ʻO ka hoʻāʻo suppression Dexamethasone

Hōʻike ka hoʻāʻo suppression Dexamethasone inā hiki ke hoʻopau ʻia ka huna adrenocorticotrophic (ACTH) e ka pituitary.

Ma kēia hōʻike, e loaʻa iā ʻoe ka dexamethasone. He lāʻau ikaika kēia a ke kanaka (synthetic) glucocorticoid. Ma hope, huki ʻia kou koko i hiki ke ana ʻia ka pae cortisol i kou koko.

ʻElua ʻano ʻokoʻa o ka hoʻāʻo suppression dexamethasone: haʻahaʻa haʻahaʻa a me nā lāʻau kiʻekiʻe. Hiki ke hana ʻia kēlā me kēia ʻano i ka pō (maʻamau) a i ʻole kahi pae maʻamau (3-lā) (kākaʻikahi). Aia kekahi mau kaʻina hana i hiki ke hoʻohana ʻia no kekahi hōʻike. Hōʻike ʻia nā laʻana o kēia mau mea ma lalo.

Maʻamau:

• Ka lāʻau haʻahaʻa ma ka pō - E loaʻa iā ʻoe 1 milligram (mg) o dexamethasone ma ka hola 11 o ke ahiahi, a na kahi mea mālama ola e huki i kou koko i ke kakahiaka aʻe ma ka hola 8 no ke ana ʻana o ka cortisol
• ʻO ka hopena kiʻekiʻe ma ka pō - E ana ka mea hāʻawi i kāu cortisol i ke kakahiaka o ka hōʻike. A laila e loaʻa iā ʻoe he 8 mg dexamethasone ma ka hola 11 p. Kuhi ʻia kou koko i ke kakahiaka aʻe i ka hola 8 no ke ana ʻana o ka cortisol.

Kakaikahi:

• Mahele haʻahaʻa haʻahaʻa - hōʻiliʻili ʻia ka mimi ma luna o 3 mau lā (mālama ʻia i loko o nā pahu hōʻiliʻili he 24 mau hola) e ana ai i ka lāʻau. Ma ka lā 2, e loaʻa ʻoe i kahi mahele haʻahaʻa (0.5 mg) o dexamethasone e ka waha i kēlā me kēia 6 mau hola no 48 mau hola.
• ʻO ka mahele lāʻau kiʻekiʻe - hōʻiliʻili ʻia ka mimi ma kahi o 3 mau lā (mālama ʻia i loko o nā pahu hōʻiliʻili he 24 mau hola) no ke ana ʻana i ka cortisol. Ma ka lā 2, e loaʻa iā ʻoe kahi lāʻau kiʻekiʻe (2 mg) o dexamethasone e ka waha i kēlā me kēia 6 mau hola no 48 mau hola.

Heluhelu a hāhai pono i nā ʻōkuhi. ʻO ke kumu maʻamau o kahi hopena hoʻāʻo ʻole ke mālama ʻole ʻia nā ʻōlelo aʻo.

E haʻi paha ka mea hāʻawi iā ʻoe e haʻalele i ka lawe ʻana i kekahi mau lāʻau i hiki ke hoʻololi i ka hōʻike, e like me:

• Nā Antibiotics
• Nā lāʻau lapaʻau kūpale
• ʻO nā lāʻau i loaʻa i nā corticosteroids, e like me hydrocortisone, prednisone
• Estrogen
• Kaohi hānau waha (nā mea pale)
• Pila wai (diuretics)

Ke hoʻokomo ʻia ke kui kele e huki i ke koko, manaʻo kekahi poʻe i ka ʻeha kaulike. ʻIke wale kekahi i kahi ʻōniʻu a i ʻole kui. Ma hope, loaʻa paha i kahi kūpikipiki a i ʻole ʻeha iki. Hele koke kēia.

Hana ʻia kēia hoʻokolohua ke manaʻo ka mea hāʻawi i kou kino ke hana nei i ka nui nui o ka cortisol. Hana ʻia ia e kōkua i ke kuhi ʻana i ka maʻi Cushing a hoʻomaopopo i ke kumu.

Hiki i ka hoʻāʻo haʻahaʻa haʻahaʻa ke kōkua e haʻi inā hana nui kou kino i ka ACTH. Hiki i ka hoʻāʻo kiʻekiʻe ke kōkua i ka hoʻoholo inā aia ka pilikia i ka pituitary gland (maʻi Cushing).

ʻO Dexamethasone kahi steroid i hana ʻia e ke kanaka (synthetic) i noi i ka mea loaʻa hoʻokahi e like me cortisol. Hoʻoemi ʻo Dexamethasone i ka hoʻokuʻu ʻana iā ACTH i ka poʻe maʻamau. No laila, ʻo ka lawe ʻana i ka dexamethasone e hoʻēmi ai i ka pae ACTH a alakaʻi i kahi pae cortisol i hoʻemi ʻia.

Inā hana ka nui o kou pituitary gland i ka nui o ka ACTH, loaʻa iā ʻoe kahi pane ʻino i ka hōʻike haʻahaʻa haʻahaʻa. Akā hiki iā ʻoe ke pane maʻamau i ka hoʻokolohua lāʻau kiʻekiʻe.

E hoʻemi ka pae Cortisol ma hope o kou loaʻa ʻana iā dexamethasone.

Ka mahele haʻahaʻa:

• ʻO ka pō - 8 am plasma cortisol ma lalo o 1.8 micrograms no deciliter (mcg / dL) a i ʻole 50 nanomoles i kēlā me kēia lita (nmol / L)
• Koo - Cortisol urinary free ma ka lā 3 ma lalo o 10 micrograms i kēlā me kēia lā (mcg / lā) a i ʻole 280 nmol / L

Kiʻi kiʻekiʻe:

• ʻO ka pō - ʻoi aku ma mua o 50% hoʻemi i ka plasma cortisol
• Kūlana - ʻoi aku ma mua o 90% hoʻemi i ka urinary free cortisol

Hiki ke loli iki nā pae waiwai maʻamau i waena o nā hale hana ʻokoʻa. Hoʻohana kekahi mau labs i nā ana like ʻole a i ʻole hoʻokolohua i nā hoʻohālikelike like ʻole. E kamaʻilio me kāu kauka e pili ana i ke ʻano o kāu mau hopena hōʻike kikoʻī.

ʻO kahi pane maʻamau i ka hoʻowalewale hoʻowalewale e hoʻoliʻiliʻi paha he kumu kāu e hoʻokuʻu kūlohelohe ai i ka cortisol (Cushing syndrome). ʻO kēia paha ma muli o:

• Adrenal tumor nāna e hana i ka cortisol
• ʻO ka tumo pituitary e hoʻopuka ai iā ACTH
• Tumor i loko o ke kino e hoʻopuka iā ACTH (ectopic Cushing Syndrome)

Hiki i ka hoʻāʻo kiʻekiʻe ke kōkua i ka haʻi ʻana i kahi kumu pituitary (Cushing disease) mai nā kumu ʻē aʻe. Hiki ke kōkua i kahi hoʻokolohua koko ACTH i ke kumu o ka kiʻekiʻe o ka cortisol.

Hoʻololi nā hopena maʻamau ma muli o ke ʻano o ka pilikia.

Hoʻokumu ʻia ʻo Cushing Syndrome e kahi tumora adrenal:

• Hōʻike hoʻohaʻahaʻa haʻahaʻa - ʻaʻohe hōʻemi o ka cortisol koko
• Pae ACTH - haʻahaʻa
• I ka hapanui o nā hihia, ʻaʻole pono ka hoʻāʻo kiʻekiʻe

Ectopic Cushing maʻi pale:

• Hōʻike hoʻohaʻahaʻa haʻahaʻa - ʻaʻohe hōʻemi o ka cortisol koko
• ʻĀpana ACTH - kiʻekiʻe
• ʻO ka hoʻāʻo kiʻekiʻe loa - ʻaʻohe hōʻemi o ka cortisol koko

ʻO Cushing Syndrome ka mea i hoʻokumu ʻia e kahi pituitary tumor (Cushing disease)

• Hōʻike hoʻohaʻahaʻa haʻahaʻa - ʻaʻohe hōʻemi o ka cortisol koko
• ʻO ka hoʻāʻo ʻana ma nā lāʻau kiʻekiʻe - e hoʻoliʻiliʻi ʻia ka nui o ke koko

Hiki ke hopena i nā hopena hōʻike hewa ma muli o nā kumu he nui, e like me nā lāʻau ʻokoʻa, ka momona, kaumaha, a me ke koʻikoʻi. ʻO nā hopena wahaheʻe ka mea maʻamau i nā wahine ma mua o nā kāne.

ʻAʻohe pilikia iki i ka lawe ʻia ʻana o kou koko. ʻOkoʻa nā aʻa a me nā aʻa i ka nui mai kekahi mea hoʻomanawanui a i kekahi ʻē aʻe, a mai kekahi ʻaoʻao o ke kino i kekahi ʻē aʻe.ʻOi aku ka paʻakikī o ka lawe ʻana i ke koko mai kekahi poʻe ma mua o nā poʻe ʻē aʻe.

ʻO nā pilikia ʻē aʻe e pili ana i ke kau ʻana o ke koko he liʻiliʻi, akā hiki ke hoʻopili ʻia:

• Kahe nui ke koko
• Pāleʻale a ʻoluʻolu paha
• Nā punctures he nui e ʻimi i nā uaua
• Hematoma (hōʻiliʻili koko ma lalo o ka ʻili)
• Maʻiʻaʻai (i iki kamepiula i kēlā me kēia manawa ka ʻili i haki)

DST; Hōʻaʻo kāohi ACTH; Hōʻike hoʻokiʻoki Cortisol

Chernecky CC, Berger BJ. Hōʻike kaohi hoʻopau Dexamethasone - diagnostic. I: Chernecky CC, Berger BJ, hua. Nā Hoʻokolohua Laboratory a me nā kaʻina hana Diagnostic. ʻElua huaʻōlelo St Louis, MO: Elsevier Saunders; 2013: 437-438.

ʻO Guber HA, Farag AF. ʻO ka loiloi o ka hana endocrine. I: McPherson RA, Pincus MR, hua. ʻO kā Henry's Clinical Diagnosis a me Management e nā Laboratory Methods. 23rd Ed. St Louis, MO: Elsevier; 2017: chap 24.

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.