Kev Ntsuas ACTH (Kev Ntsuas Synacthen Luv): Nws Qhia Txog Koj Cov Qog Adrenal

Tus yuam sij takeaways

• Kev kuaj ACTH stimulation kuaj cov qog adrenal ' muaj peev xwm teb tau, tsis yog lub qog pituitary ncaj qha.
• Ib qho kev teb zoo li qub ua rau tsis muaj peev xwm ua haujlwm ntawm adrenal thawj zaug, tab sis tsis yog qhov tseeb tias tsis suav nrog qhov tsis muaj peev xwm ua haujlwm ntawm pituitary (theem ob) adrenal tshiab lossis ib nrab.
• Cov kev txiav tawm ntawm Cortisol txawv ntawm cov chaw kuaj mob vim tias kev ntsuam xyuas sib txawv; koj tus kheej lub chaw kuaj mob qhov txwv siv tau.
• Cov tshuaj steroid, suav nrog cov tshuaj nqus pa, cov tshuaj pleev rau daim tawv nqaij, cov tshuaj txhaj rau pob qij txha thiab qee cov tshuaj ayurvedic lossis cov hmoov "mob pob qij txha" uas tsis muaj daim ntawv lo, tuaj yeem hloov qhov tshwm sim.
• Tsis txhob pib, tsum lossis txo cov tshuaj steroid uas tau muab tshuaj kom npaj rau kev kuaj mob. Tham nrog tus kws kho mob ua ntej.

Ib nrais muag

Kuj hu ua

Hauv cov chaw kuaj mob thiab cov ntawv yuav tshuaj hauv Is Nrias teb koj yuav pom: kev kuaj Synacthen , kev kuaj Synacthen luv luv (SST) , kev kuaj ACTH stim , kev kuaj cortisol stimulation , kev kuaj cosyntropin , lossis tsuas yog "kev kuaj adrenal function" . Nws txawv ntawm kev kuaj cortisol thaum sawv ntxov lossis kev kuaj ntshav ACTH hauv cov ntshav , uas yog cov qauv ib zaug xwb tsis muaj kev txhaj tshuaj.

Kev kuaj mob ACTH yog dab tsi

ACTH (adrenocorticotropic hormone) yog tsim los ntawm lub qog pituitary thiab qhia rau lub adrenal cortex kom tsim cortisol. Hauv qhov kev xeem ACTH stimulation, ib qho synthetic version ntawm ACTH raug txhaj tshuaj kom cov qog adrenal tau txais lub teeb liab muaj zog, tus qauv. Tom qab ntawd ntsuas cov cortisol hauv cov ntshav kom pom seb lub adrenal cortex puas tuaj yeem teb tau.

Tus qauv siv 250 microgram koob tshuaj. Qee lub chaw siv cov koob tshuaj tsawg (1 microgram), uas tsis yog tus qauv rau kev npaj lossis kev txhais lus thiab siv xaiv. Qhov kev kuaj mob tsis suav nrog kev siv hluav taws xob thiab tsis xav tau kev siv tshuaj loog.

Vim li cas thiaj ua qhov kev kuaj mob ACTH stimulation

• Xav tias muaj teeb meem adrenal tsis txaus: qaug zog yam tsis paub ua ntej nrog rau cov ntshav siab qis, ntshaw ntsev, poob phaus, sodium tsawg, potassium ntau, tawv nqaij tsaus zuj zus lossis poob qis tas li yam tsis paub ua ntej.
• Tom qab siv tshuaj steroid ntev ntev, cov tsos mob nram qab no yuav tshwm sim: los ntsuam xyuas seb lub adrenal ua haujlwm puas tau zoo dua, thaum tus kws kho mob txiav txim siab tias qhov kev sim no muaj txiaj ntsig.
• Paub los yog xav tias muaj kab mob pituitary: tom qab phais mob pituitary, radiotherapy, apoplexy, lossis hauv hypopituitarism, feem ntau ua ke nrog lwm yam kev kuaj pituitary.
• Kev loj hlob ntawm cov qog adrenal hauv lub cev: tshwj xeeb tshaj yog cov CAH uas tsis yog classic, qhov twg 17-hydroxyprogesterone ntsuas ua ntej thiab tom qab ACTH.
• Kev ua raws li kev phais mob adrenal thaum muaj cov adrenal reserve seem.

Leej twg yuav tsum tau txais qhov kev xeem no

Kev kuaj ACTH tsis yog kev kuaj mob thiab tsis muaj txiaj ntsig rau kev qaug zog dav dav. Nws yog qhov tsim nyog thaum tus kws kho mob muaj kev xav tias muaj mob tshwj xeeb, xws li:

• Twb tau tshaj tawm tias muaj cortisol tsawg lossis qis thaum sawv ntxov.
• Cov tsos mob thiab biochemistry qhia txog tus kab mob Addison (hyponatraemia nrog hyperkalemia, hypotension tsis paub meej, hyperpigmentation).
• Npaj tshem tawm cov glucocorticoids mus sij hawm ntev, lossis cov tsos mob thaum maj mam ploj mus.
• Kab mob pituitary uas muaj cov qauv, lossis kev phais pituitary lossis kev kho mob radiotherapy yav dhau los.
• Cov menyuam mos thiab cov menyuam yaus uas muaj qhov chaw mos tsis meej, teeb meem ntsev poob, cov plaub hau ntawm qhov chaw mos thaum ntxov lossis hypoglycemia tsis paub meej, ntsuas los ntawm tus kws kho mob endocrinologist menyuam yaus.
• Cov neeg laus uas xav tias tsis yog hom CAH qub muaj cov plaub hau hirsutism, voj voog tsis xwm yeem lossis tsis muaj menyuam.

Cov neeg uas twb noj tshuaj hydrocortisone hloov rau qhov tsis txaus adrenal feem ntau tsis tas yuav kuaj dua; kev saib xyuas yog qhov kho mob.

Qhov kev kuaj ACTH stimulation tsis tuaj yeem ntes lossis tsis suav nrog

• Nws tsis tuaj yeem nrhiav tau qhov teeb meem ntawm nws tus kheej. Yog tias cov lus teb tsis zoo qhia tau tias lub adrenal cortex ua haujlwm tsis zoo; nws tsis qhia tias qhov teeb meem yog adrenal, pituitary lossis hypothalamic. Baseline plasma ACTH, renin thiab aldosterone, adrenal antibodies thiab imaging yog qhov yuav tsum tau ua rau qhov ntawd.
• Nws tuaj yeem plam qhov tsis txaus adrenal theem ob tsis ntev los no. Yog tias ACTH hauv lub qog pituitary tsuas yog ua tsis tau zoo hauv ob peb lub lis piam dhau los no xwb, tej zaum cov qog adrenal tseem tsis tau lwj thiab tseem tuaj yeem teb tau zoo li qub. Kev kuaj mob zoo li qub hauv qhov chaw ntawd tsis suav nrog qhov tsis txaus ntawm cov adrenal hauv nruab nrab.
• Nws tuaj yeem plam ib feem lossis me me hauv nruab nrab. Kev kuaj mob insulin lossis lwm yam kev kuaj mob dynamic yuav tsum tau ua, txiav txim siab los ntawm tus kws endocrinologist.
• Nws tsis kuaj mob Cushing syndrome los yog cortisol ntau dhau.
• Nws tsis qhia dab tsi txog adrenal anatomy: tsis muaj pob, tsis muaj qog, tsis muaj ntshav, tsis muaj calcification lossis tsis muaj tuberculosis ntawm adrenals. Qhov ntawd xav tau CT lossis MRI.
• Nws tsis ntsuas kev ua haujlwm ntawm adrenal medulla (adrenaline, noradrenaline) lossis phaeochromocytoma.
• Nws tsis yog kev kuaj mob thyroid, kev loj hlob hormone lossis prolactin, txawm hais tias cov no feem ntau raug kuaj xyuas cais hauv cov kab mob pituitary.
• Ib qho txiaj ntsig ib txwm yog "tsis tau txheeb xyuas", tsis yog "tsis suav nrog". Yog tias koj cov tsos mob tseem muaj txawm tias koj tau kuaj ACTH li qub, rov qab mus ntsib koj tus kws kho mob dua li xav tias qhov teeb meem tau daws lawm.

Kev ntsuam xyuas sib txuas tab sis sib txawv, thiab lawv sib piv li cas

Cov kev xeem no teb cov lus nug sib txawv. Tsis muaj ib qho zoo tshaj plaws thoob plaws; qhov twg los ua ntej nyob ntawm qhov teeb meem kev kho mob.

Yuav npaj li cas rau qhov kev xeem ACTH stimulation

Kev npaj ua haujlwm yog qhov ua tau thiab txawv ntawm cov tsev kho mob thiab cov chaw kuaj mob. Cov lus qhia uas koj chav haujlwm muab rau koj muaj qhov tseem ceeb dua li txhua yam uas sau ntawm no.

• Daim ntawv teev cov tshuaj: Nqa txhua yam tshuaj thiab cov tshuaj ntxiv, suav nrog cov tshuaj nqus pa, cov tshuaj tsuag qhov ntswg, cov tshuaj tee qhov muag, cov tshuaj pleev rau daim tawv nqaij, cov tshuaj txhaj rau pob qij txha, cov tshuaj ayurvedic lossis homeopathic thiab cov tshuaj ntxiv rau hauv gym. Muaj ntau cov tshuaj uas tsis muaj daim ntawv lo rau kev mob thiab "muaj zog" uas muag hauv Is Nrias teb muaj cov tshuaj steroids.
• Tsis txhob tsum tsis txhob noj cov tshuaj steroid uas koj tau sau tseg. Tsuas yog tus kws sau ntawv thiaj li qhia tau seb puas yuav hloov lossis hloov koob tshuaj ua ntej kuaj, thaum twg thiab yuav ua li cas. Kev tso tseg kev siv tshuaj steroids tam sim ntawd tuaj yeem ua rau muaj kev phom sij.
• Cov tshuaj uas muaj estrogen: Cov tshuaj tiv thaiv kev xeeb tub thiab kev kho mob hormone ua rau cov cortisol-binding globulin nce thiab tuaj yeem ua rau tag nrho cov cortisol uas ntsuas tau nce. Koj tus kws kho mob yuav qhia kom ntxuav lub sijhawm, qhov no yog kev txiav txim siab kho mob, tsis yog ib yam dab tsi ua koj tus kheej.
• sij hawm: ntau chav kawm teem caij xeem thaum sawv ntxov; ua raws li koj lub sijhawm teem tseg.
• Kev yoo mov: Feem ntau qhov kev kuaj ACTH stimulation tsis tas yuav tsum tau yoo mov, tab sis qee lub chav kuaj yuav yoo mov rau cov neeg mob yog tias muaj lwm yam kev kuaj tib lub sijhawm. Paub meej nrog koj lub chav kuaj.
• Lub sijhawm tso cai: npaj yuav nyob hauv chav tsev li ntawm 60-90 feeb, qee zaum ntev dua yog tias ntxiv cov qauv kuaj thiab kev soj ntsuam 60 feeb.

Yog tias koj cev xeeb tub lossis pub niam mis

Cortisol thiab cortisol-binding globulin nce siab thaum cev xeeb tub, yog li ntawd, kev txiav txim siab ib txwm tsis siv thiab kev txhais lus xav tau tus kws kho endocrinologist. Qhia rau lub chaw kuaj mob tias koj cev xeeb tub ua ntej txhaj tshuaj.

Yog koj muaj mob ntshav qab zib uas tab tom kho mob kom txo cov piam thaj (glycolysis)

Yog koj lub chaw kho mob hais kom koj yoo mov, nug tus kws kho mob seb yuav siv insulin lossis sulfonylurea li cas thaum sawv ntxov, thiab nqa glucose nrog koj. Tsis txhob yoo mov ntev yam tsis tau txais cov lus qhia ntawd.

Yog tias koj muaj mob plawv tsis ua haujlwm, mob raum ntev lossis kev txwv dej

Tsis txhob haus dej ntau dhau rau qhov kev kuaj no. Cov lus qhia dav dav txog "haus dej ntau" tsis siv tau yog tias koj tau muab kev txwv dej rau koj haus.

Cov me nyuam

Kev kuaj mob rau menyuam yaus siv cov txheej txheem kho qhov hnyav thiab cov kev xav tau sib txawv, thiab yuav tsum tau npaj los ntawm kev pabcuam endocrinology rau menyuam yaus. Nqa ib qho khoom noj lossis khoom noj txom ncauj, thiab ib qho kev cuam tshuam rau lub cannula.

Cov neeg laus thiab cov neeg noj ntau yam tshuaj

Saib daim ntawv teev cov tshuaj kom zoo zoo; cov tshuaj steroids uas siv rau sab nraud thiab cov tshuaj uas siv rau hauv qhov ncauj feem ntau tsis nco qab thiab feem ntau yog qhov tseem ceeb.

Yuav muaj dab tsi tshwm sim thaum lub sijhawm kuaj ACTH stimulation

Cov qauv kuaj ntshav. Cov ntshav raug rho tawm rau cortisol, qee zaum nrog ACTH, aldosterone, renin lossis 17-hydroxyprogesterone.

Kev txhaj tshuaj. Cov tshuaj ACTH uas tsim los ntawm tib neeg raug muab rau hauv cov hlab ntsha lossis cov leeg nqaij. Cov neeg feem coob tsis hnov ​​​​​​dab tsi ntxiv tshaj li koob txhaj tshuaj; qee tus pom tias nws liab me ntsis.

Rov ua cov qauv kuaj dua. Cortisol raug ntsuas ntawm 30 feeb, 60 feeb, lossis ob qho tib si, nyob ntawm tus txheej txheem siv.

Kev Soj Ntsuam. Cov neeg ua haujlwm yuav cia koj nyob hauv chav tsev thaum koj kos npe. Feem ntau koj tuaj yeem nyeem ntawv lossis zaum ntsiag to; tsis txhob ua tej yam nyuaj.

Tom qab ntawd. Tej yam ua ub ua no thiab kev noj mov li qub tuaj yeem rov qab ua tau tsuas yog tias tsis tau hais lwm yam. Tsis muaj tshuaj loog, yog li koj tuaj yeem tsav tsheb mus tsev tsuas yog tias koj lub chaw kho mob qhia lwm yam.

Kev nkag siab txog koj daim ntawv qhia

Daim ntawv qhia qhia txog cortisol thaum pib thiab tom qab kev txhawb zog, feem ntau yog micrograms ib decilitre (mcg/dL) lossis nanomoles ib litre (nmol/L). Kev txhais lus nyob ntawm:

• Tus nqi cortisol siab tshaj plaws ncav cuag tom qab txhaj tshuaj, qhov no yog tus lej tseem ceeb.
• Qhov kev ntsuam xyuas tshwj xeeb siv. Cov kev ntsuas mass-spectrometry tshiab dua thiab cov kev ntsuas immunoassays tiam ob muab cov nqi cortisol qis dua li cov kev ntsuas qub, yog li cov kev ntsuas keeb kwm yav dhau los tuaj yeem kuaj pom tias muaj teeb meem adrenal tsis txaus. Koj lub chaw kuaj mob tau hais tias qhov kawg yog qhov siv tau.
• Koj daim duab kho mob thiab lwm yam tshuaj hormones, suav nrog ACTH, sodium, potassium thiab lwm yam kev kuaj mob pituitary.

Dav dav: qhov nce cortisol txaus sib cav tiv thaiv qhov tsis txaus adrenal thawj zaug; qhov nce tsis muaj lossis tsis muaj txhawb nqa nws thiab ua rau muaj kev kuaj ntxiv kom paub qhov ua rau. Vim tias qhov txwv yog qhov kev ntsuam xyuas tshwj xeeb, nplooj ntawv no tsis hais txog ib qho lej txiav tawm. Tsis muaj qhov tshwm sim yuav tsum tau txhais tus kheej, tsuas yog tus kws kho mob uas tau thov kev kuaj thiaj li tuaj yeem txhais nws hauv koj qhov xwm txheej kho mob.

Thaum cov txiaj ntsig ntawm kev xeem ACTH stimulation tuaj yeem ua rau yuam kev

Kev ntseeg siab cuav (cortisol zoo li txaus thaum lub axis raug cuam tshuam)

• Tsis ntev los no pituitary ACTH deficiency: cov qog adrenal tseem tsis tau atrophied thiab tseem teb.
• Ib nrab lossis me me hauv nruab nrab adrenal tsis txaus, qhov twg ib koob tshuaj supraphysiological ACTH overpasses ib qho me me tsis zoo.
• Cov tshuaj cortisol-binding globulin siab los ntawm kev cev xeeb tub, kev noj tshuaj estrogen lossis kev sib xyaw ua ke ntawm kev tiv thaiv kab mob, ua rau cov cortisol tag nrho nce ntxiv.
• Cov tshuaj hydrocortisone lossis prednisolone uas tau muab tso rau hauv lub cev tsis ntev los no kev sib tshuam nrog qee qhov kev ntsuam xyuas immunoassays thiab kev nce qib ntawm cortisol. Dexamethasone tsis sib tshuam tib yam.
• Cov kev ntsuam xyuas immunoassays qub dua, tsis tshua muaj kev tshwj xeeb nyeem ntawv siab dua li qhov ntsuas qhov loj.

Kev txhawj xeeb cuav (cortisol zoo li qis thaum lub axis txaus)

• Cov protein uas khi tsawgmob nephrotic syndrome, mob siab ntev, tsis muaj zaub mov zoo lossis mob hnyav ua rau cortisol tag nrho qis dua txawm tias cortisol dawb txaus.
• Kev raug tshuaj steroid tsis ntev los no ntawm txhua txoj kev uas txwv tsis pub lub axis ib ntus, suav nrog kev txhaj tshuaj ib leeg thiab cov tshuaj pleev tawv nqaij muaj zog.
• Kuaj sai dhau tom qab phais mob pituitary lossis apoplexy.
• Cov tshuaj cuam tshuam xws li mitotane, ketoconazole, metyrapone lossis etomidate, uas thaiv cortisol synthesis.
• Kev hloov pauv ntawm kev ntsuas: qhov tshwm sim uas zoo li qis dua li daim ntawv tshaj tawm qub tsuas yog qhia txog qhov kev ntsuam xyuas tshiab dua, tshwj xeeb dua, tsis yog kev puas tsuaj.
• Kev kuaj lossis kev ua yuam kev, lub sijhawm tsis raug, lossis kev txhaj tshuaj tsis xa tag nrho.

Kev ntxhov siab thiab kev mob nkeeg feem ntau ua rau cortisol nce siab dua li txo qis, tab sis kev mob nkeeg hnyav hloov cov protein khi thiab ua rau kev txhais lus tsis ntseeg tau. Hauv kev mob nkeeg hnyav, kev txiav txim siab kho mob feem ntau yog ua hauv kev kho mob es tsis yog tos kev kuaj mob.

Kev Pheej Hmoo thiab Kev Nyab Xeeb

Feem ntau kev kuaj ACTH uas ua los ntawm cov khoom siv hluavtaws yeej ua tau zoo, tiamsis tsis muaj kev txhaj tshuaj twg uas tsis muaj kev pheej hmoo. Cov txiaj ntsig thiab cov tshuaj tiv thaiv sib txawv nyob ntawm tus neeg mob tus mob.

Kev kuaj ntshav

Mob nqaij ntuag, mob ib ntus, muaj cov ntshav me me, thiab qee zaum kiv taub hau lossis tsaus muag. Tsis tshua muaj, muaj kab mob hauv zos lossis khaus cov hlab ntsha ntawm qhov chaw txhaj tshuaj.

Kev txhaj tshuaj ACTH hluavtaws (cosyntropin/tetracosactide)

Yuav muaj kev kub hnyiab, xeev siab me ntsis, mob taub hau lossis ntshav siab nce ib ntus. Tau muaj kev tshaj tawm tias muaj kev tsis haum tshuaj ntau dhau, suav nrog cov tshuaj anaphylaxis tsawg tsawg, qhov kev pheej hmoo siab dua rau cov neeg uas muaj keeb kwm ua xua rau cov tshuaj ACTH, thiab cov chaw kho mob khaws cov chaw cawm siav. Depot (ua haujlwm ntev) tetracosactide feem ntau cuam tshuam nrog kev tsis haum tshuaj ntau dua li cov tshuaj ua haujlwm luv luv thiab tsis yog tus neeg sawv cev rau qhov kev kuaj no. Qhia rau cov neeg ua haujlwm tam sim ntawd txog kev ua pob khaus, o ntawm daim di ncauj lossis tus nplaig, ua pa nrov nrov lossis tsaus muag.

Cov tshuaj tsawg tsawg

Cov tsos mob ntawm cov tshuaj no zoo sib xws, tab sis cov kauj ruam dilution ua rau muaj kev pheej hmoo ntawm kev ntsuas tshuaj yuam kev, uas yog ib qho laj thawj uas qhov kev sim tshuaj tsawg tsawg tsis siv txhua qhov chaw.

Cov xwm txheej tshwj xeeb

Cev xeeb tub

Qhov kev nce ntxiv ntawm cortisol thiab binding globulin hauv lub cev txhais tau tias kev txiav tawm ntawm cov neeg tsis cev xeeb tub tsis siv tau; kev txhais lus tshwj xeeb rau peb lub hlis twg yog qhov yuav tsum tau los ntawm tus kws kho endocrinologist. Qhov kev kuaj no yog ua thaum cev xeeb tub thaum xav tau tiag tiag, nrog rau kev pab tswv yim los ntawm kws kho mob yug menyuam.

Cov menyuam yaus thiab cov menyuam mos

Cov koob tshuaj, cov sijhawm kuaj thiab cov lus teb uas xav tau txawv ntawm cov neeg laus. Hauv cov neeg uas xav tias muaj teeb meem adrenal hyperplasia, 17-hydroxyprogesterone es tsis yog cortisol ib leeg xwb yuav yog qhov tseem ceeb ntawm kev ntsuas. Kev saib xyuas endocrinology menyuam yaus yog tus qauv.

Cov neeg noj tshuaj steroids ntev

Kev siv tshuaj steroid ntev ntev hauv qhov ncauj, nqus pa, siv rau sab nraud lossis txhaj tshuaj yuav ua rau HPA tsis ua haujlwm. Lub sijhawm ntawm kev kuaj mob piv rau qhov koob tshuaj kawg yog qhov tseem ceeb thiab tus kws sau ntawv txiav txim siab. Tsis txhob tso tseg lossis txo cov tshuaj raws li koj tus kheej xav tau.

Kab mob raum ntev thiab kab mob siab

Cov protein uas khi thiab kev siv tshuaj uas hloov pauv lawm cuam tshuam rau tag nrho cov cortisol. Cov txiaj ntsig yuav tsum tau txhais ua ke nrog albumin thiab tag nrho cov xwm txheej hauv kev kho mob.

Cov neeg mob hnyav heev

Qhov kev sim tshuaj stimulation ua tsis tau zoo rau cov mob hnyav thiab tsis pom zoo kom siv cov tshuaj steroid hauv cov mob septic shock; kev tswj hwm yog kev kho mob.

Cov laus

Cov tsos mob xws li qaug zog, tsis xav noj mov thiab kiv taub hau sib tshooj nrog ntau lwm yam mob thiab nrog cov kev phiv tshuaj, yog li cov txiaj ntsig yuav tsum tau nyeem raws li daim duab tag nrho.

Kev kuaj mob ACTH hauv Is Nrias teb

• Kab mob ntsws tseem yog ib qho ua rau muaj teeb meem adrenal tsis txaus hauv Is Nrias teb, ua ke nrog tus kab mob Addison uas tiv thaiv kab mob autoimmune. Kev thaij duab adrenal yuav raug npaj yog tias pom tseeb tias tsis muaj adrenal txaus, thiab ib txwm nug txog TB yav dhau los lossis tam sim no.
• Kev raug tshuaj steroid tsis raug tswj hwm yog qhov tshwm sim. Cov tshuaj pleev tawv nqaij uas tsis tas yuav muaj daim ntawv yuav tshuaj, cov tshuaj steroid txhaj rau mob pob qij txha, qee cov hmoov "tshuaj txo qhov mob" uas tsim tshwj xeeb, thiab cov tshuaj ntxiv uas muaj steroid tuaj yeem tswj cov adrenal axis. Kev qhia cov no yog ib qho tseem ceeb; Txoj Cai Tshuaj thiab Kev Kho Mob Khawv Koob (Kev Tshaj Tawm Tsis Zoo) Xyoo 1954 txwv tsis pub tshaj tawm cov lus thov kho mob zoo li no, tab sis cov khoom tseem muaj nyob.
• Muaj qhov chaw nyob sib txawv. Kev muab ACTH hluavtaws tuaj yeem tsis tu ncua hauv qee thaj chaw, yog li qhov kev kuaj mob feem ntau yog ua ntawm cov chaw uas muaj kev txhawb nqa endocrinology thiab nkag mus rau kev txhaj tshuaj.
• Qhov sib txawv ntawm kev ntsuam xyuas ntawm cov chaw soj nstuam hauv Is Nrias teb yog qhov tseeb. Kev muab tus nqi cortisol los ntawm ib lub chaw kuaj mob piv rau qhov txiav tawm uas lwm qhov hais tuaj yeem ua rau yuam kev. Yog tias ua tau, siv tib lub chaw kuaj mob rau kev kuaj mob ntau zaus.
• Cov ntaub ntawv ntiag tug: Cov ntaub ntawv kev noj qab haus huv tus kheej uas tau sau rau kev teem caij thiab cov ntawv qhia raug tswj hwm raws li Txoj Cai Tiv Thaiv Cov Ntaub Ntawv Tus Kheej Digital 2023.
• Cov ntaub ntawv xwm txheej ceev ntawm cov tshuaj steroid: Yog tias pom tseeb tias muaj teeb meem adrenal insufficiency, thov kom muaj cov cai sau rau hnub mob, daim npav ceeb toom steroid, thiab kev cob qhia rau kev txhaj tshuaj hydrocortisone thaum muaj xwm txheej ceev, tshwj xeeb tshaj yog qhov tseem ceeb uas kev mus rau tsev kho mob yuav siv sijhawm ntev.

Tus nqi thiab kev pov hwm hauv Is Nrias teb

Cov nqi sib txawv ntawm cov tsev kho mob tsoomfwv, cov tsev kho mob trust thiab cov chaw kuaj mob ntiag tug, thiab ntawm cov nroog. Cov nqi feem ntau yog ua los ntawm:

• Kev txhaj tshuaj ACTH hluavtaws: feem ntau yog qhov loj tshaj plaws ib qho khoom, thiab rhiab heev rau kev muab khoom thiab hom.
• Kev ntsuam xyuas Cortisol: them rau ib qho qauv, yog li ib daim ntawv pov thawj peb-qauv raug nqi ntau dua li ib daim ntawv pov thawj ob-qauv.
• Cov tshuaj hormones ntxiv xws li ACTH, aldosterone, renin lossis 17-hydroxyprogesterone.
• Cov nqi zov menyuam lossis kev soj ntsuam, lub sijhawm cannulation thiab kev pub niam mis.
• Kev sab laj nqi rau tus kws kho mob endocrinologist xaj thiab txhais cov kev kuaj mob.
• Kev kuaj rov ua dua lossis kev kuaj xyuas kom meej, thiab txhua yam kev thaij duab uas ua raws li qhov tshwm sim tsis zoo.

Tus cwj pwm ntawm kev pov hwm kuj txawv: kev kuaj mob sab nraud feem ntau raug tshem tawm ntawm cov cai them nqi yooj yim tab sis yuav raug them thaum kuaj mob thaum nkag mus lossis nyob rau hauv OPD cov nyiaj pab. Cov phiaj xwm tsoomfwv thiab cov pob khoom hauv tsev kho mob muaj lawv cov cai. Nug lub rooj them nqi hauv tsev kho mob kom tau txais kev kwv yees sau ntawv thiab koj tus neeg pov hwm kom tau txais kev taw qhia ua ntej kev teem sijhawm.

Cov lus dab neeg thiab qhov tseeb

Lus nug cov lus nug

Ntev npaum li cas ACTH stimulation test siv sijhawm?

Cov neeg feem coob nyob hauv chav li ntawm 60-90 feeb. Qhov ntawd suav nrog kev kos ntshav thawj zaug, kev txhaj tshuaj, kev kuaj ntshav thaum 30 feeb thiab feem ntau dua thaum 60 feeb, ntxiv rau lub sijhawm soj ntsuam luv luv. Kev sau npe, kev txhaj tshuaj cannulation thiab kev tos chav phlebotomy tuaj yeem ntxiv sijhawm.

Kuv puas yuav tsum tau yoo mov ua ntej ACTH stimulation test?

Feem ntau tsis tas yuav tsum yoo mov rau qhov kev kuaj ACTH nws tus kheej. Qee chav kuaj yoo mov rau cov neeg mob vim tias lwm cov kev kuaj ntshav raug sau rau tib lub sijhawm mus ntsib. Cov cai yoo mov yog tshwj xeeb rau ib chav, yog li paub meej nrog lub chaw kuaj mob thaum teem sijhawm, tshwj xeeb tshaj yog tias koj noj insulin lossis sulfonylureas.

Puas yog qhov txhaj tshuaj mob?

Qhov tsis xis nyob yog zoo li raug koob txhaj, ntxiv rau ib lossis ob zaug ntshav. Ib txhia neeg pom tias sov me ntsis lossis ntsej muag liab tom qab txhaj tshuaj. Yog tias koob txhaj ua rau koj ntxhov siab lossis tsaus muag, qhia rau cov neeg ua haujlwm ua ntej kom koj thiaj li pw tau thiab muaj sijhawm ntxiv.

Kuv puas noj tau kuv cov hydrocortisone thaum sawv ntxov ntawm qhov kev kuaj mob?

Tsis txhob txiav txim siab qhov no koj tus kheej. Cov tshuaj hydrocortisone lossis prednisolone tsis ntev los no tuaj yeem cuam tshuam rau qee qhov kev ntsuam xyuas cortisol thiab nrog lub ntsiab lus ntawm qhov tshwm sim. Nug tus kws kho mob uas tau xaj qhov kev xeem yuav ua li cas nrog koj cov tshuaj; qee lub chaw hloov cov neeg mob ib ntus mus rau cov tshuaj steroid uas tsis cuam tshuam nyob rau hauv kev saib xyuas.

Yog tias kuv qhov tshwm sim tsis raws li qhov xav tau, yuav ua li cas?

Cov txiaj ntsig ntawm cov kab ciam teb feem ntau yog vim tias qhov kev txiav txim siab ntawm kev sim tsis yog qhov tseeb. Koj tus kws kho mob endocrinologist yuav rov ua qhov kev kuaj dua, ntsuas ACTH, renin thiab aldosterone, npaj cov duab, lossis siv qhov kev kuaj mob sib txawv. Kev kho mob tuaj yeem pib thaum kev tshuaj xyuas txuas ntxiv mus yog tias cov tsos mob txhawj xeeb.

Qhov kev kuaj no txawv li cas ntawm cortisol yooj yim thaum sawv ntxov?

Cov cortisol thaum sawv ntxov yog ib qho qauv so thiab feem ntau poob rau hauv qhov ntau thiab tsawg tsis paub meej. Kev xeem ACTH stimulation sib tw cov qog adrenal nrog cov ACTH tsim thiab ntsuas qhov kev teb, uas yog cov ntaub ntawv ntau dua txog adrenal reserve, txawm hais tias tseem tsis tau ntsuas tag nrho ntawm pituitary.

Puas yuav tsum tau rov ua qhov kev kuaj ntawd dua?

Feem ntau tsis yog. Thaum paub tseeb tias tsis muaj adrenal txaus, kev saib xyuas feem ntau yog raws li kev kho mob thiab raws li koob tshuaj. Kev kuaj rov ua dua feem ntau yog siv thaum ntsuas kev rov zoo ntawm lub axis tom qab siv tshuaj steroids ntev lossis tom qab phais pituitary, thiab lub sijhawm raug txiav txim siab ib qho zuj zus.

Cov menyuam puas muaj peev xwm ua qhov kev xeem no tau?

Yog, nrog rau kev kho mob raws li qhov hnyav thiab cov txheej txheem kho mob rau menyuam yaus, uas tau npaj los ntawm pab pawg endocrinology rau menyuam yaus. Rau cov menyuam yaus, qhov kev kuaj no feem ntau siv los saib 17-hydroxyprogesterone rau kev loj hlob ntawm adrenal hyperplasia thiab cortisol. Cov lus teb uas xav tau txawv ntawm cov neeg laus.

Qhov kev kuaj puas kuaj pom tias "adrenal fatigue"?

Tsis yog. "Kev qaug zog ntawm adrenal" tsis yog kev kuaj mob uas lees paub, thiab tsis muaj ib qho version ntawm qhov kev kuaj ACTH uas lees paub qhov no. Qhov kev kuaj no nrhiav seb puas muaj adrenal tsis txaus tiag tiag. Yog tias qaug zog tseem muaj qhov tshwm sim zoo li qub, koj tus kws kho mob yuav tsum nrhiav lwm yam ua rau xws li ntshav tsis txaus, kab mob thyroid, teeb meem pw tsaug zog, ntshav qab zib lossis kev nyuaj siab.

Qhov chaw

• Bornstein SR, thiab lwm tus. Kev Kuaj Mob thiab Kev Kho Mob ntawm Primary Adrenal Insufficiency: Ib qho Endocrine Society Clinical Practice Guideline. Phau ntawv Journal ntawm chaw txhaj tshuaj Endocrinology & Metabolism, 2016.
• Fleseriu M, thiab lwm tus. Kev Hloov Tshuaj Hormonal hauv Hypopituitarism rau Cov Neeg Laus: Ib qho Endocrine Society Clinical Practice Guideline, 2016.
• Speiser PW, thiab lwm tus. Kev Loj Hlob ntawm Adrenal Hyperplasia Vim Yog Steroid 21-Hydroxylase Deficiency: Ib Daim Ntawv Qhia Txog Kev Kho Mob Hauv Endocrine Society, 2018.
• Lub Koom Haum rau Endocrinology (UK) cov lus qhia txog kev tswj hwm xwm txheej ceev ntawm cov neeg laus adrenal teeb meem thiab kev kuaj Synacthen luv luv.
• Cov chaw tsim khoom sau cov ntaub ntawv rau kev npaj tetracosactide/cosyntropin txog kev pheej hmoo hypersensitivity.
• Cov kev tshuaj xyuas luam tawm ntawm cov cortisol assay-specific peak thresholds tom qab kev txhawb nqa ACTH raws li tus qauv.