Insulinoma

Insulinoma waa buro ku dhacda ganaca soosaara insulin badan.

Xammeetidu waa xubin caloosha ku jirta. Xammeetidu waxay samaysaa dhowr enzymes iyo hormoonno, oo ay ku jiraan hormoonka insulin. Shaqada insulin waa inay yareyso heerka sonkorta (gulukooska) ee dhiiga iyadoo ka caawineysa sonkorta inay u wareegto unugyada.

Inta badan marka heerka sonkorta dhiiggaagu yaraado, xammeetidu waxay joojisaa samaynta insulin-ta si loo hubiyo in sonkorta dhiiggaagu ku sii jirto heerka caadiga ah. Burucda qanjidhada ee soo saara insulin badan waxaa loo yaqaanaa insulinomas. Insulinomasku waxay sii wadaan samaynta insulin, waxayna ka dhigi karaan heerka sonkorta dhiiggaaga mid aad u hooseeya (hypoglycemia).

Heerka insulin-ta dhiigga ee sarreeya wuxuu keenaa heer sonkor dhiig oo hooseeya (hypoglycemia). Hypoglycemia wuxuu noqon karaa mid khafiif ah, oo keena astaamo sida walaac iyo gaajo. Ama waxay noqon kartaa mid daran, oo keenta qallal, miyir beel, iyo xitaa dhimasho.

Insulinomas waa burooyin aad dhif u ah. Waxay badanaa u dhacaan sidii hal, burooyin yaryar. Laakiin sidoo kale waxaa jiri kara dhowr burooyin yaryar.

Inta badan insulinomas waa burooyin aan kansar lahayn (benign). Dadka qaba dhibaatooyinka hiddo-wadaha qaarkood, sida noocyo badan oo ah nooca loo yaqaan 'endocrine neoplasia type I', ayaa halista ugu badan ugu jira insulinomas.

Calaamaduhu waxay ugu badan yihiin markaad sooman tahay ama aad ka booddo ama aad dib u dhigto cuntada. Calaamadaha waxaa ka mid noqon kara:

• Walaaca, dabeecadda isbeddela, ama jahwareerka
• Aragti daruuro leh
• Miyir beelid ama miyir beelid
• Gariir ama gariir
• Dawakhaad ama madax xanuun
• Gaajo udhaxeysa cuntada; miisaanka oo kordha waa wax caadi ah
• Qiyaasta garaaca wadnaha ama wadna garaaca
• Dhidid

Soonka kadib, dhiigaaga waxaa laga baari karaa:

• Heerka C-peptide
• Heerka gulukoosta dhiigga
• Heerka insulin-ta dhiigga
• Daawooyinka sababa xammeetida in ay soo daayaan insulin
• Jawaabta jidhkaaga ee tallaalka glucagon
  

CT, MRI, ama PET scan ee caloosha ayaa laga yaabaa in loo sameeyo si loo baaro buro ku taal xameetida. Haddii buro aan lagu arkin baaritaannada, mid ka mid ah baaritaannada soo socda ayaa la sameyn karaa:

• Endoscopic ultrasound (tijaabo isticmaasha baaxad dabacsan iyo mowjado dhawaaq si loo eego xubnaha dheefshiidka)
• Baadhitaanka 'Octreotide scan' (baadhitaan gaar ah oo lagu hubiyo unugyada gaarka ah ee soo saara hormoonka jirka)
• Xannuunka jirka ee loo yaqaan 'Pancreatic arteriography' (tijaabada isticmaasha dheeh qaas ah si loo arko xididdada qanjirada)
• Muunad-qaadista Cirridka Dhiig-baxa ee kansarka ee insulin (baaritaanka ka caawiya helitaanka meesha ugu dhow ee buro ku taal gudaha xammeetida)

Qalliinku waa daaweynta caadiga ah ee insulinoma. Haddii uu jiro hal buro, waa la soo saari doonaa. Haddii ay jiraan burooyin badan, qayb ka mid ah beeryarada ayaa loo baahan doonaa in laga soo saaro. Ugu yaraan 15% xammeetida waa in loo daayaa si loo soo saaro heerarka caadiga ah ee enzymes ee dheefshiidka.

Marar dhif ah, ganaca oo dhan waa la tirtiraa haddii ay jiraan insulinomas badan ama ay sii wadaan inay soo noqdaan. Ka soo qaadida xammeetida oo dhan waxay keenaysaa cudurka macaanka maxaa yeelay ma sii jiraan wax insulin ah oo la soo saaro. Tallaalada insulinta (irbado) ayaa markaa loo baahan yahay.

Haddii aan buro la helin inta lagu jiro qalliinka, ama haddii aadan qalliin karin, waxaad heli kartaa daawada loo yaqaan 'diazoxide' si loo yareeyo wax soo saarka insulin-ta oo looga hortago hypoglycemia. Kiniin biyo ah (durayo) ayaa lagu siiyaa dawadan si looga ilaaliyo jirka inuu ilaaliyo dheecaanka. Octreotide waa daawo kale oo loo isticmaalo in lagu yareeyo sii deynta insulin-ta dadka qaar.

Xaaladaha badankood, buro waa kansar la'aan (benign), qalliinkuna wuu daaweyn karaa cudurka. Laakiin fal-celinta hypoglycemic ee daran ama ku faafidda buro kansar ah oo ku dhacda xubnaha kale waxay noqon kartaa mid nafta halis gelisa.

Dhibaatooyinka waxaa ka mid noqon kara:

• Dareen-celinta hypoglycemic daran
• Faafidda buro kansar ah (metastasis)
• Sonkorowga haddii xammeetida oo dhan la soo saaro (dhif ah), ama cuntada aan la nuugin haddii qanjidhada oo badan laga saaro
• Caabuq iyo barar xammeetida

Wac daryeel caafimaad bixiyahaaga haddii aad isku aragto astaamo insulinoma ah. Suuxdin iyo miyir beelid waa xaalad degdeg ah. Wac 911 ama nambarka xaaladaha deg-degga ah isla markiiba.

Insulinoma; Isen cell cell, xuubka Pancreatic neuroendocrine; Hypoglycemia - insulinoma

• Qanjirada 'Endocrine'
• Sii deynta cuntada iyo insulin-ta

Asban A, Patel AJ, Reddy S, Wang T, Balentine CJ, Chen H. Kansarka nidaamka endocrine. Gudaha: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6aad ed. Philadelphia, PA: Elsevier; 2020: cutubka 68.

Shabakada Shabakada Shabakada Kansarka oo dhameystiran. Tilmaamaha tababarka caafimaadka ee NCCN ee kansarka (tilmaamaha NCCN): Neuroendocrine iyo burooyinka adrenal. Nooca 2.2020. www.nccn.org/professionals/physician_gls/pdf/neuroendocrine.pdf. La cusbooneysiiyay July 24, 2020. Waxaa la helay Noofambar 11, 2020.

Strosberg JR, Al-Toubah T. Burooyinka Neuroendocrine. Gudaha: Feldman M, Friedman LS, Brandt LJ, eds. Cudurka caloosha iyo beerka ee Sleisenger iyo Fordtran. 11aad. Philadelphia, PA: Elsevier; 2021: cutubka 34.