I-Hypopituitarism

I-Hypopituitarism yisimo lapho indlala yepituitary ingakhiqizi inani elijwayelekile lamanye noma wonke amahomoni ayo.

Indlala ye-pituitary iyisakhiwo esincane esitholakala ngezansi nje kobuchopho. Inamathele ngesiqu ku-hypothalamus. I-hypothalamus yindawo yobuchopho elawula ukusebenza kwendlala ye-pituitary.

Ama-hormone akhishwe yindlala ye-pituitary (nemisebenzi yawo) yile:

• I-hormone ye-Adrenocorticotropic (ACTH) - ivuselela i-adrenal gland ukukhipha i-cortisol; I-cortisol isiza ukugcina umfutho wegazi noshukela wegazi
• I-Antidiuretic hormone (ADH) - ilawula ukulahleka kwamanzi ngezinso
• I-hormone evuselela i-follicle (FSH) - ilawula ukusebenza kocansi nokuzala kwabesilisa nabesifazane
• I-hormone yokukhula (GH) - ivuselela ukukhula kwezicubu namathambo
• I-Luteinizing hormone (LH) - ilawula ukusebenza kocansi nokuzala kwabesilisa nabesifazane
• I-Oxytocin - ivuselela isibeletho ukuthi sivumelane ngesikhathi sokubeletha kanye namabele ukukhipha ubisi
• Iprolactin - ivuselela ukukhula kwamabele abesifazane nokukhiqizwa ubisi
• Ihormone evuselela indlala yegilo (TSH) - ivuselela indlala yegilo ukukhipha ama-hormone athinta imetabolism yomzimba

Ku-hypopituitarism, kukhona ukungabi khona kwehomoni eyodwa noma ngaphezulu ye-pituitary. Ukuntuleka kwehomoni kuholela ekulahlekelweni ngumsebenzi endlaleni noma esithweni sokulawulwa kwamahomoni. Isibonelo, ukungabi khona kwe-TSH kuholela ekulahlekelweni komsebenzi ojwayelekile wendlala yegilo.

I-Hypopituitarism ingabangelwa:

• Ukuhlinzwa kobuchopho
• Isigaxa sobuchopho
• Ukuhlukumezeka ekhanda (ukulimala kwengqondo okulimazayo)
• Ukutheleleka noma ukuvuvukala kobuchopho nezicubu ezisekela ubuchopho
• Ukufa kwendawo yezicubu ku-pituitary gland (pituitary apoplexy)
• Ukwelashwa ngemisebe ebuchosheni
• Unhlangothi
• I-Subarachnoid hemorrhage (kusuka ekuqhumeni kwe-aneurysm)
• Amathumba endlala ye-pituitary noma i-hypothalamus

Kwesinye isikhathi, i-hypopituitarism ibangelwa amasosha omzimba angavamile noma izifo zomzimba, njenge:

• Insimbi eningi kakhulu emzimbeni (hemochromatosis)
• Ukwanda okungajwayelekile kwamaseli omzimba abizwa ngama-histiocyte (histiocytosis X)
• Isimo se-autoimmune esidala ukuvuvukala kwepituitary (lymphocytic hypophysitis)
• Ukuvuvukala kwezicubu nezitho ezahlukahlukene (sarcoidosis)
• Ukutheleleka kwepituitary, njengesifo sofuba esiyinhloko se-pituitary

I-Hypopituitarism futhi iyinkinga engajwayelekile ebangelwa ukopha okukhulu ngesikhathi sokukhulelwa. Ukulahleka kwegazi kuholela ekufeni kwezicubu endlaleni yebhinqa. Lesi simo sibizwa nge-Sheehan syndrome.

Imithi ethile ingacindezela nokusebenza kwe-pituitary. Izidakamizwa ezivame kakhulu yi-glucocorticoids (njenge-prednisone ne-dexamethasone), ethathwa ngezimo zokuvuvukala kanye nezokuzivikela ezifweni. Izidakamizwa ezisetshenziselwa ukwelapha umdlavuza we-prostate nazo zingaholela ekusebenzeni okuphansi kwe-pituitary.

Izimpawu ze-hypopituitarism zifaka noma yikuphi okulandelayo:

• Ubuhlungu besisu
• Ukwehla kwesifiso sokudla
• Ukuntuleka kocansi (kwabesilisa noma kwabesifazane)
• Isizungu noma ukuquleka
• Ukuchama ngokweqile nokoma
• Ukwehluleka ukukhipha ubisi (kwabesifazane)
• Ukukhathala, ubuthakathaka
• Ubuhlungu bekhanda
• Ukungabi nenzalo (kwabesifazane) noma ukumiswa kwezikhathi zokuya esikhathini
• Ukulahleka kwekhwapha noma izinwele zasesidlangalaleni
• Ukulahlekelwa izinwele noma izinwele ebusweni (emadodeni)
• Umfutho wegazi ophansi
• Ushukela wegazi ophansi
• Ukuzwela emakhazeni
• Ukuphakama okufushane (ngaphansi kwamamitha ama-5 noma amamitha ayi-1.5) uma kuqala kusesikhathini sokukhula
• Ukukhula okuhamba kancane nokukhula kocansi (ezinganeni)
• Izinkinga zombono
• Ukwehla kwesisindo

Izimpawu zingakhula kancane futhi zingahluka kakhulu, kuya nge:

• Inani lamahomoni alahlekile nezitho ezithintekayo
• Ubukhulu besifo

Ezinye izimpawu ezingase zivele ngalesi sifo:

• Ukuvuvukala kobuso
• Ukulahleka kwezinwele
• Ukubola noma ukushintsha kwezwi
• Ukuqina okuhlangene
• Ukuzuza kwesisindo

Ukuxilonga i-hypopituitarism, kufanele kube khona amazinga aphansi ama-hormone ngenxa yenkinga ngendlala ye-pituitary. Ukuxilongwa kufanele futhi kukhiphe izifo zomzimba ezithintekayo yile hormone.

Ukuhlolwa kungafaka:

• Ukuskena kwe-Brain CT
• I-Pituitary MRI
• ACTH
• ICortisol
• I-Estradiol (estrogen)
• I-hormone evuselela i-follicle (FSH)
• Ukukhula okufana ne-insulin 1 (IGF-1)
• I-hormone yeLuteinizing (LH)
• Ukuhlolwa kwe-Osmolality kwegazi nomchamo
• Izinga le-testosterone
• Ihomoni evuselela indlala yegilo (TSH)
• Indlala yegilo (T4)
• I-biopsy ye-pituitary

Izinga le-hormone ye-pituitary ingaba phezulu egazini uma unesifo se-pituitary esikhiqiza kakhulu lelo hormone. Isimila singagxoja amanye amaseli we-pituitary, aholele emazingeni aphansi amanye amahomoni.

Uma i-hypopituitarism ibangelwa isimila, ungadinga ukuhlinzwa ukuze ususe isimila. Ukwelashwa ngemisebe nakho kungadingeka.

Uzodinga imishanguzo yama-hormone yempilo yonke ukufaka ama-hormone angasenziwa yizitho ezingaphansi kolawulo lwendlala ye-pituitary. Lokhu kungafaka:

• I-Corticosteroids (i-cortisol)
• Ozokusebenzisa
• Ama-hormone ocansi (i-testosterone yamadoda ne-estrogen yabesifazane)
• Indlala yegilo
• Unyazi

Izidakamizwa ziyatholakala ukwelapha ukungazali okuhlobene kwabesilisa nabesifazane.

Uma uthatha imithi ye-glucocorticoid yokushoda kwe-pituitary ACTH, qiniseka ukuthi uyazi ukuthi uzothatha nini umthamo wokucindezeleka womuthi wakho. Xoxa ngalokhu nomhlinzeki wakho wezokunakekelwa kwempilo.

Ngaso sonke isikhathi phatha i-ID yezokwelapha (ikhadi, isongo, noma umgexo) okusho ukuthi awunakho ukusebenza kahle kwe-adrenal. Umazisi kufanele futhi usho uhlobo lomuthi nomthamo owudingayo uma kunesimo esiphuthumayo esidalwe ukungakwazi ukusebenza kahle kwe-adrenal.

I-Hypopituitarism ivame ukuhlala unomphela. Kudinga ukwelashwa impilo yonke ngomuthi owodwa noma ngaphezulu. Kepha ungalindela isikhathi sokuphila esijwayelekile.

Ezinganeni, i-hypopituitarism ingathuthuka uma isisu sisuswa ngesikhathi sokuhlinzwa.

Imiphumela emibi yemithi yokwelapha i-hypopituitarism ingaqala. Kodwa-ke, ungayeki noma imuphi umuthi ngokwakho ngaphandle kokukhuluma nomhlinzeki wakho kuqala.

Shayela umhlinzeki wakho uma uthuthukisa izimpawu ze-hypopituitarism.

Ezimweni eziningi, lesi sifo asivimbeki. Ukuqaphela ubungozi, njengokuthatha imishanguzo ethile, kungavumela ukuxilongwa nokwelashwa kusenesikhathi.

Ukungakwazi ukusebenza kwesikhumba; I-Panhypopituitarism

• Izindlala ze-Endocrine
• Indlala yamapayipi
• Ama-gonadotropin
• I-Pituitary ne-TSH

IBurt MG, Ho KKY. I-Hypopituitarism nokukhula kwe-hormone yokukhula. Ku: Jameson JL, De Groot LJ, de Kretser DM, et al, abahleli. I-Endocrinology: Eyabantu Abadala Neyengane. Umhla wesi-7. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 11.

IClemmons DR, uNieman LK. Sondela esigulini ngesifo se-endocrine. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-25. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 221.

UFleseriu M, Hashim IA, Karavitaki N, et al. Ukufakwa esikhundleni kweHormonal ku-hypopituitarism kubantu abadala: umhlahlandlela wokuziphatha womtholampilo we-Endocrine Society. UJ Clin Endocrinol Metab. 2016; 101 (11): 3888-3921. I-PMID: 27736313 www.ncbi.nlm.nih.gov/pubmed/27736313.