Isifo se-Cushing

Isifo se-Cushing yisimo lapho indlala ye-pituitary ikhipha i-hormone ye-adrenocorticotropic eningi kakhulu (i-ACTH). I-pituitary gland iyisitho sohlelo lwe-endocrine.

Isifo seCushing siyindlela yeCushing syndrome. Ezinye izinhlobo ze-Cushing syndrome zibandakanya i-exogenous Cushing syndrome, i-Cushing syndrome ebangelwa isimila se-adrenal, ne-ectopic Cushing syndrome.

Isifo se-Cushing sibangelwa isimila noma ukukhula ngokweqile (i-hyperplasia) yendlala ye-pituitary. Indlala ye-pituitary itholakala ngaphansi kwesisekelo sobuchopho. Uhlobo lwesimila se-pituitary esibizwa nge-adenoma yisona sizathu esivame kakhulu. I-adenoma iyisifo esibuhlungu (hhayi umdlavuza).

Ngesifo seCushing, indlala ye-pituitary ikhipha i-ACTH eningi kakhulu. I-ACTH ivuselela ukukhiqizwa nokukhululwa kwe-cortisol, i-hormone yokucindezeleka. I-ACTH eningi kakhulu ibangela ukuthi izindlala ze-adrenal zenze i-cortisol eningi kakhulu.

ICortisol ivame ukukhishwa phakathi nezimo ezicindezelayo. Ineminye imisebenzi eminingi, kufaka phakathi:

• Ukulawula ukusetshenziswa komzimba kwama-carbohydrate, amafutha, namaprotheni
• Ukunciphisa ukuphendula kwamasosha omzimba ekuvuvukeni (ukuvuvukala)
• Ukulawula umfutho wegazi nokulinganisela kwamanzi emzimbeni

Izimpawu zesifo seCushing zifaka:

• Ukukhuluphala komzimba okuphezulu (ngenhla kwesinqe) nezingalo nemilenze emincane
• Round, obomvu, ubuso obugcwele (ubuso benyanga)
• Izinga lokukhula kancane ezinganeni

Izinguquko zesikhumba ezivame ukubonwa zifaka:

• Izinduna noma izifo zesikhumba
• Amamaki anombala onsomi (1/2 intshi noma isentimitha elilodwa noma ngaphezulu ububanzi), okuthiwa i-striae, esikhunjeni sesisu, emathangeni, ezingalweni ezingaphezulu, nasemabeleni
• Isikhumba esizacile esinokulimazeka okulula, okuvame kakhulu ezandleni nasezandleni

Izinguquko zemisipha namathambo zifaka:

• Ubuhlungu beqolo, obenzeka ngemisebenzi ejwayelekile
• Ubuhlungu bamathambo noma isisa
• Ukuqoqwa kwamafutha phakathi kwamahlombe (inyathi)
• Ukwenza buthakathaka kwamathambo, okuholela ekuqhekekeni kwezimbambo nomgogodla
• Imisipha ebuthakathaka ebangela ukungabekezelelani kokuvivinya umzimba

Abesifazane bangaba:

• Ukukhula kwezinwele okwedlulele ebusweni, entanyeni, esifubeni, esiswini nasemathangeni
• Umjikelezo wokuya esikhathini oba ngokungajwayelekile noma uyeke

Amadoda angaba:

• Ukunciphisa noma ukungabi nesifiso sobulili (i-libido ephansi)
• Izinkinga zokwakhiwa

Ezinye izimpawu noma izinkinga zingafaka:

• Izinguquko zengqondo, njengokucindezeleka, ukukhathazeka, noma izinguquko ekuziphatheni
• Ukukhathala
• Ukutheleleka njalo
• Ubuhlungu bekhanda
• Ukwanda ukoma nokuchama
• Umfutho wegazi ophezulu
• Isifo sikashukela

Umhlinzeki wezokunakekelwa kwempilo uzokwenza ukuhlolwa komzimba abuze ngezimpawu zakho.

Ukuhlolwa kwenziwa kuqala ukuqinisekisa ukuthi kune-cortisol eningi kakhulu emzimbeni, bese kunqunywa imbangela.

Lezi zivivinyo ziqinisekisa i-cortisol eningi kakhulu:

• Umchamo wamahora angama-24 we-cortisol
• Isivivinyo sokucindezela i-Dexamethasone (umthamo ophansi)
• Amanqanaba e-cortisol amathe (ekuseni ngovivi kakhulu)

Lezi zivivinyo zinquma imbangela:

• Izinga le-ACTH yegazi
• I-Brain MRI
• Ukuhlolwa kwehormoni ekhipha i-Corticotropin, esebenza endlaleni ye-pituitary ukudala ukukhishwa kwe-ACTH
• Isivivinyo sokucindezela i-Dexamethasone (umthamo omkhulu)
• Isampula ye-petrosal sinus sampling (IPSS) engaphansi - ilinganisa amazinga e-ACTH emithanjeni ekhipha indlala yebhande uma iqhathaniswa nemithambo esifubeni

Olunye uvivinyo olungenziwa lubandakanya noma yikuphi okulandelayo:

• Ukuzila ukudla kwegazi ne-A1C ukuhlola isifo sikashukela
• Ukuhlolwa kwe-Lipid ne-cholesterol
• Ukuskena kwamathambo amaminerali ukuhlola i-osteoporosis

Kungadingeka ukuhlolwa okungaphezu kokukodwa ukuthola isifo seCushing. Umhlinzeki wakho angakucela ukuthi ubone udokotela osebenza ngezifo zepituitary.

Ukwelashwa kuhilela ukuhlinzwa ukuze kususwe isimila sesifuba, uma kungenzeka. Ngemuva kokuhlinzwa, indlala yepituitary ingaqala kancane ukusebenza futhi ibuyele kokujwayelekile.

Ngesikhathi senqubo yokutakula kusuka ekuhlinzweni, ungadinga ukwelashwa okufaka esikhundleni se-cortisol ngoba i-pituitary idinga isikhathi sokuqala ukwenza i-ACTH futhi.

Ukwelashwa ngemisebe ye-pituitary gland kungasetshenziswa futhi uma isimila singasuswa ngokuphelele.

Uma isimila singaphenduli ekuhlinzweni noma emisebeni, ungahle udinge imithi yokuvimba umzimba wakho ekwenzeni i-cortisol.

Uma lezi zindlela zokwelapha zingaphumeleli, izindlala ze-adrenal zingadinga ukususwa ukuze kumiswe amazinga aphakeme e-cortisol ekukhiqizweni. Ukususwa kwezindlala ze-adrenal kungadala ukuthi isimila se-pituitary sikhule kakhulu (i-Nelson syndrome).

Uma singelashwa, isifo iCushing singadala ukugula okunzima, ngisho nokufa. Ukususwa kwesimila kungaholela ekululameni okugcwele, kepha isimila singakhula futhi.

Izinkinga zempilo ezingabangelwa isifo seCushing zifaka:

• Ukucindezela ukuphuka emgogodleni
• Isifo sikashukela
• Umfutho wegazi ophezulu
• Izifo
• Amatshe ezinso
• Isimo sengqondo noma ezinye izinkinga zengqondo

Shayela umhlinzeki wakho uma uba nezimpawu zesifo seCushing.

Uma ngabe ususwe isimila se-pituitary, shayela umhlinzeki wakho uma unezimpawu zezinkinga, kufaka phakathi izimpawu zokuthi isimila sesibuyile.

Isifo sePituitary Cushing; I-ACTH-secreting adenoma

• Izindlala ze-Endocrine
• I-Striae ku-popliteal fossa
• Striae emlenzeni

UJuszczak A, uMorris DG, uGrossman AB, uNieman LK. I-Cushing’s syndrome. 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 13.

Molitch ME. I-pituitary yangaphakathi. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-25. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 224.

UStewart PM, iNewell-Price JDC. I-adrenal cortex. Ku: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, abahleli. Incwadi kaWilliams ye-Endocrinology. Umhlaka 13. IPhiladelphia, PA: Elsevier; 2016: isahluko 15.