Isivivinyo sokucindezela i-Dexamethasone

Ukuhlolwa kokucindezelwa kweDexamethasone kukala ukuthi ngabe uketshezi lwe-adrenocorticotrophic hormone (ACTH) olwenziwa yi-pituitary lungacindezelwa.

Phakathi nalolu vivinyo, uzothola i-dexamethasone. Lo ngumuthi oqinile owenziwe ngabantu (owenziwe) we-glucocorticoid. Ngemuva kwalokho, kudonswa igazi lakho ukuze kukalwe izinga le-cortisol egazini lakho.

Kunezinhlobo ezimbili ezahlukahlukene zokuhlolwa kokucindezela i-dexamethasone: umthamo ophansi nomthamo ophezulu. Uhlobo ngalunye lungenziwa ngendlela yasebusuku (ejwayelekile) noma ejwayelekile (yezinsuku ezi-3) (engajwayelekile). Kunezinqubo ezahlukahlukene ezingasetshenziselwa noma yikuphi ukuhlolwa. Izibonelo zalokhu zichazwe ngezansi.

Okuvamile:

• Umthamo ophansi ngobusuku obubodwa - Uzothola i-milligram (mg) eyi-dexamethasone ngo-11 ebusuku, futhi umhlinzeki wezokunakekelwa kwezempilo uzodonsa igazi lakho ekuseni ngakusasa ngo-8 ekuseni ukuze kukalwe i-cortisol.
• Umthamo ophezulu ngobusuku obubodwa - Umhlinzeki uzolinganisa i-cortisol yakho ekuseni kokuhlolwa. Ngemuva kwalokho uzothola u-8 mg we-dexamethasone ngo-11 ebusuku. Igazi lakho likhishwa ngakusasa ekuseni ngo-8 ekuseni ukuze kukalwe i-cortisol.

Akuvamile:

• Umthamo ophansi ojwayelekile - Umchamo uqoqwa ngaphezu kwezinsuku ezi-3 (ugcinwe ezitsheni ezingamaqoqo ezingama-24) ukukala i-cortisol. Ngosuku 2, uzothola umthamo ophansi (0.5 mg) we-dexamethasone ngomlomo njalo ngamahora ayisithupha amahora angama-48.
• Umthamo ophezulu ojwayelekile - Umchamo uqoqwa ngaphezu kwezinsuku ezi-3 (ugcinwe ezitsheni ezingamaqoqo ezingama-24) ukukalwa kwe-cortisol. Ngosuku 2, uzothola umthamo ophakeme (2 mg) we-dexamethasone ngomlomo njalo ngamahora ayisithupha ngamahora angama-48.

Funda bese ulandela imiyalo ngokucophelela. Isizathu esivame kakhulu semiphumela yokuhlolwa engajwayelekile kulapho imiyalelo ingalandelwa.

Umhlinzeki angakutshela ukuthi uyeke ukuthatha imithi ethile engathinta ukuhlolwa, kufaka phakathi:

• Imithi elwa namagciwane
• Izidakamizwa ezilwa nokuquleka
• Imithi equkethe i-corticosteroids, efana ne-hydrocortisone, i-prednisone
• I-Estrogen
• Ukulawulwa kokuzalwa komlomo (izindlela zokuvimbela inzalo)
• Amaphilisi wamanzi (isisu)

Lapho inaliti ifakwa ukudonsa igazi, abanye abantu bezwa ubuhlungu obulinganiselayo. Abanye bazizwa beshaywa noma betinyelwa kuphela. Ngemuva kwalokho, kungahle kube nokushaywa okuthile noma ukulinyazeka okuncane. Lokhu maduzane kuyaphela.

Lokhu kuhlolwa kwenziwa lapho umhlinzeki esola ukuthi umzimba wakho ukhiqiza i-cortisol eningi kakhulu. Kwenziwa ukusiza ukuxilonga i-Cushing syndrome nokuthola imbangela.

Ukuhlolwa komthamo ophansi kungasiza ekuboneni ukuthi ngabe umzimba wakho ukhiqiza i-ACTH eningi kakhulu. Ukuhlolwa komthamo ophezulu kungasiza ekunqumeni ukuthi ngabe inkinga isendlala yegciwane lengculazi (Isifo seCushing).

I-Dexamethasone iyi-steroid eyenziwe umuntu (yokwenziwa) ebiza i-receptor efanayo ne-cortisol. I-Dexamethasone inciphisa ukukhishwa kwe-ACTH kubantu abajwayelekile. Ngakho-ke, ukuthatha i-dexamethasone kufanele kwehlise izinga le-ACTH futhi kuholele ekwehleni kwe-cortisol level.

Uma i-pituitary gland yakho ikhiqiza i-ACTH eningi kakhulu, uzoba nempendulo engajwayelekile ekuhlolweni komthamo ophansi. Kepha ungaba nempendulo ejwayelekile esivivinyweni sedosi ephezulu.

Izinga leCortisol kufanele lehle ngemuva kokuthola i-dexamethasone.

Umthamo ophansi:

• Ebusuku - ngo-8 ekuseni i-plasma cortisol ingaphansi kuka-1.8 micrograms nge-deciliter (mcg / dL) noma ngama-nanomoles angama-50 ngelitha ngalinye (nmol / L)
• Okujwayelekile - i-cortisol yamahhala e-Urinary ngosuku 3 ephansi kunama-micrograms ayi-10 ngosuku (mcg / ngosuku) noma i-280 nmol / L

Umthamo ophezulu:

• Ngobusuku - kuncishiswe ngaphezu kuka-50% kwi-plasma cortisol
• Okujwayelekile - kukwehliswa okungaphezu kwama-90% ku-cortisol yamahhala yama-urinary

Ububanzi bamanani ajwayelekile bungahluka kancane phakathi kwamalabhorethri ahlukene. Amanye amalebhu asebenzisa izilinganiso ezahlukahlukene noma angahlola izinhlobo ezihlukile. Khuluma nodokotela wakho mayelana nencazelo yemiphumela yakho ethile yokuhlolwa.

Impendulo engajwayelekile esivivinyweni sedosi ephansi ingasho ukuthi unokukhishwa okungajwayelekile kwe-cortisol (Cushing syndrome). Lokhu kungabangelwa:

• Isimila se-adrenal esikhiqiza i-cortisol
• Isimila sesibeletho esikhiqiza i-ACTH
• Isimila emzimbeni esikhiqiza i-ACTH (ectopic Cushing syndrome)

Ukuhlolwa komthamo omkhulu kungasiza ekutsheleni imbangela yesifo (Isifo seCushing) kwezinye izimbangela. Ukuhlolwa kwegazi le-ACTH kungasiza futhi ekuboneni imbangela ye-cortisol ephezulu.

Imiphumela engajwayelekile iyahluka ngokuya ngesimo esidala inkinga.

I-Cushing syndrome ebangelwa isimila se-adrenal:

• Ukuhlolwa komthamo ophansi - akukho ukwehla kwegazi i-cortisol
• Izinga le-ACTH - liphansi
• Ezimweni eziningi, ukuhlolwa kwedosi ephezulu akudingeki

I-Ectopic Cushing syndrome:

• Ukuhlolwa komthamo ophansi - akukho ukwehla kwegazi i-cortisol
• Izinga le-ACTH - liphezulu
• Ukuhlolwa komthamo ophezulu - akukho ukwehla kwegazi i-cortisol

I-Cushing syndrome ebangelwa isimila se-pituitary (Cushing disease)

• Ukuhlolwa komthamo ophansi - akukho ukwehla kwegazi i-cortisol
• Ukuhlolwa komthamo ophakeme - ukwehla okulindelekile ku-cortisol yegazi

Imiphumela yokuhlola yamanga ingenzeka ngenxa yezizathu eziningi, kufaka phakathi imishanguzo ehlukene, ukukhuluphala, ukudangala, kanye nengcindezi. Imiphumela yamanga ivame kakhulu kwabesifazane kunabesilisa.

Kunengozi encane ethintekayo ekuthatheni igazi lakho. Imithambo nemithambo yegazi kuyahluka ngosayizi kusuka kwesinye isiguli kuye kwesinye, futhi kusuka kolunye uhlangothi lomzimba kuye kolunye.Ukuthatha igazi kwabanye abantu kungaba nzima kakhulu ukwedlula kwabanye.

Ezinye izingozi ezihambisana nokudonswa igazi zincane, kepha zingafaka:

• Ukopha ngokweqile
• Ukuquleka noma uzizwe unekhanda elincane
• Ukubhoboza okuningi ukuthola imithambo
• I-hematoma (ukuqoqwa kwegazi ngaphansi kwesikhumba)
• Ukutheleleka (ingozi encane noma kunini lapho isikhumba siphukile)

I-DST; Ukuvivinywa kwe-ACTH; Isivivinyo sokucindezela i-Cortisol

IChernecky CC, iBerger BJ. Ukuhlolwa kokucindezela kwe-Dexamethasone - ukuxilonga. Ku: IChernecky CC, iBerger BJ, ama-eds. Ukuhlolwa Kwelabhoratri Nezinqubo Zokuxilonga. Umhlaka 6. ISt Louis, MO: Elsevier Saunders; 2013: 437-438.

UGuber HA, uFarag AF. Ukuhlolwa komsebenzi we-endocrine. Ku: McPherson RA, Pincus MR, abahleli. UHenry’s Clinical Diagnosis and Management by Laboratory Methods. Umhla ka-23. ISt Louis, MO: Elsevier; 2017: isahluko 24.

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.