Dexamethasone kudzvinyirira bvunzo

Dexamethasone yekudzvinyirira bvunzo inoyera kuti adrenocorticotrophic hormone (ACTH) yakavharidzirwa neyepituitary inogona kudzvanywa.

Munguva yebvunzo iyi, uchagamuchira dexamethasone. Uyu ndiwo musimba wakagadzirwa nevanhu (synthetic) glucocorticoid mushonga. Mushure meizvozvo, ropa rako rinodhonzwa kuitira kuti chikamu checortisol muropa rako chikwanise kuyerwa.

Kune mhando mbiri dzakasiyana dze dexamethasone yekudzvinyirira bvunzo: yakaderera dosi uye yakakwira dosi. Mhando yega yega inogona kuitwa muhusiku (zvakajairika) kana yakajairwa (3-zuva) nzira (isingawanzo). Pane akasiyana maitirwo anogona kushandiswa kune chero bvunzo. Mienzaniso yeiyi inotsanangurwa pazasi.

Zvakajairika:

• Low-dose husiku - Iwe unozowana 1 milligram (mg) ye dexamethasone na11 pm, uye mupi wezvehutano anokwevera ropa rako mangwanani anotevera na8 mangwanani kuitira chiyero checortisol.
• Yakakwira-dhizaini husiku - Mupiro anoyera yako cortisol mangwanani emuedzo. Ipapo iwe unozogamuchira 8 mg ye dexamethasone na11 pm. Ropa rako rinodhonzwa mangwanani anotevera na8 mangwanani kuyerwa kwekortisol.

Kazhinji:

• Yepasi yakaderera-dosi - Urini inounganidzwa pamusoro pemazuva matatu (yakachengetwa mumaawa makumi maviri nemaviri ekuunganidza) kuyera cortisol. Pazuva rechipiri, iwe unowana dosi yakaderera (0.5 mg) ye dexamethasone nemuromo maawa matanhatu ese kwemaawa makumi mana nemasere.
• Yepamusoro soro-dhizaini - Urini inounganidzwa pamusoro pemazuva matatu (yakachengetwa mumaawa makumi maviri nemana ekuunganidza midziyo) kuyerwa kwekortisol. Pazuva rechipiri, iwe unogashira yakakwira dosi (2 mg) ye dexamethasone nemuromo maawa ese matanhatu kwemaawa makumi mana nemasere.

Verenga uye uteedzere rairo zvakanyatsonaka. Chikonzero chakanyanya kukonzereswa neyakajairika bvunzo ndeye apo mirawo isingateedzerwe.

Iye mupi anogona kukuudza kuti umire kutora mimwe mishonga inogona kukanganisa bvunzo, kusanganisira:

• Mishonga inorwisa mabhakitiriya
• Mishonga yekudzivirira kubata
• Mishonga ine corticosteroids, yakadai sehydrocortisone, prednisone
• Estrogen
• Oral kuberekwa kudzora (mishonga yekudzivirira)
• Mapiritsi emvura (diuretics)

Kana tsono ikaiswa kukweva ropa, vamwe vanhu vanonzwa kurwadziwa zvine mwero. Vamwe vanongonzwa kubaya kana kubaya. Mushure meizvozvo, panogona kuve nekurohwa kana kupwanya zvishoma. Izvi zvinokurumidza kuenda.

Muedzo uyu unoitwa kana mupi achifungidzira kuti muviri wako uri kuburitsa cortisol yakawandisa. Izvo zvinoitwa kuti ubatsire kuongorora Cushing syndrome uye kuona chinokonzera.

Iyo yakaderera-dose bvunzo inogona kubatsira kutaurira kana muviri wako uri kuburitsa yakawandisa ACTH. Iyo yepamusoro-dhizaini bvunzo inogona kubatsira kuona kana dambudziko riri mupituitary gland (Cushing chirwere).

Dexamethasone inogadzirwa nevanhu (synthetic) steroid iyo inonyorera kune imwechete receptor se cortisol. Dexamethasone inoderedza ACTH kuburitswa mune yakajairwa vanhu. Naizvozvo, kutora dexamethasone kunofanira kudzikisa ACTH mwero uye kutungamira kune yakaderera cortisol nhanho.

Kana yako pituitary gland ichiburitsa yakawandisa ACTH, iwe unenge uine mhinduro isina kujairika kune yakaderera-dose bvunzo. Asi iwe unogona kuve neyakajairwa mhinduro kune yakakwira-dose bvunzo.

Chikamu cheCortisol chinofanira kudzikira mushure mekutambira dexamethasone.

Low dose:

• Manheru - 8 am plasma cortisol yakaderera pane 1.8 micrograms pa deciliter (mcg / dL) kana 50 nanomoles pa litre (nmol / L)
• Yakajairwa - Urinary yemahara cortisol pazuva rechitatu rakadzika kupfuura gumi ma micrograms pazuva (mcg / zuva) kana 280 nmol / L

Mushonga wepamusoro:

• Manheru - yakakura kupfuura 50% kudzikiswa muplasma cortisol
• Standard - yakakura kudarika 90% kudzikisira muurinary yemahara cortisol

Zvakajairika kukosha masenduru anogona kusiyana zvishoma pakati pemarabhoritari akasiyana. Mamwe marabhoritari anoshandisa zviyero zvakasiyana kana anogona kuyedza mhando dzakasiyana. Taura nachiremba wako nezve zvinorehwa nemimwe miedzo yako.

Mhinduro isina kujairika kune yakaderera-dhizaini bvunzo inogona kureva kuti iwe une kusarongeka kusunungurwa kwecortisol (Cushing syndrome). Izvi zvinogona kuve nekuda kwe:

• Adrenal bundu rinogadzira cortisol
• Pituitary bundu rinogadzira ACTH
• Tumota mumuviri unoburitsa ACTH (ectopic Cushing syndrome)

Iyo yepamusoro-dhizaini bvunzo inogona kubatsira kutaurira iyo pituitary chinokonzera (Cushing chirwere) kubva kune zvimwe zvikonzero. Kuongororwa kweropa kweACTH kunogona kubatsirawo kuziva chinokonzera cortisol yakakura.

Mhedzisiro isina kujairika inosiyana zvichienderana nemamiriro ezvinhu achikonzera dambudziko.

Cushing syndrome inokonzerwa neadrenal bundu:

• Low-dose bvunzo - hapana kuderera muropa cortisol
• ACTH mwero - pasi
• Muzviitiko zvakawanda, iyo yepamusoro-dhizaini bvunzo haina kudikanwa

Ectopic Cushing chirwere:

• Low-dose bvunzo - hapana kuderera muropa cortisol
• ACTH nhanho - yakakwira
• Yepamusoro-dhizaini bvunzo - hapana kuderera kweropa cortisol

Cushing syndrome inokonzerwa nepituitary bundu (Cushing chirwere)

• Low-dose bvunzo - hapana kuderera muropa cortisol
• Yepamusoro-dose bvunzo - inotarisirwa kuderera muropa cortisol

Mhedzisiro mhedzisiro mhedzisiro inogona kuitika nekuda kwezvikonzero zvakawanda, zvinosanganisira akasiyana mishonga, kufutisa, kushushikana, uye kushushikana. Mhedzisiro mhedzisiro yakajairika muvakadzi kupfuura varume.

Pane njodzi shoma inosanganisirwa nekutorwa kweropa rako. Tsinga uye tsinga zvinosiyana muhukuru kubva kune mumwe murwere kuenda kune mumwe, uye kubva kune rimwe divi remuviri kuenda kune rimwe.Kutora ropa kubva kune vamwe vanhu kunogona kunge kwakaoma kupfuura kubva kune vamwe.

Dzimwe njodzi dzinosangana nekutorwa kweropa idiki, asi dzinogona kusanganisira:

• Kuwedzera kubuda ropa
• Kufenda kana kunzwa kushaya musoro
• Akawanda punctures ekutsvaga mutsinga
• Hematoma (ropa rinoungana pasi peganda)
• Utachiona (hushoma njodzi chero nguva ganda parinovhunika)

DST; ACTH kudzvinyirira bvunzo; Cortisol kudzvinyirira bvunzo

Chernecky CC, Berger BJ. Dexamethasone kudzvinyirira bvunzo - kuongororwa. Mune: Chernecky CC, Berger BJ, eds. Rabhoritari Kuyedza uye Maitiro Ekuongorora. 6th ed. St Louis, MO: Elsevier Saunders; 2013: 437-438.

Guber HA, Farag AF. Kuongorora kwe endocrine basa. Mune: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis uye Management nemaLabhoritari Maitiro. 23rd ed. St Louis, MO: Elsevier; 2017: chitsiko 24.

Stewart PM, Newell-Mutengo JDC. Iyo adrenal cortex. Mune: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Chinyorwa cheEndocrinology. 13 ed. Philadelphia, PA: Elsevier; 2016: chits.