Haleelay xilligii uu pituitary: sababaha, calaamadaha, daaweynta cudurka

haleelay xilligii uu pituitary (haleelay xilligii) - cudur lagu gartaa dhimaal koritaanka iyo xanuunada horumarka jireed sabab u ah dheecaan of xuubka xukuntaa pituitary somatotropin ah - hormoonka koritaanka. Waa hormone this ayaa masuul ka ah geeddi-socodka kala qeybinta unugyada jidhka bini'aadamka.

Noocyada haleelay xilligii uu pituitary

Sida laga soo xigtay haleelay xilligii uu pituitary factor ee etiological (23.0 MB) code waa:

1. Primary, horumarinta taas oo dhacda sabab u ah cudurka pituitary, iyo sida natiijo ah, yareynta heerarka hormone koritaanka.
2. Hypothalamic, horumarinta taas oo ay sabab u tahay hoos u dhac in heerka hoormoonka sii daayo hypothalamic, loogu talagalay in lagu qabto saamayn ku qanjirka pituitary ee.
3. Weheliyay iska caabin ah unugyada in hormoonka koritaanka. Its horumarinta waxaa sabab u ah awood la'aanta in receptors in unugyada diirada si fiican u jawaabaan ficil ee hoormoonka.

etiopathogenesis

Sababta oo ah haleelay xilligii uu pituitary waxaa laga yaabaa in guuldaradii ka mid ah pituitary ee: buro (meningioma, craniopharyngioma, adenoma chromophobe), dhaawacyada, sun ah, dhaawac faafa gobolka pituitary mezhutochno- ama dysregulation qanjirka pituitary by hypothalamus ah. Si kastaba ha ahaatee, cudurka noocyadiisa ugu xiriiraa nooc ka mid ah hidde.

Qaybinta weyn ayaa haleelay xilligii uu pangipopituitarnaya, taas oo u egtahay in la dhaxlay nooca inta badan recessive. Waxaa jira warar in ay jiraan laba nooc oo ah noocyada la isugu gudbiyo cudurka this - autosomal iyo iyada oo loo marayo X-koromosoomyada. Oo ay la socdaan dheecaan ka mid ah cudurada hormoonka koritaanka in foomkan of haleelay xilligii iyo waxay badanaa ka dhacdaa dheecaanka disorder ee hormoonka thyroid-madadaalo iyo gonadotropins.

dheecaan yar oo wareersan yar ee ACTH. Sida by cilmiga functional sameeyay la sii daayo bukaanka hormone muujiyay (daraasadda ayaa sidoo kale ka mid ahaa iyo koritaanka dardaro hormone-daayo hormone, oo ka kooban 29, 40 iyo 44 harta amino acid), inta badan ee dadka bukaanka ah waxay leeyihiin cudurada ka mid ah hypothalamus ah, iyo horumarka aan ku filnayn ee qanjirka pituitary jilibka horeba waa feature sare. cudurada Primary of pituitary si toos ah dhacdo dhif ah.
Waxaa jira bukaan isagoo ah nabar ah habka dhexe ee neerfayaasha la'aan oxygen, tus, uurka badan.

Xumeeyaan horumarka jireed oo yaraada qaba cuduro qasac haleelay xilligii uu sida nafaqada aan ku filnayn iyo qaloocan, lagu gartaa a la'aanta protein, zinc iyo macdano kale, arrimo kasin deegaanka, jiritaanka cudurada degaaankaaga saameen.

calaamadaha

Baaqday waxqabadka aadanaha koritaanka iyo horumarka jirka ka heerarka celceliska - in lagu muujiyey haleelay xilligii uu pituitary. photo hoose muujinayaa calaamadaha cudurka.

Waxaa intaa dheer, dhasha ah ayaa caadi ah miisaanka jidhka iyo dhererka. Hagaasid waxaa badanaa lagu arkay oo kaliya in 2-4 sano nolosha, heerka koritaanka ilmaha caafimaad wakhtigan waa 7-8 cm sannadkii, halka carruurta la haleelay xilligii uu pituitary koraan by celcelis ahaan 2-3 cm hor inta hordhaca ah ee therapy hormoon. koritaanka tixgeliyo cilin loogu tala galay dumarka ka yar 120 cm waayo, nimankii - in ka yar 130 cm.

Sawirka caafimaad ee haleelay xilligii uu pituitary

Sida caadiga ah mid aad u fudud si loo ogaado jiritaanka ugub ah oo loo yaqaan haleelay xilligii uu pituitary. Waa maxay iyo sida ay u saamayn ku muuqaalka qofka, waxaan ku tilmaami si faahfaahsan hoos ku.

jirka ah ee bukaanka ayaa Joogaba haleelay xilligii uu pituitary caan carruurta. Waxaa jira dib u dhac ah ee waqtiga lafoobid ee lafaha, iyo sidoo kale dib u dhac ah ee isbedelka ee ilkaha, horumarinta saboolka ah oo ka mid ah qaybaha nidaamka muruqyada iyo baruurta subcutaneous, doorsoonka, qallayl, iyo wrinkling maqaarka, mararka qaarkood waxaa jira baruur xad-dhaaf ah on xabadka, bowdyaha iyo caloosha. Inta badan, ma jiraan wax hairiness sare.

Ephippium in 70-75% bukaannada ma beddelmin ee size (haray - hoos), laakiin ay qaab u dhigma carruurta da'da oo uu leeyahay qaab gadood taagan a. In the case of burooyinka pituitary ephippium arkay nabaad sii kordhaya ee derbiyadeeda.

Loss of gonadotropic function pituitary dhirfinaya dib u dhac ah oo inta badan horumarka galmo ah isagoon cudurada. Sida caadiga ah, ma sifooyinka galmada sare. Ragga bukaanka ah waxaa la dhimay ee marka la barbardhigo guska da'da caadi iyo prostate, xiniinyaha dhacsan. Inta badan dhibaatada dumar ah oo ka cudur ah, ma caadadu oo ay leeyihiin naasaha dhacsan.

Inta badan Intelligence bukaannada la hayo, marka laga reebo yihiin bukaanka qaba cudurka ah "haleelay xilligii uu pituitary", pathogenesis ah taas oo ay sabab u tahay burada dhaawac maskaxeed organic ama dabeecadda argagaxa leh.
Sifo cudurka waa splanhnomikriya - hoos u size of xubnaha gudaha, hypotension halbowlaha, wadnaha cidhiidhi codadka, hypotension soo noqnoqda, bradycardia. Malaha muujin ka timid hypothyroidism sare iyo hypocorticoidism.

Garashada haleelay xilligii uu pituitary

Sida caadiga ah cudurka "haleelay xilligii" ee dadka waaweyn shaki. data Anamnesis iyo shaybaarka adag, baaritaan caafimaad oo oo radiographic waa sal hormoon lagu ogaado "haleelay xilligii uu pituitary", code MB 10 23.0.

Qiimeynta koritaanka aadanaha

Si loo ogaado, kala oo aqoonsadaan cudur sida haleelay xilligii uu pituitary, calaamadaha, iyo daaweynta si sax ah loo ogaado, sameeyey qiimaynta xisaabeed ee koritaanka aadanaha. Waayo, qiimaynta, marka lagu daro baaxadda buuxda ee jirka, loo ogaado deficiency koritaanka oo wakiil ka faraqa u dhexeeya qiimaha height bukaanka iyo Heerka isku celceliska u dhiganta ay da'da iyo jinsiga, da'da koritaanka sida tallaabadaas qiyamka ee koritaanka bukaanka heerarka qaarkood, Qiimaha mid ah leexashooyinkaasi caadi:
N = P - PCP / δ,
halkaas oo P - height of bukaanka;
PCP - qiimaha celcelis ahaan koritaanka caadiga ah ee wakiilka ka mid ah jinsiga iyo da'da,
δ - fogaanta dhexdeena ka PCP.
Qiimaha diirada N <3 waa caadiga ah ee cudurada sida haleelay xilligii uu pituitary, haleelay xilligii, N> 3 - waayo gigantism. Tilmaamahan la qalo karo, iyo si ay u qiimeeyaan, dhaq-horumarinta.

Garashada haleelay xilligii uu pituitary ee carruurta

haleelay xilligii uu pituitary ee carruurta baahan tahay in hab dheeraad ah oo ka taxadartaa in ogaanshaha cudurka, sida inta badan waa sawirka caafimaad oo ma cadda. cudurka waxaa la siiyaa muddo lix bilood ilaa sanad ah. Wakhtigan ilmaha ka yar ilaalo waa, waxaa qoray daawaynta soo celiyo oo aan therapy hormone, nafaqada leh protein badan xoolaha, khudaarta iyo miraha, macdanka kaalshiyamka iyo fosfooraska, iyo vitamins A iyo D. Maqnaanshaha ku hoos jira xaalad kuwaas oo gelinba ku filan marka la eego koritaanka iyo horumarka jireed waa aasaas u ah waxbarashada sida, sida:

• hormone koritaanka dhiig;
• raajada cranial in lagu ogaado cudurada ee dhakada,
• X-rays ee xabadka, lafaha gacmaha iyo cumaacumaha, taas oo daaha ka da'da laf ka mid ah ilmaha ah;
• MRI;
• raajito loogu xisaabiyaa.

Iyada oo ku saleysan waxbarashada, kuwaas oo go'aan ka gaari kara sababta cudurka iyo si ay u bilaabaan daaweynta hoormoonka.

daaweynta

Marka baaritaanka cudurada sida haleelay xilligii uu pituitary, ku salaysan daaweynta maamula in hormoonka koritaanka aadanaha oo ah qaab koorsooyinka daweynta go'aysa. Qiyaasta ee hormone koritaanka maamulo ay ku xiran tahay halka uu ay ka kooban tahay in dhiigga, iyo sidoo kale bukaanka shaqsi. Wixii nuugista wanaagsan oo qaadashada hormone dose weyn advantageously fuliyay saacadood subaxdii, taas oo u dhiganta sifooyinka jir ah dheecaan hormoon. Carbinta horumarinta galmada waa la fuliyay ka dib markii habka of xiritaanka of zones koritaanka iyadoo la kaashanayo hormoonnada jinsiga.

The qiyaas ugu muhiimsan ee daweynta ee daaweynta ee haleelay xilligii waxaa sidoo kale bukaannada steroids dhiska, fosfooraska, daroogada, zinc, calcium, iyo biostimulants kaxeynayo vitamin, nafaqo ku filan.

Si aad u bilaabaan daaweynta waxaa lagu talinayaa in haleelay xilligii uu ku 5-7 sano.

therapy bedelay jirayaa dhowr sano, oo ay la socdaan kormeer joogta ah waxtarka daawooyinkaan qaaday by bukaanka iyo bedelka la ool ah, iyo dhammaanaysaa tirtiridda sababaha cudurka. Haddii aanad hagaajin karo dhibaatada bukaanka loo qoro daaweynta bedelka u ah nolosha. Iyada oo daaweyn ah si fiican u kala xajmi gaaray heerka koritaanka of 8-10 cm halkii sano ah, iyo qofka bukaanka ah kama duwana caruurta caafimaad.

Waxaa waajib ah inay dhawraan nolosha bukaannada by endocrinologist ah.

daaweynta hormoonka koritaanka

Sababtoo ah koobnaanta ee hormone aadanaha koritaanka firfircoon ee daaweynta ee haleelay xilligii waa hormone kaliya koritaanka aadanaha, soo saaro jidhka iyo sidoo kale koroowga. Loo isticmaalo somatotropin soo saaray Avv bakteeriyada by injineernimada hidde isticmaalaya coli Escherichia. Waxaa jira somatotropin ah, kiimikada dardaro waxay ka dhigan tahay, laakiin waxaa la dhowaad marnaba loo isticmaalo sababta oo ah qiimaha sare.

Experience muujinaysaa in qiimaha qiyaasta ugu yar ee wax ku ool ah muddo ugu horeysay daaweynta dhigmaan 0.03-0.06 mg halkii miisaanka jidhka kiilo. oolnimada ugu badnaan la qaadan 2-4 mg 3 jeer toddobaadkii. By kordhaya qiyaasta hal ilaa 10 mg saamayn koritaanka koror ku filan lama arkay, laakiin tilmaamay formation degdeg ah unugyada somatotropin. Faa'iidada muhiim u ah daaweynta hormoonka koritaanka waa dardargelinta ma lafoobid of lafaha on taariikhdiisa.

Isticmaalka steroids dhiska

Si aad mid ka mid ah qalabka ugu muhiimsan ee daaweynta ee haleelay xilligii la xidhiidha isticmaalka bukaanka ah steroids dhiska. tallaabo ay ku salaysan tahay kicinta ee koritaanka by sii kordhaya Avv borotiinka, Kuna sii kordhaya heerka hormoonka koritaanka qoomiyadda. daaweyn Tani waxaa lagu fuliyaa muddo dhowr sano ah, daroogada firfircoon ka yar si tartiib tartiib bedelay xeryahooda firfircoon. tusmo ee beddelo daawooyinka dhiska waa hoos u 2-3 sano saamayn koritaanka, taas oo, ka bacdi, waxay leedahay saameyn ah ee dheeraad ah kor u koritaanka. haleelay xilligii uu pituitary ku lug leedahay daaweynta steroids dhiska sida course-daweynta la xilliyo nasasho, loo siman yahay si muddada daryeelka badh. In habituation kiiska muujiyay iyo nasashada dheer (ilaa 4-6 bilood). Mid ka mid ah aqbaliddoodii shot ka mid ah nooca steroids dhiska mid kaliya, isku daawooyin badan shaqayn karto, maxaa yeelay xoojiyo tallaabo dhacaan ma. Qadarka Qaadashada ee steroids dhiska bilaabataa ugu yaraan wax ku ool ah oo ay la koror tartiib ah.

Daaweynta aan qaan gaarin galmada wiilasha

Daaweynta aan qaan gaarin galmada wiilasha cudurka haleelay xilligii waxaa la sameeyaa iyadoo la isticmaalayo gonadotorobin. Isticmaalka daroogada this ma bilaabi ka hor 15 sano, oo inta badan xitaa dambe ee nolosha. Saamaynta daroogada waxaa loogu talagalay madadaalo unugyada Leydig, si ay hawsha dhiska androgenic mahad dedejisaa iyo horumarinta galmada, iyo koritaanka. mudada The qiyaasta of qiyaasta daawada waa 1000 - 1500 IU, intramuscularly maamula 1-2 jeer toddobaadkii, laba ama saddex saf sanadkiiba. Haddii wiilasha 16 sano arkay saamayn qayb ahaan on daaweynta gonadotorobin, soo saaray talantaalli ah qaadasho yar oo androgens ( "Methyltestosterone" Sublingual 5-10 mg maalintii). stage koraysa ee daaweynta bukaanka lab qaata muddo dheer ku simaha antiandrogen - daroogada "testenat", "Omnadren-250", "Sustanon-250."

Daaweynta aan qaan gaarin galmada ee gabdhaha

gabdhaha, daaweynta bilaabi kartaa at 16, simulating kuuro hooseysa oo estrogen caadada caadiga ah. Waxaa la geeyey saddex toddobaad ka bil kasta gudahood. Wejigii labaad ee wareegga caadada ka toddobaadka saddexaad aad ku wareejin kartid qiyaasta gonadotrophin chorionic 1000-1500 IU si ay u helaan jadwalka 3-5 jeer toddobaadkii. kale waa daroogada tallaabo progestin ( "Borojestaroon," "Pregnin").

daaweynta buuxiya (at xaqiiqda kaamil ah xiritaanka of zones koritaanka) qaata hormoonnada jinsiga joogto ah kala qaabab daweynta. Tani waa lagama maarmaan si ay u xubnaha galmada iyo sifooyinka galmada sare ka gaadhay horumarka buuxa, si loo hubiyo heerka saxda ah ee libido iyo awoodba. bukaanada dumarka waxaa lagu qoray diyaarinta weheliso estrogen-progestin, sida "Non-ovlon", "Infekundin", "Bisekurin", "Rigevidon".

Odoroska

Saadaasha nolosha la haleelay xilligii uu pituitary ku xiran ay qaab. Haddii aad shakhsi ahaan wajahdo dhibaato noocan oo kale ah, sida haleelay xilligii uu ku pituitary hidde, waxaa waaqiciga bartay, in jeclaan lahaa inaan idin xaqiijiyo - kiiskan, saadaasha waa wanaagsan. In joogitaanka burooyinka pituitary iyo lesions yimaada habdhiska dhimirka, dhaawac iyo wixii la mid ah E.., Saadaasha waxay ku xiran, dhaq-habka ugu weyn ee bahal ah.

Thanks to hababka casriga ah ee daaweynta ee awoodda jidhka iyo awooddaada shaqo ee dadka ka cabanaya haleelay xilligii, si weyn u kordhay hagaagay muddada ay nolosha. Inta lagu jiro muddada daawaynta firfircoon, daruuri fuliyay baaritaan nidaamsan bukaanka 2-3 bilood kasta, therapy dayactirka - baaritaan 6-12 bilood kasta.

factor asaasiga ah ee shaqada iyo la qabsashada bulshada bukaannada qaba haleelay xilligii yihiin awoodooda jireed iyo caqliga. Waxaa lagu talinayaa in ay doortaan xirfad, marka laga reebo jimicsi.