ʻO Exogenous Cushing Syndrome

ʻO Exogenous Cushing Syndrome kahi ʻano o Cushing syndrome e kū i ka poʻe e lawe nei i nā glucocorticoid (i kapa ʻia hoʻi he corticosteroid, a steroid paha).

ʻO Cushing Syndrome kahi maʻi e kū i ka wā i kiʻekiʻe ai kou kino ma mua o ka pae maʻamau o ka hormone cortisol. Hana maʻamau ʻia kēia hōmona i nā adrenal glands.

Kumu Exogenous kumu ʻia e kekahi mea ma waho o ke kino. Hana ʻia ʻo Exogenous Cushing Syndrome i ka wā e lawe ai ke kanaka i nā lāʻau a ka glucocorticoid hana ʻia e ke kanaka e mālama ai i kahi maʻi.

Hāʻawi ʻia nā Glucocorticoids no nā maʻi he nui, e like me nā maʻi māmā, nā ʻano ʻili, nā maʻi ʻōpū, nā maʻi ʻaʻai, nā maʻi lolo, a me nā maʻi hui. Hele mai kēia mau lāʻau i loko o nā ʻano like ʻole, e like me ka pila, intravenous (IV), injection i loko o kahi ami, enema, nā ʻili ʻili, nā inhalers, a me nā kulu maka.

ʻO ka hapanui o ka poʻe me Cushing Syndrome he:

• Poepoe, ʻulaʻula, helehelena piha (maka maka)
• Lohi ulu lohi (i nā keiki)
• Loaʻa kaupaona me ka hōʻiliʻili momona ma ke kumu, akā lilo ka momona mai nā lima, nā wāwae, a me nā puʻupuʻu (ka momona nui)

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

• Nā maʻi ʻili
• 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

Hoʻololi kaʻiʻo a me ka iwi i:

• Backache, i kū me nā hana maʻamau
• ʻEha iwi a palupalu paha
• ʻOhi o ka momona ma waena o nā poʻohiwi a ma luna o ka iwi kola
• Nā ʻiwi a me nā iwi o ka iwi i hana ʻia e ka lahilahi o nā iwi
• Nā nāwaliwali nāwaliwali, ʻo ka puhaka a me nā poʻohiwi

Hiki i nā pilikia ākea o ke kino (ʻōnaehana) ke:

• ʻAno 2 diabetes
• Piʻi koko kiʻekiʻe
• Kolesterol kiʻekiʻe a me nā triglycerides

Loaʻa paha i nā wahine:

• Nā wā i kūleʻa a kū hoʻi

Loaʻa paha i nā kāne:

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

ʻO nā ʻōuli ʻē aʻe e kū pū paha me:

• Hoʻololi manaʻo, e like me ke kaumaha, hopohopo, a i ʻole nā ​​loli i ka lawena
• Ka luhi
• ʻEha poʻo
• Hoʻonui i ka make wai a me ka urination

E hana ka mea mālama ola i kahi hoʻokolohua kino a nīnau e pili ana i kāu mau hōʻailona a me nā lāʻau āu e lawe nei. E haʻi i ka mea hoʻolako e pili ana i nā lāʻau āpau āu e lawe nei no nā mahina i hala. E haʻi pū aku i ka mea hoʻolako e pili ana i nā pana i loaʻa iā ʻoe ma ke keʻena o kahi mea hoʻolako.

Inā ʻoe e hoʻohana i ka cortisone, prednisone, a i ʻole nā ​​corticosteroids ʻē aʻe, hōʻike paha nā hopena hōʻike aʻe i ka exogenous Cushing syndrome.

• Papa haʻahaʻa ACTH
• ʻO ke kiʻekiʻe o ka cortisol haʻahaʻa (a i ʻole ke kiʻekiʻe o ka cortisol kiʻekiʻe) i ke koko a i ʻole ka mimi, kaukaʻi ʻia i ka lāʻau āu e lawe nei
• ʻO ka pane maʻamau i kahi cosyntropin (ACTH) hōʻike hoʻonāukiuki
• ʻOi aku ka kiʻekiʻe ma mua o ka glucose maʻamau
• Pae potassium haʻahaʻa haʻahaʻa
• Ka hoʻohaʻahaʻa iwi liʻiliʻi, e like me ke ana ʻia e ka hoʻāʻo mineral density iwi
• ʻO ke kolesterol kiʻekiʻe, ʻo nā triglycerides kiʻekiʻe a me ka lipoprotein kiʻekiʻe kiʻekiʻe (HDL)

ʻO kahi hana i kapa ʻia he chromatography wai hana kiʻekiʻe (HPLC) hiki ke hōʻike i kahi kiʻekiʻe o ka lāʻau i manaʻo ʻia i ka mimi.

Hoʻoemi ka mālama ʻana a ma hope e hōʻoki i ka lawe ʻana i kekahi corticosteroids. Hiki ke hana lohi a wikiwiki paha kēia, e hilinaʻi ana i ke kumu e mālama ʻia ai ʻoe me corticosteroid. Mai hōʻoki i ka lawe ʻana i nā lāʻau me ka ʻole e kamaʻilio mua i kāu mea hāʻawi. Ke kū koke nei i nā corticosteroids ma hope o ka lawe ʻana iā lākou no kahi manawa lōʻihi hiki ke hopena i kahi kūlana hoʻoweliweli i kapa ʻia ʻo adrenal crisis.

Inā ʻaʻole hiki iā ʻoe ke hōʻoki i ka lawe ʻana i ka lāʻau no ka maʻi (ʻo kahi laʻana, pono ʻoe i ka lāʻau glucocorticoid e mālama i ka hānō nui), e hāhai i nā ʻōlelo aʻoaʻo a ka mea hāʻawi e hoʻemi ai i ka hiki ke hoʻomohala i nā pilikia, e like me:

• ʻO ka mālama ʻana i ke kō kō kiʻekiʻe me ka papaʻai, nā lāʻau lapaʻau waha, a i ʻole ka insulin.
• ʻO ka mālama ʻana i ke kiʻekiʻe o ka cholesterol me kaʻai a me nā lāʻau.
• Lawe i nā lāʻau e pale ai i ka nalo ʻana o ka iwi. Hiki i kēia ke kōkua i ka hoʻēmi ʻana i ka makaʻu o nā haki inā ʻoe e hoʻomōhala i ka osteoporosis.
• Lawe i nā lāʻau ʻē aʻe e hōʻemi i ka nui o nā lāʻau glucocorticoid e pono ai.

Ke lohi nei i ka lāʻau i hiki ke kōkua i ka hoʻohuli i nā hopena o ke kuamoʻo adrenal gland (atrophy). He mau mahina paha kēia e like me ka lōʻihi o hoʻokahi makahiki. I kēia manawa, pono paha ʻoe e hoʻomaka hou a hoʻonui i nā mea hana o kāu mau steroid i nā manawa pilikia a maʻi paha.

ʻO nā pilikia olakino i hopena ʻia mai ka exogenous Cushing Syndrome e komo pū kekahi o kēia mau mea:

• ʻO ka ʻōnaehana pale haʻahaʻa, kahi e alakaʻi ai i nā maʻi pinepine
• Ka poino i nā maka, nā puʻupaʻa, a me nā ʻalalā ma muli o ke kō o ke kō he nui i mālama ʻole ʻia
• Diabetes
• Nā pae kolesterol kiʻekiʻe
• Hoʻonui i ka makaʻu o ka puʻuwai puʻuwai mai ka hoʻomaʻamaʻa diabetes a me ke kiʻekiʻe o ke kō
• Hoʻonui i ka makaʻu o ke kahe koko
• Nā iwi nāwaliwali (osteoporosis) a hoʻonui i ka makaʻu o nā haki

Hiki ke pale ʻia kēia mau pilikia me ka lāʻau kūpono.

Kāhea i kahi manawa me kāu mea hāʻawi inā lawe ʻoe i kahi corticosteroid a hoʻomohala ʻoe i nā ʻōuli o Cushing syndrome.

Inā ʻoe e lawe i kahi corticosteroid, e ʻike i nā hōʻailona a me nā ʻōuli o Cushing Syndrome. ʻO ka mālama ʻana i ka wanaʻao hiki ke kōkua i ka pale ʻana i nā hopena lōʻihi o Cushing Syndrome. Inā ʻoe e hoʻohana i nā steroid inhal, hiki iā ʻoe ke hoʻēmi i kou ʻike i nā steroid i ka hoʻohana ʻana i ka spacer a me ka holoi ʻana i kou waha ma hope o ka hanu ʻana i nā steroid.

Cushing Syndrome - hoʻokomo ʻia ʻo corticosteroid; Hoʻokomo ʻia ʻo Corticosteroid-Cushing Syndrome; Iatrogenic Cushing maʻi maʻi

• ʻO ka hana Hypothalamus hormone

Nieman LK, Biller BM, Findling JW, a me al.Hoʻomaʻamaʻa ʻana i ka maʻi o Cushing: kahi papa hana hoʻomaʻamaʻa ʻo Endocrine Society.J Clin Endocrinol Metab. 2015; 100 (8): 2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

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.