Isifo se-Ectopic Cushing

I-Ectopic Cushing syndrome luhlobo lweCushing syndrome apho ithumba elingaphandle kwencindi yebhinqa ivelisa ihomoni ebizwa ngokuba yihomoni yeadrenocorticotropic (ACTH).

I-Cushing syndrome sisifo esenzeka xa umzimba wakho ukwinqanaba eliphezulu kune-cortisol yehomoni. Le hormone yenziwa kwiincindi ze-adrenal. I-cortisol eninzi inokubangelwa ziingxaki ezahlukeneyo. Esinye sezizathu kukuba kukho ihomoni ye-ACTH egazini. I-ACTH ihlala yenziwa yipituitary ngesixa esincinci kwaye emva koko isayine amadlala eadrenal ukuvelisa icortisol. Ngamanye amaxesha ezinye iiseli ezingaphandle kwepituitary zinokwenza isixa esikhulu se-ACTH. Oku kubizwa ngokuba yi-ectopic Cushing syndrome. I-Ectopic ithetha ukuba kukho into eyenzeka kwindawo engaqhelekanga emzimbeni.

I-Ectopic Cushing syndrome ibangelwa ngamathumba akhupha i-ACTH. Izidumba ezinokuthi, kwiimeko ezinqabileyo, zikhuphe i-ACTH zibandakanya:

• Izibilini ze-carcinoid zemiphunga
• Islet cell tumors zepancreas
• I-medullary carcinoma ye-thyroid
• Amathumba amancinci emiphunga
• Amathumba e-thymus gland

I-Ectopic Cushing syndrome inokubangela iimpawu ezininzi ezahlukeneyo. Abanye abantu baneempawu ezininzi ngelixa abanye benembalwa. Uninzi lwabantu abanalo naluphi na uhlobo lwe-Cushing syndrome bane:

• Ujikeleze, ubomvu, kunye nobuso obugcweleyo (ubuso benyanga)
• Izinga lokukhula kancinci kubantwana
• Ukutyeba ngokonyuka kwamafutha esiqwini, kodwa ukulahleka kwamafutha ezingalweni, emilenzeni nasezimpundu (ukutyeba kakhulu)

Utshintsho lolusu oluhlala lubonwa:

• Usulelo lolusu
• Amanqaku athambileyo (1/2 intshi 1 cm okanye ngaphezulu ububanzi) ebizwa ngokuba yi-striae kwesikhumba sesisu, amathanga, iingalo eziphezulu kunye namabele
• Ulusu olucekeceke ngokugruzuka ngokulula

Utshintsho lwemisipha kunye nethambo lubandakanya:

• Umqolo obuhlungu, owenzeka ngemisebenzi yesiqhelo
• Intlungu yethambo okanye ukuthamba
• Ukuqokelelwa kwamafutha phakathi kwamagxa nangaphezulu kwethambo lekhola
• Iimbambo kunye nokuqhekeka komqolo okubangelwa kukuncipha kwamathambo
• Izihlunu ezibuthathaka, ngakumbi ezinqeni nasemagxeni

Iingxaki zomzimba ngokubanzi (zenkqubo) zinokubandakanya:

• Uhlobo lwe-2 yeswekile
• Igazi elonyukayo
• I-cholesterol ephezulu kunye ne-triglycerides
  

Abasetyhini banokuba:

• Ukukhula okungaphezulu kweenwele ebusweni, entanyeni, esifubeni, esiswini nasemathangeni
• Amaxesha angabikho mgaqweni okanye ayeke

Amadoda anokuba:

• Ukuhla okanye ukungabikho komnqweno wesini
• Ukungabi namandla

Ezinye iimpawu ezinokuthi zenzeke zibandakanya:

• Utshintsho lwengqondo, olufana nokudakumba, unxunguphalo, okanye utshintsho kwindlela yokuziphatha
• Ukudinwa
• Intloko ebuhlungu
• Ukwanda ukoma kunye nokuchama

Umboneleli wezempilo uya kwenza uvavanyo lomzimba kwaye abuze malunga neempawu zakho.

Uvavanyo olunokwenziwa lunokubandakanya:

• Isampuli yomchamo weeyure ezingama-24 ukulinganisa amanqanaba e-cortisol kunye ne-creatinine
• Uvavanyo lwegazi ukujonga i-ACTH, i-cortisol, kunye nenqanaba le-potassium (ihlala iphantsi kakhulu kwi-ectopic Cushing syndrome)
• Uvavanyo lokucinezelwa kweDexamethasone (zombini idosi ephezulu kunye nesezantsi)
• Isampulu yesono esingezantsi seprososal (uvavanyo olukhethekileyo olulinganisa i-ACTH kwimithambo ekufutshane nengqondo nasesifubeni)
• Ukuzila ukutya kweglucose
• I-MRI kunye nesisombululo esiphakamileyo se-CT sokufumana ithumba (ngamanye amaxesha amayeza enyukliya anokufuneka)

Olona nyango lulungileyo kwi-ectopic Cushing syndrome lutyando lokususa ithumba. Uqhaqho luqhele ukwenzeka xa ithumba lingenamhlaza (benign).

Ngamanye amaxesha, ithumba linomhlaza kwaye lisasazeka kwezinye iindawo zomzimba ngaphambi kokuba ugqirha afumane ingxaki kwimveliso yecortisol. Utyando alunakwenzeka kwezi meko. Kodwa ugqirha unokuyalela amayeza ukuthintela imveliso yecortisol.

Ngamanye amaxesha ukususwa kwamadlala amabini adrenal kuyadingeka ukuba alifumaneki ithumba kwaye amayeza akayithinteli ngokupheleleyo imveliso ye-cortisol.

Ugqirha lokususa ithumba kunokukhokelela ekuvuseleleni ngokupheleleyo. Kodwa kukho ithuba lokuba eli thumba liza kubuya.

I-tumor ingasasazeka okanye ibuye emva kokuhlinzwa. Inqanaba eliphezulu le-cortisol lingaqhubeka.

Tsalela umnxeba umboneleli wakho ukuba uphuhlisa iimpawu zeCushing syndrome.

Ukunyangwa ngokukhawuleza kwamathumba kunokunciphisa umngcipheko kwezinye iimeko. Amatyala amaninzi akanakuthintelwa.

Isifo se-Cushing - i-ectopic; Isifo se-Ectopic ACTH

• Amadlala endocrine

UNieman LK, uBiller BM, uKufumana uJW, et al. Unyango lwe-Cushing's syndrome: Isikhokelo sonyango se-Endocrine Society. J Ikliniki ye-Endocrinol Metab. Ngo-2015; 100 (8): 2807-2831. I-PMID 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

Stewart PM, Newell-Price JDC. I-adrenal cortex. Ku: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, ii-eds. Incwadi ebhaliweyo kaWilliam ye-Endocrinology. Umhla we-13. IPhiladelphia, PA: Elsevier; 2016: isahluko 15.