Tlhahlobo ea Bongaka ea Mathata a Endocrine
Mathata a endocrine ke sehlopha sa mafu a hlahang ka lebaka la ho se leka-lekane tlhahisong, tlhahisong, ho tsamaiseng, kapa ts'ebetsong ea lihormone liseleng tse reriloeng. Hobane lihormone li laola metabolism, kholo, ho ikatisa, likarabelo tsa khatello ea maikutlo, le ho leka-lekana ha mokelikeli le electrolyte, mathata a tsamaiso ea endocrine hangata a baka matšoao a mangata, ka linako tse ling a sa totobatseng. Ka hona, tlhahlobo ea kliniki ea mathata a endocrine e hloka mokhoa o hlophisitsoeng o kopanyang ho nka nalane, tlhahlobo ea 'mele, liteko tse loketseng tsa laboratori, le ho nka litšoantšo ha ho hlokahala. Sengoloa sena se tšohla mehato ea bohlokoa tlhahlobong ea kliniki ea mathata a endocrine, ho kenyeletsoa le melao-motheo ea tlhaloso ea sephetho sa liteko le likotsi tse tloaelehileng tsa tlhahlobo.
1. Melao-motheo e akaretsang ea tlhahlobo ea endocrine
Tsamaisong ea endocrine, litletlebo tsa bakuli hangata li hlaha e le "tse akaretsang," joalo ka mokhathala, liphetoho tsa boima ba 'mele, mathata a boroko, ho fetoha ha maikutlo, kapa ho se tsitse ha nako ea ho ilela khoeli. Bothata ba ngaka ke ho khetholla hore na litletlebo tsena ke liphetoho tsa 'mele, phello ea lefu le seng la endocrine, phello ea meriana, kapa bothata ba 'nete ba lihormone. Melao-motheo e 'meli ea bohlokoa tlhahlobong ke: (1) ho hlahloba hore na bothata bo na le hypersecretory (ho feta tekano ha lihormone) kapa hyposecretory (khaello ea lihormone), le (2) ho fumana hore na bothata ke ba mantlha (bo simoloha litšoeleseng tsa endocrine) kapa ba bobeli/ba boraro (bo simoloha pituitary kapa hypothalamus).
Ho phaella moo, lihormone li ka fetoha ho latela merethetho ea circadian (mohlala, cortisol), tsa susumetsoa ke boemo ba lijo (insulin, glucose), khatello ea maikutlo e matla, boimana, bokuli bo matla le tšebelisano-'moho ea lithethefatsi. Nako ea ho nka sampole le moelelo oa kliniki li khetholla ho nepahala ha tlhaloso.
2. Ho bala ka mokhoa o tataisang: ho batla lintlha tsa bohlokoa
Nalane ke motheo oa tlhahlobo ea endocrine. Likarolo tse ling tsa bohlokoa li kenyelletsa:
1) Tletlebo ea mantlha le tatellano ea liketsahalo
Na matšoao a hlahile ka tšohanyetso kapa butle-butle? Mathata a qoqotho a ka hlaha butle-butle, ha ho se sebetse hantle ha adrenal ho ka mpefala ka potlako, haholo-holo tlas'a khatello ea tšoaetso.
2) Matšoao a tsamaiso ea 'mele
Liphetoho tsa boima ba 'mele, ho se mamelle mocheso/serame, liphetoho takatsong ea lijo, polyuria/polydipsia, ho otla ha pelo ka matla, ho thothomela, ho pipitleloa/letšollo, bofokoli ba mesifa, liphetoho tsa letlalo le moriri.
3) Nalane ea ho ikatisa
Ho basali: ho se tsitse ha nako ea ho ilela khoeli, ho hloka thari, galactorrhea, matšoao a hyperandrogenism (makhopho a maholo, hirsutism). Ho banna: ho fokotseha ha takatso ea thobalano, ho se sebetse hantle ha thobalano, ho hloka thari, gynecomastia.
4) Nalane ea lelapa
Mafu a autoimmune (Hashimoto's thyroiditis, Graves'), lefu la tsoekere, kapa mafu a liphatsa tsa lefutso a kang MEN (Multiple Endocrine Neoplasia) a ka fana ka leseli la sesosa sa lefu lena.
5) Meriana le ho pepesehela batho ba bang
Li-glucocorticoids (li ka hatella HPA axis), amiodarone (mathata a thyroid), lithium (hypothyroidism), meriana e itseng ea antipsychotic (hyperprolactinemia), tekanyo e phahameng ea biotin (e sitisa liteko tsa immunochemical), le li-supplement tsa lihormone kapa li-steroid tsa anabolic.
6) Maemo a khethehileng
Boimana, ho anyesa, bokuli bo matla bo tebileng, khaello ea phepo e nepahetseng, kapa mathata a kelello a ka etsisa kapa a fetola setšoantšo sa endocrine.
3. Tlhahlobo ea 'mele: hlahloba matšoao a lihormone
Tlhahlobo e hlokolosi ea 'mele hangata e fana ka lintlha tse matla tsa tlhahlobo:
– Matšoao a lefu la thyroid: tšoelesa ea thyroid e holileng, ho thothomela ho fokolang, tachycardia, li-reflexes tse matla haholo (hyperthyroidism), letlalo le omileng le bradycardia (hypothyroidism), le Graves' orbitopathy.
– Matšoao a lefu la Cushing: botenya bo bohareng, lifahleho tse chitja, striae e pherese e pharaletseng, ho taboha habonolo, bofokoli ba mesifa e haufi, khatello e phahameng ea mali.
– Matšoao a ho se sebetse hantle ha adrenal: ho phahama ha pigmentation (ho se sebetse hantle ha mantlha), ho fokotseha ha khatello ea mali ka mokhoa o sa laoleheng, ho felloa ke metsi 'meleng.
– Matšoao a acromegaly: ho hola ha matsoho le maoto, liphetoho tsa sefahleho, ho bolela esale pele, ho fufuleloa ho feteletseng.
– Matšoao a mathata a parathyroid/calcium: tetany, ho opeloa ke mesifa, letšoao la Chvostek/Trousseau (hypocalcemia), kapa majoe a liphio le bohloko ba masapo (hypercalcemia).
– Tlhahlobo ea bocha le litšobotsi tsa bobeli tsa thobalano: ea bohlokoa mathateng a gonadal le pituitary.
4. Tlhahlobo ea laboratori: ho khetha liteko tse nang le moelelo
Thutong ea endocrinology, ha se liteko tsohle tse "lekanngoang ka tekanyo e le 'ngoe." Maemo a mangata a hloka liteko tsa tlhahlobo, tse lateloang ke liteko tse tiisang kapa tse matla.
a) Hormone ea qoqotho
– TSH le T4 e lokolohileng ke motswako wa mantlha. TSH e na le kutloelo-bohloko bakeng sa hypothyroidism ya mantlha, empa mathateng a pituitary (hypothyroidism e bohareng), TSH e ka ba e tloaelehileng kapa e tlase, e leng se etsang hore T4 e lokolohileng e be ea bohlokoa.
– Li-antibodies (anti-TPO, TRAb) li thusa ho fumana sesosa sa ho itšireletsa ha 'mele.
b) Lefu la tsoekere le metabolism ea tsoekere
– GDP (glucose e potlakileng maling), HbA1c, le OGTT li sebelisoa ho latela moelelo.
– Ho hypoglycemia e iphetang khafetsa, tlhahlobo ea "Whipple's triad" le tlhahlobo ea insulin, C-peptide, le sulfonylureas li ka hlahloba monyetla oa insulinoma kapa tšebeliso ea lithethefatsi.
c) Mothapo oa adrenal (cortisol)
– Bakeng sa Cushing's e belaelloang, tlhahlobo e ka kenyelletsa teko ea ho hatella dexamethasone ka tekanyo e tlase, cortisol ea mathe ea bosiu, kapa cortisol ea moroto ea lihora tse 24.
– Bakeng sa ho se sebetse hantle ha adrenal, cortisol ea hoseng le ACTH, ebe ho etsoa teko ea ho hlohlelletsa ACTH (Synacthen) haeba ho hlokahala.
d) Prolactin le gonadotropin
– Hyperprolactinemia e lokela ho nahanoa ka lebaka la boimana, hypothyroidism, meriana le prolactinoma. Teko ea TSH e bohlokoa e le sesosa sa bobeli.
– LH/FSH le lihormone tsa thobalano (estradiol/testosterone) li thusa ho khetholla hypogonadism ea mantlha khahlanong le ea bobeli.
e) Khalsiamo, PTH, le vithamine D
– Hypercalcemia e hloka tlhahlobo ea PTH (e phahameng ho hyperparathyroidism ea mantlha; e tlase ho kankere ea mali kapa lisosa tse ling).
– Hypocalcemia e hloka ho lokisoa ha maemo a albumin, le ho nahaneloa ha magnesium le vithamine D.
5. Teko e matla: e hlokahala neng?
Teko e matla e sebediswa ha ditekanyo tsa motheo di sa lekana ka lebaka la dihormone tse feto-fetohang kapa ha ho hlokahala ho lekola dikarabo tsa ditshwaelo. Mehlala:
– Teko ea ho thibela Dexamethasone bakeng sa Cushing's.
– Teko ea ho hlohlelletsa ACTH bakeng sa ho se sebetse hantle ha adrenal.
– OGTT le GH ho hlahloba acromegaly (GH e lokela ho hatelloa ka mora glucose).
Liteko tse matla li lokela ho etsoa ho nahaneloa polokeho, lithibelo le boemo ba mokuli, kaha li ka baka liphetoho tse kholo tsa 'mele.
6. Mekhoa ea ho etsa litšoantšo le ea ho tšehetsa
Hang ha biochemistry e lebisa tlhahlobong, ho nka litšoantšo ho thusa ho fumana sebaka le sesosa:
– Ultrasound ea thyroid bakeng sa li-nodule kapa goiter; scintigraphy e ka hlahloba li-nodule tse "chesang" kapa "tse batang".
– MRI ea pituitary bakeng sa adenoma e belaelloang (prolactinoma, acromegaly, Cushing's e bakoang ke ACTH).
– Adrenal CT/MRI bakeng sa lihlahala kapa hyperplasia.
– DXA (bone densitometry) mathateng a amang masapo, a kang hyperthyroidism e telele, hyperparathyroidism, kapa hypogonadism.
Ho bohlokoa ho hopola hore ho nka litšoantšo ntle le motheo oa biochemical ka linako tse ling ho ka lebisa liphuputsong tse ferekanyang tse sa reroang. Ka hona, tatellano e ntle hangata ke ho qala ka tlhahlobo ea bongaka le ea biochemical, e lateloang ke ho nka litšoantšo tse reretsoeng.
7. Likotsi tse tloaelehileng tsa tlhahlobo ea mafu
Liphoso tse ling tse tloaelehileng tlhahlobong ea endocrine li kenyelletsa:
– Hlokomoloha tšusumetso ea lithethefatsi le li-supplement, mohlala, biotin e ka etsang hore liphetho tsa TSH/free T4 li bonahale li le "mashano".
– Ho hlalosa diphetho ntle le ho nahana ka merethetho ya letsatsi le letsatsi, haholoholo cortisol.
– Ha e kgetholle pakeng tsa mathata a mantlha le a bohareng, a kang hypothyroidism e bohareng e sa fumaneheng haeba ho shejwa TSH feela.
– O se ke wa pheta tlhahlobo ha diphetho di le moeding, hobane diphetoho tsa baeloji le tsa tlhahlobo di ka ama diphetho.
8. Qetello
Tlhahlobo ea kliniki ea mathata a endocrine e hloka mokhoa o hlophisitsoeng: ho qala ka nalane e felletseng, tlhahlobo e felletseng ea 'mele, liteko tse loketseng tsa laboratori (ho kenyeletsoa le liteko tse matla ha ho hlokahala), le litšoantšo tse thehiloeng ho matšoao a biochemical le a kliniki. Ka ho utloisisa melao-motheo ea karabelo ea lihormone, liphetoho tsa 'mele, le lintlha tse ferekanyang tse kang meriana le maemo a tšohanyetso, lingaka li ka ntlafatsa ho nepahala ha tlhahlobo le ho qoba mekhoa e sa hlokahaleng ea ho kenella. Qetellong, tlhahlobo e ntle e feta feela ho fumana "linomoro tsa lihormone" empa ho e-na le hoo e beha liphetho tseo moelelong oa mokuli e mong le e mong ho fumana tlhahlobo le moralo oa kalafo o nepahetseng ka ho fetisisa.
