Maliseche osadziwika

Maliseche osadziwika ndi vuto lobadwa kumene maliseche akunja sawoneka ngati anyamata kapena atsikana.

Kugonana kwamwana kumatsimikizika pakubadwa. Selo la dzira la mayi limakhala ndi X chromosome, pomwe umuna wa abambo umakhala ndi X kapena Y chromosome. Ma chromosomes awa a X ndi Y amadziwika za chibadwa cha mwanayo.

Nthawi zambiri, khanda limalandira ma chromosomes awiri, 1 X kuchokera kwa mayi ndi 1 X kapena Y imodzi kuchokera kwa abambo. Abambo "amatsimikiza" zakubadwa kwa mwanayo. Mwana amene amatenga X chromosome kuchokera kwa abambo ndi wamkazi ndipo amakhala ndi ma 2 X chromosomes. Mwana amene amalandira chromosome Y kuchokera kwa abambo amakhala wamwamuna ndipo ali ndi 1 X ndi 1 Y chromosome.

Ziwalo zoberekera zamwamuna ndi mkazi ndi ziwalo zoberekera zonse zimachokera ku minofu yomweyo ya mwana wosabadwayo. Ziwalo zoberekera zodabwitsazi zimatha kuchitika ngati njira yomwe imapangitsa kuti fetusyu ikhale "yamwamuna" kapena "wamkazi" yasokonezedwa. Izi zimapangitsa kuti zikhale zovuta kuzindikira khanda ngati lamwamuna kapena wamkazi. Kukula kwake kumasiyanasiyana. Nthawi zambiri, mawonekedwe athupi amakula mokwanira ngati wotsutsana ndi jini. Mwachitsanzo, chibadwa chamwamuna chimakhala ndi mawonekedwe achikazi wabwinobwino.

Nthawi zambiri, maliseche osamveka bwino azimayi (ana omwe ali ndi ma 2 X chromosomes) amakhala ndi izi:

• Nkongo wokulitsa womwe umawoneka ngati mbolo yaying'ono.
• Kutsegula kwa urethral (komwe mkodzo umatuluka) kumatha kukhala kulikonse, pamwambapa, kapena pansi pankongo.
• Malaba amatha kusakanikirana ndikuwoneka ngati chikopa.
• Khanda lingaganizidwe kuti ndi lamwamuna lokhala ndi machende osavomerezeka.
• Nthawi zina chotupa cha minofu chimamveka mkati mwa labia yosakanikirana, ndikupangitsa kuti chiwoneke ngati chotupa ndi machende.

Mwa mwamuna wamwamuna (1 X ndi 1 Y chromosome), maliseche ovuta nthawi zambiri amakhala ndi izi:

• Mbolo yaing'ono (yochepera 2 mpaka 3 masentimita, kapena 3/4 mpaka 1 1/4 mainchesi) yomwe imawoneka ngati yotakata (khungu la mwana wakhanda nthawi zambiri limakulitsidwa pakubadwa).
• Kutsegula kwa urethral kumatha kukhala kulikonse, pamwambapa, kapena pansi pa mbolo. Itha kupezeka kutsika kwa perineum, ndikupangitsa kuti khanda liwoneke ngati lachikazi.
• Pakhoza kukhala kachilombo kakang'ono kamene kamasiyanitsidwa ndipo kamawoneka ngati labia.
• Machende osatsitsidwa amapezeka nthawi zambiri ndi maliseche osamveka bwino.

Kupatula zochepa, maliseche ophatikizika nthawi zambiri sawopseza moyo. Komabe, zimatha kubweretsa mavuto pakati pa mwana ndi banja. Pachifukwa ichi, gulu la akatswiri odziwa zambiri, kuphatikiza ma neonatologists, akatswiri a zamoyo, ma endocrinologists, ndi akatswiri amisala kapena ogwira nawo ntchito azithandizira kusamalira mwana.

Zomwe zimayambitsa maliseche osaphatikizapo ndi awa:

• Zachinyengo. Maliseche ndi a amuna kapena akazi okhaokha, koma mawonekedwe ena azinthu zina amapezeka.
• Zoona zenizeni za hermaphroditism. Izi ndizosowa kwambiri, momwe minofu ya mazira ndi machende ilipo. Mwanayo akhoza kukhala ndi ziwalo zoberekera za amuna ndi akazi.
• Zosakaniza gonadal dysgenesis (MGD). Ichi ndi chikhalidwe cha ma intersex, momwe mumakhala nyumba zamwamuna (gonad, testis), komanso chiberekero, nyini, ndi mazira.
• Kobadwa nako adrenal hyperplasia. Matendawa ali ndi mitundu ingapo, koma mawonekedwe ofala kwambiri amachititsa kuti mkazi wamtunduwu azioneka wamwamuna. Mayiko ambiri amayesa izi zomwe zitha kupha moyo pakamayesedwa.
• Chromosomal zovuta, kuphatikiza Klinefelter syndrome (XXY) ndi Turner syndrome (XO).
• Ngati mayi atenga mankhwala ena (monga androgenic steroids), chiberekero chachikazi chimawoneka chachimuna kwambiri.
• Kuperewera kwama mahomoni ena kumatha kupangitsa kuti mluza uzikula ndi thupi la mkazi, ngakhale atakhala kuti ndi wamkazi.
• Kupanda ma testosterone ma receptors. Ngakhale thupi limapangitsa mahomoni ofunikira kuti akhale amphongo, thupi silimatha kuyankha mahomoni amenewo. Izi zimatulutsa mtundu wamthupi lachikazi, ngakhale chiberekero chiri chachimuna.

Chifukwa cha zomwe zitha kukhala pagulu komanso m'maganizo, makolo ayenera kusankha ngati angalere mwana wamwamuna kapena wamkazi koyambirira atazindikira. Ndibwino ngati chisankhochi chapangidwa m'masiku ochepa oyamba amoyo. Komabe, ili ndi chisankho chofunikira, chifukwa chake makolo sayenera kufulumira.

Lumikizanani ndi omwe amakuthandizani ngati muli ndi nkhawa ndi mawonekedwe akumaliseche a mwana wanu, kapena mwana wanu:

• Zimatenga milungu yopitilira 2 kuti ayambirenso kulemera kwake
• Ndi kusanza
• Imawoneka yopanda madzi (mkamwa mouma mkamwa, osagwetsa misozi polira, matewera osachepera 4 onyowa pamaola 24, maso amawonekera)
• Ali ndi njala yocheperako
• Ali ndi ma buluu (kanthawi kochepa pomwe magazi ocheperako amapita m'mapapu)
• Ali ndi vuto kupuma

Izi zonse zikhoza kukhala zizindikiro za kubadwa kwa adrenal hyperplasia.

Maliseche osadziwika atha kupezeka poyesedwa koyambirira kwa mwana wakhanda.

Woperekayo ayesa mayeso omwe angawonetse maliseche omwe si "amuna wamba" kapena "akazi wamba," koma pakati penapake.

Wothandizirayo afunsa mafunso a mbiri yakale kuti athandizire kuzindikira zovuta zilizonse za chromosomal. Mafunso angaphatikizepo:

• Kodi pali mbiri yabanja yakupita padera?
• Kodi pali mbiri yakale yabanja yobadwa ndi mwana?
• Kodi pali mbiri yakale yabanja yakumwalira msanga?
• Kodi pali aliyense m'banjamo amene anali ndi makanda omwe adamwalira m'masabata angapo oyamba amoyo kapena omwe anali ndi maliseche osamveka?
• Kodi pali mbiri yakale yabanja yamavuto omwe amayambitsa maliseche osamveka?
• Ndi mankhwala ati omwe mayi amamwa asanakhale ndi pakati kapena ali ndi pakati (makamaka ma steroids)?
• Ndi zisonyezo zina ziti zomwe zilipo?

Kuyezetsa magazi kumatha kudziwa ngati mwanayo ndi wamwamuna kapena wamkazi. Nthawi zambiri maselo ang'onoang'ono amatha kupukutidwa kuchokera mkati mwa masaya a mwanayo kuti ayesedwe. Kuyesa maselowa nthawi zambiri kumakhala kokwanira kudziwa zakubadwa kwa khanda. Kusanthula kwa Chromosomal ndiyeso yayikulu kwambiri yomwe ingafunike pamavuto okayikitsa.

Endoscopy, m'mimba x-ray, m'mimba kapena m'chiuno ultrasound, ndi mayeso ofanana angafunike kudziwa kupezeka kapena kupezeka kwa ziwalo zoberekera zamkati (monga mayeso osavomerezeka).

Kuyesa kwa labotale kungathandize kudziwa momwe ziwalo zoberekera zimagwirira ntchito. Izi zitha kuphatikizira kuyesa kwa adrenal ndi gonadal steroids.

Nthawi zina, laparoscopy, laparotomy yowunikira, kapena ma biopsy a ma gonads angafunike kutsimikizira zovuta zomwe zingayambitse maliseche osamveka bwino.

Kutengera chifukwa, opareshoni, m'malo mwa mahomoni, kapena mankhwala ena amagwiritsidwa ntchito pochiza zinthu zomwe zingayambitse maliseche osamveka.

Nthawi zina, makolo ayenera kusankha kuti alere mwanayo ngati wamwamuna kapena wamkazi (mosasamala ma chromosomes a mwanayo). Chisankhochi chimatha kukhala ndi gawo lalikulu pamaubwenzi ndi malingaliro pamwana, chifukwa chake upangiri umalimbikitsidwa nthawi zambiri.

Zindikirani: Nthawi zambiri kumakhala kosavuta kuchiza (ndikulera) mwanayo ngati wamkazi. Izi ndichifukwa choti ndikosavuta kuti dotoloyu apange maliseche achikazi kuposa momwe amapangira maliseche achimuna. Chifukwa chake, nthawi zina izi zimalimbikitsidwa ngakhale mwanayo ali wamwamuna. Komabe, ili ndi chisankho chovuta. Muyenera kukambirana ndi banja lanu, omwe amakupatsani mwana wanu, dokotalayo, endocrinologist wa mwana wanu, komanso mamembala ena azachipatala.

Ziwalo zoberekera - zosokoneza

• Zovuta zakukula kwa nyini ndi kumaliseche

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Rey RA, Josso N. Kuzindikira ndikuchiza zovuta zakukula kwakugonana. Mu: Jameson JL, De Groot LJ, de Kretser DM, et al, olemba. Endocrinology: Akuluakulu ndi Ana. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier Saunders; 2016: chap 119.

PC yoyera. Zovuta zakukula kwakugonana. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. Wolemba 25. Philadelphia, PA: Elsevier Saunders; 2016: chap 233.

PC yoyera. Congenital adrenal hyperplasia ndi zovuta zina. Mu: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, olemba. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 594.