Matenda achilengedwe a Cushing

Exogenous Cushing syndrome ndi mtundu wa Cushing syndrome womwe umapezeka mwa anthu omwe amatenga glucocorticoid (yotchedwanso corticosteroid, kapena steroid) mahomoni.

Cushing syndrome ndi vuto lomwe limachitika thupi lanu likakhala ndi mahomoni ochulukirapo kuposa a cortisol. Hormone iyi imapangidwa ndimatenda a adrenal.

Njira zodziwika bwino zomwe zimayambitsidwa ndi china chake kunja kwa thupi. Exogenous Cushing syndrome imachitika munthu akamamwa mankhwala opangidwa ndi anthu (synthetic) glucocorticoid kuti athetse matenda.

Glucocorticoids amaperekedwa chifukwa cha matenda ambiri, monga matenda am'mapapo, khungu, matenda am'matumbo, khansa, zotupa zamaubongo, ndi matenda olumikizana. Mankhwalawa amabwera m'njira zosiyanasiyana, kuphatikizapo mapiritsi, intravenous (IV), jekeseni wolumikizira, enema, mafuta opangira khungu, ma inhalers, ndi madontho amaso.

Anthu ambiri omwe ali ndi matenda a Cushing ali:

• Chozungulira, chofiira, nkhope yathunthu (nkhope ya mwezi)
• Kukula kwakanthawi kochepa (mwa ana)
• Kulemera ndi mafuta omwe amapezeka pamtengo, koma kutaya mafuta m'manja, miyendo, ndi matako (kunenepa kwambiri)

Kusintha kwa khungu komwe kumawoneka nthawi zambiri kumaphatikizapo:

• Matenda a khungu
• Zizindikiro zofiirira (1/2 inchi kapena 1 sentimita kapena kupitilira apo), yotchedwa striae, pakhungu la pamimba, ntchafu, mikono yakumtunda, ndi mabere
• Khungu loyera lokhala ndi mabala osavuta

Kusintha kwa minofu ndi mafupa kumaphatikizapo:

• Mmbuyo, yomwe imachitika ndi zochitika wamba
• Kupweteka kwa mafupa kapena kukoma
• Kutolere mafuta pakati pamapewa komanso pamwamba pa kolala
• Nthiti ndi mafupa a msana amayamba chifukwa cha kupindika kwa mafupa
• Minofu yofooka, makamaka m'chiuno ndi m'mapewa

Mavuto amthupi (systemic) atha kuphatikiza:

• Type 2 matenda ashuga
• Kuthamanga kwa magazi
• Cholesterol wokwera ndi triglycerides

Azimayi atha kukhala ndi:

• Nthawi zomwe zimakhala zosasintha kapena kusiya

Amuna akhoza kukhala ndi:

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

Zizindikiro zina zomwe zingachitike ndi monga:

• Kusintha kwamaganizidwe, monga kukhumudwa, kuda nkhawa, kapena kusintha kwamachitidwe
• Kutopa
• Mutu
• Kuchuluka kwa ludzu ndi kukodza

Wothandizira zaumoyo adzakuyesani ndikufunsani za zomwe mukudziwa komanso mankhwala omwe mukumwa. Uzani wothandizira za mankhwala onse omwe mwakhala mukumwa kwa miyezi ingapo yapitayo. Komanso uzani wothandizira za zipolopolo zomwe mudalandira kuofesi ya omwe amakupatsani.

Ngati mumagwiritsa ntchito cortisone, prednisone, kapena ma corticosteroids ena, zotsatira zotsatirazi zitha kunena za matenda a Cushing:

• Mulingo wotsika wa ACTH
• Mulingo wa cortisol wotsika (kapena mulingo wokwanira wa cortisol) m'magazi kapena mkodzo, kutengera mankhwala omwe mumamwa
• Kuyankha kosazolowereka poyesa kukondoweza kwa cosyntropin (ACTH)
• Wapamwamba kuposa shuga wamba wabwinobwino
• Mulingo wochepa wa potaziyamu
• Kuchepetsa mafupa, monga kumayesedwa ndi kuyesa kwa kuchuluka kwa mchere
• Cholesterol wambiri, makamaka ma triglycerides komanso otsika kwambiri a lipoprotein (HDL)

Njira yotchedwa high performance fluid chromatography (HPLC) imatha kuwonetsa mulingo wokwanira wamankhwala omwe mukuwakayikira mkodzo.

Chithandizo ndi kuchepa ndipo pamapeto pake kusiya kumwa corticosteroids. Izi zitha kuchitika pang'onopang'ono kapena mwachangu, kutengera chifukwa chake mukukumana ndi corticosteroid. Osasiya kumwa mankhwala osalankhula ndi omwe akukuthandizani. Kuyimitsa mwadzidzidzi ma corticosteroids atawamwa kwa nthawi yayitali kumatha kubweretsa vuto lowopsa lotchedwa adrenal mavuto.

Ngati simungaleke kumwa mankhwalawa chifukwa cha matenda (mwachitsanzo, mukufunika mankhwala a glucocorticoid kuti muchiritse mphumu), tsatirani malangizo a omwe amakupatsani momwe mungachepetsere zovuta zakubwera, kuphatikizapo:

• Kuchiza shuga wambiri wamagazi ndi zakudya, mankhwala akumwa, kapena insulin.
• Kuchiza cholesterol yambiri ndi zakudya kapena mankhwala.
• Kutenga mankhwala kuti muteteze mafupa. Izi zitha kuthandiza kuchepetsa ngozi ya mafupa ngati mukudwala matenda a kufooka kwa mafupa.
• Kutenga mankhwala ena kuti muchepetse kuchuluka kwa mankhwala a glucocorticoid omwe mukufuna.

Kuchepetsa mankhwala omwe akuyambitsa vutoli pang'onopang'ono kungathandize kuthana ndi zovuta za adrenal gland shrinkage (atrophy). Izi zitha kutenga miyezi mpaka chaka chimodzi. Munthawi imeneyi, mungafunike kuyambiranso kapena kuwonjezera kuchuluka kwa ma steroids mukamapanikizika kapena mutadwala.

Mavuto azaumoyo omwe angabwere chifukwa cha matenda achilengedwe a Cushing ndi awa:

• Kuteteza thupi kumatenda, komwe kumatha kubweretsa matenda pafupipafupi
• Kuwonongeka kwa maso, impso, ndi misempha chifukwa chosagwidwa ndi shuga wambiri wamagazi
• Matenda a shuga
• Kuchuluka kwa cholesterol
• Kuchulukitsa chiwopsezo cha matenda amtima kuchokera ku matenda ashuga osalandiridwa komanso cholesterol
• Kuchuluka kwa chiwopsezo cha magazi
• Mafupa ofooka (kufooka kwa mafupa) komanso chiopsezo chowonjezeka cha mafupa

Zovuta izi zimatha kupewedwa ndi chithandizo choyenera.

Funsani nthawi yokumana ndi omwe amakupatsani ngati mukumwa corticosteroid ndipo mumayamba kukhala ndi matenda a Cushing.

Ngati mutenga corticosteroid, dziwani zizindikilo za Cushing syndrome. Kuchiritsidwa mwachangu kumathandizira kupewa zovuta zilizonse za Cushing syndrome. Ngati mumagwiritsa ntchito ma steroids, mutha kuchepetsa kukhudzika kwanu pogwiritsa ntchito spacer komanso kutsuka mkamwa mutapumira mu ma steroids.

Cushing syndrome - corticosteroid yoyambitsidwa; Matenda a Cushing a Corticosteroid; Matenda a Iatrogenic Cushing

• Kupanga kwa mahomoni a Hypothalamus

Nieman LK, Biller BM, Wopeza JW, et al.Chithandizo cha matenda a Cushing's: malangizo othandizira a Endocrine Society.J CLin Endocrinol Metab. 2015; 100 (8): 2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

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.