Exogenous Cushing syndrome

Exogenous Cushing syndrome ke mofuta oa Cushing syndrome e hlahang ho batho ba nkang glucocorticoid (eo hape e bitsoang "corticosteroid" kapa "hormone" hormone).

Cushing syndrome ke lefu le hlahang ha 'mele oa hau o na le "cortisol" e phahameng ho feta e tloaelehileng. Hormone ena hangata e etsoa litšoeleng tsa adrenal.

Mokhoa o moholo o bakoang ke ntho e kantle ho 'mele. Exogenous Cushing syndrome e hlaha ha motho a noa meriana e entsoeng ke motho (synthetic) glucocorticoid ho phekola lefu.

Li-glucocorticoids li fanoa bakeng sa maloetse a mangata, joalo ka mafu a matšoafo, maemo a letlalo, maloetse a ho ruruha, mofetše, lihlahala tsa boko le lefu la manonyeletso. Meriana ena e tla ka mefuta e mengata, ho kenyeletsoa pilisi, intravenous (IV), ente lenonyong, enema, litlolo tsa letlalo, li-inhalers le marotholi a mahlo.

Batho ba bangata ba nang le Cushing syndrome ba na le:

• Ho potoloha, bofubelu, sefahleho se tletseng (sefahleho sa khoeli)
• Sekhahla se holang butle (ho bana)
• Boima ba 'mele ka ho bokella mafura ka kutu, empa tahlehelo ea mafura matsohong, maotong le marameng (botenya bo bohareng)

Liphetoho tsa letlalo tse atisang ho bonoa li kenyelletsa:

• Tšoaetso ea 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 ho longoa habonolo

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 le kaholimo ho lesapo la molaleng
• Ho robeha likhopo le mokokotlo ho bakoang ke ho sohla masapo
• Mesifa fokola, haholo-holo ea letheka le mahetleng

Mathata a mmele ka bophara (systemic) a ka kenyelletsa:

• Mofuta oa 2 oa lefu la tsoekere
• Khatello ea mali e phahameng
• Cholesterol e phahameng le triglycerides

Basali ba ka ba le:

• Linako tse sa fetoheng kamehla kapa tse emisang

Banna ba kanna ba ba le:

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

Matšoao a mang a ka bang teng a kenyelletsa:

• Liphetoho tsa kelello, joalo ka khatello ea maikutlo, ho tšoenyeha kapa ho fetoha ha boitšoaro
• Mokhathala
• Ho opeloa ke hlooho
• Nyora e eketsehileng le ho ntša metsi

Mofani oa tlhokomelo ea bophelo o tla etsa tlhahlobo ea 'mele' me a botse ka matšoao a hau le meriana eo u e sebelisang. Bolella mofani ka meriana eohle eo esale u e noa likhoeling tse 'maloa tse fetileng. Hape bolella mofani ka lithunya tseo u li fumaneng ofising ea mofani oa thepa.

Haeba u sebelisa cortisone, prednisone, kapa tse ling tsa corticosteroids, liphetho tse latelang tsa liteko li ka fana ka maikutlo a Cushing syndrome e sa tloaelehang:

• Boemo bo tlaase ba ACTH
• Boemo bo tlase ba cortisol (kapa boemo bo phahameng ba cortisol) maling kapa morong, ho latela moriana oo u o noang
• Karabelo e sa tloaelehang ho teko ea ts'usumetso ea cosyntropin (ACTH)
• E phahameng ho feta tsoekere e tloaelehileng ea ho itima lijo
• Potassium e tlaase ea mali
• Matšoao a fokolang a masapo, joalo ka ha a lekantsoe ke teko ea letsoai la masapo
• Cholesterol e phahameng, haholo-holo triglycerides le high-density lipoprotein (HDL)

Mokhoa o bitsoang high performance liquid chromatography (HPLC) o ka bontša boemo bo phahameng ba moriana o belaelloang morong.

Kalafo ke ho fokotseha mme qetellong e emise ho noa li-corticosteroids. Sena se ka etsoa butle kapa kapele, ho latela hore na hobaneng o phekoloa ka corticosteroid. Se ke oa emisa ho noa moriana leha o sa bua le mofani oa hau pele. Ho emisa ka tšohanyetso li-corticosteroids kamora ho li nka nako e telele ho ka baka boemo bo sokelang bophelo bo bitsoang mathata a adrenal.

Haeba o sitoa ho emisa ho noa moriana ka lebaka la mafu (mohlala, o hloka meriana ea glucocorticoid ho phekola asma e matla), latela litaelo tsa mofani oa hau mabapi le mokhoa oa ho fokotsa monyetla oa ho ba le mathata, ho kenyeletsoa:

• Ho phekola tsoekere e phahameng maling ka phepo, meriana ea molomo, kapa insulin.
• Ho phekola k'holeseterole e phahameng ka lijo kapa meriana.
• Ho noa meriana ho thibela tahlehelo ea masapo. Sena se ka thusa ho fokotsa menyetla ea ho robeha haeba u ba le lefu la ho fokola ha masapo.
• Ho nka meriana e meng ho fokotsa palo ea meriana ea glucocorticoid eo o e hlokang.

Ho theola butle-butle moriana o bakang boemo boo ho ka thusa ho khutlisa litlamorao tsa adrenal gland shrinkage (atrophy). Sena se ka nka likhoeli ho isa selemong. Nakong ena, o kanna oa hloka ho qala bocha kapa ho eketsa litekanyetso tsa li-steroid tsa hau nakong ea khatello ea maikutlo kapa bokuli.

Mathata a bophelo bo botle a ka bakoang ke Cushing syndrome e makatsang a kenyelletsa tse latelang:

• Sesole se tlase sa mmele, se ka lebisang tšoaetsong khafetsa
• Tšenyo ea mahlo, liphio le methapo ka lebaka la tsoekere e phahameng ea mali e sa alafshoang
• Lefu la tsoekere
• Lik'holeseterole tse phahameng
• Kotsi e eketsehileng ea tlhaselo ea pelo e tsoang ho lefu la tsoekere le sa phekoleheng le k'holeseterole e phahameng
• Kotsi e eketsehileng ea maqeba a mali
• Masapo a fokolang (lefu la ho fokola ha masapo) le kotsi e eketsehileng ea ho robeha

Mathata ana ka kakaretso a ka thibeloa ka kalafo e nepahetseng.

Bitsa kopano le mofani oa hau haeba o nka corticosteroid mme o ba le matšoao a Cushing syndrome.

Haeba u nka corticosteroid, tseba matšoao a Cushing syndrome. Ho fumana kalafo kapele ho ka thusa ho thibela litlamorao tsa Cushing syndrome tsa nako e telele. Haeba u sebelisa li-steroid tse inhaled, u ka fokotsa ho pepesetsoa ha hau li-steroid ka ho sebelisa spacer le ka ho hlatsoa molomo oa hau kamora ho phefumoloha li-steroids.

Cushing syndrome - corticosteroid e susumetsoa; Cushing syndrome e bakoang ke Corticosteroid; Lefu la Cushing la Iatrogenic

• Tlhahiso ea lihormone tsa Hypothalamus

Nieman LK, Biller BM, Findling JW, le al.Kalafo ea Cushing's syndrome: tataiso ea bongaka ea Endocrine Society.J Clin Endocrinol Metab. 2015; 100 (8): 2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

Stewart PM, Newell-Price JDC. Karolo ea adrenal cortex. Ka: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, bahlophisi. Buka ea Williams ea Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016: khaolo ea 15.