Pituitary apoplexy

Pituitary apoplexy ndiyosowa, koma yovuta kwambiri pamatenda am'mimba.

Pituitary ndi kansalu kakang'ono m'munsi mwa ubongo. Pituitary imapanga mahomoni ambiri omwe amayang'anira zochitika zofunika mthupi.

Pituitary apoplexy imatha kuyambitsidwa ndikutuluka magazi kwamkati mwa magazi kapena magazi otsekedwa kupita nawo. Apoplexy amatanthauza kutuluka magazi m'chiwalo kapena kutayika kwa magazi kulowa m'chiwalo.

Pituitary apoplexy nthawi zambiri imayamba chifukwa chakutuluka magazi mkati mwa chotupa cha khansa. Zotupa izi ndizofala ndipo nthawi zambiri sizipezeka. Matendawa amawonongeka pomwe chotupacho chimakula mwadzidzidzi. Amathira magazi m'matenda am'magazi kapena amalepheretsa kupezeka kwa magazi kuchipatala. Kukula kwa chotupacho, kumawonjezera chiopsezo chamtsogolo cha pituitary apoplexy.

Kutuluka magazi kwa pituitary kumachitika mwa mayi nthawi yobereka kapena itatha, amatchedwa Sheehan syndrome. Izi ndizosowa kwambiri.

Zowopsa za pituitary apoplexy mwa osakhala ndi pakati opanda chotupa ndi awa:

• Kusokonezeka kwa magazi
• Matenda a shuga
• Kuvulala pamutu
• Kutentha kwa khungu la pituitary
• Kugwiritsa ntchito makina opumira

Pituitary apoplexy muzochitika izi ndizosowa kwambiri.

Pituitary apoplexy nthawi zambiri amakhala ndi zizindikilo zochepa (zovuta), zomwe zitha kupha moyo. Zizindikiro nthawi zambiri zimaphatikizapo:

• Mutu wowawa (woyipa kwambiri pamoyo wanu)
• Kufooka kwa minofu ya diso, kuyambitsa masomphenya awiri (ophthalmoplegia) kapena mavuto otsegulira chikope
• Kutayika kwa masomphenya kapena kutayika kwa masomphenya m'modzi kapena m'maso onse
• Kuthamanga kwa magazi, nseru, kusowa kwa njala, komanso kusanza chifukwa chokwanira kwa adrenal
• Kusintha kwa umunthu chifukwa chakuchepa kwadzidzidzi kwa umodzi mwa mitsempha muubongo (mtsempha wamkati wamkati)

Pafupifupi, kuchepa kwa pituitary kumatha kuwonekera pang'onopang'ono. Mwachitsanzo, mu Sheehan syndrome, chizindikiro choyamba chimakhala kulephera kutulutsa mkaka chifukwa chosowa kwa hormone ya prolactin.

Pakapita nthawi, mavuto amtundu wina wamatenda amayamba kukula, ndikupangitsa zizindikilo za izi:

• Kukula kwa mahomoni okula
• Kulephera kwa adrenal (ngati kulibe kale kapena kuchiritsidwa)
• Hypogonadism (ziwalo zoberekera za thupi zimatulutsa mahomoni pang'ono kapena ayi)
• Hypothyroidism (chithokomiro chotulutsa chithokomiro sichimapanga mahomoni amtundu wambiri)

Nthawi zambiri, mbali yakumbuyo (yam'mbuyo) ya pituitary imakhudzidwa, zizindikilo zimatha kuphatikizira:

• Kulephera kwa chiberekero kubereka mwana (mwa akazi)
• Kulephera kutulutsa mkaka wa m'mawere (mwa akazi)
• Kukodza pafupipafupi komanso ludzu lalikulu (matenda a shuga insipidus)

Wothandizira zaumoyo adzakuyesani ndikufunsani za matenda anu.

Mayeso omwe atha kulamulidwa ndi awa:

• Mayeso amaso
• MRI kapena CT scan

Kuyezetsa magazi kudzachitika kuti muwone kuchuluka kwa:

• ACTH (adrenocorticotropic hormone)
• Cortisol
• FSH (hormone yolimbikitsa)
• Hormone yakukula
• LH (mahomoni a luteinizing)
• Prolactin
• TSH (hormone yotulutsa chithokomiro)
• Kukula ngati insulin-1 (IGF-1)
• Sodium
• Osmolarity m'magazi ndi mkodzo

Acople apoplexy angafunike kuchitidwa opaleshoni kuti athetse vuto la pituitary ndikusintha masomphenya. Milandu yayikulu imafunika kuchitidwa opaleshoni mwadzidzidzi. Ngati masomphenya sakukhudzidwa, nthawi zambiri opaleshoni sikofunikira.

Chithandizo cha msangamsanga chokhala ndi mahomoni obwezeretsa adrenal (glucocorticoids) angafunike. Mahomoni amenewa nthawi zambiri amaperekedwa kudzera mumitsempha (ya IV). Mahomoni ena amatha kusintha m'malo mwake, kuphatikiza:

• Hormone yakukula
• Mahomoni ogonana (estrogen / testosterone)
• Mahomoni a chithokomiro
• Vasopressin (ADH)

Pituitary apoplexy ikhoza kukhala pangozi. Malingaliro ake ndiabwino kwa anthu omwe ali ndi vuto la pituitary lomwe limakhalapo kwanthawi yayitali lomwe limapezeka ndikuchiritsidwa.

Zovuta za pituitary apoplexy zitha kuphatikizira izi:

• Mavuto a adrenal (zomwe zimachitika mukakhala kuti mulibe cortisol yokwanira, timadzi timene timatulutsidwa ndimatenda a adrenal)
• Kutaya masomphenya

Ngati mahomoni ena omwe akusowa sanasinthidwe, zizindikilo za hypothyroidism ndi hypogonadism zitha kuyamba, kuphatikiza kusabereka.

Itanani omwe akukuthandizani ngati muli ndi zizindikilo zosakwanira za matendawa.

Pitani kuchipinda chodzidzimutsa kapena itanani nambala yadzidzidzi yakomweko (monga 911) ngati muli ndi zizindikilo za pituitary apoplexy, kuphatikiza:

• Kufooka kwa minofu yamaso kapena kutayika kwamaso
• Mwadzidzidzi, mutu wopweteka kwambiri
• Kuthamanga kwa magazi (komwe kumatha kukomoka)
• Nseru
• Kusanza

Ngati mukukhala ndi zizindikirazi ndipo mwapezeka kale kuti muli ndi chotupa cha pituitary, pitani kuchipatala nthawi yomweyo.

Matenda a pituitary; Pituitary chotupa apoplexy

• Matenda a Endocrine

Hannoush ZC, Weiss RE. Pituitary apoplexy. Mu: Feingold KR, Anawalt B, Boyce A, et al, olemba. Mapeto ake [Internet]. Kumwera kwa Dartmouth, MA: MDText.com. 2000-. www.ncbi.nlm.nih.gov/books/NBK279125. Idasinthidwa pa Epulo 22, 2018. Idapezeka pa Meyi 20, 2019.

Melmed S, Kleinberg D. Maselo a pituitary ndi zotupa. Mu: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, olemba. Buku la Williams la Endocrinology. Wolemba 13. Philadelphia, PA: Elsevier; 2016: chap 9.