Exogenous Cushing mob siab

Exogenous Cushing syndrome yog ib hom mob Cushing syndrome uas tshwm sim hauv cov neeg uas siv glucocorticoid (tseem hu ua corticosteroid, lossis steroid) cov tshuaj hormones.

Cushing syndrome yog ib qho kev tsis sib haum xeeb uas tshwm sim thaum koj lub cev muaj qib siab dua li theem ntawm cov tshuaj hormones cortisol. Qhov tshuaj hormones no ib txwm muaj nyob rau hauv cov qog adrenal.

Exogenous txhais tau tias tshwm sim los ntawm qee yam sab nraud lub cev. Exogenous Cushing syndrome tshwm sim thaum ib tus neeg siv tshuaj glucocorticoid los ua tib neeg tsim (kho mob).

Glucocorticoids tau muab rau ntau yam kab mob, xws li mob ntsws, mob ntawm daim tawv nqaij, mob plab hnyuv, mob qog nqaij hlav, mob hlwb, thiab mob pob txha. Cov tshuaj no tuaj rau hauv ntau yam, suav nrog hauv ncoo, tso ntshav (IV), txhaj tshuaj rau hauv cov leeg, tshuaj ntxau, pleev rau tawv nqaij, nqus pa, thiab tshuaj pleev qhov muag.

Feem coob cov neeg muaj tus mob Cushing muaj:

• Hloov, liab, tag nrho lub ntsej muag (lub ntsej muag lub hli)
• Qeb kev loj hlob qeeb (hauv menyuam yaus)
• Lub cev hnyav nrog cov rog ntau nyob rau ntawm pob tw, tab sis rog rog los ntawm caj npab, ceg, thiab pob tw (nruab nrab rog)

Cov tawv nqaij hloov uas feem ntau pom xws li:

• Cov kab mob ntawm daim tawv nqaij
• 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 nqaij tawv nrog doog yooj yim

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
• Sau cov rog ntawm lub xwb pwg thiab sab saud dab tshos
• Cib thiab txha nraub qaum ua rau pob txha lov
• Cov leeg tsis muaj zog, tshwj xeeb ntawm lub duav thiab lub xub pwg nyom

Lub cev thoob plaws (txheej txheem) muaj xws li:

• Mob ntshav qab zib Hom 2
• Ntshav siab
• Cov roj (cholesterol) thiab triglycerides

Cov poj niam yuav muaj:

• Lub sijhawm ua haujlwm tsis meej lossis 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 uas yuav tshwm sim suav nrog:

• Hloov pauv hlwb, xws li kev nyuaj siab, ntxhov siab lossis hloov tus cwj pwm
• Nkees
• Mob taub hau
• Nce nqhis dej thiab tso zis

Tus kws kho mob yuav kuaj ib ce thiab nug txog koj cov tsos mob thiab cov tshuaj koj noj. Qhia tus kws khomob paub txog txhua yam tshuaj koj tau siv nyob rau ntau lub hlis dhau los. Thiab qhia tus kws khomob txog cov kev txhaj tshuaj uas koj tau txais ntawm chaw khomob.

Yog tias koj siv cortisone, prednisone, lossis lwm yam corticosteroids, cov kev sim hauv qab no tuaj yeem hais qhia qhov cuam tshuam Cushing syndrome:

• Qis ACTH qib
• Qib qis cortisol (lossis theem siab cortisol) hauv cov ntshav lossis zis, nyob ntawm cov tshuaj koj noj
• Lus teb tsis meej rau cov cosyntropin (ACTH) kev sim tshuaj ntsuam
• Tshaj siab dua li ib txwm ntsuas nrawm ntawm cov piam thaj
• Cov ntshav poov tshuaj theem qis
• Tsawg pob txha ceev, raws li ntsuas los ntawm cov pob txha ntxhia pob zeb txhawm rau kev ntsuas
• Cov roj (cholesterol) hnyav, tshwj xeeb cov roj triglycerides thiab cov lipoprotein uas muaj ntau tsawg (HDL)

Ib txoj kev hu ua kev ua haujlwm siab kua nyeem ua kua nyeem (HPLC) tuaj yeem qhia tau qib siab uas xav tias muaj tshuaj nyob hauv cov zis.

Txoj kev kho yog kom tsawg thiab thaum kawg tso tseg tsis noj ib qho corticosteroids. Qhov no tuaj yeem ua qeeb lossis sai, nyob ntawm seb vim li cas koj thiaj li raug kho nrog corticosteroid. Tsis txhob tsum tsis noj cov tshuaj yam tsis tau tham ua ntej nrog koj tus kws kho mob. Dheev tsum tsis txhob noj cov tshuaj corticosteroids tom qab noj lawv ntev ntev tuaj yeem ua rau muaj kev phom sij txog lub neej hu ua adrenal teebmeem.

Yog tias koj tsis tuaj yeem tsis noj tshuaj vim muaj kab mob (piv txwv li, koj xav tau cov tshuaj glucocorticoid los kho kev mob ntsws asthma), ua raws koj tus kws kho mob cov lus qhia yuav ua li cas los txo cov kev pheej hmoo ntawm kev tsim muaj cov kev mob tshwm sim, suav nrog:

• Kev kho cov ntshav qab zib nrog kev noj haus, tshuaj noj qhov ncauj, lossis insulin.
• Kho cov roj (cholesterol) siab nrog rau khoom noj lossis tshuaj noj.
• Noj tshuaj los tiv thaiv kom tsis txhob pob txha. Qhov no tuaj yeem pab txo qis kev pheej hmoo yog tias koj muaj pob txha tawg.
• Noj lwm yam tshuaj los txo cov glucocorticoid tshuaj uas koj xav tau.

Maj mam nyem cov tshuaj uas ua rau muaj mob tuaj yeem pab thim rov qab cov txiaj ntsig ntawm qog qog adrenal qog (atrophy). Nws yuav siv sijhawm ntev mus txog li ib xyoos. Nyob rau lub sijhawm no, koj yuav tsum tau rov qab pib dua lossis nce qhov ntau dua ntawm koj cov tshuaj steroids thaum lub sijhawm muaj kev ntxhov siab lossis mob.

Cov teeb meem kev noj qab haus huv uas yuav tshwm sim los ntawm tus kab mob Cushing exogenous muaj xws li ib qho hauv qab no:

• Kev tiv thaiv kab mob qis, uas yuav ua rau muaj kev sib kis ntau zaus
• Kev puas tsuaj rau lub qhov muag, raum, thiab cov leeg vim muaj ntshav qab zib tsis kho
• Mob ntshav qab zib
• Cov ntshav siab ntau ntau
• Nce kev pheej hmoo ntawm lub plawv los ntawm kev tsis kho ntshav qab zib thiab cov roj (cholesterol) siab
• Nce kev pheej hmoo ntawm cov ntshav txhaws
• Cov pob txha tsis muaj zog (osteoporosis) thiab muaj kev pheej hmoo ntawm pob txha lov

Cov teeb meem no feem ntau tuaj yeem tiv thaiv nrog kev kho kom zoo.

Hu mus teem sijhawm nrog koj tus kws khomob yog tias koj noj lub corticosteroid thiab koj pib muaj tsos mob ntawm Cushing syndrome.

Yog tias koj noj lub corticosteroid, paub cov cim thiab tsos mob ntawm tus mob Cushing. Tau txais kev kho ntxov ntxov tuaj yeem pab tiv thaiv ib qho kev mob tshwm sim mus ntev los ntawm tus mob Cushing. Yog tias koj siv cov tshuaj nqus pa, koj tuaj yeem txo qhov kev raug rau cov tshuaj steroids ntau dua los ntawm kev siv lub raj tshuaj thiab los yaug koj lub qhov ncauj tom qab ua pa ntawm cov tshuaj steroid.

Cushing syndrome - corticosteroid vim raug yuam; Corticosteroid-vim raug Cushing syndrome; Iatrogenic Cushing syndrome

• Kev ua haujlwm hauv Hypothalamus

Nieman LK, Biller BM, Tshawb JW, li al.Kev Kho Mob ntawm Cushing's syndrome: ib qho ntawm Endocrine Society cov chaw coj los soj ntsuam.J Clin Endocrinol Metab. Xyoo 2015; 100 (8): 2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

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