I-Cushing syndrome

I-Cushing syndrome yisifo esenzeka lapho umzimba wakho unezinga eliphakeme le-hormone cortisol.

Isizathu esivame kakhulu seCushing syndrome sithatha umuthi omningi we-glucocorticoid noma we-corticosteroid. Leli fomu le-Cushing syndrome libizwa nge-exogenous Cushing syndrome. I-Prednisone, i-dexamethasone, ne-prednisolone yizibonelo zalolu hlobo lomuthi. I-Glucocorticoids ilingisa isenzo se-hormone yemvelo yomzimba i-cortisol. Le mithi isetshenziselwa ukwelapha izimo eziningi ezifana nesifuba somoya, ukuvuvukala kwesikhumba, umdlavuza, isifo samathumbu, ubuhlungu bamalunga, nesifo samathambo.

Abanye abantu baba ne-Cushing syndrome ngoba umzimba wabo ukhiqiza i-cortisol eningi kakhulu. Le hormone yenziwa kwizindlala ze-adrenal. Izimbangela ze-cortisol eningi kakhulu yilezi:

• Isifo se-Cushing, esenzeka lapho indlala yesibeletho yenza kakhulu i-hormone adrenocorticotrophic hormone (ACTH). I-ACTH bese isayina izindlala ze-adrenal ukuthi zikhiqize i-cortisol eningi kakhulu. I-pituitary gland tumor ingadala lesi simo.
• Isigaxa sendlala ye-adrenal
• Isimila kwenye indawo emzimbeni esikhiqiza i-corticotropin-ikhulula i-hormone (CRH)
• Izicubu kwenye indawo emzimbeni ezikhiqiza i-ACTH (ectopic Cushing syndrome)

Izimpawu ziyahlukahluka. Akuwona wonke umuntu one-Cushing syndrome onezimpawu ezifanayo. Abanye abantu banezimpawu eziningi kanti abanye abanazo izimpawu.

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 zingafaka:

• Ukutheleleka kwesikhumba
• Amamaki anombala onsomi (1/2 intshi noma isentimitha elilodwa noma ngaphezulu ububanzi) abizwa ngokuthi i-striae esikhunjeni sesisu, izingalo ezingaphezulu, amathanga namabele
• Isikhumba esinciphile esinokulimaza okulula (ikakhulukazi ezingalweni nasezandleni)

Izinguquko zemisipha namathambo zifaka:

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

Izinguquko zomzimba wonke (systemic) zifaka:

• Thayipha i-2 yesifo sikashukela
• Umfutho wegazi ophezulu (umfutho wegazi ophakeme)
• Ukwandisa i-cholesterol ne-triglycerides (i-hyperlipidemia)

Abesifazane abane-Cushing syndrome bangaba:

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

Amadoda angaba:

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

Ezinye izimpawu ezingase zivele ngalesi sifo:

• 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.

Ukuhlolwa kwelabhorathri okungenziwa ukuthola i-Cushing syndrome nokuthola imbangela yile:

• Izinga le-cortisol yegazi
• Ushukela wegazi
• Izinga le-cortisol yamathe
• Isivivinyo sokucindezela i-Dexamethasone
• Umchamo wamahora angama-24 we-cortisol ne-creatinine
• Izinga le-ACTH
• Ukuhlolwa kokukhuthaza kwe-ACTH (ezimweni ezingavamile)

Ukuhlolwa kokuthola imbangela noma izinkinga kungafaka:

• I-CT yesisu
• I-Pituitary MRI
• Ubuningi bamathambo

Ukwelashwa kuya ngesizathu.

I-Cushing syndrome ebangelwa ukusetshenziswa kwe-corticosteroid:

• Umhlinzeki wakho uzokuyala ukuthi wehlise kancane umthamo wemithi. Ukuyeka umuthi kungazelelwe kungaba yingozi.
• Uma ungeke uyeke ukuthatha umuthi ngenxa yesifo, ushukela wegazi lakho ophakeme, amazinga aphezulu e-cholesterol, nokuncipha kwamathambo noma i-osteoporosis kufanele kuhlolwe futhi kwelashwe kakhulu.

Nge-Cushing syndrome ebangelwa i-pituitary noma isimila esikhipha i-ACTH (Cushing disease), ungahle udinge:

• Ukuhlinzwa ukukhipha isimila
• Imisebe ngemuva kokususwa kwesimila se-pituitary (kwezinye izimo)
• Ukwelashwa kokushintshwa kweCortisol ngemuva kokuhlinzwa
• Imithi ezothatha isikhundla sama-hormone e-pituitary ayantula
• Imithi yokuvikela umzimba ekwenzeni i-cortisol eningi kakhulu

Nge-Cushing syndrome ngenxa yesimila se-pituitary, isimila se-adrenal, noma ezinye izicubu:

• Ungadinga ukuhlinzwa ukuze ususe isimila.
• Uma isimila singeke sisuswe, ungadinga imithi yokusiza ukuvimba ukukhishwa kwe-cortisol.

Ukususa isimila kungaholela ekululameni ngokugcwele, kodwa kunethuba lokuthi isimo sizobuya.

Ukusinda kwabantu abane-Cushing syndrome okubangelwa izicubu kuncike ohlotsheni lwesimila.

Ukungalashwa, i-Cushing syndrome ingasongela impilo.

Izinkinga zempilo ezingabangelwa yi-Cushing syndrome zifaka phakathi noma yikuphi okulandelayo:

• Isifo sikashukela
• Ukwandiswa kwesisu se-pituitary
• Amathambo aqhekekile ngenxa ye-osteoporosis
• Umfutho wegazi ophezulu
• Amatshe ezinso
• Izifo ezinzima

Shayela umhlinzeki wakho uma unezimpawu 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.

Hypercortisolism; I-Cortisol ngokweqile; I-Glucocorticoid ngokweqile - I-Cushing syndrome

• Izindlala ze-Endocrine

UNieman LK, uBiller BM, uTholeling JW, et al; I-Endocrine Society. 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 Saunders; 2016: isahluko 15.