Cushing lefu

Boloetse ba Cushing ke boemo boo ho lona tšoelesa ea pituitary e ntšang hormone ea adrenocorticotropic e ngata haholo (ACTH). Tšoelesa ea pituitary ke setho sa sistimi ea endocrine.

Boloetse ba Cushing ke mofuta oa Cushing syndrome. Mefuta e meng ea Cushing syndrome e kenyelletsa Cushing syndrome e makatsang, Cushing syndrome e bakoang ke hlahala ea adrenal le ectopic Cushing syndrome.

Boloetse ba cushing bo bakoa ke hlahala kapa kholo e fetelletseng (hyperplasia) ea tšoelesa ea pituitary. Tšoelesa ea pituitary e ka tlase botlaaseng ba boko. Mofuta oa hlahala ea pituitary e bitsoang adenoma ke lona sesosa se tloaelehileng haholo. Adenoma ke hlahala e nang le bothata (eseng mofetše).

Ka lefu la Cushing, tšoelesa ea pituitary e ntša ACTH e ngata haholo. ACTH e hlohlelletsa tlhahiso le tokollo ea cortisol, hormone ea khatello ea maikutlo. ACTH e ngata haholo e etsa hore litšoelesa tsa adrenal li etse cortisol e ngata haholo.

Cortisol hangata e lokolloa nakong ea maemo a sithabetsang. E na le mesebetsi e meng e mengata, ho kenyelletsa:

• Ho laola tšebeliso ea 'mele ea lik'habohaedreite, mafura le liprotheine
• Ho fokotsa karabelo ea sesole sa 'mele ho ruruha (ho ruruha)
• Ho laola khatello ea mali le ho leka-lekana ha metsi 'meleng

Matšoao a lefu la Cushing a kenyelletsa:

• Botenya ba mmele o kaholimo (kaholimo ho letheka) le matsoho le maoto a masesaane
• Ho potoloha, bofubelu, sefahleho se tletseng (sefahleho sa khoeli)
• Sekhahla sa kholo ea bana

Liphetoho tsa letlalo tse atisang ho bonoa li kenyelletsa:

• Makhopho kapa makhopho a letlalo
• Matšoao a pherese (1/2 cm kapa 1 cm kapa bophara ho feta), a bitsoang striae, letlalong la mpa, lirope, matsoho a kaholimo le matsoele
• Letlalo le lesesaane le nang le matetetso a bonolo, hangata matsohong le matsohong

Liphetoho tsa mesifa le masapo li kenyelletsa:

• Ho opeloa ke mokokotlo, ho etsahalang ka mesebetsi e tloahelehileng
• Ho opeloa ke masapo kapa bonolo
• Pokello ea mafura lipakeng tsa mahetla (hump ea nare)
• Ho fokola ha masapo, a lebisang ho ho robeha ha likhopo le mokokotlo
• Mesifa e fokolang e baka ho se mamellane ka boikoetliso

Basali ba ka ba le:

• Khōlo e feteletseng ea moriri sefahlehong, molaleng, sefubeng, mpeng le liropeng
• Nako ea ho ilela khoeli e sa tloaelehang kapa ea emisa

Banna ba kanna ba ba le:

• Ho fokotsa kapa ho se na takatso ea thobalano (low libido)
• Mathata a ho emisa

Matšoao a mang kapa mathata a ka kenyelletsa:

• Liphetoho tsa kelello, joalo ka khatello ea maikutlo, ho tšoenyeha kapa ho fetoha ha boitšoaro
• Mokhathala
• Ho tšoaetsoa khafetsa
• Ho opeloa ke hlooho
• Nyora e eketsehileng le ho ntša metsi
• Khatello ea mali e phahameng
• Lefu la tsoekere

Mofani oa tlhokomelo ea bophelo o tla etsa tlhahlobo ea 'mele' me a botse ka matšoao a hau.

Liteko li etsoa pele ho netefatsa hore ho na le cortisol e ngata haholo 'meleng, ebe ho fumana sesosa.

Liteko tsena li tiisa cortisol e ngata haholo:

• Moroto oa lihora tse 24 cortisol
• Teko ea khatello ea Dexamethasone (tekanyetso e tlase)
• Maqhubu a "cortisol" a salivary (hoseng haholo le bosiu haholo)

Liteko tsena li supa sesosa:

• Boemo ba mali ba ACTH
• MRI ea boko
• Teko ea li-hormone ea Corticotropin e lokollang 'mele, e sebetsang ho tšoelesa ea pituitary ho baka ho lokolloa ha ACTH
• Teko ea khatello ea Dexamethasone (tekanyetso e phahameng)
• Sampling ea petrosal sinus sampling (IPSS) - e lekanya maemo a ACTH methapong e ntšang tšoelesa ea pituitary ha e bapisoa le methapo e sefubeng

Liteko tse ling tse ka etsoang li kenyelletsa tse ling tsa tse latelang:

• Ho itima lijo ka tsoekere ea mali le A1C ho leka lefu la tsoekere
• Ho hlahloba lipid le k'holeseterole
• Sesebelisoa sa masapo a masapo ho lekola lefu la masapo

Ho ka hlokahala liteko tse fetang e le 'ngoe ho hlahloba lefu la Cushing. Mofani oa hau a ka u botsa hore u bone ngaka e sebetsanang le mafu a pituitary.

Kalafo e kenyelletsa ho buuoa ho tlosa hlahala ea pituitary, haeba ho khonahala. Kamora 'opereishene, tšoelesa ea pituitary e ka qala ho sebetsa hape butle ebe e khutlela setloaeling.

Nakong ea ts'ebetso ea ho hlaphoheloa ho tloha opereisheneng, o kanna oa hloka kalafo e ncha ea cortisol hobane pituitary e hloka nako ea ho qala ACTH hape.

Kalafo ea mahlaseli ea pituitary e ka sebelisoa hape haeba hlahala e sa tlosoe ka botlalo.

Haeba hlahala e sa arabele opereisheneng kapa mahlaseling, o kanna oa hloka meriana ho emisa 'mele oa hau ho etsa cortisol.

Haeba litlhare tsena li sa atlehe, litšoelesa tsa adrenal li kanna tsa hloka ho tlosoa ho emisa maemo a phahameng a cortisol hore e se hlahisoe. Ho tlosoa ha litšoelesa tsa adrenal ho ka etsa hore hlahala ea pituitary e hole haholo (Nelson syndrome).

Ha e sa alafshoa, lefu la Cushing le ka baka mafu a maholo, esita le lefu. Ho tlosa hlahala ho ka lebisa ho foleng ka botlalo, empa hlahala e ka hola hape.

Mathata a bophelo bo botle a ka bakoang ke lefu la Cushing a kenyelletsa:

• Ho sithabela ha mokokotlo mokokotlong
• Lefu la tsoekere
• Khatello ea mali e phahameng
• Tšoaetso
• Majoe a liphio
• Mood kapa mathata a mang a kelello

Bitsa mofani oa hau haeba u ba le matšoao a lefu la Cushing.

Haeba u tlositsoe hlahala ea pituitary, letsetsa mofani oa thepa ea hau haeba u na le matšoao a mathata, ho kenyeletsoa matšoao a hore hlahala e khutlile.

Pituitary Cushing lefu; ACEN-ho boloka adenoma

• Litšoelesa tsa endocrine
• Striae sebakeng sa popliteal fossa
• Striae leotong

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Molitch ME. Pituitary e ka pele. Ka: Goldman L, Schafer AI, li-eds. Phekolo ea Goldman-Cecil. La 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: khaolo ea 224.

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