Cushing tus kab mob

Cushing disease yog ib yam kev mob uas lub caj pas pituitary tso tawm ntau dhau adrenocorticotropic hormone (ACTH). Lub caj pas pituitary yog ib qho khoom ntawm endocrine system.

Cushing disease yog ib hom mob ntawm Cushing syndrome. Lwm hom mob Cushing syndrome suav nrog exogenous Cushing syndrome, Cushing syndrome los ntawm qog adrenal, thiab ectopic Cushing syndrome.

Cushing disease yog tshwm sim los ntawm qog lossis hlav loj dua (hyperplasia) ntawm lub caj pas pituitary. Lub caj pas pituitary tsuas nyob hauv qab ntawm lub hauv paus ntawm lub paj hlwb. Ib hom qog pituitary hu ua adenoma yog qhov ua rau ntau tshaj. Tus adenoma yog lub qog benign (tsis yog mob cancer).

Nrog rau tus kab mob Cushing, lub caj pas pituitary tso tawm ACTH ntau dhau. ACTH pab txhawb kev tsim khoom thiab tso tawm cortisol, kev ua kom muaj kev ntxhov siab. Ntau dhau lawm ACTH ua rau cov qog ua haujlwm ntau dhau cortisol.

Cortisol ib txwm tso tawm thaum lub sijhawm muaj kev ntxhov siab. Nws tseem muaj lwm lub luag haujlwm, suav nrog:

• Tswj kev siv lub cev ntawm cov carbohydrates, cov rog, thiab cov protein
• Txo lub cev tiv thaiv kab mob teb rau o (o)
• Kev tswj ntshav siab thiab lub cev qhov sib npaug ntawm cov dej

Cov tsos mob ntawm tus mob Cushing muaj xws li:

• Kev rog dhau ntawm lub cev (saum lub duav) thiab nyias caj npab thiab ceg
• Hloov, liab, tag nrho lub ntsej muag (lub ntsej muag lub hli)
• Kev loj hlob qeeb hauv cov menyuam yaus

Cov tawv nqaij hloov uas feem ntau pom xws li:

• Mob ntxau lossis mob voos
• Ntshav ua xim daj (1/2 nti lossis 1 centimeter lossis ntau dua), hu ua striae, ntawm daim tawv nqaij ntawm lub plab, ncej puab, sab caj npab, thiab ob lub mis
• Tawv tawv nqaij nrog lub doog yooj yim, feem ntau tshwm sim ntawm caj npab thiab tes

Hloov nqaij thiab pob txha muaj xws li:

• Mob caj pas, uas tshwm sim nrog cov kev ua ub no
• Mob leeg los yog rhiab
• Kev sib sau ntawm cov rog ntawm lub xwb pwg (twm hump)
• Kev tsis muaj zog ntawm cov pob txha, uas ua rau txha caj qaum thiab txha nraub qaum
• Cov leeg tsis muaj zog ua rau qoj ib ce tsis raug

Cov poj niam yuav muaj:

• Kev hle plaub hau ntau dhau ntawm lub ntsej muag, caj dab, hauv siab, plab, thiab ncej puab
• Kev coj khaub ncaws uas tsis xwm yeem los sis nres

Tus txiv neej yuav muaj:

• Tsawg lossis tsis muaj siab rau kev sib deev (tsis tshua muaj libido)
• Teeb meem Erection

Lwm cov tsos mob lossis teeb meem tuaj yeem suav nrog:

• Hloov pauv hlwb, xws li kev nyuaj siab, ntxhov siab lossis hloov tus cwj pwm
• Nkees
• Ntau zaus kis mob
• Mob taub hau
• Nce nqhis dej thiab tso zis
• Ntshav siab
• Mob ntshav qab zib

Tus kws kho mob yuav kuaj nws lub cev thiab nug txog koj cov tsos mob.

Kev ntsuam xyuas raug ua tiav ua ntej kom paub tseeb tias muaj cortisol ntau heev hauv lub cev, thiab tom qab ntawd los txiav txim siab qhov ua rau.

Cov kev kuaj no qhia meej ntau dhau cortisol:

• 24-teev tso zis cortisol
• Kev Tshuaj Ntsuam Dexamethasone (kev txhaj tshuaj qis)
• Qib Salivary cortisol ntau ntau (thaum sawv ntxov ntxov thiab yav tsaus ntuj)

Cov kev sim no txiav txim siab qhov ua rau:

• Ntshav ACTH theem
• Lub Hlwb MRI
• Corticotropin-tso kev sim tshuaj keeb, uas ua rau lub caj pas pituitary ua rau tso tawm ntawm ACTH
• Kev Tshuaj Ntsuam Dexamethasone (qib siab)
• Kev coj tus kheej hauv qhov nruab nrab ntawm lub cev nqaij tawv qis (IPSS) - ntsuas ACTH qib hauv cov leeg uas tso cov kua paim pituitary piv rau cov leeg hauv siab

Lwm yam kev ntsuas uas yuav ua tau muaj xws li ib qho ntawm cov hauv qab no:

• Kev yoo mov ntshav qabzib thiab A1C txhawm rau kuaj ntshav qab zib
• Kev kuaj lipid thiab roj (cholesterol)
• Pob txha pob txha cov pob txha kuaj ntshav txhawm rau kuaj txha txha caj qaum

Yuav tsum muaj ntau tshaj ib qho kev kuaj mob txhawm rau kuaj mob Cushing. Koj tus kws khomob yuav hais kom koj mus ntsib ib tus kws khomob uas tshwj xeeb txog cov kabmob pituitary.

Kev kho mob cuam tshuam nrog kev phais kom tshem tawm cov qog pituitary, yog tias ua tau. Tom qab phais, lub caj pas pituitary yuav maj mam pib rov ua haujlwm dua thiab rov qab ua qub.

Thaum lub sijhawm ua kom rov qab los ntawm kev phais mob, koj yuav tsum kho cortisol hloov kho vim tias lub pituitary xav tau sijhawm los pib ua ACTH dua.

Kev siv tshuaj tua hluav taws xob rau lub qog pituitary kuj tseem siv tau yog tias cov qog ntshav tsis tau txiav tawm.

Yog tias cov qog tsis teb rau kev phais lossis hluav taws xob, koj yuav xav tau tshuaj los ua kom koj lub cev tsis ua cortisol.

Yog tias cov kev kho mob no ua tsis tiav, cov qog adrenal yuav raug tshem tawm kom tsis txhob muaj cortisol ntau ntau los ntawm kev tsim tawm. Kev tshem tawm cov qog ntawm qog tuaj yeem ua rau lub qog pituitary tau loj dua (Nelson syndrome).

Yog tsis kho, Cushing tus kab mob yuav ua rau mob hnyav, tuag taus. Kev tshem tawm cov qog tuaj yeem ua rau tag nrho rov qab, tab sis cov qog tuaj yeem rov qab tuaj.

Cov teeb meem kev noj qab haus huv uas tuaj yeem yog los ntawm tus mob Cushing:

• Compression kev sib txhuam hauv qhov nqaj qaum
• Mob ntshav qab zib
• Ntshav siab
• Kab mob
• Raum pob zeb
• Mus los yog lwm yam teeb meem kev mob hlwb

Hu rau koj tus kws kho mob yog tias koj muaj tus mob Cushing.

Yog tias koj muaj qog nqaij hlav tawm, hu rau koj tus kws kho mob yog tias koj muaj cov tsos mob tshwm sim, suav nrog cov cim qhia tias cov qog tau rov qab los.

Pituitary Cushing kab mob; ACTH-secreting adenoma

• Cov qog endocrine
• Striae hauv lub popliteal fossa
• Striae ntawm ceg

Juszczak A, Morris DG, Grossman AB, Nieman LK. Cushing's syndrome. Hauv: Jameson JL, De Groot LJ, de Kretser DM, li al, eds. Endocrinology: Cov Neeg Loj thiab PediatricCov. 7 tus ed. Philadelphia, PA: Elsevier Saunders; 2016: tshooj 13.

Molitch KUV. Ua ntej plam. Hauv: Goldman L, Schafer AI, eds. Goldman-Cecil TshuajCov. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 224.

Stewart PM, Newell-Nqe JDC. Lub adrenal cortex. Hauv: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Phau Ntawv ntawm EndocrinologyCov. 13th ed. Philadelphia, PA: Elsevier; 2016: chap 15.