Xanuunka 'Cushing syndrome'

Xanuunka 'Cushing syndrome' ee 'Exogenous Cushing syndrome' waa nooc ka mid ah xanuunka 'Cushing syndrome' oo ku dhaca dadka qaata daawooyinka loo yaqaan 'glucocorticoid' (sidoo kale loo yaqaan 'corticosteroid', ama steroid) hormoonnada.

Cudurka 'Cushing syndrome' waa cillad dhacda marka jirkaagu leeyahay heer ka sarreeya heerka caadiga ah ee hormoonka cortisol. Hormoonkan waxaa caadi ahaan lagu sameeyaa qanjidhada adrenal.

Exogenous waxaa loola jeedaa wax ka baxsan jirka. Xanuunka 'Cushing Syndrome' wuxuu dhacaa marka qofku qaato dawooyinka man-ka sameysan ee loo yaqaan 'glucocorticoid' si loo daweeyo cudur.

Glucocorticoids waxaa loo siiyaa cuduro badan, sida cudurada sanbabada, xaaladaha maqaarka, cudurada caloosha ee caabuqa, kansarka, burooyinka maskaxda, iyo cudurada kalagoysyada. Daawooyinkani waxay ku yimaadaan qaabab badan, oo ay ka mid yihiin kiniin, xididka xididka (IV), cirbadeyn la gashaday wadajir, enema, kareemada maqaarka, neefta, iyo dhibcaha isha.

Inta badan dadka qaba xanuunka 'Cushing syndrome' waxay leeyihiin:

• Wareeg, casaan, waji buuxa (wajiga dayaxa)
• Heerka koritaanka gaabiska ah (ee carruurta)
• Kordhinta culeyska dufanka ku urursan jirridda, laakiin dufanka oo ka lumiya gacmaha, lugaha, iyo badhida (buurnida dhexe)

Isbedelada maqaarka ee badanaa la arko waxaa ka mid ah:

• Caabuqyada maqaarka
• Calaamadaha fidinta (guduudka ah) (1/2 inji ama 1 sentimitir ama ka ballaaran), oo loo yaqaan 'striae', maqaarka caloosha, bowdyaha, gacmaha kore, iyo naasaha
• Maqaar khafiif ah oo nabar fudud leh

Isbedelada murqaha iyo lafaha waxaa ka mid ah:

• Dhabar xanuun, oo ku dhaca waxqabadyada caadiga ah
• Lafa xanuun ama danqasho
• Uruurinta dufanka inta udhaxeysa garbaha iyo lafta qoorta
• Feeraha iyo jabka lafdhabarta ee ay keento khafiifinta lafaha
• Murqaha daciifka ah, gaar ahaan miskaha iyo garbaha

Dhibaatooyinka jirka oo dhan (nidaamsan) waxaa ka mid noqon kara:

• Nooca 2aad ee sonkorowga
• Dhiig kar
• Kalastarol iyo triglycerides badan

Haweenka waxaa laga yaabaa inay yeeshaan:

• Muddooyinka oo noqda kuwo aan caadi ahayn ama joogsada

Ragga waxaa laga yaabaa inay leeyihiin:

• Hoos udhaca ama rabitaanka galmada (libido hoose)
• Dhibaatooyinka kacsiga

Calaamadaha kale ee dhici kara waxaa ka mid ah:

• Isbeddelada maskaxda, sida niyadjabka, walwalka, ama isbeddelada dabeecadda
• Daal
• Madax xanuun
• Haraad iyo kaadi badan

Bixiyaha xanaanada caafimaadka ayaa sameyn doona baaritaan jireed wuxuuna weydiin doonaa astaamahaaga iyo daawooyinka aad qaadato. U sheeg daryeel bixiyaha dhammaan daawooyinka aad qaadatay dhowrkii bilood ee la soo dhaafay. Sidoo kale u sheeg daryeel bixiyaha tallaalada aad ka heshay xafiiska bixiyaha.

Haddii aad isticmaasho cortisone, prednisone, ama corticosteroids kale, natiijooyinka baaritaanka soo socda ayaa soo jeedin kara xanuunka 'Cushing syndrome':

• Heerka ACTH oo hooseeya
• Cortisol heerkiisu hooseeyo (ama heerka sare ee cortisol) ee dhiiga ama kaadida, waxay kuxirantahay daawada aad qaadanaysid
• Jawaab aan caadi ahayn oo ku saabsan baaritaanka kicinta cosyntropin (ACTH)
• Ka sarreysa gulukooska soonka caadiga ah
• Heerka potassium dhiigga oo hooseeya
• Cufnaanta lafaha oo hooseeya, sida lagu qiyaaso baaritaanka cufnaanta macdanta lafaha
• Kalastarol sare, gaar ahaan triglycerides sare iyo lipoprotein-cufnaanta hooseysa (HDL)

Habka loo yaqaan chromatography dareere sare (HPLC) wuxuu muujin karaa heer sare oo daawada looga shakisan yahay kaadida.

Daaweyntu waa in la yareeyo ugu dambayntiina la joojiyaa qaadashada wax corticosteroids ah. Tan waxaa loo samayn karaa si tartiib tartiib ah ama dhaqso ah, iyadoo kuxiran sababta laguu daweynayo daawada 'kortikosteroid'. Ha joojin qaadashada wax daawo ah adiga oo aan marka hore lahadlin takhtarkaaga. Si lama filaan ah u joojiya corticosteroids ka dib markaad qaadato muddo dheer waxay sababi kartaa xaalad naf-gooya oo loo yaqaan 'adrenal crisis'.

Haddii aadan joojin karin qaadashada daawada cudur dartiis (tusaale ahaan, waxaad u baahan tahay daawada 'glucocorticoid' si loo daaweeyo neefta daran), raac tilmaamaha bixiyahaaga ee ku saabsan sida loo yareeyo suurtagalnimada dhibaatooyinka soo raaca, oo ay ka mid yihiin:

• Ku daweynta sonkorta dhiigga sare ee cuntada, daawooyinka afka laga qaato, ama insulin.
• Ku daweynta kolestaroolka badan cuntada ama daawooyinka.
• Qaadashada daawooyinka si looga hortago lafo beelid. Tani waxay kaa caawin kartaa yareynta halista jabka haddii aad isku aragto lafo-beel.
• Qaadashada daawooyin kale si loo yareeyo qadarka daawada glucocorticoid ee aad u baahan tahay.

Si tartiib tartiib tartiib ah dawada sababta u ah xaalada waxay gacan ka geysan kartaa dib u celinta saameynta qanjidhada qanjirada 'adrenal gland' (atrophy). Tani waxay qaadan kartaa bilo illaa iyo sanadka. Inta lagu jiro waqtigan, waxaad u baahan kartaa inaad dib u bilowdo ama aad kordhiso qiyaasta daawadaada 'steroids' waqtiyada walaaca ama jirrada.

Dhibaatooyinka caafimaad ee ka dhalan kara xanuunka 'Cushing syndrome' ee ka baxsan waxaa ka mid ah kuwa soo socda:

• Difaaca jirka oo hooseeya, oo keeni kara infekshanno isdaba joog ah
• Waxyeello u geysata indhaha, kilyaha, iyo neerfaha sababo la xiriira sonkorta dhiigga ee sare oo aan la daaweyn
• Sonkorowga
• Heerarka kolestaroolka sareeya
• Khatarta wadna xanuunka oo kordhay oo ka imaanaysa cudurka macaanka ee aan la daaweyn iyo kolestaroolka badan
• Khatarta sii kordheysa ee xinjirowga dhiigga
• Lafaha daciifka ah (lafo-beelka) iyo halista jabka

Dhibaatooyinkan guud ahaan waa looga hortagi karaa daaweyn habboon.

Ballan wac wac bixiyahaaga haddii aad qaadanayso corticosteroid oo aad yeelato calaamadaha Cushing syndrome.

Haddii aad qaadato kortikosteroid, ogow calaamadaha iyo astaamaha Cushing syndrome. Daaweynta goor hore ayaa kaa caawin karta kahortagga waxyeellooyinka muddada-dheer ee Cushing syndrome. Haddii aad isticmaasho steroids la neefsaday, waad yareyn kartaa u-soo-gaadhistaada steroids adoo isticmaalaya kabareer iyo adigoo luqluqaya afkaaga ka dib markaad ku neefsatid steroids.

Cudurka 'Cushing syndrome' - corticosteroid laaluushey; Corticosteroid-ku-soo-saarey Cushing syndrome; Iatrogenic Cushing syndrome

• Soosaarka hormoonka Hypothalamus

Nieman LK, Biller BM, Findling JW, iyo al.Daaweynta Cudurka 'Cushing's syndrome': tilmaamaha ku-takhasuska bukaan-socodka ee Endocrine Society.J Clin Endocrinol Metab. 2015; 100 (8): 2807-2831. PMID: 26222757 www.ncbi.nlm.nih.gov/pubmed/26222757.

Stewart PM, Newell-Price JDC. Kiliyaha adrenal. Gudaha: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Buugga Buugga Endocrinology. 13aad. Philadelphia, PA: Elsevier; 2016: cutubka 15.