Lefu la Ectopic Cushing

Ectopic Cushing syndrome ke mofuta oa Cushing syndrome moo hlahala ka ntle ho tšoelesa ea pituitary e hlahisang hormone e bitsoang adrenocorticotropic hormone (ACTH).

Cushing syndrome ke lefu le hlahang ha 'mele oa hau o na le "cortisol" e phahameng ho feta e tloaelehileng. Hormone ena e entsoe ka litšoelesa tsa adrenal. Cortisol e ngata haholo e ka bakoa ke mathata a fapaneng. E 'ngoe ea lisosa ke haeba ho na le hormone e ngata ea ACTH maling. Hangata ACTH e entsoe ke pituitary ka chelete e nyane ebe e sa tšoaea litšoelesa tsa adrenal ho hlahisa cortisol. Ka linako tse ling lisele tse ling tse kantle ho pituitary li ka etsa ACTH e ngata. Sena se bitsoa ectopic Cushing syndrome. Ectopic e bolela hore ho na le ho hong ho etsahalang sebakeng se sa tloaelehang 'meleng.

Ectopic Cushing syndrome e bakoa ke lihlahala tse lokollang ACTH. Lihlahala tse ka hlahisang ACTH maemong a sa tloaelehang li kenyelletsa:

• Lihlahala tsa Benign carcinoid tsa matšoafo
• Li-Islet cell tumor tsa li-pancreas
• Medullary carcinoma ea qoqotho
• Lisele tse nyane tsa sefuba tsa matšoafo
• Lihlahala tsa tšoelesa ea thymus

Ectopic Cushing syndrome e ka baka matšoao a mangata a fapaneng. Batho ba bang ba na le matšoao a mangata ha ba bang ba na le a fokolang feela. Batho ba bangata ba nang le mofuta ofe kapa ofe oa Cushing syndrome ba na le:

• Sefahleho se pota-potileng, se sefubelu le se tletseng (sefahleho sa khoeli)
• Sekhahla sa kholo ea 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:

• Tšoaetso ea letlalo
• Matšoao a pherese (1/2 cm 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:

• Khōlo e feteletseng ea moriri sefahlehong, molaleng, sefubeng, mpeng le liropeng
• Linako tse sa fetoheng kamehla kapa tse emisang

Banna ba kanna ba ba le:

• Ho fokotseha kapa ho se na takatso ea thobalano
• Ho hloka matla

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 mme a botse ka matšoao a hau.

Liteko tse ka etsoang li kenyelletsa:

• Sampula ea lihora tse 24 ea ho ntša metsi ho lekanya maemo a cortisol le creatinine
• Liteko tsa mali ho lekola maemo a ACTH, cortisol, le potasiamo (hangata e tlase haholo ho ectopic Cushing syndrome)
• Teko ea khatello ea Dexamethasone (tekanyetso e phahameng le e tlase)
• Mohlala o tlase oa `` petrosal sinus sampling '' (teko e khethehileng e lekanyang ACTH ho tsoa methapong e haufi le boko le sefubeng)
• Ho itima lijo ka tsoekere
• MRI le litlhahlobo tse phahameng tsa CT ho fumana hlahala (ka linako tse ling ho ka hlokahala litlhahlobo tsa meriana ea nyutlelie)

Kalafo e ntle ka ho fetisisa bakeng sa ectopic Cushing syndrome ke ho buuoa ho tlosa hlahala. Hangata ho etsoa opereishene ha hlahala e sa tsoele kankere (benign).

Maemong a mang, hlahala e na le mofetše mme e namela libakeng tse ling tsa 'mele pele ngaka e ka fumana bothata ka tlhahiso ea cortisol. Ho buuoa ho kanna ha se khonehe maemong ana. Empa ngaka e ka fana ka meriana ho thibela tlhahiso ea cortisol.

Ka linako tse ling ho tlosoa litšoelesa tsa adrenal ka bobeli ho hlokahala haeba hlahala e sa fumanehe mme meriana e sa thibele tlhahiso ea cortisol ka botlalo.

Ho buoa ho tlosa hlahala ho ka lebisa ho foleng ka botlalo. Empa ho na le monyetla oa hore hlahala e tla khutla.

Hlahala e ka hasana kapa ea khutla kamora ho buuoa. Tekanyo e phahameng ea cortisol e kanna ea tsoela pele.

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

Kalafo e potlakileng ea lihlahala e ka fokotsa kotsi maemong a mang. Maemong a mangata ha a qojoe.

Lefu la Cushing - ectopic; Lefu la Ectopic ACTH

• Litšoelesa tsa endocrine

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

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.