Insulinoma

Insuloma ndi chotupa m'mapapo chomwe chimatulutsa insulin yochulukirapo.

Mphepete ndi chiwalo m'mimba. Mphunoyi imapanga michere yambiri ndi mahomoni, kuphatikiza mahomoni a insulin. Ntchito ya insulini ndikuchepetsa shuga (shuga) m'magazi pothandiza shuga kulowa m'maselo.

Nthawi zambiri shuga yako m'magazi ikamachepa, kapamba amasiya kupanga insulin kuti awonetsetse kuti shuga wanu wamagazi amakhala munthawi yoyenera. Zotupa za kapamba zomwe zimatulutsa insulin yochuluka zimatchedwa insulinomas. Insulinomas amapitilizabe kupanga insulini, ndipo amatha kupanga shuga wambiri m'magazi kutsika kwambiri (hypoglycemia).

Kuchuluka kwa insulini wamagazi kumayambitsa shuga wambiri wamagazi (hypoglycemia). Hypoglycemia itha kukhala yofatsa, yotsogolera kuzizindikiro monga nkhawa ndi njala. Kapenanso zitha kukhala zowopsa, zomwe zingayambitse kugwa, kukomoka, ngakhale kufa kumene.

Insulinomas ndimatupa osowa kwambiri. Nthawi zambiri zimachitika ngati zotupa zochepa. Koma pangakhalenso zotupa zingapo zazing'ono.

Ambiri a insulinomas ndi zotupa zopanda khansa (zabwino). Anthu omwe ali ndi vuto linalake, monga ma endocrine neoplasia amtundu wa I, ali pachiwopsezo chachikulu cha insulinomas.

Zizindikiro zimakonda kupezeka ngati mukusala kudya kapena kudumpha kapena kuchedwetsa kudya. Zizindikiro zimaphatikizapo:

• Kuda nkhawa, kusintha kwamakhalidwe, kapena kusokonezeka
• Masomphenya akuda
• Kutaya chidziwitso kapena kukomoka
• Kugwedezeka kapena kunjenjemera
• Chizungulire kapena kupweteka mutu
• Njala pakati pa chakudya; kunenepa kumakhala kofala
• Kuthamanga kwa mtima kapena kugundana kwamtima
• Kutuluka thukuta

Mutatha kusala, magazi anu atha kuyesedwa:

• Mulingo wamagazi C-peputayidi
• Mulingo wama glucose amwazi
• Mulingo wama insulin
• Mankhwala omwe amachititsa kuti kapamba atulutse insulini
• Kuyankha kwa thupi lanu kuwombera glucagon
  

Kuyeza kwa CT, MRI, kapena PET m'mimba kumatha kuchitidwa kuti tifufuze chotupa m'mapapo. Ngati chotupa sichimawoneka m'mayeso, mayeso awa akhoza kuchitidwa:

• Endoscopic ultrasound (mayeso omwe amagwiritsa ntchito mawonekedwe osinthasintha ndi mafunde omveka kuti awone ziwalo zogaya)
• Kusanthula kwa Octreotide (mayeso apadera omwe amafufuza ma cell omwe amapanga ma hormone mthupi)
• Pancreatic arteriography (mayeso omwe amagwiritsa ntchito utoto wapadera kuti awone mitsempha yomwe ili m'mapapo)
• Pancreatic venous sampling for insulin (mayeso omwe amathandiza kupeza komwe kuli chotupacho mkati mwa kapamba)

Opaleshoni ndi njira yodziwika bwino yothandizira insulinoma. Ngati pali chotupa chimodzi, chimachotsedwa. Ngati pali zotupa zambiri, gawo lina laziphuphu liyenera kuchotsedwa. Pafupifupi 15% ya kapamba iyenera kusiyidwa kuti ipange michere yofananira yogaya.

Nthawi zambiri, kapamba amachotsedwa ngati pali insulinomas ambiri kapena apitilizabe kubwerera. Kuchotsa kapamba wonse kumabweretsa matenda ashuga chifukwa sipakhalanso insulin yopangidwa. Ziphuphu za insulin (jakisoni) ndizofunikira.

Ngati palibe chotupa chomwe chimapezeka panthawi yochita opareshoni, kapena ngati simungathe kuchitidwa opareshoni, mutha kupeza mankhwala a diazoxide kuti muchepetse kupanga kwa insulin ndikupewa hypoglycemia. Piritsi lamadzi (diuretic) limaperekedwa ndi mankhwalawa kuteteza thupi kuti lisasunge madzi. Octreotide ndi mankhwala ena omwe amagwiritsidwa ntchito kuchepetsa kumasulidwa kwa insulin mwa anthu ena.

Nthawi zambiri, chotupacho sichikhala cha khansa (chosaopsa), ndipo opaleshoni imatha kuchiza matendawa. Koma kukhudzidwa kwambiri kwa hypoglycemic kapena kufalikira kwa chotupa cha khansa ku ziwalo zina kumatha kupha moyo.

Zovuta zingaphatikizepo:

• Kwambiri hypoglycemic anachita
• Kufalikira kwa chotupa cha khansa (metastasis)
• Matenda ashuga ngati kapamba amachotsedwa (osowa), kapena chakudya chomwe sichingatengeke ngati kapamba atachotsedwa
• Kutupa ndi kutupa kwa kapamba

Itanani okhudzana ndiumoyo wanu mukakhala ndi matenda a insulinoma. Kukomoka ndi kutaya chidziwitso ndi vuto ladzidzidzi. Imbani 911 kapena nambala yachangu yakomweko nthawi yomweyo.

Insulinoma; Islet cell adenoma, chotupa cha Pancreatic neuroendocrine; Hypoglycemia - insulinoma

• Matenda a Endocrine
• Chakudya ndi insulin kumasulidwa

Asban A, Patel AJ, Reddy S, Wang T, Balentine CJ, Chen H. Khansa ya endocrine system. Mu: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, olemba. Chipatala cha Abeloff's Oncology. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2020: chap 68.

Tsamba la National Comprehensive Cancer Network. Malangizo azachipatala a NCCN mu oncology (malangizo a NCCN): Neuroendocrine ndi zotupa za adrenal. Mtundu wa 2.2020. www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf. Idasinthidwa pa Julayi 24, 2020. Idapezeka Novembala 11, 2020.

Strosberg JR, Al-Toubah T. Zotupa za Neuroendocrine. Mu: Feldman M, Friedman LS, Brandt LJ, olemba. Sleisenger ndi Matenda a Mimba ndi a Fordtran Amatenda a Chiwindi. 11th ed. Philadelphia, PA: Elsevier; 2021: chaputala 34.