Cushing syndrome

Cudurka 'Cushing syndrome' waa cillad dhacda marka jirkaagu leeyahay heer sare oo ah hormoonka cortisol.

Sababta ugu badan ee keenta xanuunka 'Cushing syndrome' waa qaadashada daawada 'glucocorticoid' aad u badan ama daawada 'corticosteroid'. Qaabkan cudurka 'Cushing syndrome' waxaa loo yaqaan 'Cushing syndrome' exogenous Cushing syndrome. Prednisone, dexamethasone, iyo prednisolone waa tusaalooyinka daawada noocan ah. Glucocorticoids waxay ku daydaan ficilka hormoonka dabiiciga ah ee cortisol. Daawooyinkan waxaa loo isticmaalaa in lagu daaweeyo xaalado badan sida neefta, maqaarka oo barara, kansarka, cudurada mindhicirka, xanuunka kalagoysyada, iyo laabotooyinka.

Dadka kale waxay ku dhacdaa cilladda 'Cushing syndrome' sababtoo ah jirkoodu wuxuu soo saaraa cortisol aad u badan. Hormoonkan waxaa lagu sameeyay qanjidhada adrenal. Sababaha keena cortisol aad u badan ayaa ah:

• Cudurka 'Cushing', oo dhaca marka qanjirka 'pituitary gland' uu wax badan ka sameeyo hormoonka hormoonka adrenocorticotrophic (ACTH). ACTH ayaa markaa calaamadaha qanjidhada adrenal si ay u soo saarto cortisol aad u tiro badan. Buro qanjirka 'pituitary gland' ayaa sababi kara xaaladdan.
• Buro ka mid ah qanjidhada adrenal
• Buro meel kale oo jirka ah oo soo saarta hormoon sii deynaya corticotropin (CRH)
• Burooyinka meel kale oo jirka ah oo soo saara ACTH (ectopic Cushing syndrome)

Calaamaduhu way kala duwan yihiin. Ma aha in qof kasta oo qaba Cushing syndrome uu isku calaamado leeyahay. Dadka qaarkiis waxay leeyihiin calaamado badan halka kuwa kale ay ku adag tahay inay yeeshaan wax calaamado ah.

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 waxaa ka mid noqon kara:

• Caabuqyada maqaarka
• Calaamadaha fidsan oo casaan ah (1/2 inji ama 1 sintimitir ama ka ballaaran) oo loo yaqaan 'striae' maqaarka caloosha, gacmaha kore, bowdyaha, iyo naasaha
• Maqaarka khafiifka ah ee nabar fudud (gaar ahaan gacmaha iyo gacmaha)

Isbedelada murqaha iyo lafaha waxaa ka mid ah:

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

Isbedelada jirka oo dhan (nidaamsan) waxaa ka mid ah:

• Nooca 2aad ee sonkorowga mellitus
• Dhiig kar (dhiig kar)
• Kalastaroolka iyo triglycerides oo kordhay (hyperlipidemia)

Haweenka qaba Cushing syndrome waxaa laga yaabaa inay yeeshaan:

• Kordhinta timaha ee wejiga, qoorta, laabta, caloosha, iyo bowdyaha
• 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 ku dhici kara cudurkan:

• 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.

Tijaabooyinka shaybaarka ee la qaadi karo si loo ogaado cudurka Cushing iyo in la ogaado sababta ayaa ah:

• Heerka cortisol ee dhiiga
• Sonkorta dhiigga
• Saliva cortisol
• Imtixaanka xakamaynta Dexamethasone
• 24-saac kaadi ah cortisol iyo creatinine
• Heerka ACTH
• Tijaabada kicinta ACTH (xaalado dhif ah)

Tijaabooyinka lagu ogaanayo waxa sababay ama dhibaatooyinka waxaa ka mid noqon kara:

• Caloosha CT
• Pituitary MRI
• Cufnaanta macdanta lafaha

Daaweyntu waxay kuxirantahay sababta.

Cudurka 'Cushing syndrome' ee ay keento isticmaalka 'kortikosteroid':

• Bixiyahaaga ayaa ku faray inaad si tartiib tartiib ah u yareysid qiyaasta daawada. Joojinta daawada si lama filaan ah waxay noqon kartaa khatar.
• Haddii aadan joojin karin qaadashada daawada cudur dartiis, sonkorta dhiiggaaga oo sarreeya, heerarka kolestaroolka oo sarreeya, iyo khafiifinta lafaha ama lafa-beelka waa in si dhow loola socdaa loona daaweeyaa.

Cudurka 'Cushing syndrome' ee uu keeno pituitary ama buro sii deysa ACTH (Cudurka Cushing), waxaad u baahan kartaa:

• Qalliin si looga saaro buro
• Shucaac ka dib marka laga saaro buro pituitary (xaaladaha qaarkood)
• Daaweynta beddelka Cortisol qalliinka kadib
• Daawooyinka lagu beddelayo hoormoonka pituitary-ga oo yaraada
• Daawooyinka ka ilaaliya jirka inuu sameeyo cortisol aad u badan

Cudurka 'Cushing syndrome' oo ay ugu wacan tahay buro pituitary, buro adrenal ah, ama burooyin kale:

• Waxaad u baahan kartaa qalliin si looga saaro burada.
• Haddii burada aan la soo saari karin, waxaad u baahan kartaa daawooyin kaa caawinaya joojinta sii deynta cortisol.

Ka soo bixida burada waxay u horseedi kartaa soo kabasho buuxda, laakiin waxaa jira fursad ah in xaaladdu soo laabaneyso.

Badbaadinta dadka qaba Cushing syndrome oo ay sababaan burooyin waxay kuxirantahay nooca burooyinka.

Cudurka 'Cushing syndrome' ee aan la daaweynin wuxuu noqon karaa mid nafta halis geliya.

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

• Sonkorowga
• Ballaarinta burooyinka pituitary
• Jabka lafaha oo ay ugu wacan tahay lafo-beelka
• Dhiig kar
• Dhagaxaanta kilyaha
• Infekshano halis ah

Wac daryeel bixiyahaaga haddii aad leedahay calaamado ah '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.

Hypercortisolism; Cortisol xad-dhaaf ah; Xaddiga Glucocorticoid - Cushing syndrome

• Qanjirada 'Endocrine'

Nieman LK, Biller BM, Findling JW, iyo al; Bulshada Endocrine. Daaweynta Cudurka 'Cushing's syndrome': tilmaamaha ku-takhasuska bulshada 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 Saunders; 2016: cutubka 15.