I-Exogenous Cushing syndrome

I-Exogenous Cushing syndrome iyindlela yeCushing syndrome eyenzeka kubantu abathatha i-glucocorticoid (ebizwa nangokuthi i-corticosteroid, noma i-steroid) hormone.

I-Cushing syndrome yisifo esenzeka lapho umzimba wakho unezinga eliphakeme kunelijwayelekile le-hormone cortisol. Le hormone ivame ukwenziwa ezincwadini ze-adrenal.

Izindlela ezingajwayelekile ezibangelwa okuthile ngaphandle komzimba. I-Exogenous Cushing syndrome yenzeka lapho umuntu ethatha imishanguzo eyenziwe ngabantu (yokwenziwa) ye-glucocorticoid ukwelapha isifo.

Ama-Glucocorticoids anikezwa izifo eziningi, njengezifo zamaphaphu, izimo zesikhumba, izifo zamathumbu ezivuthayo, umdlavuza, izicubu zobuchopho kanye nezifo ezihlangene. Le mithi iza ngezindlela eziningi, kubandakanya iphilisi, imithambo yegazi (IV), ukujova kujoyinti, i-enema, okhilimu besikhumba, ama-inhalers namaconsi wamehlo.

Iningi labantu abane-Cushing syndrome bane:

• Round, obomvu, ubuso obugcwele (ubuso benyanga)
• Izinga lokukhula kancane (ezinganeni)
• Ukuzuza kwesisindo ngokunqwabelana kwamafutha esiqwini, kepha ukulahleka kwamafutha ezandleni, emilenzeni nasezinqeni (ukukhuluphala okuphakathi)

Izinguquko zesikhumba ezivame ukubonwa zifaka:

• Ukutheleleka kwesikhumba
• 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

Izinguquko zemisipha namathambo zifaka:

• Ubuhlungu beqolo, obenzeka ngemisebenzi ejwayelekile
• Ubuhlungu bamathambo noma isisa
• Ukuqoqwa kwamafutha phakathi kwamahlombe nangaphezulu kwethambo lekhola
• Ubambo kanye nokuqhekeka komgogodla okubangelwa ukuncipha kwamathambo
• Imisipha ebuthakathaka, ikakhulukazi okhalweni nasemahlombe

Izinkinga zomzimba wonke (zesistimu) zingafaka:

• Thayipha 2 sikashukela
• Umfutho wegazi ophezulu
• I-cholesterol ephezulu ne-triglycerides

Abesifazane bangaba:

• Izikhathi eziba ngokungajwayelekile noma ukuma

Amadoda angaba:

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

Ezinye izimpawu ezingenzeka zibandakanya:

• Izinguquko zengqondo, njengokucindezeleka, ukukhathazeka, noma izinguquko ekuziphatheni
• Ukukhathala
• Ubuhlungu bekhanda
• Ukwanda ukoma nokuchama

Umhlinzeki wezokunakekelwa kwempilo uzokwenza ukuhlolwa ngokomzimba abuze ngezimpawu zakho nemithi oyiphuzayo. Tshela umhlinzeki ngayo yonke imithi obuyiphuza ezinyangeni ezimbalwa ezedlule. Phinda utshele umhlinzeki ngamashothi owathole ehhovisi lomhlinzeki.

Uma usebenzisa i-cortisone, i-prednisone, noma amanye ama-corticosteroids, imiphumela elandelayo yokuhlolwa ingaphakamisa i-exogenous Cushing syndrome:

• Izinga eliphansi le-ACTH
• Izinga eliphansi le-cortisol (noma ileveli ephezulu ye-cortisol) egazini noma emchameni, kuya ngomuthi owuthathayo
• Impendulo engajwayelekile esivivinyweni sokuvuselela i-cosyntropin (ACTH)
• Kuphakeme kune-glucose ejwayelekile yokuzila ukudla
• Izinga eliphansi le-potassium yegazi
• Ubuningi bamathambo aphansi, njengoba kulinganiswa ukuhlolwa kwesisindo samaminerali
• I-cholesterol ephezulu, ikakhulukazi i-triglycerides ephezulu kanye ne-low-density lipoprotein (HDL)

Indlela ebizwa nge-high performance liquid chromatography (HPLC) ingakhombisa izinga eliphakeme lomuthi osolwayo emchameni.

Ukwelashwa ukwehla futhi ekugcineni kuyeke ukuthatha noma yimaphi ama-corticosteroids. Lokhu kungenziwa kancane noma ngokushesha, kuya ngokuthi kungani uphathwa nge-corticosteroid. Ungayeki ukuthatha noma imuphi umuthi ngaphandle kokuqala ukhulume nomhlinzeki wakho. Ukumisa ngokungazelelwe ama-corticosteroids ngemuva kokuwaphuza isikhathi eside kungaholela esimweni esisongela impilo esibizwa nge-adrenal crisis.

Uma ungeke uyeke ukuthatha umuthi ngenxa yesifo (isibonelo, udinga umuthi we-glucocorticoid ukwelapha i-asthma enamandla), landela imiyalo yomhlinzeki wakho yokuthi unganciphisa kanjani amathuba okuba nezinkinga, kufaka phakathi:

• Ukwelapha ushukela wegazi ophakeme ngokudla, ngemithi yomlomo, noma nge-insulin.
• Ukwelapha i-cholesterol ephezulu ngokudla noma ngemithi.
• Ukuthatha imithi ukuvimbela ukulahleka kwamathambo. Lokhu kungasiza ekunciphiseni ubungozi bokuqhekeka uma uba ne-osteoporosis.
• Ukuthatha eminye imithi ukunciphisa inani lemithi ye-glucocorticoid oyidingayo.

Ukuncipha kancane umuthi obangela isimo kungasiza ukuguqula imiphumela ye-adrenal gland shrinkage (atrophy). Lokhu kungathatha izinyanga kuze kube unyaka. Ngalesi sikhathi, ungadinga ukuqala kabusha noma ukwandisa umthamo we-steroids yakho ngezikhathi zokucindezeleka noma ukugula.

Izinkinga zempilo ezingabangelwa i-exogenous Cushing syndrome zifaka noma yikuphi okulandelayo:

• Amasosha omzimba aphansi, angaholela ekuthelelekeni njalo
• Ukulimala kwamehlo, izinso, nezinzwa ngenxa kashukela ophezulu wegazi ongelashwa
• Isifo sikashukela
• Amazinga aphezulu e-cholesterol
• Ingozi eyengeziwe yokuhlaselwa yisifo sikashukela esingalashwa kanye ne-cholesterol ephezulu
• Ingozi eyengeziwe yamahlule egazi
• Amathambo abuthakathaka (i-osteoporosis) kanye nengozi eyengeziwe yokwaphuka

Lezi zinkinga ngokuvamile zingavinjelwa ngokwelashwa okufanele.

Shayela i-aphoyintimenti nomhlinzeki wakho uma uthatha i-corticosteroid futhi uba nezimpawu ze-Cushing syndrome.

Uma uthatha i-corticosteroid, yazi izimpawu nezimpawu ze-Cushing syndrome. Ukwelashwa ngaphambi kwesikhathi kungasiza ekuvimbeleni noma yimiphi imiphumela yesikhathi eside yeCushing syndrome. Uma usebenzisa i-inhaled steroids, unganciphisa ukuvezwa kwakho kuma-steroids ngokusebenzisa i-spacer nangokuhlanza umlomo wakho ngemuva kokuphefumula kuma-steroids.

I-Cushing syndrome - i-corticosteroid eyenziwe; I-Corticosteroid-indened Cushing syndrome; Iatrogenic Cushing syndrome

• Ukukhiqizwa kwehypothalamus hormone

UNieman LK, uBiller BM, uTholeling JW, et al.Ukwelashwa kwe-Cushing's syndrome: umhlahlandlela wokusebenza komtholampilo we-Endocrine Society.UJ CI-lin Endocrinol Metab. 2015; 100 (8): 2807-2831. I-PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

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.