Hypopituitarism

Hypopituitarism ndimkhalidwe momwe chiberekero cha pituitary sichimatulutsa kuchuluka kwake kapena mahomoni ake onse.

Matenda a pituitary ndi kamangidwe kakang'ono kamene kamakhala pansi pamunsi mwa ubongo. Amamangiriridwa ndi phesi ku hypothalamus. Hypothalamus ndi dera laubongo lomwe limayang'anira ntchito ya gland pituitary.

Mahomoni omwe amatulutsidwa ndi pituitary gland (ndi ntchito zawo) ndi awa:

• Adrenocorticotropic hormone (ACTH) - imalimbikitsa adrenal gland kutulutsa cortisol; cortisol imathandizira kukhalabe ndi magazi komanso shuga wamagazi
• Antidiuretic hormone (ADH) - imayang'anira kutayika kwa madzi ndi impso
• Follicle-stimulating hormone (FSH) - imayang'anira magwiridwe antchito ndi kubala mwa amuna ndi akazi
• Hormone yokula (GH) - imathandizira kukula kwa minyewa ndi mafupa
• Luteinizing hormone (LH) - imayang'anira magwiridwe antchito ndi kubala mwa amuna ndi akazi
• Oxytocin - imathandizira kuti chiberekero chizigwira ntchito nthawi yowawa komanso mabere kutulutsa mkaka
• Prolactin - imathandizira kukula kwa mawere achikazi ndi kupanga mkaka
• Mahomoni otulutsa chithokomiro (TSH) - amathandizira chithokomiro kutulutsa mahomoni omwe amakhudza kagayidwe kake ka thupi

Mu hypopituitarism, pamakhala kusowa kwa mahomoni amodzi kapena angapo am'magazi. Kuperewera kwa mahomoni kumabweretsa kutayika kwa gland kapena chiwalo chowongolera mahomoni. Mwachitsanzo, kusowa kwa TSH kumabweretsa kuchepa kwa ntchito yamtundu wa chithokomiro.

Hypopituitarism itha kuyambitsidwa ndi:

• Kuchita opaleshoni yaubongo
• Chotupa chaubongo
• Kupwetekedwa mutu (kuvulala koopsa muubongo)
• Matenda kapena kutupa kwaubongo ndi minofu yomwe imathandizira ubongo
• Imfa ya malo am'matumbo (pituitary apoplexy)
• Thandizo la radiation kuubongo
• Sitiroko
• Kutaya magazi kwa Subarachnoid (kuchokera kuphulika kwa aneurysm)
• Zotupa za chikhodzodzo kapena hypothalamus

Nthawi zina, hypopituitarism imachitika chifukwa cha chitetezo chamthupi chodziwika bwino kapena matenda amadzimadzi, monga:

• Zitsulo zambiri m'thupi (hemochromatosis)
• Kuwonjezeka kwapadera kwa maselo amthupi otchedwa histiocytosis (histiocytosis X)
• Zomwe zimayambitsa matenda zimayambitsa kutupa kwa pituitary (lymphocytic hypophysitis)
• Kutupa kwamatenda ndi ziwalo zosiyanasiyana (sarcoidosis)
• Matenda a pituitary, monga chifuwa chachikulu cha chifuwa chachikulu

Hypopituitarism ndimavuto osowa omwe amayamba chifukwa chakutuluka magazi kwambiri panthawi yapakati. Kutayika kwa magazi kumabweretsa minyewa m'matumbo. Matendawa amatchedwa Sheehan syndrome.

Mankhwala ena amathanso kupondereza kugwira ntchito kwa pituitary. Mankhwala omwe amapezeka kwambiri ndi glucocorticoids (monga prednisone ndi dexamethasone), omwe amatengedwa chifukwa cha zotupa komanso chitetezo chamthupi. Mankhwala omwe amagwiritsidwa ntchito pochiza khansa ya prostate amathanso kubweretsa vuto lochepa.

Zizindikiro za hypopituitarism ndi izi:

• Kupweteka m'mimba
• Kuchepetsa chilakolako
• Kusowa kwa chiwerewere (mwa amuna kapena akazi)
• Chizungulire kapena kukomoka
• Kukodza kwambiri ndi ludzu
• Kulephera kumasula mkaka (mwa akazi)
• Kutopa, kufooka
• Mutu
• Kusabereka (mwa akazi) kapena kusiya kusamba
• Kutaya kwamakhwapa kapena kumabanja
• Kutaya thupi kapena tsitsi (mwa amuna)
• Kuthamanga kwa magazi
• Shuga wamagazi ochepa
• Kuzindikira kuzizira
• Kutalika kwakanthawi kochepa (osakwana 5 mapazi kapena 1.5 mita) ngati kuyambika kuli pakukula
• Kukula kwakuchedwa komanso kukula kwakugonana (mwa ana)
• Mavuto masomphenya
• Kuchepetsa thupi

Zizindikiro zimatha kuyamba pang'onopang'ono ndipo zimatha kusiyanasiyana, kutengera:

• Chiwerengero cha mahomoni omwe akusowa komanso ziwalo zomwe zimakhudza
• Kukula kwa vutoli

Zizindikiro zina zomwe zingachitike ndi matendawa:

• Kutupa nkhope
• Kutaya tsitsi
• Kuwopsya kapena kusintha mawu
• Kuuma pamodzi
• Kulemera

Kuti muzindikire hypopituitarism, payenera kukhala magulu ochepa a mahomoni chifukwa chazovuta zamatenda am'mimba. Matendawa amayeneranso kuthana ndi matenda amthupi omwe amakhudzidwa ndi hormone iyi.

Mayeso atha kuphatikiza:

• Kujambula kwa Brain CT
• Pituitary MRI
• ACTH
• Cortisol
• Estradiol (esitirojeni)
• Hormone yolimbikitsa (FSH)
• Kukula kwa insulin monga 1 (IGF-1)
• Mahomoni a Luteinizing (LH)
• Osmolality amayesa magazi ndi mkodzo
• Mulingo wa testosterone
• Mahomoni otulutsa chithokomiro (TSH)
• Mahomoni a chithokomiro (T4)
• Chidziwitso cha pituitary

Mulingo wa mahomoni a pituitary amatha kukhala m'magazi ambiri ngati muli ndi chotupa chomwe chimatulutsa mahomoni ochulukirapo. Chotupacho chitha kuphwanya maselo ena am'mimba, zomwe zimabweretsa mahomoni ena otsika.

Ngati hypopituitarism imayamba chifukwa cha chotupa, mungafunike kuchitidwa opaleshoni kuti muchotse chotupacho. Thandizo la radiation lingafunikirenso.

Mudzafunika mankhwala a mahomoni amoyo wonse kuti mutenge mahomoni omwe sanapangidwenso ndi ziwalo zoyang'aniridwa ndi chithokomiro. Izi zingaphatikizepo:

• Corticosteroids (cortisol)
• Hormone yakukula
• Mahomoni ogonana (testosterone ya amuna ndi estrogen ya akazi)
• Mahomoni a chithokomiro
• Kuchotsera

Mankhwala amapezekanso kuti athetse vuto la kusabereka mwa abambo ndi amai.

Ngati mumamwa mankhwala a glucocorticoid pituitary ACTH, onetsetsani kuti mukudziwa nthawi yoyenera kumwa mankhwala anu. Kambiranani izi ndi omwe akukuthandizani.

Nthawi zonse nyamulani chiphaso chachipatala (khadi, chibangili, kapena mkanda) chomwe chimati mulibe mphamvu ya adrenal. Chizindikirocho chiyeneranso kunena mtundu wa mankhwala ndi mlingo womwe mungafune pakagwa vuto ladzidzidzi chifukwa chokwanira kwa adrenal.

Hypopituitarism nthawi zambiri imakhala yokhazikika. Amafuna chithandizo cha moyo wonse ndi mankhwala amodzi kapena angapo. Koma mutha kuyembekezera kutalika kwa moyo.

Kwa ana, hypopituitarism imatha kusintha ngati chotupacho chikuchotsedwa pakuchita opaleshoni.

Zotsatira zoyipa zamankhwala zochizira hypopituitarism zitha kukula. Komabe, osayimitsa mankhwala aliwonse panokha osalankhula ndi omwe akukuthandizani kaye.

Itanani omwe akukuthandizani ngati mukukula ndi matenda a hypopituitarism.

Nthaŵi zambiri, matendawa sangalephereke. Kudziwitsa za chiopsezo, monga kumwa mankhwala ena, kumatha kulola kuti munthu adziwe ngati ali ndi kachilombo koyambitsa matendawa.

Kulephera kwa pituitary; Panhypopituitarism

• Matenda a Endocrine
• Matenda a pituitary
• Gonadotropin
• Pituitary ndi TSH

Burt MG, Ho KKY. Hypopituitarism ndi kuchepa kwa mahomoni okula. Mu: Jameson JL, De Groot LJ, de Kretser DM, et al, olemba. Endocrinology: Akuluakulu ndi Ana. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier Saunders; 2016: chap 11.

Clemmons DR, Nieman LK. (Adasankhidwa) Njira kwa wodwalayo ndi matenda a endocrine. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. Wolemba 25. Philadelphia, PA: Elsevier Saunders; 2016: chap 221.

Fleseriu M, Hashim IA, Karavitaki N, ndi al. Kusintha kwa mahormonal mu hypopituitarism mwa akulu: malangizo a Endocrine Society azachipatala. J Clin Endocrinol Metab. 2016; 101 (11): 3888-3921. (Adasankhidwa) PMID: 27736313 www.ncbi.nlm.nih.gov/pubmed/27736313.