I-Ectopic Cushing syndrome

I-Ectopic Cushing syndrome iyindlela yeCushing syndrome lapho isimila esingaphandle kwendlala yesibeletho sikhiqiza i-hormone ebizwa nge-adrenocorticotropic hormone (ACTH).

I-Cushing syndrome yisifo esenzeka lapho umzimba wakho unezinga eliphakeme kunelijwayelekile le-hormone cortisol. Le hormone yenziwa kwizindlala ze-adrenal. I-cortisol eningi kakhulu ingabangelwa izinkinga ezahlukahlukene. Enye yezimbangela ukuthi uma kunehomoni eminingi kakhulu i-ACTH egazini. I-ACTH ivame ukwenziwa yi-pituitary ngamanani amancane bese isayina izindlala ze-adrenal ukuthi zikhiqize i-cortisol. Kwesinye isikhathi amanye amaseli angaphandle kwepituitary angenza inani elikhulu le-ACTH. Lokhu kubizwa nge-ectopic Cushing syndrome. I-Ectopic isho ukuthi kukhona okwenzekayo endaweni engajwayelekile emzimbeni.

I-Ectopic Cushing syndrome ibangelwa izicubu ezikhipha i-ACTH. Ama-tumors angathi, ezimweni ezingavamile, akhiphe i-ACTH afaka:

• Izicubu ze-Benign carcinoid zamaphaphu
• Izicubu ze-Islet cell of the pancreas
• I-medullary carcinoma yegilo
• Izicubu ezincane zamaphaphu
• Amathumba endlala ye-thymus

I-Ectopic Cushing syndrome ingadala izimpawu eziningi ezihlukile. Abanye abantu banezimpawu eziningi kanti abanye banezimbalwa kuphela. Iningi labantu abananoma yiluphi uhlobo lwe-Cushing syndrome bane:

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

Izinguquko zesikhumba ezivame ukubonwa:

• Ukutheleleka kwesikhumba
• Amamaki anombala onsomi (1/2 intshi 1 sentimitha noma ngaphezulu ububanzi) abizwa ngokuthi 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 i-2 yesifo sikashukela
• Umfutho wegazi ophezulu
• I-cholesterol ephezulu ne-triglycerides
  

Abesifazane bangaba:

• Ukukhula kwezinwele okwedlulele ebusweni, entanyeni, esifubeni, esiswini nasemathangeni
• Izikhathi eziba ngokungajwayelekile noma ukuma

Amadoda angaba:

• Ukwehla noma ukungabi nasifiso sobulili
• Ukungabi namandla

Ezinye izimpawu ezingenzeka zibandakanya:

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

Umhlinzeki wezokunakekelwa kwempilo uzokwenza ukuhlolwa komzimba abuze ngezimpawu zakho.

Ukuhlolwa okungenziwa kufaka phakathi:

• Isampula lomchamo wamahora angama-24 ukukala amazinga e-cortisol ne-creatinine
• Ukuhlolwa kwegazi ukuhlola amazinga e-ACTH, i-cortisol, ne-potassium (imvamisa iphansi kakhulu ectopic Cushing syndrome)
• Isivivinyo sokucindezela i-Dexamethasone (umthamo ophakeme nophansi)
• Isampula ye-petrosal sinus engezansi (isivivinyo esikhethekile esilinganisa i-ACTH emithanjeni esondele ebuchosheni nasesifubeni)
• Ukuzila ukudla kweglucose
• I-MRI kanye nezisombululo eziphezulu ze-CT zokuthola isimila (kwesinye isikhathi kungadingeka ukuskena kwemithi yenuzi)

Ukwelashwa okungcono kakhulu kwe-ectopic Cushing syndrome ukuhlinzwa ukuze kususwe isimila. Ukuhlinzwa kuvame ukwenzeka lapho isimila singelona umdlavuza (benign).

Kwezinye izimo, isimila sinomdlavuza futhi sisakazekela kwezinye izindawo zomzimba ngaphambi kokuba udokotela athole inkinga ngokukhiqizwa kwe-cortisol. Ukuhlinzwa kungenzeka kungenzeki kulezi zimo. Kepha udokotela anganikeza imithi yokuvimba ukukhiqizwa kwe-cortisol.

Kwesinye isikhathi ukususwa kwezindlala zombili ze-adrenal kuyadingeka uma isimila singatholakali futhi nemithi ingavimbeli ngokuphelele ukukhiqizwa kwe-cortisol.

Ukuhlinzwa ukukhipha isimila kungaholela ekululameni ngokugcwele. Kepha kunethuba lokuthi isimila sizobuya.

Isimila singasabalala noma sibuye emuva kokuhlinzwa. Izinga eliphakeme le-cortisol lingaqhubeka.

Shayela umhlinzeki wakho uma uba nezimpawu ze-Cushing syndrome.

Ukwelashwa ngokushesha kwezicubu kunganciphisa ubungozi kwezinye izimo. Amacala amaningi awavikeleki.

I-Cushing syndrome - i-ectopic; I-Ectopic ACTH syndrome

• Izindlala ze-Endocrine

UNieman LK, uBiller BM, uTholeling JW, et al. Ukwelashwa kwe-Cushing's syndrome: umhlahlandlela wokusebenza komtholampilo we-Endocrine Society. UJ Clin 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.