Cushing lefu

Cushing syndrome ke boloetse bo hlahang ha 'mele oa hau o na le "cortisol" e phahameng ea hormone.

Lebaka le tloaelehileng ka ho fetisisa la Cushing syndrome ke ho noa meriana ea glucocorticoid kapa corticosteroid haholo. Mofuta ona oa Cushing syndrome o bitsoa Cushing syndrome e makatsang. Prednisone, dexamethasone, le prednisolone ke mehlala ea mofuta ona oa meriana. Li-glucocorticoids li etsisa ketso ea "cortisol" ea tlhaho ea 'mele. Meriana ena e sebelisetsoa ho alafa maemo a mangata a kang asma, ho ruruha ha letlalo, mofetše, lefu la mala, bohloko ba manonyeletso le ramatiki ea ramatiki.

Batho ba bang ba ba le Cushing syndrome hobane 'mele ea bona e hlahisa cortisol e ngata haholo. Hormone ena e entsoe ka litšoelesa tsa adrenal. Lisosa tsa cortisol e ngata ke:

• Cushing disease, e hlahang ha tšoelesa ea pituitary e etsa hormone ea adrenocorticotrophic e ngata haholo (ACTH). ACTH e ntan'o bontša hore litšoelesa tsa adrenal li hlahisa cortisol e ngata haholo. Lefu la pituitary gland le ka baka boemo bona.
• Hlahala ea adrenal gland
• Ho hlahala kae kapa kae 'meleng ho hlahisang "corticotropin-releasing hormone" (CRH)
• Lihlahala kae kapa kae 'meleng tse hlahisang ACTH (ectopic Cushing syndrome)

Matšoao a fapana. Ha se motho e mong le e mong ea nang le Cushing syndrome ea nang le matšoao a tšoanang. Batho ba bang ba na le matšoao a mangata ha ba bang ba sena matšoao a letho.

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 li ka kenyelletsa:

• Tšoaetso ea letlalo
• Matšoao a pherese (1/2 cm kapa 1 cm kapa bophara ho feta) a bitsoang striae letlalong la mpa, matsoho a kaholimo, lirope le matsoele
• Letlalo le lesesaane le ho longoa habonolo (haholo 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 le masapo a kaholimo
• Ho robeha likhopo le mokokotlo ho bakoang ke ho sohla masapo
• Mesifa fokola, haholo-holo ea letheka le mahetleng

Liphetoho tsa 'mele (systemic) li kenyelletsa:

• Mofuta oa 2 oa lefu la tsoekere
• Khatello ea mali e phahameng (hypertension)
• Ho eketsa k'holeseterole le triglycerides (hyperlipidemia)

Basali ba nang le Cushing syndrome 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 fokotsa kapa ho se na takatso ea thobalano (low libido)
• Mathata a ho emisa

Matšoao a mang a ka hlahang ka lefu lena:

• 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.

Liteko tsa laboratori tse ka etsoang ho fumana lefu la Cushing le ho tseba sesosa ke:

• Boemo ba cortisol ea mali
• Tsoekere ea mali
• Tekano ea saliva cortisol
• Teko ea khatello ea Dexamethasone
• Moroto oa lihora tse 24 oa cortisol le creatinine
• Boemo ba ACTH
• Teko ea ho hlohlelletsa ACTH (maemong a sa tloaelehang)

Liteko tsa ho fumana sesosa kapa mathata li ka kenyelletsa:

• Mpeng CT
• MRI ea pituitary
• Boima ba masapo a masapo

Kalafo e ipapisitse le sesosa.

Cushing syndrome e bakoang ke ts'ebeliso ea corticosteroid:

• Mofani oa hau o tla u laela hore u fokotse butle butle litekanyetso tsa meriana. Ho emisa moriana ka tšohanyetso ho ka ba kotsi.
• Haeba o sitoa ho emisa ho noa moriana ka lebaka la mafu, tsoekere ea hao e phahameng maling, k'holeseterole e phahameng, le ho fokotsa masapo kapa lefu la masapo li lokela ho beoa leihlo le ho phekoloa ka hloko.

Le Cushing syndrome e bakoang ke pituitary kapa hlahala e hlahisang ACTH (Cushing disease), o ka hloka:

• Ho buoa ho tlosa hlahala
• Mahlaseli ka mor'a ho tlosoa ha hlahala ea pituitary (maemong a mang)
• Phekolo ea Cortisol kamora ho buuoa
• Meriana e nkang sebaka sa lihormone tsa pituitary tse haelloang
• Meriana e thibelang 'mele ho etsa cortisol e ngata haholo

Le Cushing syndrome ka lebaka la hlahala ea pituitary, hlahala ea adrenal kapa lihlahala tse ling:

• U kanna ua hloka ho buuoa ho tlosa hlahala.
• Haeba hlahala e ke ke ea tlosoa, o kanna oa hloka meriana ho thusa ho thibela tokollo ea cortisol.

Ho tlosa hlahala ho ka lebisa ho hlaphoheloeng ka botlalo, empa ho na le monyetla oa hore boemo bo khutle.

Ho pholoha ha batho ba nang le lefu la Cushing le bakoang ke lihlahala ho latela mofuta oa hlahala.

Ha e sa alafshoa, Cushing syndrome e ka beha bophelo kotsing.

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

• Lefu la tsoekere
• Ho atolosoa ha hlahala ea pituitary
• Ho robeha ha masapo ka lebaka la lefu la masapo
• Khatello ea mali e phahameng
• Majoe a liphio
• Maloetse a tebileng

Bitsa mofani oa hau haeba u e-na 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.

Hypercortisolism; Ho feta ha Cortisol; Ho feta tekano ea glucocorticoid - Cushing syndrome

• Litšoelesa tsa endocrine

Nieman LK, Biller BM, Findling JW, le al; Mokhatlo oa Endocrine. 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.

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 Saunders; 2016: khaolo ea 15.