Kev Ntshav Siab

Hypopituitarism yog ib qho mob uas cov qog pituitary tsis ua kom ntau npaum ntawm qee yam lossis tag nrho nws cov keeb kwm.

Lub caj pas pituitary yog ib lub qauv me me uas nyob hauv qab ntawm lub hlwb. Nws tau txuas los ntawm tus soj caum rau hypothalamus. Qhov hypothalamus yog thaj chaw ntawm lub hlwb uas tswj hwm lub caj pas pituitary.

Cov tshuaj hormones tawm los ntawm lub caj pas pituitary (thiab lawv lub zog) yog:

• Adrenocorticotropic hormone (ACTH) - txhawb kev ua haujlwm ntawm lub qog adrenal los tso cortisol; cortisol pab tswj cov ntshav siab thiab cov ntshav qab zib
• Antidiuretic hormone (ADH) - tswj cov dej poob los ntawm lub raum
• Cov tshuaj hormone follicle-stimulating (FSH) - tswj kev ua haujlwm ntawm kev sib deev thiab kev muaj peev xwm hauv txivneej thiab poj niam
• Kev loj hlob hormone (GH) - txhawb kev loj hlob ntawm cov nqaij thiab pob txha
• Luteinizing hormone (LH) - tswj kev ua haujlwm ntawm kev sib deev thiab kev muaj menyuam hauv txivneej thiab pojniam
• Oxytocin - ua rau lub tsev menyuam sib cog lus thaum sib deev thiab lub mis ua kom tso mis tawm
• Prolactin - txhawb kev loj hlob poj niam lub mis thiab kev tsim kua mis
• Cov thyroid-stimulating hormone (TSH) - ua rau cov thyroid caj pas tso cov tshuaj hormones uas cuam tshuam rau lub cev metabolism

Hauv hypopituitarism, tsis muaj ib lossis ntau qhov kev tshaj tawm ntawm lub cev. Tsis muaj cov tshuaj hormones ua rau cov kev ua haujlwm hauv lub qog lossis cov khoom hauv nruab nrog cev ua cov tshuaj hormones. Piv txwv li, tsis muaj TSH ua rau qhov kev ua haujlwm ntawm lub qog ua haujlwm ib txwm tsis ua haujlwm.

Kev ua haujlwm Hypopituitarism los ntawm:

• Kev phais mob hlwb
• Mob hlav
• Mob taub hau (kev raug mob ntawm lub paj hlwb)
• Cov mob sib kis lossis mob hlwb thiab cov nqaij mob uas txhawb nqa lub hlwb
• Kev tuag ntawm thaj chaw ntawm cov nqaij hauv lub caj pas pituitary (pituitary apoplexy)
• Kev siv hluav taws xob mus rau lub hlwb
• Mob stroke
• Hemorrhage Subarachnoid (los ntawm pob tawg pob tawg)
• Cov qog ntawm lub caj pas pituitary lossis hypothalamus

Qee zaum, hypopituitarism yog vim qhov tsis muaj zog lossis lub cev tsis haum, xws li:

• Ntau dhau cov hlau hauv lub cev (hemochromatosis)
• Kev qog ntshav hauv lub cev tsis zoo uas hu ua histiocytes (histiocytosis X)
• Tus mob autoimmune uas ua rau mob ntawm lub caj pas (lymphocytic hypophysitis)
• Kev mob ntawm ntau cov nqaij thiab kabmob (sarcoidosis)
• Kev kis mob ntawm lub pituitary, xws li mob ntsws rau thawj lub ntsws

Hypopituitarism kuj yog ib qho kev mob uas tsis tshua pom tshwm sim los ntawm ntshav los ntshav ntau thaum cev xeeb tub. Kev ploj ntawm cov ntshav ua rau cov ntaub so ntswg tuag hauv lub caj pas pituitary. Tus mob no yog hu ua Sheehan syndrome.

Qee hom tshuaj noj kuj tuaj yeem siv lub zog pituitary. Cov tshuaj siv feem ntau yog glucocorticoids (xws li prednisone thiab dexamethasone), uas tau noj rau cov mob tiv thaiv kab mob thiab tiv thaiv kab mob. Cov tshuaj siv los kho tus mob prostate kuj tseem tuaj yeem ua rau lub zog tsis ua haujlwm.

Cov tsos mob ntawm hypopituitarism suav nrog ib qho ntawm cov hauv qab no:

• Mob plab
• Tsis qab los noj mov
• Tsis muaj poj niam txiv neej tsav (hauv cov txiv neej lossis poj niam)
• Kiv taub hau lossis tsaus muag
• Ntau dhau lawm tso zis thiab nqhis dej
• Ua tsis tau tso mis (rau poj niam)
• Qaug zog, qaug zog
• Mob taub hau
• Ntxiv lawm tshob (hauv cov poj niam) lossis tsum tsis coj khaub ncaws
• Poob rau qhov tso quav lossis cov plaub hau
• Poob lub cev lossis ntsej muag plaub hau (hauv cov txiv neej)
• Cov ntshav siab qis
• Cov piam thaj hauv ntshav tsawg
• Hnov kom txias
• Luv qhov siab (tsawg dua 5 ko taw lossis 1.5 metres) yog pib thaum lub sijhawm kev loj hlob
• Kev loj hlob qeeb thiab kev sib deev (hauv menyuam yaus)
• Cov teeb meem tsis pom kev
• Lub cev yuag

Cov tsos mob yuav pib qeeb thiab yuav sib txawv heev, nyob ntawm:

• Tus naj npawb ntawm cov tshuaj hormones uas ploj lawm thiab cov kabmob uas lawv cuam tshuam
• Qhov loj heev ntawm kev cuam tshuam

Lwm tus tsos mob uas yuav tshwm sim nrog tus kab mob no:

• Ntsej muag ntsej muag
• Cov plaub hau poob lawm
• Hoarseness lossis hloov lub suab
• Ob leeg txhav txhav txhav
• Qhov hnyav nce

Txhawm rau kuaj hypopituitarism, yuav tsum muaj cov tshuaj hormones qis vim muaj teeb meem nrog lub qog pituitary. Kev kuaj mob tseem yuav tsum txiav txim tawm cov kab mob ntawm cov khoom nruab nrog uas cuam tshuam los ntawm cov tshuaj no.

Kev ntsuam xyuas yuav muaj xws li:

• Lub paj hlwb CT scan
• Qhov tshij MRI
• ACTH
• Cortisol
• Estradiol (estrogen)
• Cov tshuaj hormone Follicle-stimulating (FSH)
• Insulin-zoo li qhov kev loj hlob zoo 1 (IGF-1)
• Luteinizing lawm (LH)
• Kev kuaj Osmolality rau ntshav thiab zis
• Qib Testosterone qib
• Cov thyroid-stimulating hormone (TSH)
• Cov thyroid hormones (T4)
• Siv me me ntawm lub pituitary

Qib ntawm cov tshuaj pituitary yuav nyob rau hauv cov hlab ntshav ntau yog tias koj muaj qog pituitary uas ua rau ntau cov ntawd. Cov qog yuav zuaj lwm cov hlwb ntawm lub pituitary, uas ua rau kom qis ntawm lwm cov tshuaj hormones.

Yog tias hypopituitarism tshwm sim los ntawm cov qog, koj yuav tsum muaj kev phais kom tshem tawm cov qog. Kuj yuav tau siv hluav taws xob kho thiab.

Koj yuav xav tau cov tshuaj nyob ntev mus hloov cov tshuaj hormones uas tsis ua haujlwm los ntawm cov kabmob nyob hauv qab tswjhwm ntawm lub caj pas pituitary. Cov no suav nrog:

• Corticosteroids (cortisol)
• Kev loj hlob lawm
• Cov tshuaj hormones poj niam txiv neej (testosterone rau txiv neej thiab estrogen rau cov poj niam)
• Cov thyroid hormones
• Ntshaw-chim

Yeeb tshuaj kuj tseem siv tau los kho kev cuam tshuam ntxiv ntawm cov menyuam hauv plab thiab txiv neej.

Yog tias koj noj cov tshuaj glucocorticoid rau cov tshuaj pituitary ACTH tsis txaus, nco ntsoov tias koj paub thaum twg yuav tsum tau noj qhov kev ntxhov siab ntawm koj cov tshuaj. Tham nrog koj tus kws kho mob.

Nco ntsoov nqa ID kho mob (daim npav, tes tes, lossis caj dab) uas hais tias koj muaj adrenal tsis txaus. Daim ID tseem yuav tsum tau hais txog hom tshuaj thiab ntau npaum li cas koj xav tau thaum muaj xwm txheej tshwm sim los ntawm adrenal tsis txaus.

Kev ua haujlwm Hypopituitarism feem ntau yog nyob ruaj khov. Nws yuav tsum tau kho lub neej nrog ib lossis ntau hom tshuaj. Tab sis koj tuaj yeem cia siab lub neej zoo.

Hauv cov menyuam yaus, kev hypopituitarism tuaj yeem hloov kho yog tias cov qog tshem tawm thaum phais.

Kev phiv los ntawm cov tshuaj kho hypopituitarism tuaj yeem loj hlob. Txawm li cas los xij, tsis txhob tso tseg ib qho tshuaj ntawm koj tus kheej yam tsis tau tham nrog koj tus kws kho mob ua ntej.

Hu rau koj tus kws kho mob yog tias koj muaj cov tsos mob ntawm hypopituitarism.

Feem ntau, qhov kev cuam tshuam no tsis tuaj yeem tiv thaiv. Kev paub txog kev pheej hmoo, xws li los ntawm kev siv qee yam tshuaj, tuaj yeem tso cai kuaj mob thiab kho mob ntxov.

Pituitary tsis txaus ntseeg; Panhypopituitarism

• Cov qog endocrine
• Pituitary caj pas
• Gonadotropins
• Pituitary thiab TSH

Burt MG, Ho KKY. Hypopituitarism thiab kev loj hlob hormone tsis txaus. Hauv: Jameson JL, De Groot LJ, de Kretser DM, li al, eds. Endocrinology: Cov Neeg Loj thiab Pediatric. 7 tus ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 11.

Clemmons DR, Nieman LK. Mus rau tus neeg mob uas muaj kab mob endocrine. Hauv: Goldman L, Schafer AI, eds. Goldman-Cecil Tshuaj. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: cha 221.

Fleseriu M, Hashim IA, Karavitaki N, li al. Kev hloov kho Hormonal hauv hypopituitarism rau cov neeg laus: Endocrine Society soj ntsuam kev coj ua. J Clin Endocrinol Metab. 2016; 101 (11): 3888-3921. PMID: 27736313 www.ncbi.nlm.nih.gov/pubmed/27736313.