Cushing's Syndrome waxaa keena Cortisol-ka xad-dhaafka ah
Cushing's syndrom waa cudur aan caadi ahayn marka uu jirku ku dhaco cortisol aad u badan. Cortisol waxaa soo saaro jirka waxaana sidoo kale loo isticmaalaa daawooyinka corticosteroid. Cushing's syndrome ayaa ku dhici karta sababtoo ah cortisol waxaa ka buuxa jirka ama isticmaalka daroogooyinka leh cortisol (sida prednisone). Marka Cushing's syndrome uu keeno isticmaalka muddada dheer ee daawooyinka korticosteroid, waxaa sidoo kale loo yaqaan 'hypercortisolism'.
Ku saabsan Cortisol
Cortisol waa hoormoonka ugu wayn ee jirka. Cortisol ayaa qarsoodi ah qanjirrada adrenal ee ka jawaab celinta dheecaanka hormoonka adrenocorticotropic hormone (ACTH) by pituitary. Qaab ka mid ah Cushing's syndrome ayaa laga yaabaa in ay sababto kormeerka ACTH by pituitary taasoo horseedaysa in ka badan cortisol.
Cortisol wuxuu leeyahay shaqooyin dhowr ah, oo ay ku jiraan qawaaniinta caabuqa iyo xakamaynta sida jidhku u isticmaalo karbohidratka, dufanka, iyo borotiinka. Corticosteroids sida prednisone, kuwaas oo inta badan loo isticmaalo daaweynta xaaladaha caabuqa, waxay la jaanqaadaan saameynta cortisol.
Sababaha Cushing's Syndrome
Waxaa jira dhowr sababood oo kala duwan oo Cushing's syndrome ah.
Cushing Cudurka. Cushing's cudurku waa hal sabab oo caadi ah Cushing's syndrome kaas oo dhacaya marka ay sii deynayso dheecaanka pituitary ee ACTH, taasoo keenaysa cortisol dheeraad ah. Tani waxay ka dhalan kartaa buro xanuun ama koritaan kale.
Iatrogenic Cushing's Syndrome. Isticmaalka qiyaaso badan oo daawooyinka steroid ah muddo dheer waxay sababi karaan noocaan Cushing's syndrome.
Dawooyinka steroids ama daawooyinka corticosteroid waxaa loo isticmaalaa in lagu daaweeyo xaalado badan oo caabuq ah, oo ay ku jiraan neefta, lupus, rheumatoid arthritis, iyo caabuqa bararka caabuqa (IBD) . Xaaladaha qaarkood, waxaa lagu qoraa qiyaaso sarreeya iyo muddo dheer.
Adrenal Gland Tumor. Ugu dambeyntii, sabab kale, inkastoo ay ka yar tahay mid caadi ah, waxaa si toos ah u keena qanjidhada qanjidhada adrenal.
Noocyada noocaan ah waxay keenaan heerarka sare ee cortisol, oo ka madaxbannaan wax soo saarka ACTH ee qanjirka pituitary. Marka buro ay ku jirto hal qanjirka 'adrenal', qadarka xad-dhaafka ah ee cortisol ee soo saara wuxuu keeni karaa qanjirrada adrenal-aan ee aan adkaaneyn in uu bilaabo inuu hoos u dhigo oo uu yareeyo.
Calaamadaha Cushing's Syndrome
Astaamaha iyo calaamadaha Cushing's syndrome waxay ku jiri karaan kuwan soo socda:
- finan
- Duufaan Buffalo (dufan dheeraad ah oo lagu shubo dhabarka qoorta)
- heerarka gulukoosta ee sareeya
- haraad xad dhaaf ah
- daal
- kordhay kaadida
- madax xanuun
- cadaadiska dhiigga sareeya
- Hirsutism (korriin xad dhaaf ah timo)
- isbeddel caadada ah
- buurnaanta ku wareegsan jirkaaga
- calaamadaha nafsiga ah sida xasilooni la'aan, niyadjab, walaac, weeraro argagax
- wareegsan, waji buuxa (oo loo yaqaan wajiga wajiga)
- isbedelka maqaarka
- calaamadee calaamadaha caloosha, gacmaha, naasaha, barida, iyo bowdaha (oo loo yaqaan 'striae')
- daciifnimo
Waxaa jiri kara calaamado iyo astaamo xaaladdan aan kor ku soo sheegin. Waa muhiim in la arko dhakhtar walaac kasta oo ku saabsan calaamadaha Cushing's syndrome.
Cabbiraadda Cushing's Syndrome
Waxaa jira dabeecado muuqda oo muuqda, sida wajiga wajiga wareegga iyo burka boodhka, kuwaas oo ah kuwa dadka caadiga ah qaba Cushing's syndrome. Haddii dhakhtarku uu ka shakiyo Cushing, ka dib taariikhda joogtada ah, baaritaanka jireed, iyo shaqada dhiigga ee aasaasiga ah, waxay ku amri doontaa baaritaanka dhiigga iyo kaadida si loo cabbiro xaddiga cortisol ee jirka ku jirta.
Haddii heerarkan ay sarreeyaan, dhakhtarku wuxuu dalban karaa baaritaan lagu magacaabo baaritaanka dexamethasone. Tani waa tijaabo ah in steroid afka laga yiraahdo dexamethasasone la bixiyo waxaana la mariyaa baaritaanada dhiiga iyo kaadida si loo cabbiro cortisol iyo hoormoon kale oo hormoonno ah. Baaritaano dheeraad ah ayaa la dalban karaa haddii tijaabooyinka bilowga ah ay ku soo noqdaan natiijooyinka muujinaya Cushing's syndrome oo laga yaabo inay tahay arrin walaac ah.
Dhakhtarka ayaa u wareegi kara nidaam tijaabo ah oo dheeri ah haddii baaritaanka bilowga ahi muujiyo in tani ay lagama maarmaan tahay. Haddii buro laga shakisan yahay sababta Cushing's, baaritaano kale oo laga yaabo in lagu dalbado waxaa ka mid ah CT scan ama MRI .
Inkastoo imtixaanku uu u eg yahay shaqo badan ama aan habooneyn, waxaa muhiim ah in la raaco oo dhamaystiro dhammaan tijaabooyinka uu dhakhtarku amro.
Daaweynta Cushing's Syndrome
Cushing's syndrome waxaa sida ugu fiican loola dhaqmaa iyadoo la go'aamiyo waxa keena heerarka sare ee cortisol iyo ka qaadida.
Cushing cudurka. Qaliinka ayaa badanaa daaweynta ugu horeysa ee bukaannada qaba Cushing. Kala saaridda burooyinka pituitary iyo mararka qaarkood qanjirka pituitary oo dhan, iyada oo loo marayo nidaam la yiraahdo dib-u-ceshad joojinta transsphenoidal (sanka ka dambeeya sanka) by neurosurgeon waa lagama maarmaan. Haddii pituitary u baahan yahay in la saaro, dheellitirka cortisol, thyroid, iyo hoormoonka galmada ayaa u baahan doona in la siiyo. Haddii qalliin looga hortago ama burooyinka aan laga saari karin, daaweynta shucaaca waxaa loo isticmaali karaa in lagu yareeyo burooyinka. Haddii bukaanka la ogaado inuu yahay mid khafiif ah , kiimiko ama shucaac ayaa loo qori karaa si loo yareeyo khatarta ah in dib-u-noqoshada. Waxaa jira daaweyn caafimaad oo loo heli karo daaweynta cudurka Cushing, sidoo kale waxaa ku jira Pasireotide (Signifor) iyo Mifepristone (Korlik).
Iatrogenic Cushing's syndrome. Haddii uu cudurku keeno daawo cayiman, waxaa haboon in la bilaabo inuu daaweeyo hoosta daawada, oo uu kormeero takhtar, si looga saaro steroid xad-dhaaf ah. Waa muhiim in si tartiib tartiib ah loo yareeyo xaddiga corticosteroid ee laga qaado muddada todobaadyada ama xataa bilo. Daaweyn kala duwan ama daawo ayaa laga yaabaa in lagu ogaado daaweyn ku haboon xaaladda xaalada. Waa muhiim in la raaco tilmaamaha si sax ah, maadaama steroids lama joojin karo si lama filaan ah, laakiin waa in si tartiib ah hoos loogu dhigo.
Haddii steroids aan la joojin karin, ama haddii ay qaadanayso waqti dheer si ay u joojiso, daawooyinka kale waxaa laga yaabaa in la siiyo si loo maareeyo qaar ka mid ah calaamadaha iyo astaamaha Cushing's syndrome. Qaar ka mid ah qaybaha cilladkan oo laga yaabo in ay u baahdaan daaweyn daawooyinka kale iyo isbedelka cuntada ayaa waxaa ka mid ah sonkorta dhiigga oo saraysa iyo kolestaroolka sare. Yareynta halista jabka ee daawooyinka loo isticmaalo daaweynta lafdhabarta ayaa sidoo kale lagama maarmaan ah. Marka ay jirto xaalad niyadjab ama walaac, u gudbinta takhasusaha caafimaadka maskaxda ee daaweynta ayaa sidoo kale noqon karta mid waxtarka leh.
Xusuusin ah
Xaaladda cudurka Cushing, dadka badankoodu si fiican ayay u bogsadaan qalliinka ka dib. Qaar ka mid ah calaamadaha cudurka ayaa sii wadi kara qalliinka ka dib, sida hypertension, laakiin kuwaan waxaa badanaa lagu maamuli karaa daawooyinka. Haddii qaliinka aan suuragal ahayn, waxaa sidoo kale jira daaweyn caafimaad oo la heli karo taas oo yareyn karta saameynta cortisol-kaca.
Cushing's syndrome waa halis ah in la qaato dawooyinka steroid, laakiin ma aha mid caadi ah. Isticmaalka steroids iyo halista suurtagalka ah ee faa'iidooyinka waa in lagala hadlo dhakhtarka. Cushing's syndrome waxaa lagu daaweyn karaa iyadoo la yareeynayo qadarka steroids la qaado, iyo iyadoo la daaweynayo qaar ka mid ah calaamadaha iyo astaamaha. Hadafku waa marwalba inuu bukaanjiifku ka saaro steroids sida ugu dhakhsaha badan iyo sida ugu badbaado badan.
> Ilo:
> Margulies, P. "Cudurrada Adrenal - Cushing's Syndrome: Xaqiiqooyinka aad u Baahan Tahay Inaad Ogaato." Cudurrada Qaranka ee Adrenal Foundation. 2017.
> Machadyada Qaranka ee Caafimaadka. "Cushing's Syndrome" Machadka Qaran ee Sonkorowga iyo Cudurrada Diidmada iyo Kelyaha (NIDDK) Apr 2012.
> Sharma ST, Nieman LK. "Cushing's syndrome: dhammaan noocyada, ogaanshaha, iyo daaweynta." E ndocrinol Metab Clin North Am . 2011 Jun; 40: 379-391, viii-ix. doi: 10.1016 / j.ecl.2011.01.006
> Sharma ST, Nieman LK. Cushing's Syndrome: Dhammaan kala duwanaanshaha, ogaanshaha, iyo daaweynta. "Endocrinol Metab Clin North Am. 2011; 40: 379-391. doi: 10.1016 / j.ecl.2011.01.006