga. Amachiza ahlukeneyo okanye umthamo ungabonwa ukuba yonyango olulungele ngakumbi imeko. Kubalulekile ukulandela imiyalelo ngokuchanekileyo, njengoko i-steroids ayikwazi ukunqunyulwa ngokukhawuleza, kodwa kufuneka ihlulwe ngokukhawuleza.
Ukuba i-steroids ayikwazi ukuma, okanye ukuba kuya kuthatha ixesha elide ukuyiyeka, ezinye iindlela zonyango zinganikwa ukulawula ezinye iimpawu neempawu ze-Cushing's syndrome. Ezinye zeempawu zale syndrome ezingadinga unyango ngamanye amayeza kunye noshintsho ekudleni ziquka ishukela ephezulu yegazi kunye ne-cholesterol ephezulu. Ukunciphisa umngcipheko wezaphulelo kunye nemichiza esetyenziselwa ukunyanga i-osteoporosis inokufuneka kwakhona. Kwimeko yokudandatheka okanye ukuxhalaba, ukuhanjiswa kwingcali yengqondo yengqondo kunokusebenza.
Inqaku esuka
Kwimeko yesifo sikaCushing, abaninzi abantu baphila kakuhle emva kokuhlinzwa. Ezinye iimpawu zesifo zingaqhubeka emva kokuhlinzwa, ezinjengexinzelelo, kodwa ezi zihlala zilawulwa ngamachiza. Ukuba ukuhlinzwa kungenakwenzeka, kukho uphuhliso lwezokwelapha olukhoyo oluya kunciphisa imiphumo ye-cortisol.
I-Cushing's syndrome ingozi yokuthatha imishanguzo ye-steroid, kodwa ayiqhelekanga. Ukusetyenziswa kwe-steroids kunye nomngcipheko onokubakho ngokubhekiselele kwizibonelelo kufuneka kuxoxwe nodokotela. I-Cushing's syndrome inokuphathwa ngokunciphisa inani le-steroids ethatyathwa, kunye nokuphatha ezinye iimpawu kunye neempawu. Injongo isoloko ifumana izigulane zisuse i-steroids ngokukhawuleza kwaye ngokukhuselekileyo ngokunokwenzeka.
> Imithombo:
> Margulies, P. "Ii-Adrenal Diseases - Cushing's Syndrome: Amaqiniso Okufuneka Uyazi." I-National Adrenal Diseases Foundation. 2017.
> AmaZiko eNational Health. "I-Cushing's Syndrome." I-National Institute of Diabetes ne-Digestive and Kidney Diseases (NIDDK) ngoMatshi 2012.
> Sharma ST, Nieman LK. "I-Cushing's syndrome: zonke izinto ezihlukeneyo, ukufumanisa, kunye nonyango." I- ndocrinol I-Metab Clinic North Am . 2011 Juni; 40: 379-391, viii-ix. i-doi: 10.1016 / j.ecl.2011.01.006
> Sharma ST, Nieman LK. I-Cushing's Syndrome: Zonke iindidi, ukufumana, kunye nonyango. "I-Endocrinol Metab Clin North Am. 2011; 40: 379-391. i-doi: 10.1016 / j.ecl.2011.01.006