Cushing matenda

Cushing matenda ndi mkhalidwe womwe pituitary gland imatulutsa kwambiri adrenocorticotropic hormone (ACTH). Matenda a pituitary ndi chiwalo cha endocrine system.

Cushing matenda ndi mawonekedwe amtundu wa Cushing. Mitundu ina ya Cushing syndrome imaphatikizaponso Cushing syndrome, Cushing syndrome yoyambitsidwa ndi adrenal chotupa, ndi ectopic Cushing syndrome.

Cushing matenda amayamba chifukwa cha chotupa kapena kukula mopitilira muyeso (hyperplasia) wamatenda a pituitary. Matenda a pituitary amapezeka kumunsi kwenikweni kwa ubongo. Mtundu wa chotupa chotchedwa adenoma ndi chomwe chimayambitsa matendawa. Adenoma ndi chotupa chosaopsa (osati khansa).

Ndi matenda a Cushing, vuto la pituitary limatulutsa ACTH yochulukirapo. ACTH imalimbikitsa kupanga ndi kutulutsa cortisol, mahomoni opsinjika. Kuchuluka kwa ACTH kumapangitsa kuti adrenal glands apange cortisol yambiri.

Cortisol nthawi zambiri imamasulidwa panthawi yamavuto. Ilinso ndi ntchito zina zambiri, kuphatikiza:

• Kulamulira momwe thupi limagwiritsira ntchito chakudya, mafuta, ndi mapuloteni
• Kuchepetsa kuyankha kwa chitetezo chamthupi pakatupa (kutupa)
• Kuwongolera kuthamanga kwa magazi komanso kuchuluka kwa madzi mthupi

Zizindikiro za matenda Cushing ndi awa:

• Kunenepa kwambiri (pamwamba pa m'chiuno) ndi mikono ndi miyendo yopyapyala
• Chozungulira, chofiira, nkhope yathunthu (nkhope ya mwezi)
• Kukula pang'onopang'ono kwa ana

Kusintha kwa khungu komwe kumawoneka nthawi zambiri kumaphatikizapo:

• Ziphuphu kapena matenda apakhungu
• Zizindikiro zofiirira (1/2 inchi kapena 1 sentimita kapena kupitilira apo), yotchedwa striae, pakhungu la pamimba, ntchafu, mikono yakumtunda, ndi mabere
• Khungu lochepera lomwe lakhala ndi mabala osavuta, makamaka m'manja ndi m'manja

Kusintha kwa minofu ndi mafupa kumaphatikizapo:

• Mmbuyo, yomwe imachitika ndi zochitika wamba
• Kupweteka kwa mafupa kapena kukoma
• Kutolere mafuta pakati pamapewa (njati hump)
• Kufooka kwa mafupa, komwe kumabweretsa nthiti ndi mafupa a msana
• Minofu yofooka yomwe imayambitsa kusagwirizana

Azimayi atha kukhala ndi:

• Kukula kwa tsitsi kumaso, m'khosi, pachifuwa, pamimba, ndi ntchafu
• Kusamba kwa msambo komwe kumakhala kosasintha kapena kuyima

Amuna akhoza kukhala ndi:

• Kuchepetsa kapena kusakhala ndi chilakolako chogonana (low libido)
• Mavuto okonzekera

Zizindikiro zina kapena mavuto atha kukhala:

• Kusintha kwamaganizidwe, monga kukhumudwa, kuda nkhawa, kapena kusintha kwamachitidwe
• Kutopa
• Matenda pafupipafupi
• Mutu
• Kuchuluka kwa ludzu ndi kukodza
• Kuthamanga kwa magazi
• Matenda a shuga

Wothandizira zaumoyo adzakufufuza ndikufunsa za zizindikiro zanu.

Kuyesedwa kumachitika koyamba kuti zitsimikizire kuti pali cortisol yochuluka mthupi, ndiyeno kudziwa chifukwa chake.

Mayesowa amatsimikizira cortisol yochuluka kwambiri:

• Mkodzo wa maola 24 cortisol
• Mayeso opondereza a Dexamethasone (mlingo wochepa)
• Masamba a cortisol am'madzi (m'mawa kwambiri ndi usiku)

Mayesowa amadziwika chifukwa chake:

• Mulingo wamagazi ACTH
• MRI yaubongo
• Corticotropin-yotulutsa kuyesa kwa mahomoni, komwe kumagwira pituitary gland kuyambitsa kutulutsidwa kwa ACTH
• Mayeso opondereza a Dexamethasone (mlingo waukulu)
• Sampling petrosal sinus sampling (IPSS) - amayesa milingo ya ACTH m'mitsempha yomwe imatulutsa chiberekero cha pituitary poyerekeza ndi mitsempha ya pachifuwa

Mayesero ena omwe angachitike ndi awa:

• Kusala magazi shuga ndi A1C kuyesa matenda ashuga
• Kuyesedwa kwa lipid ndi cholesterol
• Kuchulukitsa kwa mafupa amchere kuti muwone ngati kufooka kwa mafupa

Kuyeserera kowunika kamodzi kungafunike kuti mupeze matenda a Cushing. Wopezayo akhoza kukupemphani kuti muonane ndi dokotala wodziwa bwino zamatenda am'mimba.

Chithandizo chimaphatikizapo kuchitidwa opaleshoni kuti muchotse chotupa cha pituitary, ngati zingatheke. Pambuyo pa opaleshoni, khungu la pituitary limatha kuyambiranso kugwira ntchito ndikubwerera mwakale.

Mukachira, mungafunike mankhwala othandizira a cortisol m'malo mwake chifukwa pituitary imafunikira nthawi kuti iyambirenso ACTH.

Chithandizo cha radiation cha pituitary gland chitha kugwiritsidwanso ntchito ngati chotupacho sichichotsedwe kwathunthu.

Ngati chotupacho sichiyankha pa opaleshoni kapena poizoniyu, mungafunike mankhwala oletsa thupi lanu kupanga cortisol.

Ngati izi sizikuyenda bwino, ma adrenal gland angafunikire kuchotsedwa kuti aletse kuchuluka kwa cortisol kuti isapangidwe. Kuchotsa ma adrenal gland kumatha kupangitsa kuti chotupa cha pituitary chikule kwambiri (Nelson syndrome).

Osachizidwa, Cushing matenda atha kuyambitsa matenda akulu, ngakhale kufa. Kuchotsa chotupacho kumatha kubweretsa kuchira kwathunthu, koma chotupacho chimatha kukula.

Mavuto azaumoyo omwe angabwere chifukwa cha Cushing matenda ndi awa:

• Kupanikizika kwapakhosi pamsana
• Matenda a shuga
• Kuthamanga kwa magazi
• Matenda
• Miyala ya impso
• Maganizo kapena mavuto ena amisala

Itanani omwe akukuthandizani ngati mukudwala matenda a Cushing.

Ngati anachotsedwa chotupa cha pituitary, itanani ndi omwe amakupatsani chithandizo ngati muli ndi zizindikiro za zovuta, kuphatikizapo zizindikilo zakuti chotupacho chabwerera.

Matenda a Pituitary Cushing; ACTH-chinsinsi adenoma

• Matenda a Endocrine
• Striae mu anthu ambiri fossa
• Striae pa mwendo

Juszczak A, Morris DG, Grossman AB, Nieman LK (Adasankhidwa) Matenda a Cushing. 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 13.

Molitch INE. Anterior pituitary. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. Wolemba 25. Philadelphia, PA: Elsevier Saunders; 2016: chap 224.

Stewart PM, Newell-Price JDC. Kachilombo kotchedwa adrenal cortex. Mu: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, olemba. Buku la Williams la Endocrinology. Wolemba 13. Philadelphia, PA: Elsevier; 2016: chap 15.