I-Hyperplasia ye-adrenal gland - yintoni na? Iimpawu kunye nokunyangwa kwesifo

Oogqirha-i-endocrinologists ekusebenzeni kwabo bavame ukujamelana neengxaki kwimisebenzi yeentso. I-Hyperplasia ye-adrenal gland - yintoni na? Iinjongo ziyilungu elibiniweyo, ngasentla zingama-adrenals, anesigxina. Apha, ama-hormone ayimfuneko kumzimba womntu (i-adrenaline, i-norepinephrine, i-glucocorticoids, kunye ne-hormone yesini). I-Hyperplasia iphazamisa ukuveliswa kakuhle kwama-hormone, kwaye oku kuhamba kunye neempawu ezahlukahlukeneyo.

I-Hyperplasia ye-adrenal gland - yintoni na?

Nge-adrenal hyperplasia, izicubu zeselula zendoda yesigxina zikhula ngokunyuka, ilungu likhula ngokukhulu, nangona ligcina ifomu yalo. I-adrenal gland iqukethe i-brain substance kunye ne-cortex.

Ngokuqhelekileyo, i-hyperplasia ichaphazela i-correnx ye-adrenal, kwaye inkqubo yentsholongwane ikhula apho. Iimvumi ezininzi zivame ukuxilongwa kwi-brain substance.

Esi sifo senziwa nanini na ubudala kubafazi, amadoda kunye nabantwana.

I-congenital adrenal hyperplasia ivela rhoqo kwiiyeza. Ngokuqhelekileyo ithwala uhlobo lokuzalwa, kodwa lungavela kumanani amaninzi angaphakathi okanye angaphandle. Njenge-pathology edibeneyo, ibonakala kwizigulane ezine-Cushing's syndrome (kwiimeko ezingama-40%). Le syndrome isoloko ifunyaniswa kwixesha elidala kunye nelidala.

Le ngozi enkulu kakhulu ayikwazi ukunyanzelwa. Kuphuhliso lwe-hormonela ye-hormone efunekayo iphukile. Kubasetyhini, ngokuqhelekileyo kubangela ukungabikho komntwana. Kukho iintlobo ezininzi zesifo: i-nodular adrenal hyperplasia, nodular, i-diffuse, i-congenital kunye ne-micronodular, kunye ne-hyperplasia ye-pedicle ephakathi. Ngokuqhelekileyo esi sifo senzeke kwabasetyhini.

Izizathu zesifo

Iimbangela zeempawu eziphuhlisayo ze-hyperplasia ye-correl ye-adrenal kubantwana, amadoda okanye abafazi bayahluka. Konke kuya kuxhomekeka kwimeko yesifo. I-Hyperplasia ibhekisela kwenye yezilwanyana, ingaba yi-hypertonic, i-salting, i-viril.

Udidi oluxinzelelekileyo, uphuhliso olusebenzayo lwe-androgens kunye ne-mineralocorticoids lwenzeka, le nkqubo inefuthe elibi kwiinqanawa zezintso kunye ne-fundus, ihlala iholele kwisifo se-hypertensive syndrome.

Uhlobo lokulahlekelwa ngetyuwa lwe-hyperplasia, ukuveliswa kwe-androgens kwanda, ngelixa kukho ukungabikho kweminye i-hormone eveliswa yi-correx ye-adrenal. Kukho i-hyperkalemia okanye i-hypoglycemia. Ingozi kukuba umzimba uphelelwe amandla, isisindo silahlekile.

Ngomthamo wentsholongwane ye hyperplasia, imfihlelo ye-androgen yinto engasebenzi. Izabelo zangaphandle zanda kakhulu ngobukhulu, i-acne ibonakala ininzi, ukunyuka kwenyameko kwanda, i-musculature iqhutywe kakhulu.

Okokuqala, i-pathology iqala ukuqhubela phambili ngenxa yokunyuswa kwe-hormone ye-steroid. Ifomu efunyenweyo yesifo sele inezona zizathu ezibalulekileyo ezivela kuyo:

• Ingxaki yokuxilonga;
• Uxinzelelo olunzulu;
• Isifo sikaCushing;

I-hyperplasia yama-congenital of the adrenal glands ngenxa yokuba nangona ngexesha lokukhulelwa, ngexesha lokugaya, ukuguqulwa komsebenzi kuphuhlisiwe. Esinye isicatshulwa kukudluliselwa kwesi sifo kwi-genetic level. Izinto ezibangela ukubonakaliswa kwezibonakaliso zesifo: ukungasebenzi kakubi kwi-hypothalamus kunye ne-pituitary gland, ukungabikho kwemvelo kwi-genetic level, ukuzimela kokuzalwa komntwana kwintlambo yeengqungquthela ezibiniweyo, ezizuzwa kwiihlo.

Hyperplasia yeNodular

Oogqirha banokwabelana ngokuqhubela phambili kwe-hyperplasia ye-correx ye-adrenal kumaqela amaninzi kwimifanekiso yekliniki, kunye nohlobo lwekhosi.

I-nodal hyperplasia yezigulane ze-adrenal. Le fomu ifa. Ngokuqhelekileyo ixilongwa ngokugqithiseleyo ekudala, ngelixesha liye linyusa. Xa kuqhutyelwa ukuxilongwa, uphawu oluphawulekayo lubonakalisiwe - kwi-correx ye-adrenal, i-nodules. Zingabininzi (isakhiwo esicatshuweyo) kunye nesinye, ukuya kutsho kwi-4-5 cm ngobukhulu. I-Cushing's syndrome iqala. I-Pathology ngenxa yefuthe elinamandla lamahomoni e-adrenocorticotropic, ahlanganiswe kwi-gullet. Impawu eziphambili ze-nodular hyperplasia kunye ne-Cushing's syndrome ziquka:

• Intloko;
• "Izimpukane" phambi kwamehlo;
• Ukuxhalaba;
• Utywala;
• Jikelele;
• Ukwandisa ubunzima bomzimba (ikakhulu isisu, intamo, ubuso);
• Ukwandisa ukutya;
• Gweba amanqaku esikhumbeni;
• Acne;
• Izinwele ezingaphezulu (kubasetyhini);
• Ukuhlaziywa kakubi;
• Ukuchithwa kwamanzi;
• Uxinzelelo lwegazi;
• Ukuqhekeka rhoqo;
• Ukuxinezeleka.

Ukusasaza i-hyperplasia

Ngalolu hlobo lwe-hyperplasia, iingqungquthela azitshintshi ukuma kwazo, ukwanda kuqhubeka kancane. Kodwa ngelo xesha bafaka iigununu. Ukuchonga olu hlobo lwesifo lunzima. Ngeendlela eziqhelekileyo zokuxilongwa kwi-ultrasound, akukho mphumo. Utshintsho kwiqumrhu lufunyanwa kuphela kwi-MRI okanye kwi-CT. Zivame ukuhlakulela iifom ezixubeneyo ezenzeka ngeempawu ezilandelayo: i-hyperplasia ye-correnx ye-adrenal kubasetyhini idla ngokukhokelela ekunyuseni ukunyuka, ukuhlaselwa kwexhala, uxinzelelo lwegazi, ukukhuluphala. Kwamanye, indawo ye-glomerular ichaphazeleka kwaye i-hyperplasia yamazwe ngamazwe iyaqala.

Ukukhubazeka kwe-idiopathic hyperaldosteronism kusekelwe ekwandiseni ukukhutshwa kwe-aldosterone. Xa i-hyperplasia ye-glomerular zone, ezi zibonakaliso zilandelayo zibonakaliswe ngokwazo: ingozi yomshumbuliso, ukuxhalaba, ukunyanzelwa kwemisipha, ukunciphisa ukunyakaza, ukuqina kuze kube yilapho ukukhubazeka, ukoma, ukunyuka kwe-diuresis, ukuhamba ngokuhlwa. Iziphene zibangelwa ukwanda kwegazi le potassium, i-acidosis. Ukunyuswa kwengcinezelo yegazi kugcinwa ngokuqhubekayo.

Iifom zeNodular kunye nezomntwana

Ifomula iqhubela phambili kubantwana nakwishumi elivisayo. Iyakwenzeka ngenxa yokuphulwa kweengqungquthela ze-adrenal okanye ngenxa yokudluleka kwe-glucocorticoids. Iimpawu eziphambili zefomilyular: iifom yefowuni engalinganiyo, i-atrophy ye-muscle, i-skin pigmentation, iimpawu zesifo sikashukela, umonakalo kwinkqubo yenzwa kunye ne-cardiovascular, i-osteoporosis. Ukuba abantwana banezibonakaliso zesifo ngelixesha, unyango lwama-hormone lwenziwa, ngoko uhlaselo luyabonakala. I-hyperplasia ye-adrenal gland ekhohlo - yintoni na? Kule meko, i-hyperplasia ayixhomekeke kwizenzo zamahomoni. Xa i-tumor ikhula ngaphezu kwe-3 cm, ukuhlinzwa kuyadingeka. I-Laparoscopy okanye indlela yeFomorov nge-lumbotomic access to peritoneum kwicala lasekhohlo isetyenziswe.

I-hyperplasia yama-congenital ye-correnx ye-adrenal (VDKN) ifunyaniswa ngokuphindaphindiweyo kunezinye iintlobo. Iintsana zifunyanwe ngethuba eli-1 ukuya kwi-12 lamawaka. Kule meko, umntwana unenkinga yokuxilonga nokubonakala. Kukho iifom ezintathu eziphambili (nonclassical, classical simple, virilic and soltering.

Eyona ndlela ixhaphakileyo yile ifomu yokulahlekelwa ngetyuwa. Kubonakala kumantombazana njengengqungquthela ye-hermaphroditism, kumakhwenkwe kwesikhumba ejikeleze i-scrotum darkens, ipenisi iyanda ngobukhulu. Kwizigulane ezibonakaliswa ngokukhula okuphantsi kunye neempawu ezifana nokulala, ukuphalaza, ukunyamezela, uxinzelelo lwegazi oluphantsi, ukunyanzeliswa kwamanzi, ukungondleki. Isifo kufuneka siphathwe ukususela kwimini yokuqala yokubonakaliswa, ngaphandle koko umphumo obulalayo unokwenzeka.

Ngefom yeklasi ayikho impawu echazwe ngentla apha, kodwa kukho ukwanda kwe-hormone yesini. Ukuba isifo asiphatywanga, ke kwixesha elizayo abasetyhini banengxaki kwi-sex and psychiatric sphere.

Ifom engekho yeklasikhi ibonakaliswe kumabhinqa a badala kunye nabaselula. Izikhalazo eziphambili zingabikho komsebenzi, ukungenanga kwexesha, i-hirsutism kunye ne-acne.

I-Hyperplasia yeengqungquthela ze-adrenal: iimpawu eziqhelekileyo

Ngokuqhelekileyo kubantwana, amadoda namabhinqa kukho uhlobo olusuliweyo lwesifo, xa kungekho zibonakaliso ze-symptomatology, kwiimeko ezinjalo kunzima ukuxilonga ukugula. Ifom yokuzalwa yenziwa kubantwana abasele beneminyaka yesibini yokuqala yobomi.

Ngokuqhelekileyo, i-hyperplasia ye-adrenal gland (oko kukuthi, sele sichazile) inempawu ezilandelayo:

• Uxinzelelo lwegazi oluzinzileyo (oluphantsi okanye oluphezulu);
• Iingxelo eziqhubekayo zesifo sikashukela;
• Ukwandiswa kwesisindo;
• Ukubonakaliswa kwe-osteoporosis;
• Ubungqina bemisipha, i-atrophy yabo elandelayo;
• Abafazi bajongwa "ubuso obunjengenyanga";
• Ukukhubazeka kwememori;
• Ukuphazamiseka kwemiba;
• Isigulane;
• Gweba amanqaku esikhumbeni;
• Ukuphazamiseka emsebenzini wegciwane lesisu;
• Ukunciphisa umzimba;
• Ubusuku bokuvuthwa kwamanzi ebusuku;
• Nxaniwe;
• Iingqondo;
• Ukungenzi lutho;
• Amenorrhea;
• Awuhambisani nokukhula okuphezulu;
• Iimpawu zokuzihlaziya ezikwimimandla yendawo;
• Hirsutism.

Kwindoda nabasetyhini, iimpawu zeklinikhi zesifo ziyahluka.

Iimigaqo zonyango

Isiseko sonyango oluqhubekayo, eqinisweni, lonyango lwe-hormone. Iingcali zenzululwazi azikaze zenze isigqibo sokuba zinokuchaphazela njani ngempumelelo i-adrenal hyperplasia. Uphulo luvame ukuhlanganiswa. Kwabantwana abaselula, iimali zimiselwe ukuba zijonge ukubonakaliswa kwempawu zesini zesibini, amantombazana aboniswa ngama-estrogens, kunye namakhwenkwe-androgens.

Isetyenziswe kunyango lwe-glucocorticoids elandelayo:

• Cortisone acetate;
• Hydrocortisone;
• Dexamethasone;
• Prednisolone.

Ngethuba lemini, isigulane sithola ama-hormone ama-2 okanye ama-3 (ngexabiso elilinganayo). Isisombululo se-glucose nesi-5%. Amantombazana, ngokungafani namakhwenkwe, kufuneka athathe amalungiselelo ayimfuneko bonke ubomi bawo.

Kwimeko yesigulane ngasinye, ugqirha kufuneka athole indlela ekhethekileyo, achaze iindlela zakhe zokwenza unyango (konke kuxhomekeke kumava kunye nolwazi). Akukho lonyango elilodwa kunyango lwesi sifo.

I-hyperplasia yama-congenital ye-correl ye-adrenal yefom ephezulu iphathwa ngamagqirha. Kukho imeko xa izitho zesini zingenakuhlukana njengowesifazane okanye umfana. Kumantombazana, iplastiki iyacetyiswa ukuba i-labia ingumntu ongacwangcanga. Sekuqaleni konyaka wokuqala wobomi unjalo umsebenzi ubonakaliswa, ngamanye amaxesha (kwimeko embi) yenziwa kamva. Kananjalo benza imisebenzi kunye nezicubu.

Ukuba umzimba awunalo ityuwa, isigulane kufuneka sikwandise umthamo we-daily by 1-3 grams. Abanyulwe kwiimeko ezinjalo kunye ne-mineralocorticoids.

Ngoxinzelelo lwe-hyperplasia, unyango lweziyobisi aluba nempembelelo eninzi. I-Adrenalectomy iyadingeka kwiimeko ezinjalo. Unyango olungasebenzi kwaye xa luhlanganiswe ne-aldosterome diffuse hyperplasia. Ubungakanani buya kuba bubi. Isihloko esikhethiweyo sonyango lonyango kunye ne-hyperplasia yamazwe angama-zone ye-glomerular (idiopathic hyperaldosteronism). Ukusebenza kweli meko kuyimilinganiselo eyingozi.

Isiseko sokonyango kwe-IGA kukulawulwa kwe-spironolactone, ngumchasi we-aldosterone. Kananjalo kusebenza ngephilisi eplerenone. Ngokuqhelekileyo i-spironolactone ithathwa ngokudibanisa nabaphikisi be-calcium. Ukuba kukho i-blood pressure ephambili kwiimpawu ze-symptomatology, i-ACE inhibitors zifakwe kunyango.

Kwimeko yokudityaniswa kwemfuneko, kuyimfuneko ukuthatha izilwanyana zesondlo ngokuqhubekayo. Ukuba uhlobo lwe-adrenal hyperplasia lubhekisela kulungelelaniso, ukulawulwa kwe-cortisol kuyimfuneko. Ingasetyenziselwa njengesilenze se-intramuscular. Umthamo ukhethwa ngudokotela oya. Kubantwana abadala, i-prednisolone ingasetyenziswa.

Ukuba akukho nonyango olufanelekileyo, i-hyperplasia ingakhokelela ekuphuhlisweni kwesifo sikaCohn okanye isifo sikaCushing. Emva kokuxilongwa ngokuchanekileyo, unyango kufuneka luqale ngokukhawuleza.

Ukuxilongwa kwesi sifo

I-Hyperplasia ye-adrenal gland - yintoni na? Isifo sifumaneka njani? I-hyperplasia engabonakaliyo kunye neyosabalalisa ibonakaliswe ngexesha lokufunda kunye neengcali zebhubhoratri. Ukuxilongwa kubandakanya: umbuzo wemibuzo yesigulane, ukuhlolwa kwempilo, uviwo lweklinikhi, ukuhlolwa kwe-X okanye i-imagination magnetic resonance, i-radionuclide scan. Ngokusekelwe kwiziphumo, ubukhulu, kunye nokubunjwa kweentlobo zombini ze-adrenal, kuhlolwa. Uvavanyo lwebhubhoratri lwe-radioimmunoassay luqhutywa. Umxholo we-cortisol kumchamo negazi uzimisele. Ukuhlola imeko ye-hormonal, i-enzyme immunoassay yenziwa. Ngamanye amaxesha kuyimfuneko yokwenza umnqweno wokuvala.

Ngokusekelwe ekuxilongweni, ugqirha ugxilwe kwaye uchaza indlela efanelekileyo kakhulu yokonyango.

Hyperplasia kubantu abadala: benzani?

Ngokuqhelekileyo uxinzelelo lwe-correnx ye-adrenal lufunyaniswa kusebuntwaneni, kodwa abantu abadala babonisa iimpawu zesifo. I-Hyperplasia yeengqungquthela ze-adrenal kubasetyhini ibonakaliswa ukwanda kweenwele ze-pubic, izwi eliphantsi, i-acne, intlungu kwindima ye-occipital, i-cramps yesantya, isifuba esingathuthukiyo, uxinzelelo lwegazi oluphezulu, i-adrenogenital syndrome.

Ukuba ufumana ufumana ezi mpawu, ungazami ukuzihlolisisa. Kule meko, abantu abanokuthi bancede. Ukukhawulela ngokukhawuleza oogqirha. Kufuneka unyango lwemodemoni. Ngokuqhelekileyo abafazi abanokuxilongwa okufanayo abacebisi ukuba baceba ukukhulelwa. Kwiimeko ezininzi, kwanqatshelwe ukuzala. Ngamanye amaxesha isisombululo esifanelekileyo kwingxaki kukupheliswa ngokupheleleyo kweentliziyo ezigulayo kunye nazo zonke izixhobo zayo.

Thintelo

Yiyiphi i-adrenal hyperplasia - oku kufuneka baqonde ezi zibini ezicwangcise ukuzalwa komntwana, kwaye kwi-genus (i-genetically) zineengxaki ze-congenital hyperplasia. Kubalulekile ukuphendukela kwii-geneticists - iingcali eziqeqeshekileyo, ezinolwazi. Ukuthintela eso sifo, kuya kufuneka ukuba wenze ukuxilongwa kwangaphambi kokubeleka (ngexesha apho umntwana esasakhulayo kwaye esesibelekweni sikamama). Kwi-trimester yokuqala yokukhulelwa, i-chorionic biopsy yenziwa. Kwisiqingatha sesibini, uhlalutyo lwe-amniotic fluid, oluya kumisela izinga lamahomoni, liyadingeka.

Inketho ekhoyo yi-IVF. Kule meko, uhlalutyo lokuqala lwezityalo zesini lunokwenziwa ngaphambi kokuba luzaliswe.

Ngethuba lokubanjwa komfazi wesifo sokuxilongwa kwe-hyperplasia kufuneka kube phantsi kweliso lugqirha rhoqo, uthabathe rhoqo iimvavanyo ezifunekayo. Kubalulekile ukuba ungabandakanyi ebomini yonke into enobungozi kunye nemiphumo yemisebe.

Ukuthintela i-hyperplasia yeengqungquthela ze-adrenal, indima ebalulekileyo idlalwa ngokuhlolwa kweemvavanyo eziqhutywe kumntwana osandula. Ukuhlalutya, kuyimfuneko ukuthabatha igazi kwi-capillary (indawo yokuqhawula isicatshulwa esithendeni).