Matenda a Ectopic Cushing

Ectopic Cushing syndrome ndi mtundu wa Cushing syndrome momwe chotupa kunja kwa pituitary gland chimatulutsa hormone yotchedwa adrenocorticotropic hormone (ACTH).

Cushing syndrome ndi vuto lomwe limachitika thupi lanu likakhala ndi mahomoni ochulukirapo kuposa a cortisol. Hormone iyi imapangidwa m'matenda a adrenal. Kuchuluka kwa cortisol kumatha kukhala chifukwa cha zovuta zosiyanasiyana. Chimodzi mwazomwe zimayambitsa ndimakhala kuti pali mahomoni ochuluka kwambiri a ACTH m'magazi. ACTH nthawi zambiri imapangidwa ndi pituitary pang'ono ndipo kenako imalemba ma adrenal gland kuti apange cortisol. Nthawi zina maselo ena kunja kwa chimbudzi amatha kupanga ACTH yambiri. Izi zimatchedwa ectopic Cushing syndrome. Ectopic amatanthauza kuti china chake chikuchitika m'malo osazolowereka mthupi.

Ectopic Cushing syndrome imayambitsidwa ndi zotupa zomwe zimatulutsa ACTH. Zotupa zomwe nthawi zambiri zimatulutsa ACTH ndi izi:

• Benign carcinoid zotupa zam'mapapo
• Zilonda za Islet cell za kapamba
• Medullary carcinoma ya chithokomiro
• Zotupa zazing'ono zam'mapapo
• Zotupa za thymus gland

Matenda a Ectopic Cushing amatha kuyambitsa zizindikilo zosiyanasiyana. Anthu ena amakhala ndi zizindikiro zambiri pomwe ena amakhala ndi zochepa. Anthu ambiri omwe ali ndi mtundu uliwonse wa matenda a Cushing ali:

• Chozungulira, chofiira, ndi nkhope yathunthu (nkhope ya mwezi)
• Kukula pang'onopang'ono kwa ana
• Kulemera ndi mafuta omwe amapezeka pamtengo, koma kutaya mafuta m'manja, miyendo, ndi matako (kunenepa kwambiri)

Kusintha kwa khungu komwe kumawonekera:

• Matenda a khungu
• Zizindikiro zofiirira (1/2 mainchesi 1 sentimita kapena kupitilira apo) zotchedwa 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 a shuga
• Kuthamanga kwa magazi
• Cholesterol wokwera ndi triglycerides
  

Azimayi atha kukhala ndi:

• Kukula kwa tsitsi kumaso, m'khosi, pachifuwa, pamimba, ndi ntchafu
• Nthawi zomwe zimakhala zosasintha kapena kusiya

Amuna akhoza kukhala ndi:

• Kuchepetsa kapena kusakhala ndi chilakolako chogonana
• Mphamvu

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 matenda anu.

Mayeso omwe angachitike ndi awa:

• Chitsanzo cha mkodzo wa maola 24 kuti muyese milingo ya cortisol ndi creatinine
• Kuyezetsa magazi kuti muwone ACTH, cortisol, ndi potaziyamu (nthawi zambiri amakhala otsika kwambiri mu ectopic Cushing syndrome)
• Mayeso opondereza a Dexamethasone (onse otsika komanso otsika)
• Zitsanzo zochepa za sinus petrosal sampling (mayeso apadera omwe amayesa ACTH kuchokera mumitsempha pafupi ndi ubongo komanso pachifuwa)
• Kusala shuga
• MRI ndi ma scan apamwamba a CT kuti apeze chotupacho (nthawi zina pamafunika mankhwala amagetsi a nyukiliya)

Mankhwala abwino a ectopic Cushing syndrome ndi opaleshoni yochotsa chotupacho. Nthawi zambiri opaleshoni imatheka ngati chotupacho sichikhala khansa (chosaopsa).

Nthawi zina, chotupacho chimakhala ndi khansa ndipo chimafalikira kumadera ena amthupi adotolo dokotala asanapeze vuto lakapangidwe ka cortisol. Kuchita opaleshoni sikungakhale kotheka pazochitika izi. Koma adotolo amatha kupereka mankhwala kuti aletse kupanga kwa cortisol.

Nthawi zina kuchotsedwa kwa ma gland onse a adrenal kumafunikira ngati chotupacho sichingapezeke ndipo mankhwala samatchinga kwathunthu kotisoli.

Kuchita opaleshoni kuti muchotse chotupacho kumatha kuchiritsa. Koma pali mwayi woti chotupacho chibwererenso.

Chotupacho chitha kufalikira kapena kubwerera pambuyo pochitidwa opaleshoni. Mulingo wapamwamba wa cortisol ukhoza kupitilirabe.

Itanani omwe akukuthandizani ngati mukudwala matenda a Cushing.

Kuchiza mwachangu zotupa kumachepetsa chiopsezo nthawi zina. Milandu yambiri siyitetezedwa.

Matenda a Cushing - ectopic; Matenda a Ectopic ACTH

• Matenda a Endocrine

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. (Adasankhidwa)

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.