Cushing maʻi maʻi

ʻO Cushing Syndrome kahi maʻi e kū i ka wā i loaʻa i kou kino kahi pae kiʻekiʻe o ka hormone cortisol.

ʻO ke kumu maʻamau o Cushing syndrome ke lawe nei i ka nui o ka glucocorticoid a i ʻole ka lāʻau corticosteroid. Kāhea ʻia kēia ʻano o Cushing syndrome ʻo exogenous Cushing Syndrome. ʻO Prednisone, dexamethasone, a me prednisolone nā laʻana o kēia ʻano lāʻau. Hoʻohālikelike nā Glucocorticoids i ka hana o ka kino maoli hormone cortisol. Hoʻohana ʻia kēia mau lāʻau e mālama ai i nā ʻano he nui e like me ka hānō, ka pehu ʻana o ka ʻili, maʻi ʻaʻai, maʻi ʻōpū, ʻeha pū, a me ka rheumatoid arthritis.

Hoʻolālā kekahi poʻe ʻē aʻe i ka maʻi Cushing no ka mea ke hana nui nei ko lākou kino i ka cortisol. Hana ʻia kēia hormona i loko o nā adrenal glands. ʻO nā kumu o ka nui o ka cortisol:

• ʻO ka maʻi cushing, i ka wā e hana ka pituitary gland i ka nui o ka hormone adrenocorticotrophic hormone (ACTH). Hōʻailona ʻo ACTH i nā glandula adrenal e hana i ka nui o ka cortisol. Hiki i kahi tumo pituitary gland ke kumu i kēia ʻano.
• Tumor o ka adrenal gland
• Tumor ma nā wahi ʻē aʻe i ke kino e hoʻopuka i ka hormone-hoʻokuʻu i ka corticotropin (CRH)
• Nā Tumors ma kahi ʻē aʻe o ke kino e hana ana iā ACTH (ectopic Cushing Syndrome)

Kūlike nā ʻōuli. ʻAʻole loaʻa nā kānaka like me ka Cushing Syndrome i nā ʻōuli like. Loaʻa i kekahi poʻe nā ʻōuli he nui a ʻo nā mea ʻē aʻe paʻakikī loa i kekahi ʻōuli.

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)

Hiki i nā hoʻololi o ka ʻili ke hoʻopili:

• Nā maʻi ʻili
• ʻO nā māka poni (1/2 iniha a i ʻole 1 kenimika a ʻoi ākea paha) i kapa ʻia ʻo striae ma ka ʻili o ka ʻōpū, nā lima o luna, nā ʻūhā, a me nā umauma.
• Nani ka ʻili me ka palapū maʻalahi (ʻoi aku 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
• ʻOhi o ka momona ma waena o nā poʻohiwi a ma luna o nā 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

ʻO ke hoʻololi ākea o ke kino (ʻōnaehana):

• ʻAno 2 diabetes mellitus
• Ke koko kiʻekiʻe (hypertension)
• Hoʻonui i ka cholesterol a me nā triglycerides (hyperlipidemia)

Loaʻa i nā wahine me ka maʻi Cushing:

• ʻO ka ulu nui o ka lauoho ma ka maka, ka ʻāʻī, ka umauma, ʻōpū, a me nā ʻūhā
• Nā wā i kūleʻa a kū hoʻi

Loaʻa paha i nā kāne:

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

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

• 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.

ʻO nā hoʻokolohua Laboratory e hana ʻia e ʻike pono i ka maʻi Cushing a hoʻomaopopo i ke kumu.

• Pae pae cortisol
• Koko kō
• ʻO ka pae saliva cortisol
• ʻO ka hoʻāʻo suppression Dexamethasone
• 24-hola mimi no ka cortisol a me ka creatinine
• Pae ACTH
• Hōʻike hoʻonāukiuki ACTH (i nā hanana kakaikahi)

Nā hoʻokolohua e hoʻoholo ai i ke kumu a i ʻole nā ​​pilikia e komo pū paha:

• ʻO CT ʻōpū
• ʻO Pituitary MRI
• Ka mānoanoa o ka iwi

Pili ka mālama ʻana i ke kumu.

ʻO Cushing Syndrome ka mea i hana ʻia e ka Corticosteroid:

• E kauoha aku kāu mea lawelawe iā ʻoe e hoʻoliʻiliʻi mālie i nā lāʻau lapaʻau. Hiki ke weliweli ke kū ʻana i ka lāʻau.
• Inā ʻaʻole hiki iā ʻoe ke hōʻoki i ka lawe ʻana i ka lāʻau no ka maʻi, pono ke nānā pono ʻia a mālama ʻia i kāu kō kō kiʻekiʻe, nā kiʻekiʻe o ke kolesterol, a me ka ʻoki ʻana o ka iwi a i ʻole ka osteoporosis.

Me ka maʻi Cushing i hoʻokumu ʻia e kahi pituitary a i ʻole kahi tumo e hoʻokuʻu iā ACTH (maʻi Cushing), pono ʻoe:

• ʻOki kino e wehe i ka hikoko
• ʻO ka uila ma hope o ka hemo ʻana o kahi tumo pituitary (i kekahi mau manawa)
• Cortisol replacement therapy ma hope o ke kahakaha ʻana
• Nā lāʻau e hoʻololi i nā hormones pituitary e lilo i mea hemahema
• Nā lāʻau e pale aku ai i ke kino mai ka hana ʻana i ka nui o ka cortisol

Me ka maʻi Cushing ma muli o kahi pituitary tumor, adrenal tumor, a i ʻole nā ​​tumors ʻē aʻe:

• Pono ʻoe i ke ʻoki e wehe i ka tumo.
• Inā hiki ʻole ke hemo i ka tumo, pono paha ʻoe i nā lāʻau e kōkua ai i ka pale ʻana i ka hoʻokuʻu ʻia ʻana o cortisol.

ʻO ka hemo ʻana o ka tumo e alakaʻi ai i ka hoʻihoʻi piha, akā aia kahi manawa e hoʻi ai ke ʻano.

ʻO ke ola no nā poʻe me ka maʻi Cushing i hoʻokumu ʻia e nā tumors e pili ana i ka tumo type.

ʻAʻole mālama ʻia, hiki i ka Cushing maʻi ke hoʻoweliweli i ke ola.

ʻO nā pilikia olakino i hopena ʻia mai Cushing maʻi pū kekahi o kēia mau mea:

• Diabetes
• Ke hoʻonui nei i ka hikoko pituitary
• Nā haʻi iwi ma muli o ka osteoporosis
• Piʻi koko kiʻekiʻe
• Pohaku hakuʻala
• Nā maʻi nui

Kāhea i kāu mea hāʻawi inā loaʻa iā ʻoe 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.

Hypercortisolism; ʻOi aku ka nui o Cortisol; ʻOi aku ka nui o Glucocorticoid - Cushing Syndrome

• Nānā Endocrine

Nieman LK, Biller BM, Findling JW, a me al. ʻAhahui Endocrine. Hoʻomaʻamaʻa ʻana i ka maʻi o Cushing: kahi papa hana hoʻomaʻamaʻa ʻo Endocrine Society. ʻO 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 Saunders; 2016: chap 15.