Uvavanyo lokucinezelwa kweDexamethasone

Imilinganiselo yovavanyo lokucinezelwa kweDexamethasone nokuba ngaba i-adrenocorticotrophic hormone (ACTH) iyimfihlo ye-pituitary inokucinezelwa.

Ngexesha lovavanyo, uya kufumana i-dexamethasone. Eli liyeza elinamandla elenziwe ngumntu (elenziweyo) le-glucocorticoid. Emva koko, igazi lakho litsaliwe ukuze inqanaba le-cortisol egazini lakho lilinganiswe.

Zimbini iintlobo ezahlukeneyo zovavanyo lokucinezelwa kwe-dexamethasone: idosi esezantsi kunye nedosi ephezulu. Uhlobo ngalunye lunokwenziwa ngobusuku obuqhelekileyo (obuqhelekileyo) okanye umgangatho (weentsuku ezi-3) (onqabileyo). Kukho iinkqubo ezahlukeneyo ezinokusetyenziselwa uvavanyo. Imizekelo yoku ichazwe ngezantsi.

Ngokuqhelekileyo:

• Idosi ephantsi ngobusuku bonke-Uya kufumana i-milligram (mg) ye-dexamethasone ngo-11 emva kwemini, kwaye umboneleli wezempilo uza kutsala igazi ngentsasa elandelayo ngo-8 kusasa ngomlinganiso we-cortisol.
• Idosi ephezulu ebusuku - Umboneleli uya kulinganisa i-cortisol yakho ngentsasa yovavanyo. Emva koko uya kufumana i-8 mg ye-dexamethasone ngo-11 ebusuku. Igazi lakho litsalwa ngentsasa elandelayo ngentsimbi yesi-8 ngomlinganiso wecortisol.

Rare:

• Umgangatho ophantsi wedosi-Umchamo uqokelelwa ngaphezulu kweentsuku ezi-3 (zigcinwe kwizikhongozelo zeeyure ezingama-24) ukulinganisa i-cortisol. Ngomhla wesi-2, uya kufumana idosi ephantsi (0.5 mg) ye-dexamethasone ngomlomo rhoqo kwiiyure ezingama-6 iiyure ezingama-48.
• Umgangatho ophakamileyo wedosi ephezulu - Umchamo uqokelelwa ngaphezulu kweentsuku ezi-3 (zigcinwe kwizikhongozelo zokuqokelela iiyure ezingama-24) zomlinganiso wecortisol. Ngomhla wesi-2, uya kufumana idosi ephezulu (2 mg) ye-dexamethasone ngomlomo rhoqo kwiiyure ezingama-6 iiyure ezingama-48.

Funda kwaye ulandele imiyalelo ngononophelo. Esona sizathu siqhelekileyo sesiphumo sovavanyo esingaqhelekanga kuxa imiyalelo ingalandelwa.

Umboneleli unokukuxelela ukuba uyeke ukuthatha amayeza athile anokuchaphazela uvavanyo, kubandakanya:

• Amayeza okubulala iintsholongwane
• Iziyobisi ezichasene nokuhlutha
• Amayeza aqukethe iicorticosteroids, ezinjengehydrocortisone, prednisone
• Estrogen
• Ulawulo lokuzalwa ngomlomo (izinto zokucwangcisa)
• Iipilisi zamanzi (i-diuretics)

Xa kufakwa inaliti ukutsala igazi, abanye abantu baziva iintlungu eziphakathi. Abanye baziva behlaba okanye behlaba kuphela. Emva koko, kunokubakho ukubetha okanye ukutyumza kancinci. Oku kuya kuhamba kungekudala.

Olu vavanyo lwenziwa xa umboneleli ekrokrela ukuba umzimba wakho uvelisa kakhulu i-cortisol. Kuyenziwa ukunceda ukufumanisa isifo seCushing kunye nokuchonga unobangela.

Uvavanyo lwedosi esezantsi lunokukunceda ukuba umzimba wakho uvelisa kakhulu i-ACTH. Uvavanyo lwedosi ephezulu lunokunceda ekuboneni ukuba ingxaki ikwindawo yebhinqa (isifo seCushing).

I-Dexamethasone yinto eyenziwe ngumntu (eyenziweyo) steroid ebiza kwi-receptor efanayo ne-cortisol. I-Dexamethasone inciphisa ukukhutshwa kwe-ACTH kubantu abaqhelekileyo. Ke ngoko, ukuthatha i-dexamethasone kufuneka kunciphise inqanaba le-ACTH kwaye kukhokelele kwinqanaba lokuhla kwecortisol.

Ukuba i-pituitary gland yakho ivelisa kakhulu i-ACTH, uya kuba nempendulo engaqhelekanga kuvavanyo lwedosi esezantsi. Kodwa unokuba nempendulo eqhelekileyo kuvavanyo lwedosi ephezulu.

Inqanaba leCortisol kufuneka lehle emva kokuba ufumane i-dexamethasone.

Umthamo ophantsi:

• Ngokuhlwa- i-8 i-cortisol ye-plasma isezantsi kwe-1.8 micrograms nge-deciliter nganye (mcg / dL) okanye i-nanomoles ezingama-50 kwilitha nganye (nmol / L)
• Umgangatho-Urinary yasimahla i-cortisol ngomhla we-3 isezantsi kwe-10 micrograms ngosuku (mcg / ngosuku) okanye i-280 nmol / L

Umthamo ophezulu:

• Ubusuku - ngaphezulu kwe-50% yokunciphisa i-plasma cortisol
• Umgangatho-mkhulu kune-90% yokuncitshiswa kwe-cortisol yasimahla yokuchama

Amaxabiso esiqhelo ahluka kancinci phakathi kweelebhu ezahlukeneyo. Ezinye iilebhu zisebenzisa imilinganiselo eyahlukeneyo okanye zinokuvavanya iisampulu ezahlukeneyo. Thetha nogqirha wakho malunga nentsingiselo yeziphumo zakho zovavanyo.

Impendulo engaqhelekanga kuvavanyo lwedosi esezantsi inokuthetha ukuba ukhuphe ngokungaqhelekanga i-cortisol (Cushing syndrome). Oku kunokuba ngenxa:

• Ithumba le-Adrenal elivelisa icortisol
• Ithumba lesisu elivelisa i-ACTH
• Ithumba emzimbeni ovelisa i-ACTH (ectopic Cushing syndrome)

Uvavanyo lwedosi ephezulu lunokunceda ukuxelela unobangela wepituitary (Isifo seCushing) kwezinye izizathu. Uvavanyo lwegazi lwe-ACTH lunokunceda ekuchongeni unobangela wecortisol ephezulu.

Iziphumo ezingaqhelekanga ziyahluka ngokuxhomekeke kwimeko ebangela ingxaki.

I-Cushing syndrome ebangelwa yithumba le-adrenal:

• Uvavanyo lwedosi ephantsi- akukho kuncipha kwegortisol yegazi
• Inqanaba le-ACTH-liphantsi
• Kwiimeko ezininzi, uvavanyo lwedosi ephezulu aludingeki

I-Ectopic Cushing syndrome:

• Uvavanyo lwedosi ephantsi- akukho kuncipha kwegortisol yegazi
• Inqanaba le-ACTH-liphezulu
• Uvavanyo lweedosi eziphezulu- akukho kuncipha kwigortisol yegazi

I-Cushing syndrome ebangelwa yithumba lesifo (isifo seCushing)

• Uvavanyo lwedosi ephantsi- akukho kuncipha kwegortisol yegazi
• Uvavanyo lwedosi ephezulu- kulindelwe ukwehla kwegazi le-cortisol

Iziphumo zovavanyo lobuxoki zinokwenzeka ngenxa yezizathu ezininzi, kubandakanya amayeza ahlukeneyo, ukutyeba kakhulu, uxinzelelo noxinzelelo. Iziphumo zobuxoki zixhaphake kakhulu kwabasetyhini kunamadoda.

Akukho mngcipheko ubandakanyekileyo ekuthatheni igazi lakho. Imithambo kunye nemithambo iyahluka ngokobukhulu ukusuka kwisigulana ukuya kwesinye, nakwelinye icala lomzimba liye kwelinye.Ukuthatha igazi kwabanye abantu kunokuba nzima ngakumbi kunabanye.

Eminye imingcipheko enxulumene nokutsalwa kwegazi incinci, kodwa inokubandakanya:

• Ukopha kakhulu
• Ukufa isiqaqa okanye ukuziva ungenantloko
• Ukugqobhoza okuninzi ukufumana imithambo
• I-Hematoma (igazi eliqokelela phantsi kwesikhumba)
• Usulelo (umngcipheko omncinci nangaliphi na ixesha ulusu lwaphukile)

DST; Uvavanyo lokucinezelwa kwe-ACTH; Uvavanyo lokucinezelwa kweCortisol

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UGuber HA, uFarag AF. Uvavanyo lomsebenzi we-endocrine. Ku: McPherson RA, Pincus MR, ii-eds. Ukuchongwa kweKlinikhi kaHenry kunye noLawulo ngeendlela zeLebhu. Umhla we-23. ISt Louis, MO: Elsevier; Ngo-2017: isahluko 24.

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.