Hypopituitarism

Hypopituitarism waa xaalad qanjirka 'pituitary gland' uusan soo saarin qaddar caadi ah qaar ama dhammaan hormoonnadiisa.

Qanjirka 'pituitary gland' waa qaab dhismeed yar oo ka hooseeya maskaxda. Waxaa ku lifaaqan jirid loo yaqaan 'hypothalamus'. Hypothalamus waa aagga maskaxda ee xukuma shaqada qanjirka 'pituitary gland'.

Hormoonnada uu sii daayo qanjirka 'pituitary gland' (iyo shaqooyinkooda) waa:

• Hormarka Adrenocorticotropic (ACTH) - wuxuu kiciyaa qanjirka 'adrenal gland' si uu u sii daayo cortisol; cortisol waxay caawisaa sidii loo ilaalin lahaa cadaadiska dhiiga iyo sonkorta dhiiga
• Hormoonka loo yaqaan 'Antidiuretic hormone' (ADH) - wuxuu xakameeyaa biyo luminta kilyaha
• Hormoonka kiciya follicle (FSH) - wuxuu xakameeyaa shaqada galmada iyo taranka ragga iyo dumarka
• Hormoonka koritaanka (GH) - wuxuu kiciyaa koritaanka unugyada iyo lafaha
• Hormoonka luteinizing (LH) - wuxuu xakameeyaa shaqada galmada iyo taranka ragga iyo dumarka
• Oxytocin - wuxuu kiciyaa ilmo-galeenka si uu u fooraro xilliga foosha iyo naasaha si ay u sii daayaan caano
• Prolactin - wuxuu kiciyaa naasaha dumarka horumarkooda iyo wax soo saarkooda caano
• Hormone-kiciyaha hoormoonka (TSH) - wuxuu kiciyaa qanjirka 'thyroid' si uu u sii daayo hormoonnada saameeya dheef-shiid kiimikaadka jirka

Hypopituitarism, waxaa jira hal ama in ka badan oo ah hormoonnada pituitary. Hormoon la’aan ayaa keenta inuu shaqadiisa ku waayo qanjirka ama xubinta hormoonku xukumo. Tusaale ahaan, la'aanta TSH waxay keenaysaa luminta shaqadii caadiga ahayd ee qanjirka 'thyroid'.

Hypopituitarism waxaa sababi kara:

• Qalliinka maskaxda
• Burada maskaxda
• Dhaawac madaxa ah (dhaawac maskaxda soo gaadhay)
• Infekshannada ama caabuqa maskaxda iyo unugyada taageera maskaxda
• Dhimashada aag unug ka mid ah qanjirka 'pituitary gland' (pituitary apoplexy)
• Daweynta shucaaca maskaxda
• Faalig
• Dhiig-baxa subarachnoid (oo ka yimaada aneurysm dilaacay)
• Burooyinka qanjirka pituitary ama hypothalamus

Mararka qaarkood, hypopituitarism waxaa sabab u ah habka difaaca jirka oo aan caadi ahayn ama cudurada dheef-shiid kiimikaadka, sida:

• Bir badan oo jirka ku jirta (hemochromatosis)
• Kordhin aan caadi ahayn ee unugyada difaaca jirka ee loo yaqaan histiocytes (histiocytosis X)
• Xaaladda isdifaaca jirka ee sababa caabuqa pituitary (lymphocytic hypophysitis)
• Caabuq ku dhaca unugyada iyo xubnaha kala duwan (sarcoidosis)
• Cudurrada pituitary, sida qaaxada pituitary ee aasaasiga ah

Hypopituitarism sidoo kale waa dhibaato dhif ah oo uu keeno dhiig bax daran inta lagu guda jiro uurka. Luminta dhiiggu waxay keentaa geerida unugyada qanjirka 'pituitary gland'. Xaaladdaan waxaa lagu magacaabaa Sheehan syndrome.

Daawooyinka qaarkood ayaa sidoo kale xakamayn kara shaqada pituitary. Daawooyinka ugu caansan waa glucocorticoids (sida prednisone iyo dexamethasone), oo loo qaato xaaladaha bararka iyo difaaca jirka. Daawooyinka loo isticmaalo in lagu daaweeyo kansarka qanjirka 'prostate' sidoo kale waxay u horseedi karaan shaqada pituitary hooseeya

Astaamaha hypopituitarism waxaa ka mid ah kuwa soo socda:

• Calool xanuun
• Cunto yaraanta
• Jinsi la'aan (ragga ama dumarka)
• Dawakhaad ama suuxdin
• Kaadi badan iyo harraad
• Ka gaabinta sii deynta caanaha (haweenka)
• Daal, daciifnimo
• Madax xanuun
• Dhalmo la'aan (dumarka) ama joojinta caadada caadada
• Lumida kilkisha ama timaha xubinta taranka
• Jirka jirka ama timaha wajiga (ragga)
• Cadaadis dhiig oo hooseeya
• Sonkorta dhiigga oo hooseysa
• Xasaasiyadda qabowga
• Dherer gaaban (in ka yar 5 fuudh ama 1.5 mitir) haddii bilowgu yahay muddada koritaanka
• Kobaca gaabiska ah iyo horumarka galmada (carruurta)
• Dhibaatooyinka aragga
• Miisaanka oo yaraada

Calaamaduhu si tartiib tartiib ah ayey u horumari karaan wayna kala duwanaan karaan, iyadoo ku xiran

• Tirada hormoonnada maqan iyo xubnaha ay saameynayaan
• Darnaanta cilladda

Calaamadaha kale ee ku dhici kara cudurkan:

• Barar wejiga
• Timo lumis
• Cabaadis ama cod beddelasho
• Qalafsanaan wadajir ah
• Miisaanka oo kordha

Si loo ogaado hypopituitarism, waa inuu jiraa heerar hoormoon oo hooseeya dhibaato ka haysata qanjirka 'pituitary gland'. Baadhitaanku waa inuu sidoo kale meesha ka saaraa cudurada ku dhaca xubinta ee uu saameeyo hormoonkan.

Tijaabooyinka waxaa ka mid noqon kara:

• Maskaxda CT scan
• Pituitary MRI
• ACTH
• Cortisol
• Estradiol (estrogen)
• Hormone-kiciyaha follicle (FSH)
• Cunsurka u eg insulin-ta 1 (IGF-1)
• Hormoonka luteinizing (LH)
• Baadhitaannada 'Osmolality' ee dhiigga iyo kaadida
• Heerka testosterone
• Hormone-kicinta hoormoonka (TSH)
• Hoormoonka tayroodhka (T4)
• Biopsy ee pituitary

Heerka hoormoonka pituitary ayaa laga yaabaa inuu ku sarreeyo marinka dhiigga haddii aad leedahay buro pituitary oo soo saarta wax badan oo hoormoonkaas ah. Burooyinka ayaa burburin kara unugyada kale ee pituitary, taasoo horseeda heerar hoose oo hormoonno kale ah.

Haddii hypopituitarism uu sababo buro, waxaad u baahan kartaa qalliin si looga saaro burada. Daaweynta shucaaca sidoo kale waa loo baahan karaa.

Waxaad u baahan doontaa daawooyinka hoormoonka cimrigaaga oo dhan si aad u beddesho hormoonnada aan mar dambe sameynin xubnaha ku jira gacanta qanjirka 'pituitary gland'. Kuwaas waxaa ka mid noqon kara:

• Corticosteroids (cortisol)
• Hormoonka koritaanka
• Hormoonnada galmada (testosterone ragga iyo estrogen ee haweenka)
• Hormoonka tayroodhka
• Desmopressin

Daawooyinka ayaa sidoo kale la heli karaa si loogu daaweeyo dhalmo la'aanta la xiriirta ragga iyo dumarka.

Haddii aad u qaadato daawooyinka loo yaqaan 'glucocorticoid' ee loo yaqaan 'pituitary ACTH' oo yaraada, hubi inaad taqaano goorta la qaato qiyaasta buufiska ee daawadaada. Kala hadal tan daryeel caafimaad bixiyahaaga.

Had iyo jeer qaado aqoonsi caafimaad (kaar, jijin, ama silsilad) oo sheegaysa inaad leedahay ku filnaan la'aanta adrenal. Aqoonsigu sidoo kale waa inuu sheegaa nooca daawada iyo qiyaasta aad u baahan tahay haddii ay dhacdo xaalad deg-deg ah oo ka timaadda ku filnaansho la'aanta adrenal.

Hypopituitarism caadi ahaan waa joogto. Waxay ubaahantahay daaweyn cimri dheer hal ama dhowr daawo. Laakiin waxaad filan kartaa nolol caadi ah.

Carruurta, hypopituitarism ayaa laga yaabaa inay soo fiicnaadaan haddii burooyinka laga saaro inta lagu jiro qalliinka.

Dhibaatooyinka ay keento daawooyinka ee lagu daaweynayo hypopituitarism ayaa horumarin kara. Si kastaba ha noqotee, ha u istaagin wax daawo ah kaligaa adigoon lahadlin daryeel bixiyahaaga marka hore.

Wac takhtarkaaga haddii aad isku aragto astaamaha hypopituitarism.

Xaaladaha badankood, cilladdu ma aha mid laga hortagi karo. Ogaanshaha halista, sida qaadashada daawooyinka qaarkood, waxay u oggolaan kartaa ogaanshaha hore iyo daaweynta.

Cillad la'aanta pituitary; Panhypopituitarism

• Qanjirada 'Endocrine'
• Qanjirka 'pituitary gland'
• Gonadotropins
• Pituitary iyo TSH

Burt MG, Ho KKY. Hypopituitarism iyo yaraanshaha hoormoonka koritaanka. Gudaha: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Dadka waaweyn iyo carruurta. 7aad ed. Philadelphia, PA: Elsevier Saunders; 2016: cutubka 11.

Clemmons DR, Nieman LK. U dhowaanshaha bukaanka qaba cudurka endocrine. Gudaha: Goldman L, Schafer AI, eds. Daawada Goldman-Cecil. 25aad. Philadelphia, PA: Elsevier Saunders; 2016: cutubka 221.

Fleseriu M, Hashim IA, Karavitaki N, iyo al. Beddelka hormoonka ee hypopituitarism ee dadka qaangaarka ah: tilmaamaha ku-takhasuska daaweynta bulshada ee Endocrine. J Clin Endocrinol Metab. 2016; 101 (11): 3888-3921. PMID: 27736313 www.ncbi.nlm.nih.gov/pubmed/27736313.