Hypopituitarism

ʻO ka Hypopituitarism kahi kūlana kahi a ka pituitary gland e hana ʻole ai i nā nui maʻamau o kekahi a i ʻole nā ​​mea āpau āpau.

ʻO ka pituitary gland kahi hana liʻiliʻi i aia ma lalo pono o ka lolo. Hoʻopili ʻia e kahi koʻokoʻo i ka hypothalamus. ʻO ka hypothalamus kahi o ka lolo e kaohi ana i ka hana o ka pituitary gland.

ʻO nā hormones i hoʻokuʻu ʻia e ka pituitary gland (a me kā lākou mau hana):

• Adrenocorticotropic hormone (ACTH) - hoʻonāukiuki i ka adrenal gland e hoʻokuʻu i ka cortisol; kōkua ka cortisol i ka mālama ʻana i ke koko a me ke kō i ke kō
• Antidiuretic hormone (ADH) - kaohi i ka nalowale o ka wai e nā puʻupaʻa
• Follicle-stimulate hormone (FSH) - kaohi i ka hana moekolohe a me ka momona o nā kāne a me nā wahine
• ʻO ka hormone ulu (GH) - hoʻonāukiuki i ka ulu ʻana o nā pūnaewele a me ka iwi
• Luteinizing hormone (LH) - kaohi i ka hana moekolohe a me ka momona o nā kāne a me nā wahine
• Oxytocin - hoʻonāukiuki i ka kōpū e ʻaelike i ka wā o ka hana a me nā umauma e hoʻokuʻu i ka waiū
• Prolactin - hoʻonāukiuki i ka ulu ʻana o ka umauma wahine a me ka hana ʻana i ka waiū
• ʻO ka hōmona hoʻowalewale thyroid (TSH) - hoʻonāukiuki i ka gland thyroid e hoʻokuʻu i nā homone e hoʻopili i ka metabolism o ke kino

I ka hypopituitarism, aia ka hemahema o hoʻokahi a ʻoi paha nā hormones pituitary. ʻO ka nele o kahi hormone e alakaʻi i ka nalo o ka hana i ka gland a i ʻole organ kaohi o ka hormone. ʻO kahi laʻana, ʻo ka nele o TSH ke alakaʻi i ka nalo ʻana o ka hana maʻamau o ka pona thyroid.

Hoʻokumu ʻia paha ka hypopituitarism e:

• ʻOki kino o ka lolo
• Tumo lolo
• Poʻomanaʻo poʻo (ʻeha lolo traumatic)
• ʻO nā maʻi a me nā mumū o ka lolo a me nā ʻano i kākoʻo i ka lolo
• Ka make ʻana o kahi ʻili o ka pituitary gland (pituitary apoplexy)
• ʻO ka radiation radiation i ka lolo
• Hahau
• Subarachnoid hemorrhage (mai kahi aneurysm haki)
• Nā tumors o ka pituitary gland a i ʻole hypothalamus

I kekahi manawa, pili ka hypopituitarism i ka ʻōnaehana pale ʻole a i ʻole nā ​​maʻi metabolic, e like me:

• Nui loa ka hao i ke kino (hemochromatosis)
• Hoʻonui kūpono ʻole i nā hunaola pale i kapa ʻia histiocytes (histiocytosis X)
• ʻO ke kūlana autoimmune e kumu i ka hoʻā o ka pituitary (lymphocytic hypophysitis)
• ʻO ka hoʻowahāwahā o nā ʻano a me nā mea like ʻole (sarcoidosis)
• Nā maʻi o ka pituitary, e like me ka maʻi pituitary tuberculosis

ʻO ka hypopituitarism kekahi pilikia paʻakikī i hoʻokumu ʻia e ke kahe nui i ka wā hāpai. ʻO ka lilo o ke koko e alakaʻi i ka make ʻana o ka iʻa i ka pituitary gland. Kapa ʻia kēia ʻano ʻo Sheehan Syndrome.

Hiki i kekahi mau lāʻau ke kāohi i ka hana pituitary. ʻO nā lāʻau lapaʻau maʻamau nā glucocorticoids (e like me prednisone a me dexamethasone), i lawe ʻia no nā kūlana hōʻeha a me nā pale. ʻO nā lāʻau i hoʻohana ʻia e mālama ai i ka maʻi ʻaʻai prostate hiki ke alakaʻi i ka hana pituitary haʻahaʻa.

ʻO nā ʻōuli o ka hypopituitarism me kekahi o kēia mau mea:

• Abdominal eha
• Hoʻoemi i ka makemake
• Ka nele o ka hoʻokele moekolohe (i nā kāne a i ʻole nā ​​wahine)
• Pōpō a maule paha
• ʻO ka urination nui loa a me ka make wai
• ʻAʻole e hoʻokuʻu i ka waiū (i nā wahine)
• Ka luhi, nāwaliwali
• ʻEha poʻo
• Infertility (i nā wahine) a i ʻole ke kū ʻana o nā wā menstrual
• Lilo o ka armpit a i ʻole ka lauoho pubic
• Ka nalowale o ke kino a i ʻole ka helehelena maka (i nā kāne)
• Kaomi haʻahaʻa
• Koko kōpaʻa haʻahaʻa
• ʻIke i ke anuanu
• ʻO ke kiʻekiʻe pōkole (ʻoi aku ma mua o 5 kapuaʻi a 1.5 mau mika paha) inā ka hoʻomaka ʻana i ka wā ulu
• Hoʻonui lohi a me ka hoʻomohala moekolohe (i nā keiki)
• Nā pilikia ʻike
• Kaumaha emi

E ulu lohi paha nā ʻōuli a loli paha ka loli, kaukaʻi ʻia:

• Ka helu o nā hormoni e nalo ana a me nā ʻokena a lākou e hoʻopili ai
• ʻO ke koʻikoʻi o ka maʻi

Nā ʻōuli ʻē aʻe i hiki ke loaʻa me kēia maʻi.

• Huʻi maka
• Lilo ka lauoho
• Hoarseness a hoʻololi paha i ka leo
• ʻOʻoleʻa hui
• Kaumaha hoʻonui

No ke kuhi ʻana i ka hypopituitarism, pono e loaʻa nā pae hormone haʻahaʻa ma muli o kahi pilikia me ka pituitary gland. Pono ka diagnostics e kāpae i nā maʻi o ka mea i loli ʻia e kēia hōmona.

E komo pū paha nā hoʻāʻo:

• Scanner ʻo Brain CT
• ʻO Pituitary MRI
• KANAWAI
• Cortisol
• Estradiol (estrogen)
• ʻO ka hormone hoʻonāukiuki Follicle (FSH)
• ʻO ka ulu ulu ulu ʻana ʻo Insulin 1 (IGF-1)
• Luteinizing hormone (LH)
• Nā hoʻāʻo Osmolality no ke koko a me ka mimi
• Pae testosterone
• ʻO ka hōmona stimulus thyroid (TSH)
• ʻO ka hormone thyroid (T4)
• ʻO Biopsy o ka pituitary

Hiki ke kiʻekiʻe ke kiʻekiʻe o ka hormone pituitary i ke kahe o ke koko inā loaʻa iā ʻoe kahi pituitary tumo e hana nui nei i kēlā hormone. Hiki i ka tumo ke wāwahi i nā hunaola ʻē aʻe o ka pituitary, e alakaʻi ana i nā pae haʻahaʻa o nā hormones ʻē aʻe.

Inā kumu ʻia ka hypopituitarism e kahi tumo, pono paha ʻoe i ke ʻoki e wehe i ka tumo. Pono paha e mālama i ka radiation radiation.

Pono ʻoe i nā lāʻau o ke ola holoʻokoʻa e kāpae i nā homone i hana ʻole ʻia e nā ʻokena ma lalo o ka kaohi o ka pituitary gland. Pākuʻi ʻia kēia mau mea:

• ʻO Corticosteroids (cortisol)
• Hone ulu
• Nā homone moekolohe (testosterone no nā kāne a me estrogen no nā wahine)
• Hīmona thyroid
• Desmopressin

Loaʻa i nā lāʻau lapaʻau e mālama ai i ka infertility pili i nā kāne a me nā wahine.

Inā ʻoe e lawe i nā lāʻau a glucocorticoid no ka hemahema pituitary ACTH, e ʻike pono ʻoe ʻike i ka wā e lawe ai i kahi hopena koʻikoʻi o kāu lāʻau. Kūkākūkā i kēia me kāu mea mālama ola.

Lawe mau i ka ID olakino (kāleka, kūpeʻe lima, a i ʻole ka lei) i ʻōlelo e loaʻa ka lawa ʻole o ka adrenal. Pono e ʻōlelo ka ID i ke ʻano o ka lāʻau a me nā lāʻau āu e pono ai i ka wā o kahi ulia pōpilikia i hoʻokumu ʻia e ka adrenal insufficiency.

ʻO ka hypopituitarism ka mea mau. Pono ia i ka mālama ola ʻana me hoʻokahi a ʻoi aku nā lāʻau. Akā hiki iā ʻoe ke manaʻo i kahi ola maʻamau.

I nā keiki, hoʻomaikaʻi paha ka hypopituitarism inā hemo ka tumo i ka wā o ke ʻoki.

Nā hopena o nā lāʻau e mālama i ka hypopituitarism hiki ke ulu. Eia naʻe, mai hooki i kekahi lāʻau iā ʻoe iho me ka kamaʻilio ʻole ʻole ʻana me kāu mea hāʻawi.

Kāhea i kāu mea hāʻawi inā hoʻomōhala ʻoe i nā ʻōuli o ka hypopituitarism.

I ka hapanui o nā hihia, ʻaʻole hiki ke pale ʻia ka maʻi. ʻO ka hoʻomaopopo ʻana i ka makaʻu, e like me ka lawe ʻana i kekahi mau lāʻau, e ʻae paha i ka ʻike mua ʻana a me ka lāʻau.

Ka lawa ʻole o ka pituitary; Panhypopituitarism

• Nānā Endocrine
• Kelepona pituitary
• ʻO Gonadotropins
• Pituitary a me TSH

Burt MG, Ho KKY. ʻO ka hypopituitarism a me ka hemahema o ka hormone ulu. I: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Makua a Pediatric. ʻEpekema 7 Piladelapia, PA: Elsevier Saunders; 2016: chap 11.

ʻO Clemmons DR, Nieman LK. Hele i ka mea maʻi me ka maʻi endocrine. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 25th hua. Piladelapia, PA: Elsevier Saunders; 2016: chap 221.

Fleseriu M, Hashim IA, Karavitaki N, et al. Hoʻololi Hormonal i ka hypopituitarism i nā mākua: kahi Endocrine Society klinika hana pilikino. ʻO J Clin Endocrinol Metab. 2016; 101 (11): 3888-3921. PMID: 27736313 www.ncbi.nlm.nih.gov/pubmed/27736313.