Matenda a Cushing

Cushing syndrome ndimatenda omwe amapezeka thupi lanu likakhala ndi hormone cortisol yambiri.

Chifukwa chofala kwambiri cha Cushing syndrome ndikumwa mankhwala ochulukirapo a glucocorticoid kapena corticosteroid. Mtundu uwu wa Cushing syndrome umadziwika kuti Cushing syndrome. Prednisone, dexamethasone, ndi prednisolone ndi zitsanzo za mankhwala amtunduwu. Glucocorticoids amatsanzira zochita za thupi la mahomoni achilengedwe a cortisol. Mankhwalawa amagwiritsidwa ntchito pochiza matenda monga mphumu, kutupa pakhungu, khansa, matumbo, kupweteka kwa mafupa, ndi nyamakazi ya nyamakazi.

Anthu ena amadwala matenda a Cushing chifukwa thupi lawo limapanga cortisol yochulukirapo. Hormone iyi imapangidwa m'matenda a adrenal. Zomwe zimayambitsa cortisol yochulukirapo ndi izi:

• Cushing matenda, omwe amapezeka pomwe pituitary gland imapanga kwambiri mahomoni adrenocorticotrophic hormone (ACTH). Kenako ACTH imasonyeza kuti adrenal gland imatulutsa cortisol yochulukirapo. Chotupa cha pituitary gland chingayambitse vutoli.
• Chotupa cha adrenal gland
• Zotupa kwinakwake m'thupi zomwe zimatulutsa corticotropin-release hormone (CRH)
• Zotupa kwina kulikonse m'thupi zomwe zimatulutsa ACTH (ectopic Cushing syndrome)

Zizindikiro zimasiyanasiyana. Si onse omwe ali ndi matenda a Cushing omwe ali ndi zizindikilo zofananira. Anthu ena ali ndi zizindikilo zambiri pomwe ena alibe zizindikiro zilizonse.

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 kumatha kuphatikiza:

• Matenda a khungu
• Zojambula zofiirira (1/2 inchi kapena 1 sentimita kapena kupitilira apo) zotchedwa striae pakhungu la pamimba, mikono yakumtunda, ntchafu, ndi mabere
• Khungu loyera lokhala 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 ndi pamwamba pama kolala
• Nthiti ndi mafupa a msana amayamba chifukwa cha kupindika kwa mafupa
• Minofu yofooka, makamaka m'chiuno ndi m'mapewa

Kusintha kwa thupi lonse (systemic) kumaphatikizapo:

• Type 2 matenda a shuga
• Kuthamanga kwa magazi (matenda oopsa)
• Kuchulukanso kwa cholesterol ndi triglycerides (hyperlipidemia)

Azimayi omwe ali ndi matenda a Cushing 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 (low libido)
• Mavuto okonzekera

Zizindikiro zina zomwe zingachitike ndi matendawa:

• 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.

Kuyesa kwa Laborator komwe kungachitike kuti mupeze matenda a Cushing ndikuzindikira chomwe chikuyambitsa ndi awa:

• Mulingo wama cortisol wamagazi
• Shuga wamagazi
• Mulingo wamaliseche wa cortisol
• Mayeso opondereza a Dexamethasone
• Mkodzo wa maola 24 wa cortisol ndi creatinine
• Mulingo wa ACTH
• Mayeso okondoweza a ACTH (nthawi zina)

Kuyesa kudziwa chomwe chimayambitsa kapena zovuta kungaphatikizepo:

• M'mimba CT
• Pituitary MRI
• Kuchuluka kwa mafupa amchere

Chithandizo chimadalira chifukwa.

Cushing syndrome yoyambitsidwa ndi kugwiritsa ntchito corticosteroid:

• Wothandizira anu amakulangizani kuti muchepetse pang'ono mankhwala. Kuletsa mankhwala mwadzidzidzi kungakhale koopsa.
• Ngati simungaleke kumwa mankhwalawa chifukwa cha matenda, shuga wanu wamagazi ambiri, kuchuluka kwama cholesterol, komanso kupukuta mafupa kapena kufooka kwa mafupa kuyenera kuyang'aniridwa ndikuchiritsidwa.

Ndi Cushing syndrome yoyambitsidwa ndi pituitary kapena chotupa chomwe chimatulutsa ACTH (Cushing matenda), mungafunike:

• Opaleshoni kuchotsa chotupacho
• Magetsi atachotsedwa chotupa cha pituitary (nthawi zina)
• Cortisol m'malo mwake atachitidwa opaleshoni
• Mankhwala obwezeretsa mahomoni a pituitary omwe amasowa
• Mankhwala oteteza thupi kuti lisapangitse cortisol yambiri

Ndi Cushing syndrome chifukwa cha chotupa cha pituitary, chotupa cha adrenal, kapena zotupa zina:

• Mungafunike kuchitidwa opaleshoni kuti muchotse chotupacho.
• Ngati chotupacho sichingachotsedwe, mungafunike mankhwala kuti athandize kutseka kwa cortisol.

Kuchotsa chotupacho kumatha kubweretsa kuchira kwathunthu, koma pali mwayi kuti vutoli libwererenso.

Kupulumuka kwa anthu omwe ali ndi matenda a Cushing omwe amayamba chifukwa cha zotupa kumadalira mtundu wa chotupacho.

Matenda a Cushing osachiritsidwa amatha kupha moyo.

Mavuto azaumoyo omwe amabwera chifukwa cha Cushing syndrome ndi awa:

• Matenda a shuga
• Kukulitsa kwa chotupa cha pituitary
• Mafupa amathyoka chifukwa cha kufooka kwa mafupa
• Kuthamanga kwa magazi
• Miyala ya impso
• Matenda akulu

Itanani omwe akukuthandizani ngati muli 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.

Hypercortisolism; Kuchuluka kwa Cortisol; Kuchulukitsa kwa Glucocorticoid - Cushing syndrome

• Matenda a Endocrine

Nieman LK, Biller BM, Wopeza JW, et al; Bungwe la Endocrine. 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 Saunders; 2016: chap 15.