Mayeso opondereza a Dexamethasone

Mayeso opondereza a Dexamethasone amayesa ngati chinsinsi cha adrenocorticotrophic hormone (ACTH) chochitidwa ndi pituitary chitha kuponderezedwa.

Mukamayesedwa, mudzalandira dexamethasone. Imeneyi ndi mankhwala amphamvu opangidwa ndi anthu (kupanga) a glucocorticoid. Pambuyo pake, magazi anu amakopedwa kotero kuti gawo la cortisol m'magazi anu likhoza kuyezedwa.

Pali mitundu iwiri yosiyana ya mayesero opondereza a dexamethasone: mlingo wochepa ndi mlingo waukulu. Mtundu uliwonse ukhoza kuchitika munthawi yomweyo (wamba) kapena muyezo (masiku atatu) (osowa). Pali njira zosiyanasiyana zomwe zingagwiritsidwe ntchito poyesa. Zitsanzo za izi zafotokozedwa pansipa.

Zofala:

• Mlingo wocheperako usiku - Mupeza milligram (mg) 1 ya dexamethasone nthawi ya 11 koloko masana, ndipo wothandizira zaumoyo amakoka magazi anu m'mawa wamawa pa 8 koloko kuti muyese cortisol.
• Mlingo waukulu usiku umodzi - Woperekayo amayesa cortisol yanu m'mawa wa mayeso. Kenako mudzalandira 8 mg wa dexamethasone nthawi ya 11 koloko. Magazi anu amatengedwa m'mawa wotsatira nthawi ya 8 koloko kuti muyese cortisol.

Kawirikawiri:

• Mlingo wotsika pang'ono - Mkodzo umasonkhanitsidwa masiku atatu (osungidwa m'makontena a maola 24) kuti muyese cortisol. Patsiku 2, mudzalandira mlingo wochepa (0.5 mg) wa dexamethasone pakamwa maola 6 aliwonse kwa maola 48.
• Mlingo wapamwamba kwambiri - Mkodzo umasonkhanitsidwa kwa masiku atatu (osungidwa mumakontena a maola 24) kuti muyese cortisol. Patsiku 2, mudzalandira mulingo wambiri (2 mg) wa dexamethasone pakamwa maola 6 aliwonse kwa maola 48.

Werengani ndikutsatira malangizowa mosamala. Chomwe chimafala kwambiri pazotsatira zoyeserera ndikuti malangizo satsatiridwa.

Wothandizirayo angakuuzeni kuti musiye kumwa mankhwala ena omwe angakhudze mayeso anu, kuphatikiza:

• Maantibayotiki
• Mankhwala oletsa kulanda
• Mankhwala omwe amakhala ndi corticosteroids, monga hydrocortisone, prednisone
• Estrogen
• Kulera pakamwa (njira zolerera)
• Mapiritsi amadzi (okodzetsa)

Pamene singano imayikidwa kuti ikoke magazi, anthu ena amamva kupweteka pang'ono. Ena amangomva kubaya kapena kuluma. Pambuyo pake, pakhoza kukhala kupunduka kapena kuvulala pang'ono. Izi posachedwa zichoka.

Kuyesaku kumachitika pamene wothandizirayo akukayikira kuti thupi lanu likupanga cortisol wambiri. Zimachitidwa kuti zithandizire kuzindikira matenda a Cushing ndikuzindikira chomwe chimayambitsa.

Kuyezetsa magazi pang'ono kungakuthandizeni kudziwa ngati thupi lanu likupanga ACTH yambiri. Kuyezetsa kwamphamvu kwambiri kumatha kuthandizira kudziwa ngati vutoli lili pituitary gland (Cushing matenda).

Dexamethasone ndi yopangidwa ndi anthu (synthetic) steroid yomwe imayitanitsa kulandila komweko monga cortisol. Dexamethasone imachepetsa kutulutsidwa kwa ACTH mwa anthu abwinobwino. Chifukwa chake, kumwa dexamethasone kuyenera kuchepetsa mulingo wa ACTH ndikuwongolera kutsika kwa cortisol.

Ngati chifuwa cha pituitary chimatulutsa ACTH yochulukirapo, mudzakhala ndi yankho lachilendo pamayeso ochepa. Koma mutha kukhala ndi yankho labwinobwino poyesedwa kwambiri.

Mulingo wa Cortisol uyenera kuchepa mukalandira dexamethasone.

Mlingo wotsika:

• Usiku wonse - 8 m'mawa plasma cortisol yotsika kuposa 1.8 ma micrograms pa deciliter (mcg / dL) kapena 50 nanomoles pa lita (nmol / L)
• Standard - Urinary free cortisol patsiku 3 kutsika kuposa 10 micrograms patsiku (mcg / tsiku) kapena 280 nmol / L

Mlingo waukulu:

• Usiku wonse - kuposa 50% yochepetsa plasma cortisol
• Standard - yochulukirapo kuposa 90% yochepetsera mkodzo wopanda cortisol

Mitengo yamtengo wapatali imatha kusiyanasiyana pakati pa ma labotore osiyanasiyana. Ma lab ena amagwiritsa ntchito miyeso yosiyana kapena amatha kuyesa mitundu yosiyanasiyana. Lankhulani ndi dokotala wanu tanthauzo la zotsatira zanu zoyesa.

Kuyankha kwachilendo pamayeso ochepa kungatanthauze kuti mwatulutsidwa modabwitsa cortisol (Cushing syndrome). Izi zitha kuchitika chifukwa cha:

• Chotupa cha adrenal chomwe chimapanga cortisol
• Pituitary chotupa chomwe chimapanga ACTH
• Chotupa m'thupi chomwe chimatulutsa ACTH (ectopic Cushing syndrome)

Kuyesa kwamankhwala okwera kwambiri kumatha kukuthandizani kudziwa zomwe zimayambitsa matenda (Cushing matenda) pazifukwa zina. Kuyezetsa magazi kwa ACTH kungathandizenso kuzindikira chomwe chimayambitsa kuchuluka kwa cortisol.

Zotsatira zachilendo zimasiyana kutengera vuto lomwe limayambitsa vutoli.

Cushing syndrome yoyambitsidwa ndi chotupa cha adrenal:

• Mayeso otsika - osachepetsedwa ndi cortisol yamagazi
• Mulingo wa ACTH - wotsika
• Nthaŵi zambiri, kuyesa kwa mlingo waukulu sikofunikira

Matenda a Ectopic Cushing:

• Mayeso otsika - osachepetsedwa ndi cortisol yamagazi
• Mulingo wa ACTH - wokwera
• Kuyesa kwamphamvu kwambiri - kuchepa kwa cortisol yamagazi

Cushing syndrome yoyambitsidwa ndi chotupa cha pituitary (Cushing matenda)

• Mayeso otsika - osachepetsedwa ndi cortisol yamagazi
• Kuyesa kwapamwamba-kuyembekezera kuchepa kwa cortisol yamagazi

Zotsatira zoyesa zabodza zimatha kuchitika pazifukwa zambiri, kuphatikiza mankhwala osiyanasiyana, kunenepa kwambiri, kukhumudwa, komanso kupsinjika. Zotsatira zabodza ndizofala kwambiri mwa akazi kuposa amuna.

Pali chiopsezo chochepa chotenga magazi anu. Mitsempha ndi mitsempha imasiyana mosiyanasiyana kuchokera kwa wodwala kupita kwa wina, komanso kuchokera mbali imodzi ya thupi kupita mbali inayo.Kutenga magazi kuchokera kwa anthu ena kumatha kukhala kovuta kuposa ena.

Zowopsa zina zomwe zimakoka magazi ndi zochepa, koma mwina ndi izi:

• Kutaya magazi kwambiri
• Kukomoka kapena kumva mopepuka
• Ma punctures angapo kuti mupeze mitsempha
• Hematoma (magazi akuchuluka pansi pa khungu)
• Kutenga (chiopsezo chochepa nthawi iliyonse khungu likasweka)

DST; Mayeso opondereza a ACTH; Kuyesa kwa Cortisol

Chernecky CC, Berger BJ. Mayeso opondereza a Dexamethasone - kuzindikira. Mu: Chernecky CC, Berger BJ, olemba., Eds. Kuyesa Kwantchito ndi Njira Zakuzindikira. Lachisanu ndi chimodzi. St Louis, MO: Elsevier Saunders; 2013: 437-438.

Guber HA, Farag AF. Kuwunika kwa endocrine ntchito. Mu: McPherson RA, Pincus MR, olemba., Eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. Wachitatu. St Louis, MO: Elsevier; 2017: mutu 24.

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.