Maʻi ʻo Cushing

ʻO ka maʻi Cushing kahi kūlana kahi e hoʻokuʻu ai ka pituitary gland i ka nui o ka nui adrenocorticotropic hormone (ACTH). ʻO ka pituitary gland kahi ʻōnaehana o ka ʻōnaehana endocrine.

ʻO ka maʻi Cushing kahi ʻano o Cushing Syndrome. ʻO nā ʻano ʻē aʻe o Cushing syndrome e komo pū ana me ka exogenous Cushing Syndrome, Cushing Syndrome i hoʻokumu ʻia e ka adrenal tumor, a me ka ectopic Cushing syndrome.

Hoʻokumu ʻia ka maʻi Cushing e kahi tumo a i ʻole ulu nui (hyperplasia) o ka pituitary gland. Aia ka pituitary gland ma lalo pono o ke kumu o ka lolo. ʻO kekahi ʻano pituitary tumar i kapa ʻia he adenoma ke kumu maʻamau. ʻO ka adenoma kahi tumo maikaʻi (ʻaʻole ka maʻi ʻaʻai).

Me ka maʻi Cushing, hoʻokuʻu ka pituitary gland i ka nui o ka ACTH. Hoʻoikaika ʻo ACTH i ka hana a me ka hoʻokuʻu ʻana o cortisol, kahi hōmona koʻikoʻi. ʻOi aku ka nui o ka ACTH i nā adrenal glands e hana i ka nui o ka cortisol.

Hoʻokuʻu maʻamau ʻia ʻo Cortisol i nā manawa pilikia. He nui nā hana ʻē aʻe, e like me:

• ʻO ka kaohi ʻana i ka hoʻohana ʻana o ke kino i nā haʻalaki, nā momona, a me nā protein
• Ke hōʻemi nei i ka pane o ka ʻōnaehana pale i ka pehu (mumū)
• Ke hoʻoponopono nei i ke kahe o ke koko a me ke kaulike wai o ke kino

ʻO nā ʻōuli o ka maʻi Cushing ka:

• ʻO ke kino momona o luna (ma luna o ka pūhaka) a me nā lima lahilahi a me nā wāwae
• Poepoe, ʻulaʻula, helehelena piha (maka maka)
• Lohi ka ulu ʻana o nā keiki

ʻO nā loli ʻili i ʻike pinepine ʻia e pili pū me:

• Huehue a ʻili paha
• Nā māka poni (1/2 iniha a 1 kenimika a ʻoi ākea paha), i kapa ʻia ʻo striae, ma ka ʻili o ka ʻōpū, nā ʻūhā, nā lima luna, a me nā umauma
• ʻIli lahilahi me ka palapū maʻalahi, ʻo ka mea maʻamau ma nā lima a me nā lima

Hoʻololi kaʻiʻo a me ka iwi i:

• Backache, i kū me nā hana maʻamau
• ʻEha iwi a palupalu paha
• Ka hōʻiliʻili o nā momona ma waena o nā poʻohiwi (halo buffalo)
• Nāwaliwali o nā iwi, kahi e alakaʻi ai i nā iwi iwi a me nā iwi
• Nā nāwaliwali nāwaliwali e hoʻonāukiuki i ka hoʻoikaika kino

Loaʻa paha i nā wahine:

• ʻO ka ulu nui o ka lauoho ma ka maka, ka ʻāʻī, ka umauma, ʻōpū, a me nā ʻūhā
• ʻO ke kalapona Menstrual e lilo i mea maʻamau a kū paha

Loaʻa paha i nā kāne:

• Hoemi a ʻaʻohe makemake i ka moekolohe (libido haʻahaʻa)
• Nā pilikia kūkulu

ʻO nā ʻōuli ʻē aʻe a i ʻole nā ​​pilikia e hoʻopili pū paha:

• Hoʻololi manaʻo, e like me ke kaumaha, hopohopo, a i ʻole nā ​​loli i ka lawena
• Ka luhi
• Nā maʻi pinepine
• ʻEha poʻo
• Hoʻonui i ka make wai a me ka urination
• Piʻi koko kiʻekiʻe
• Diabetes

E hana ka mea mālama ola i kahi hoʻokolokolo kino a nīnau e pili ana i kāu mau hōʻailona.

Hana mua ʻia nā hoʻokolohua e hōʻoia he nui loa ka cortisol i ke kino, a laila e hoʻoholo ai i ke kumu.

Hōʻoia kēia mau ho'āʻo i ka nui o ka cortisol:

• 24-hola mimi kortisol
• ʻO ka hoʻāʻo suppression Dexamethasone (haʻahaʻa haʻahaʻa)
• Nā pae salivary cortisol (kakahiaka nui a pō i ke aumoe)

Hoʻoholo kēia mau ho'āʻo i ke kumu:

• Pae ACTH koko
• Koʻo MRI
• Hoʻomaʻamaʻa Corticotropin-hoʻokuʻu i ka hormone, e hana nei ma ka pituitary gland e hoʻokumu i ka hoʻokuʻu ʻia o ACTH
• ʻO ka hoʻāʻo suppression Dexamethasone (kiʻekiʻe kiʻekiʻe)
• Inferior petrosal sinus sampling (IPSS) - ana i nā pae o ka ACTH i nā aʻa e ninini ai i ka pituitary gland ke hoʻohālikelike ʻia me nā uaua i ka umauma.

Nā hoʻokolohua ʻē aʻe i hana ʻia e komo pū kekahi o kēia mau mea:

• ʻO ka hoʻokēʻai ʻana i ke kō glucose a me ka A1C e hoʻāʻo ai no ka maʻi kō
• ʻO ka hoʻāʻo ʻana ʻo Lipid a me kolesterol
• ʻImi i ka minamina iwi iwi e nānā no ka osteoporosis

Ma mua o hoʻokahi hōʻike hoʻokolohua e pono ai e hōʻoia i ka maʻi Cushing. E noi paha kāu mea hāʻawi iā ʻoe e ʻike i kahi kauka e loea i nā maʻi pituitary.

Hoʻopili ka hana me ka ʻoki ʻana e wehe i ka tumo pituitary, inā hiki. Ma hope o ke kāpili ʻana, hoʻomaka paha ka pituitary gland e hana hou a hoʻi i ka maʻamau.

I ka wā o ke ola ʻana mai ke ʻoki ʻana, pono ʻoe i nā lāʻau pani pani hou ma muli o ka pono o ka pituitary i ka manawa e hoʻomaka ai e hana hou iā ACTH.

Hiki ke hoʻohana ʻia ka mālama radiation o ka pituitary gland inā ʻaʻole hemo loa ka tumo.

Inā ʻaʻole pane ka tumo i ke ʻoki a me ka pāhawewe paha, pono ʻoe i nā lāʻau e hōʻoki i kou kino mai ka hana ʻana i ka cortisol.

Inā kūleʻa ʻole kēia mau ʻano hana, pono paha e hemo nā ʻōpū adrenal e hoʻōki i nā kiʻekiʻe kiʻekiʻe o ka cortisol mai ka hana ʻia ʻana. Hiki i ka hemo ʻana o nā adrenal adrenal ke kumu e ulu nui ai ka tumo pituitary (Nelson syndrome).

ʻAʻole mālama ʻia, hiki i ka maʻi Cushing ke hana i nā maʻi ʻino, a ʻo ka make pū kekahi. ʻO ka hemo ʻana o ka tumo e alakaʻi i ke ola hou, akā hiki i ka tumo ke ulu hou.

ʻO nā pilikia olakino i hopena ʻia mai ka maʻi Cushing pū kekahi:

• ʻO nā haʻihaʻi paʻa i ka iwi kuamoʻo
• Diabetes
• Piʻi koko kiʻekiʻe
• Nā maʻi ʻino
• Pohaku hakuʻala
• Mood a i ʻole nā ​​pilikia psychiatric

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

Inā ua hemo ʻia kahi tumo pituitary, kāhea aku i kāu mea hāʻawi inā loaʻa nā hōʻailona o nā pilikia, e like me nā hōʻailona i hoʻi mai ka tumo.

Maʻi maʻi Pituitary Cushing; Hoʻolaha ʻo ACTH i ka adenoma

• Nānā Endocrine
• Striae i ka popliteal fossa
• Striae ma ka wāwae

ʻO Juszczak A, Morris DG, Grossman AB, Nieman LK. ʻO Cushing's syndrome. I: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Makua a Pediatric. ʻEpekema 7 Piladelapia, PA: Elsevier Saunders; 2016: chap 13.

Molitch ME. Pituitary ma mua. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 25th hua. Piladelapia, PA: Elsevier Saunders; 2016: chap 224.

ʻO Stewart PM, Newell-Kumukūʻai JDC. ʻO ka Cortex adrenal. I: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. ʻO Williams Textbook of Endocrinology. 13th ed. Piladelapia, PA: Elsevier; 2016: chap 15.