I-Cushing's Syndrome Yenzelwa I-Cortisol Eyengeziwe
I-Cushing's syndrome yinkinga eyenzekayo lapho umzimba ubonakala ku-cortisol kakhulu. I-Cortisol ikhiqizwa umzimba futhi isetshenziselwa izidakamizwa ze-corticosteroid. I-Cushing's syndrome ingenzeka ngenxa yokuthi i-cortisol yenziwa ngokweqile ngomzimba noma ekusebenziseni izidakamizwa eziqukethe i-cortisol (njenge-prednisone). Lapho i-Cushing's syndrome ibangelwa ukusetshenziswa kwesikhathi eside kwemithi ye-corticosteroid, ibizwa nangokuthi i-hypercortisolism.
Mayelana ne-Cortisol
I-Cortisol iyinhloko ye-hormone yokucindezeleka yomzimba. I-Cortisol ifihliwe yizigulane eziyingozi ekuphenduleni ukucinwa kwe-horrenone ye-adrenocorticotropic (ACTH) yi-pituitary. Olunye uhlobo lwe-Cushing's syndrome lungabangelwa ukucindezeleka kwe-ACTH nge-pituitary eholele ekugqeni kwe-cortisol.
I-Cortisol inemisebenzi eminingi, kuhlanganise nokulawulwa kokuvuvukala nokulawula indlela umzimba osebenzisa ngayo ama-carbohydrates, amafutha namaprotheni. I-Corticosteroids njenge-prednisone, ejwayele ukusetshenziselwa ukuphatha izimo zokuvuvukala, ukulingisa imiphumela ye-cortisol.
Izimbangela zeCushing's Syndrome
Kunezimbangela ezimbalwa ezihlukahlukene ze-Cushing's syndrome.
Izifo zikaCushing. Isifo sikaCushing yisinye sezizathu ezivamile ze-Cushing's syndrome eyenzeka lapho i-pituitary ikhishwa i-ACTH eyengeziwe, okuholela ekwenzeni i-cortisol eyengeziwe. Lokhu kungabangela isisu se-pituitary noma enye ukukhula.
Iatrogenic Cushing's Syndrome. Ukusetshenziswa kwezidakamizwa eziphezulu zemithi ye- steroid isikhathi eside kungabangela leli fomu le-Cushing's syndrome.
Imithi ye-steroid noma izidakamizwa ze-corticosteroid zisetshenziselwa ukuphatha izimo eziningi zokuvuvukala, kuhlanganise ne-asthma, lupus, i-rthumicid arthritis, nesifo sesifo sofuba (IBD) . Kwezinye izimo, kunqunywe amazinga aphezulu kanye nesikhathi eside.
I-Adrenal Gland Tumor. Okokugcina, esinye isizathu, nakuba singavamile, sibangelwa ngqo yi-tumor ezinhlambini ze-adrenal.
Lezi zinhlobo zamathumba zidala amazinga aphezulu e-cortisol, azimele ngokukhiqizwa kwe-ACTH kusuka emthonjeni we-pituitary. Uma lesi sifo sinomgogodla owodwa kuphela, inani elidlula le-cortisol elikhiqizwayo lingenza imbangela ye-adrenal engathintekile iqale ukukhula nokuhlehlisa.
Izimpawu zeCushing's Syndrome
Izimpawu ze-Cushing's syndrome zingabandakanya okulandelayo:
- i-acne
- I-Buffalo hump (amafutha engeziwe afakwa ngemuva kwetamo)
- amazinga e-glucose ephakeme
- ukoma ngokweqile
- ukukhathala
- ukuvuthwa okwandisiwe
- ikhanda
- umfutho wegazi ophezulu
- i-hirsutism (ukukhula kwezinwele ngokweqile)
- ukushintsha esikhathini
- ukukhuluphala kuzungeze isiqu
- izimpawu zengqondo ezifana nokungahlali kahle kwemizwelo, ukucindezeleka, ukukhathazeka, ukuhlaselwa kwesibindi
- nxazonke, ubuso obugcwele (owaziwa njengezinyanga)
- izinguquko zesikhumba
- gweba isisu esiswini, izingalo, amabele, izintambo, namathanga (okubizwa ngokuthi i-striae)
- ubuthakathaka
Kukhona ezinye izibonakaliso nezimpawu zalesi simo ezingahlanganiswa ngenhla. Kubalulekile ukubona udokotela nganoma yikuphi ukukhathazeka mayelana nezimpawu ze-Cushing's syndrome.
Ukuxilongwa kweCushing's Syndrome
Kukhona izici zomzimba ezihlukaniswayo, njengobuso benyanga obumbulu kanye ne-bumpalo hump, okujwayelekile phakathi kwabantu abane-Cushing's syndrome. Uma udokotela esho uCushing, ngemuva komlando wendabuko, ukuhlolwa ngokomzimba, kanye nomsebenzi wegazi osemqoka, uzokwenza ukuhlolwa kwegazi ne-urine ukukala inani le-cortisol ekhona emzimbeni.
Uma lezo zinga ziphakeme, udokotela angalawula ukuhlolwa okubizwa ngokuthi i-dexamethasone yokucindezela ukuhlolwa. Lokhu kuhlolwa lapho i-steroid yomlomo ebizwa ngokuthi i-dexamethasone inikezwa futhi ukuhlolwa kwegazi kanye nomchamo kuthathwa futhi ukukala i-cortisol namanye amahomoni adrenal. Ukuhlolwa okwengeziwe kungalawulwa uma lezi zivivinyo zokuqala zibuya ngemiphumela ebonisa ukuthi i-Cushing's syndrome ingase ibe ukukhathazeka.
Udokotela angathuthela enkambweni yokuhlola ejulile uma ukuhlolwa kokuqala kubonisa ukuthi lokhu kuyadingeka. Uma isifo sikhishwa ukuthi imbangela yeCushing's, ezinye izivivinyo ezingase zibekwe zihlanganisa i- CT scan noma i- MRI .
Ngesikhathi ukuhlolwa kungabonakala sengathi kunomsebenzi omningi noma okungahambi kahle, kubalulekile ukulandelela uphinde ugcwalise konke okuhlolwayo okugunyazwa udokotela.
Ukwelashwa kwe-Cushing's Syndrome
I-Cushing's syndrome iphathwe kangcono ngokunquma ukuthi yini ebangela amazinga aphezulu e-cortisol nokuyisusa.
Isifo sikaCushing. Ukwelashwa kuvame ukwelashwa kokuqala kwamagciwane ngezifo zikaCushing. Ukususwa kwe- tumor ye- pituitary futhi ngezinye izikhathi yonke ingubo ye-pituitary, ngokusebenzisa inqubo ebizwa ngokuthi i-transsphenoidal resection (ngemuva kwempumu) yi-neurosurgeon ngokuvamile iyadingeka. Uma yonke i-pituitary idinga ukususwa, izithasiselo ze-cortisol, ye-thyroid, nama-hormone ocansi kuyodingeka unikezwe. Uma ukuhlinzeka kuyaphambene noma isisu asikwazi ukususwa, ukwelapha imishanguzo kungasetshenziselwa ukunciphisa isisu. Uma lesi sifo sitholakala ukuthi sinamahloni , i-chemotherapy noma imisebe ingase ibekwe ukuba kuncishiswe ingozi yokuphindaphinda. Kunezindlela zokwelashwa ezitholakalayo zokwelapha izifo zikaCushing, kuhlanganise noPasireotide (Signifor) noMifepristone (Korlym).
Iatrogenic Cushing's syndrome. Uma ngabe i-syndrome ibangelwa imithi enqunyiwe, kungcono ukuqala ukuthatha imithi phansi, eqondiswa udokotela, ukususa i-steroid eyengeziwe. Kubalulekile ukwehlisa kancane kancane inani le-corticosteroid ethathwe phakathi kwamasonto noma ngisho nezinyanga. Imithi ehlukile noma umthamo ungatholwa ukuthi uyindlela yokwelapha efanelekile yenkinga engaphansi. Kubalulekile ukulandela imiyalelo ngokuqondile, njengoba i-steroids ikwazi ukuma ngokuzumayo, kodwa kumele ihambe kancane kancane.
Uma i-steroids ingakwazi ukumiswa, noma uma kuthatha isikhathi eside ukuyiyeka, ezinye izindlela zokwelapha zinganikezwa ukuphatha ezinye izimpawu nezimpawu ze-Cushing's syndrome. Ezinye zezici zalesi sifo esingadinga ukwelashwa nezinye izidakamizwa kanye nezinguquko ekudleni zihlanganisa ushukela ephezulu wegazi kanye ne-cholesterol ephezulu. Ukunciphisa ingozi yezinsalela ngemithi esetshenziselwa ukwelapha i-osteoporosis kungase kudingeke futhi. Endabeni yokucindezeleka noma ukukhathazeka, ukuhanjiswa kwingcweti yezempilo yengqondo kungase kusebenze.
Inothi Kusuka
Endabeni yesifo sikaCushing, abantu abaningi baphila kahle ngemva kokuhlinzwa. Ezinye izibonakaliso zalesi sifo zingase ziqhubeke ngemuva kokuhlinzwa, njenge-hypertension, kodwa lezi zivame ukuphathwa ngemithi. Uma ukuhlinzeka kungenakwenzeka, kunezindlela zokwelapha ezitholakalayo ezingahle zinciphise imiphumela ye-cortisol eyanda.
I-Cushing's syndrome ingozi yokuthatha imithi ye-steroid, kodwa ayivamile. Ukusetshenziswa kwe-steroids kanye nobungozi obungase kube khona kanye nezinzuzo kufanele kukhulunywe nodokotela. I-Cushing's syndrome ingaphathwa ngokunciphisa inani le-steroids ethathwa, nangokuphatha ezinye izimpawu nezimpawu. Umgomo uhlale uthola iziguli zisuse i-steroids ngokushesha futhi ngokuphepha ngangokunokwenzeka.
> Imithombo:
> Ama-Margulies, P. "Izifo Ezibangelwa I-Adrenal Diseases - Cushing's Syndrome: Amaqiniso Okudingeka Uwazi." I-National Adrenal Diseases Foundation. 2017.
> Izikhungo Zikazwelonke Zempilo. "I-Cushing's Syndrome." Isikhungo Sikazwelonke Sesifo Sikashukela Nesifo Sezinyosi kanye Nezinso (NIDDK).
> Sharma ST, u-Nieman LK. "Cushing's syndrome: zonke izinhlobo, ukutholakala, nokuphathwa." I- ndocrinol iMetab Clin North Am . 2011 Jun; 40: 379-391, viii-ix. doi: 10.1016 / j.ecl.2011.01.006
> Sharma ST, u-Nieman LK. I-Cushing's Syndrome: Zonke izinhlobo, ukutholakala, nokuphathwa. "I-Endocrinol Metab Clin North Am. 2011; 40: 379-391. doi: 10.1016 / j.ecl.2011.01.006