Hypopituitarism

I-Hypopituitarism yimeko apho i-pituitary gland ingavelisi ixabiso eliqhelekileyo lezinye okanye zonke iihomoni zalo.

Idlala lengqula sisakhiwo esincinci esisezantsi kwengqondo. Iqhotyoshelwe ngesiqu kwi-hypothalamus. Ihypothalamus yindawo yengqondo elawula umsebenzi wedlala yebhinqa.

Iihomoni ezikhutshwe yi-pituitary gland (kunye nemisebenzi yazo) zezi:

• Adrenocorticotropic hormone (ACTH) - ivuselela i-adrenal gland ukukhulula i-cortisol; I-cortisol inceda ukugcina uxinzelelo lwegazi kunye neswekile yegazi
• Ihomoni ye-Antidiuretic (ADH) - ilawula ukulahleka kwamanzi zizintso
• I-follicle-evuselela i-hormone (FSH) -ukulawula ukusebenza ngokwesondo kunye nokuzala emadodeni nakwabasetyhini
• I-hormone yokukhula (GH)-ivuselela ukukhula kwezicubu kunye nethambo
• I-Luteinizing hormone (LH) -ukulawula ukusebenza ngokwesondo kunye nokuzala emadodeni nakwabasetyhini
• I-Oxytocin-ivuselela isibeleko ukuba singene ngexesha lomsebenzi kunye namabele ukukhupha ubisi
• Iprolactin-ivuselela ukukhula kwamabele amabhinqa kunye nemveliso yobisi
• Ihomoni ekhuthaza idlala lengqula (TSH) - ivuselela idlala lengqula ukukhupha iihomoni ezichaphazela imetabolism yomzimba

Kwi-hypopituitarism, kukho ukunqongophala kwencindi yedlala enye okanye nangaphezulu. Ukunqongophala kwehomoni kukhokelela ekuphulukaneni nomsebenzi kwidlala okanye kwilungu kulawulo lwehomoni. Umzekelo, ukungabikho kwe-TSH kukhokelela ekuphulukaneni nomsebenzi oqhelekileyo we-thyroid gland.

I-Hypopituitarism inokubangelwa:

• Utyando lobuchopho
• Ithumba lobuchopho
• Intlungu yentloko (ukwenzakala kwengqondo ebuhlungu)
• Usulelo okanye ukudumba kwengqondo kunye nezicubu ezixhasa ingqondo
• Ukufa kwendawo yethishu kwincindi yebhinqa (i-pituitary apoplexy)
• Unyango ngemitha kwingqondo
• Ukubetha
• I-Subarachnoid hemorrhage (ukusuka kwi-aneurysm eqhumayo)
• Ukudumba kwencindi yebhinqa okanye ihipothalamus

Ngamanye amaxesha, i-hypopituitarism ibangelwa ngamajoni omzimba aqhelekileyo okanye izifo ze-metabolic, ezinje:

• Intsimbi eninzi emzimbeni (hemochromatosis)
• Ukwanda okungaqhelekanga kwiiseli zomzimba ezibizwa ngokuba zii-histiocytes (histiocytosis X)
• Isimo sokuzimela komzimba esibangela ukudumba kwe-pituitary (i-lymphocytic hypophysitis)
• Ukudumba kwezicubu ezahlukeneyo kunye namalungu (sarcoidosis)
• Usulelo lwe-pituitary, olufana nesifo sephepha sokuqala sepituitary

I-Hypopituitarism ikwayingxaki enqabileyo ebangelwa kukopha kakhulu ngexesha lokukhulelwa. Ukuphulukana kwegazi kukhokelela ekufeni kwethishu kwindlala yebhinqa. Le meko ibizwa ngokuba yi-Sheehan syndrome.

Amayeza athile anokucinezelela umsebenzi wepituitary. Ezona ziyobisi zixhaphakileyo zii-glucocorticoids (ezinje nge-prednisone kunye ne-dexamethasone), ethathelwa iimeko zokudumba kunye nezokuzivikela komzimba. Iziyobisi ezisetyenziselwa ukunyanga umhlaza wedlala lesinyi zinokukhokelela ekusebenzeni okuphantsi kwepituitary.

Iimpawu ze-hypopituitarism zibandakanya nayiphi na kwezi zinto zilandelayo:

• Intlungu zesisu
• Ukunciphisa ukutya
• Ukungabikho kokuqhuba ngesondo (kumadoda okanye kwabasetyhini)
• Ukuba nesiyezi okanye ukuphelelwa ngamandla
• Ukuchama kakhulu nokunxanwa
• Ukusilela ukukhupha ubisi (kwabasetyhini)
• Ukudinwa, ubuthathaka
• Intloko ebuhlungu
• Ukungachumi (kwabasetyhini) okanye ukuyeka ukuya exesheni
• Ukuphulukana nekhwapha okanye iinwele zasesidlangalaleni
• Ukuphulukana komzimba okanye iinwele zobuso (emadodeni)
• Uxinzelelo lwegazi oluphantsi
• Iswekile esezantsi yegazi
• Uvakalelo kubanda
• Ukuphakama okufutshane (ngaphantsi kwe-5 yeenyawo okanye i-1.5 yeemitha) ukuba ukuqala kukwixesha lokukhula
• Ukukhula okucothayo kunye nophuhliso lwezesondo (ebantwaneni)
• Iingxaki zombono
• Ukuhla ukusinda

Iimpawu zinokukhula kancinci kwaye zinokwahluka kakhulu, kuxhomekeke:

• Inani leehomoni ezingekhoyo kunye namalungu abachaphazelayo
• Ubunzima besifo

Ezinye iimpawu ezinokuthi zenzeke kwesi sifo:

• Ukudumba kobuso
• Ukulahleka kweenwele
• Ukugquma okanye ukutshintsha kwelizwi
• Ukuqina ngokudibeneyo
• Ukutyeba kwakho

Ukuchonga i-hypopituitarism, kufuneka kubekhona amanqanaba asezantsi ehomoni ngenxa yengxaki yedlala lengqula. Ukuxilongwa kufuneka kukhuphe izifo zelungu ezichaphazelekayo yile hormone.

Uvavanyo lunokubandakanya:

• Ukuskena kweBrain CT
• I-MRI yePituitary
• I-ACTH
• ICortisol
• I-Estradiol (estrogen)
• I-follicle evuselela i-hormone (FSH)
• Ukukhula okufana ne-insulin 1 (IGF-1)
• Ihomoni yeLuteinizing (LH)
• Uvavanyo lwe-Osmolality yegazi kunye nomchamo
• Inqanaba le testosterone
• Ihomoni evuselela idlala lengqula (TSH)
• Idlala lengqula (T4)
• I-Biopsy yendawo yebhinqa

Inqanaba lehomoni yebhinqa inokuphakama egazini ukuba unethumba lelungu elivelisa kakhulu loo hormone. Ithumba inokuzityumza ezinye iiseli zepituitary, zikhokelele kumanqanaba asezantsi ezinye iihomoni.

Ukuba i-hypopituitarism ibangelwa yi-tumor, unokufuna ukuhlinzwa ukuze ususe i-tumor. Unyango ngemitha lunokufuneka.

Uya kudinga amayeza ehommon ubomi bakho bonke ukubuyisela iihormone ezingasenziwa ngamalungu aphantsi kolawulo lwendlala yebhinqa. Oku kunokubandakanya:

• ICorticosteroids (cortisol)
• Ukukhula kwehomoni
• Ihomoni zesondo (testosterone yamadoda kunye ne-estrogen yabasetyhini)
• Idlala lengqula
• Unyuselwa

Iziyobisi ziyafumaneka ukunyanga ukungachumi okunxulumene kwindoda kunye nabasetyhini.

Ukuba uthatha amayeza e-glucocorticoid okusilela kwesifo se-ACTH, qiniseka ukuba uyazi xa uthatha idosi yoxinzelelo kunyango lwakho. Xoxa oku nomboneleli wakho wezempilo.

Soloko uphethe i-ID yonyango (ikhadi, isongo, okanye isacholo somqala) esithi awonelanga yi-adrenal. Isazisi kufuneka kwakhona sichaze uhlobo lwamayeza kunye nedosi oyifunayo kwimeko kaxakeka ebangelwa kukungoneliseki kwe-adrenal.

I-Hypopituitarism ihlala isigxina. Ifuna unyango lobomi bonke ngeyeza elinye okanye nangaphezulu. Kodwa unokulindela ubomi obuqhelekileyo.

Kubantwana, i-hypopituitarism inokuphucula ukuba isisu sisuswe ngexesha lotyando.

Iziphumo ebezingalindelekanga zamayeza ukunyanga i-hypopituitarism zinokuphuhla. Nangona kunjalo, musa ukuyeka naliphi na iyeza ngaphandle kokuthetha nomboneleli wakho kuqala.

Tsalela umnxeba umboneleli wakho ukuba uphuhlisa iimpawu ze-hypopituitarism.

Kwiimeko ezininzi, ukuphazamiseka akunakukhuselwa. Ukuqaqanjiswa komngcipheko, njengokuthatha amayeza athile, kunokuvumela ukuxilongwa kwangoko kunye nonyango.

Ukungoneli kwesifo; Panhypopituitarism

• Amadlala endocrine
• Indawo yolwimi lamathe
• IiGonadotropins
• I-Pituitary kunye ne-TSH

I-Burt MG, iHo KKY. I-Hypopituitarism kunye nokusilela kwehommone yokukhula. Ku: Jameson JL, De Groot LJ, de Kretser DM, et al, ii-eds. Endocrinology: Abantu abadala kunye nabantwana. Umhla wesi-7. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 11.

IClemmons DR, uNieman LK. Indlela yesigulana ngesifo se-endocrine. Ku: IGoldman L, iSchafer AI, ii-eds. Amayeza eGoldman-Cecil. Umhla wama-25. IPhiladelphia, PA: Elsevier Saunders; I-2016: isahluko 221.

UFleseriu M, uHashim IA, uKaravitaki N, et al. Ukutshintshwa kweHormonal kwi-hypopituitarism kubantu abadala: Isikhokelo se-Endocrine Society sonyango. J Ikliniki ye-Endocrinol Metab. Ngo-2016; 101 (11): 3888-3921. IINKCUKACHA: 27736313 www.ncbi.nlm.nih.gov/pubmed/27736313.