Impendulo eqondile
Ukuhlolwa kwe-cortisol kulinganisa i-hormone i-cortisol egazini, emchameni noma ematheni ukuze kuhlolwe ukuthi izindlala ze-adrenal kanye ne-hypothalamic-pituitary-adrenal (HPA) axis zisebenza kanjani. Ukuhlolwa kwe-cortisol kusekela ukuhlolwa kwe-Cushing's syndrome okusolwayo noma ukungasebenzi kahle kwe-adrenal. Inani elilodwa le-cortisol alikwazi ukuqinisekisa noma ukukhipha noma yisiphi isimo ngokwaso.
Ukuthatha okhiye
- Incazelo yokushayela kwesikhathi: I-cortisol ilandela isigqi sansuku zonke, ngakho-ke inani elifanayo lingaba elijwayelekile ngo-8 ekuseni futhi lingabi elingavamile phakathi kwamabili.
- Inani elilodwa alivamile ukuxazulula lo mbuzo: Izivivinyo ezishintshashintshayo ezifana nokuhlolwa okufushane kwe-Synacthen (ACTH stimulation) noma ukuhlolwa kokucindezela i-dexamethasone ebusuku zivame ukudingeka.
- Umphumela ojwayelekile awuyona into ekhishwayo: ichaza leso sampula, ngaleso sikhathi, ngaphansi kwalezo zimo.
- Imithi nezimo ezivamile zihlanekezela imiphumela ngezindlela ezingalindelekile, amaphilisi aqukethe i-estrogen, ama-steroid nganoma yiluphi uhlobo, ukukhulelwa, ukugula okubucayi, umsebenzi wesikhashana.
- "Ukukhathala kwe-adrenal" akuyona into eqashelwayo yokwelapha; Ukuhlolwa kwe-cortisol akukuhloli.
Nge-shazi
| Isici | Imininingwane |
|---|---|
| Yini kukalwa | I-Cortisol, i-hormone ye-steroid evela ku-adrenal cortex |
| Izinhlobo zesampula | Igazi (i-serum), umchamo wamahora angama-24 (i-cortisol engenayo umchamo), i-cortisol yamathe ebusuku kakhulu |
| Isikhathi esivamile | Igazi livame ukuba sebusuku kakhulu; amathe avame ukuba sebusuku kakhulu; umchamo uthatha amahora angama-24 |
| Isikhathi esithathiwe | Ukukhishwa kwegazi: imizuzu embalwa. Isampula yamathe: imizuzu emi-2-5 ekhaya. Umchamo: iqoqo eligcwele lamahora angama-24. Ukuhlolwa okufushane kwe-Synacthen: cishe imizuzu engama-30-60 endaweni yokunakekelwa kwasemini |
| Ukuzila | Akudingeki kuwo wonke umuntu; kuncike elabhorethri nakwezinye izivivinyo ezibhukiwe nayo |
| Kuvame ukulandelwa yi | I-ACTH, ukuhlolwa kokucindezela i-dexamethasone, ukuhlolwa okufushane kwe-Synacthen, ukuhlolwa kwe-pituitary noma kwe-adrenal |
| Ngubani ochaza lokho | Udokotela ocele ukuhlolwa, kanye nezimpawu, imithi kanye nokuhlolwa |
Obeye aziwe njengo
- I-cortisol ye-plasma, i-cortisol ye-plasma
- I-cortisol yasekuseni, i-cortisol engu-8 ekuseni
- I-cortisol yamathe ebusuku kakhulu (LNSC)
- I-cortisol yamahhala yomchamo (UFC) yamahora angama-24
- Ngokuvamile kucelwa eNdiya njengokuthi "ukuhlolwa kwe-cortisol hormone", "ukuhlolwa kwe-stress hormone" noma "ukuhlolwa kwe-adrenal"
- Okuhlobene kodwa okuhlukile: Ukuhlolwa kwe-ACTH, ukuhlolwa kwe-Synacthen, ukuhlolwa kokucindezela i-dexamethasone
Kuyini ukuhlolwa kwe-cortisol
I-Cortisol ikhiqizwa yizindlala ze-adrenal ngaphansi kokulawulwa yi-ACTH evela ku-pituitary gland. I-Cortisol isiza ekulawuleni ushukela wegazi, umfutho wegazi, impendulo yomzimba kanye nokusingatha komzimba ukucindezeleka ngokomzimba. Ukukhiqizwa kwe-Cortisol kuyashaya futhi kulandela isigqi se-circadian, esiphezulu ekuseni kakhulu, esiphansi kakhulu phakathi kwamabili kumuntu onephethini yokulala evamile.
Ngenxa yaleso sigqi, ukuhlolwa kwe-cortisol kuchazwa kanye nesikhathi esiqondile isampula ethathwe ngaso. Izinhlobo ezintathu zamasampula ziphendula imibuzo ehlukene:
- I-cortisol egazini: isithombe. Kuwusizo kakhulu ekuseni kakhulu uma kusolwa ukungasebenzi kahle kwe-adrenal, noma njengengxenye yokuhlolwa okunamandla.
- I-cortisol yamathe ebusuku kakhulu: ihlola ukuthi ukuwa okuvamile kwe-cortisol ebusuku kugcinwe yini. Isetshenziswa lapho kusolwa ukuthi i-Cushing's syndrome.
- I-cortisol engenawo umchamo amahora angama-24: isilinganiso esihlanganisiwe sokukhishwa kwe-cortisol ngosuku. Siphinde sisetshenziswe ku-Cushing's syndrome okusolwa ukuthi iyasebenza.
Kungani kwenziwa ukuhlolwa kwe-cortisol
- Ukungapheleli kahle kwe-adrenal okusolwayo (kufaka phakathi isifo sika-Addison): ukukhathala okungachazeki okuhambisana nokwehla kwesisindo, umfutho wegazi ophansi noma isiyezi sokuma, i-sodium ephansi, ukunxanela usawoti, ukufiphala kwesikhumba, ushukela wegazi ophansi ngendlela engachazeki.
- Isifo sikaCushing esisolwayo: ukuphuka okulula, izimpawu zokwelula ezinsomi, ubuthakathaka bemisipha eseduze, isifo sikashukela esisha noma esinzima ukusilawula kanye nomfutho wegazi ophakeme ndawonye, ukusatshalaliswa kabusha kwamafutha, isikhumba esinciphile.
- Ukungapheleli kwesibili kwe-adrenal okusolwayo ngemva kwesifo se-pituitary, ukuhlinzwa kwe-pituitary, ukulimala ekhanda, noma ngemva kokusetshenziswa isikhathi eside kwe-glucocorticoid kuyancishiswa noma kuyekwe.
- I-Adrenal incidentaloma: Isisindo se-adrenal esitholakala kuskeni esenziwe ngesinye isizathu sivame ukudinga ukuhlolwa kwamahomoni.
- Ukuqapha ukwelashwa kwesifo esaziwayo se-adrenal noma se-pituitary, njengoba kuqondiswe udokotela we-endocrinologist.
- Isifo esibuhlungu: I-cortisol engahleliwe ngezinye izikhathi ihlolwa esigulini esiwa phansi noma esishaqekile ngenkinga ye-adrenal esolwayo, lapha ukwelashwa kuqala ngaphambi kokuba imiphumela ibuye.
Ubani okufanele athole lolu vivinyo
Ukuhlolwa kwe-cortisol kuwukuhlolwa okuqondiwe, hhayi ukuhlolwa okuvamile noma ukuhlolwa "kokuphila kahle". Kuyafaneleka uma:
- Udokotela uthole iphethini yezokwelapha efanelana nokweqile noma ukuntuleka kwe-cortisol.
- Uke wahlinzwa i-pituitary noma i-adrenal, welashwa ngemisebe noma watholakala une-tumor eyaziwayo.
- Usebenzise ama-steroid asetshenziswa ngomlomo, ngomjovo, ngokuphefumula noma ngamandla isikhathi eside futhi udokotela wakho uhlola ukululama kwe-adrenal.
- Kutholakale i-adrenal mass ngengozi.
- Unezinkinga ze-electrolyte ezingachazeki, i-hypoglycemia ephindaphindayo, noma umfutho wegazi ophakeme omelana ne-hypokalemia.
Obani ngokuvamile abangakudingi: abantu abazizwa bekhathele, becindezelekile noma bekhathele ngaphandle kwanoma yiziphi izici ezingenhla. Kulelo qembu ukuhlolwa kwe-cortisol akuvamile ukushintsha ukuphathwa futhi imiphumela ebonakala ingajwayelekile ivame ukukhombisa isikhathi, imithi noma ukugula kunezifo ze-adrenal. Khuluma nodokotela ngalokho okubangela izimpawu, isifo se-thyroid, i-anemia, izinkinga zokulala, ukucindezeleka nesifo sikashukela yizincazelo ezivame kakhulu.
Lokho ukuhlolwa kwe-cortisol okungenakukuthola noma okungakukhiphi
- Ayikwazi ukuxilonga noma ukukhipha "ukukhathala kwe-adrenal" noma "ukukhathala". Lokhu akubonakali ukuthi kubangelwa yi-endocrine diagnosis futhi akukho ndlela ye-cortisol echaza lokhu.
- I-cortisol eyodwa evamile ayikususi i-Cushing's syndrome. Ukweqisa kwe-Cortisol kungaba ngezikhathi ezithile (i-Cushing's ejikelezayo), futhi izimo ezincane zingase zinikeze imiphumela evamile yokuhlolwa. Kungadingeka ukuhlolwa okuphindaphindiwe noma okunye.
- I-cortisol eyodwa evamile ayikuvimbeli ukungasebenzi kahle kwe-adrenal, ikakhulukazi ukungasebenzi kahle okuyingxenye noma okwesibili. Ukuhlolwa kokukhuthazwa kuvame ukudingeka.
- Akuyitholi inkinga endaweni ethile. I-cortisol ephezulu ayikutsheli ukuthi umthombo wayo yi-pituitary, isimila se-adrenal, isimila esikhiqiza i-ACTH kwenye indawo, noma ama-steroid angaphandle. Lokho kudinga ukulinganiswa kwe-ACTH, ukuhlolwa kokucindezela kanye nokuthwebula izithombe.
- Akulinganisi ukuthi "ucindezeleke kangakanani" nganoma iyiphi indlela ewusizo ngokwezokwelapha, futhi ayikwazi ukulinganisa ukucindezeleka kwengqondo.
- Ayilinganisi umphumela we-steroid yezicubu. Umuntu osebenzisa imithi yama-steroid angaba ne-cortisol ephansi ngenkathi ethola ama-steroid amaningi, ngoba ukuhlolwa okuningi akubonisi ama-steroid okwenziwa njenge-prednisolone noma i-dexamethasone.
- Ayihloli amanye ama-hormone e-adrenal. I-Aldosterone, i-renin, i-DHEAS kanye ne-catecholamines ziyizivivinyo ezihlukene.
- Umphumela ongemuhle noma ojwayelekile awufani nesimo esikhishwa ngaphandle. Uma izimpawu ziqhubeka naphezu komphumela ojwayelekile we-cortisol, buyela kudokotela wakho kunokuba ucabange ukuthi umbuzo uphelile.
Ukuhlolwa okuhlobene kodwa okuhlukile
| test | Umbuzo uyaphendula | Umehluko oyinhloko |
|---|---|---|
| I-cortisol ye-serum yasekuseni | Ingabe ukukhiqizwa kwe-cortisol okuyisisekelo kwanele? | Iphuzu lesikhathi esisodwa; amanani aphakathi avamile futhi avame ukudinga ukuhlolwa kokukhuthazwa ukuze kuxazululwe |
| I-cortisol yamathe ebusuku kakhulu | Ingabe ukwehla okuvamile kwe-cortisol ebusuku kulahlekile? | Ukuhlolwa kwe-cortisol eningi, hhayi ukuntuleka kwayo; akusebenzi ekuxilongeni i-cortisol ephansi; kudinga indlela ejwayelekile yokulala |
| I-cortisol engenawo umchamo amahora angama-24 | Iyini i-cortisol ephelele ekhishwa ngosuku? | Kuncike ngokuphelele ekuqoqweni okuphelele; akuthembekile ekuphazamisekeni okukhulu kwezinso |
| Ukuhlolwa kokucindezela i-dexamethasone ebusuku / ngomthamo ophansi | Ingabe i-cortisol iyacima ngokujwayelekile uma kunikezwa i-steroid yokwenziwa? | Ukuhlolwa okunamandla ngethebhulethi ngesikhathi esibekiwe; ukuchazwa kuthinteka yimithi eshintsha indlela umzimba we-dexamethasone osebenza ngayo |
| Ukuhlolwa kwe-Synacthen emfushane (i-ACTH stimulation) | Ingabe izindlala ze-adrenal zingasabela ekukhuthazeni? | Ukuhlolwa okuvamile kokuqinisekisa ukungasebenzi kahle kwe-adrenal; kungaba yinto evamile ngokungeyikho ekuhlulekeni kwe-pituitary okusanda kuqala. |
| I-Plasma ACTH | Ingabe inkinga ikwindlala ye-adrenal noma ingaphezu kwayo? | Ithola indawo yenkinga; kumele ihlanganiswe ne-cortisol ngesikhathi esisodwa futhi iphathwe ngokucophelela elabhorethri |
| Amathe "amaphaneli okucindezeleka" athengiswa ngqo kubathengi | Kuthengiswa njengephrofayili ye-adrenal noma yokucindezeleka | Akufani nokuhlolwa kwe-endocrine yokuxilonga futhi akusona isisekelo sezinqumo zokwelapha |
Akukho noyedwa kulezi zivivinyo "ongcono" emhlabeni wonke. Ukuthi yikuphi okuza kuqala kuncike embuzweni wezokwelapha: ukusolakala kokuntuleka kwe-cortisol kuvame ukuqala nge-cortisol esegazini ekuseni kakhulu; okusolakala ukuthi i-cortisol ingaphezu kwamandla ngokuvamile kuqala nge-cortisol yamathe ebusuku kakhulu, i-cortisol engenawo umchamo amahora angama-24 noma ukuhlolwa kokucindezela i-dexamethasone ebusuku, okukhethwa udokotela olaphayo.
Ungalungiselela kanjani
Ukulungiselela kusethwa yilabhorethri kanye nenqubo ethile udokotela wakho ayiyalile. Imiyalelo iyahluka phakathi kwamayunithi kanye nokuhlolwa, futhi imiyalelo ebhaliwe yeyunithi yakho iza kuqala kunanoma yini ekuleli khasi.
- Tshela udokotela wakho ngakho konke ukuchayeka kuma-steroid: amaphilisi, imijovo emalungeni, ama-inhaler, ama-spray ekhala, amaconsi amehlo, ama-cream esikhumba anamandla, kanye nemithi ye-ayurvedic, i-homeopathic, imithi yamakhambi noma yokuzivocavoca/yokwakha umzimba engabhalwanga. Imikhiqizo eminingana enjalo itholakale iqukethe ama-steroid angadalulwanga, acindezela i-cortisol.
- Bhala yonke imithi kanye nezithasiselo, kufaka phakathi izithibela-nzalo eziqukethe i-estrogen, ukwelashwa ngama-hormone, izidakamizwa zokulwa nesifo sokuwa, i-rifampicin kanye nemithi yokulwa namagciwane.
- Ungayeki noma ushintshe noma yimuphi umuthi owunikezwe udokotela: kufaka phakathi ama-steroid, ukuze ulungiselele lokhu kuhlolwa. Buza udokotela; ukuyeka ama-steroid ngokuzumayo kungaba yingozi.
- Umsebenzi wokulala nokushintshana: khuluma ngamashifti asebusuku noma izindawo zesikhathi ezisanda kudlula, njengoba zishintsha isigqi se-cortisol.
- Ukuzila ukudla: Akudingeki njalo i-cortisol kuphela emalabhorethri amaningi, kodwa ngezinye izikhathi kuyadingeka lapho kwenziwa ezinye izivivinyo ngesikhathi esisodwa. Qinisekisa nesikhungo sakho sokuqoqa.
- Amasampula amathe: ngokuvamile akukho ukudla, isiphuzo, ukubhema, ugwayi/utshwala, noma ukuxubha amazinyo isikhathi esithile ngaphambi kokuqoqwa, futhi akukho zinsini eziphuma igazi ngaleso sikhathi. Landela iwindi eliqondile elisekhithini yakho.
- Umchamo wamahora angama-24: lahla isampula yokuqala yasekuseni, bese uqoqa yonke ithonsi amahora angama-24 kufaka phakathi isampula yokuqala yasekuseni ngakusasa, bese ugcina njengoba ilabhorethri iyala.
Uma ukhulelwe noma uncelisa
I-Cortisol kanye ne-cortisol-binding globulin ziyanda ngokomzimba ngesikhathi sokukhulelwa, ngakho-ke izikhawu ezijwayelekile zokubhekisela kanye nokuhlolwa okujwayelekile kokuhlolwa azisebenzi ngokuqondile. Ukuhlolwa ngesikhathi sokukhulelwa kufanele kuhlelwe futhi kuhunyushwe ngokufakwa kwe-endocrine.
Uma unesifo sikashukela ekwelashweni kokwehlisa i-glucose
Uma ucelwa ukuba uzile ukudla, noma ukuba uye esivivinyweni esishintshashintshayo, buza udokotela kusengaphambili ukuthi ungayisebenzisa kanjani i-insulin noma i-sulfonylureas ekuseni, bese uphatha i-glucose. Ungazili ukudla isikhathi eside ngaphandle kwaleso seluleko.
Uma unesifo sezinso esingamahlalakhona
I-cortisol engenayo umchamo emahoreni angama-24 ayibe isathembekile njengoba ukusebenza kwezinso kwehla, futhi imiphumela ingase ibe phansi ngendlela ekhohlisayo. Xoxa ngezinye izindlela zokuhlola nodokotela wakho.
Uma unenhliziyo engasebenzi kahle noma uketshezi oluningi oludingekayo
Ungandisi umthamo woketshezi oluthathwayo ukuze uthole umchamo. Qoqa noma yiliphi inani olidlula ngendlela evamile bese uqhubeka nomkhawulo wakho onqunyiwe.
Izingane
Ukuhlolwa kwe-cortisol yezingane, umthamo wokuhlolwa kokukhuthaza kanye nokuchazwa kwayo kuhlukile kubantu abadala futhi kufanele kugadwe udokotela wezingane noma udokotela we-endocrinologist wezingane. Ukuqoqwa kwamathe kuvame ukuthandwa ukuze kuncishiswe ukucindezeleka kwenaliti, kusetshenziswa amadivayisi afanele ubudala.
Abantu abadala abadala
Imithi eminingi, ukungalali kahle, ukugula okuhambisanayo kanye nobunzima bokuqeda iqoqo eligcwele lamahora angama-24 konke kwenza ukuhumusha kube nzima. Ukuhlolwa okulula nokufike ngesikhathi kuvame ukuba wusizo kakhulu.
Kwenzekani ngesikhathi sokuhlolwa kwe-cortisol
- Isampula yegazi: kufakwa i-tourniquet, kukhishwe igazi emthanjeni osengalweni bese isikhathi sokuqoqwa siyaqoshwa. Ukudweba ngokwako kuthatha imizuzu embalwa.
- Isampula yamathe asebusuku kakhulu: Uqoqa ekhaya ngesikhathi esibekiwe, ngokuvamile cishe ngo-11 ebusuku kuya phakathi kwamabili, ngokuhlafuna i-swab noma ukuconsa amathe epayipini, bese uligcina bese ulibuyisela njengoba kuyalelwe. Isampula ngayinye ithatha imizuzu embalwa.
- Umchamo wamahora angama-24: Iqoqo lihamba phakathi kosuku olugcwele nobusuku esitsheni esinophawu.
- Ukuhlolwa okufushane kwe-Synacthen: isampula yokuqala, umjovo we-ACTH yokwenziwa, bese kuba isampula elilodwa noma amabili engeziwe ngezikhathi ezibekiwe. Lindela ukuhlala endaweni yokunakekela izingane cishe imizuzu engama-30-60, ngezinye izikhathi isikhathi eside kuye ngokuthi inqubo iyasebenza yini.
- Ukuhlolwa kokucindezela i-dexamethasone ebusuku: iphilisi ngehora elibekiwe lokugcina ekhaya, kulandele isampula yegazi ngakusasa ekuseni.
Imiphumela iyahlukahluka kuye ngezimo zomtholampilo ngazinye, futhi isikhathi sokubika sincike ekutheni ukuhlolwa kwenziwa ngaphakathi noma kudluliselwe elabhorethri eliphakathi. Buza isikhungo sakho sokuqoqa ukuthi ulindele nini umbiko.
Ukuqonda umbiko wakho we-cortisol
Funda umphumela we-cortisol kanye nezinto ezintathu eziphrintiwe noma ezinamathiselwe embikweni: uhlobo lwesampula, isikhathi esiqondile sokuqoqwa, kanye nesikhathi sokubhekisela selabhorethri uqobo. Ukuhlolwa kwe-Cortisol kuyahluka phakathi kwamapulatifomu, ngakho-ke izikhathi zokubhekisela ziqondene nelabhorethri futhi imiphumela evela kumalabhorethri amabili ayifani ngqo. Ungaqhathanisi inombolo yakho nobubanzi obutholakala ku-inthanethi noma embikweni omdala ovela kwelinye ilabhorethri.
Ngokubanzi:
- Umphumela ophakeme ngokusobala kwandisa amathuba okuba ne-cortisol eningi, ngemithi ye-steroid, i-pituitary adenoma (isifo sikaCushing), isimila se-adrenal, noma ukukhiqizwa kwe-ACTH engaphandle kwesisu. Kungabonisa futhi ukugula okukhulu, ubuhlungu, ukukhulelwa, ukwelashwa nge-estrogen noma ukucindezeleka okukhulu ngesikhathi sokuthatha isampula.
- Umphumela ophansi ngokusobala, ikakhulukazi ekuseni kakhulu uma kunezimpawu ezifanayo, kwandisa amathuba okuthi i-adrenal insufficiency, eyinhloko (i-adrenal) noma eyesibili (i-pituitary/hypothalamic), okuhlanganisa nokucindezelwa kokwelashwa ngama-steroid.
- Umphumela ophakathi nendawo kuvamile futhi ngokuvamile akunalo ulwazi ngokwako. Lokhu kuvame ukuba lapho kufakwa khona ukuhlolwa okunamandla.
Ukuhlolwa kwe-cortisol akukwenzi ukuxilongwa ngokwakho. Ukuchazwa kungokwadokotela okucelile, ngokwezimpawu zakho, ukuhlolwa kanye nemithi.
Lapho imiphumela ye-cortisol ingadukisa khona
Imiphumela engaphakanyiswa ngamanga
- Izindlela zokuvimbela inzalo eziqukethe i-estrogen, ukwelashwa ngama-hormone kanye nokukhulelwa: kukhulisa i-globulin ebopha i-cortisol, ngakho-ke i-cortisol ephelele egazini iyanda ngisho noma i-cortisol esebenzayo ikhululekile.
- Ukugula okukhulu, i-sepsis, ukuhlinzwa, ukuhlukumezeka, ubuhlungu obukhulu, isithuthwane esingalawuleki: ukunyuka kwangempela okubangelwa ukucindezeleka okungabonisi i-Cushing's syndrome.
- Ukucindezeleka, ukusebenzisa utshwala isikhathi eside, isifo sikashukela esingalawulwa kahle, i-obstructive sleep apnea: kungakhiqiza ukuhlolwa kokweqisa kwe-cortisol okuncane kanye nokuhlolwa kokucindezela okungavamile ngaphandle kwe-Cushing's syndrome.
- Umsebenzi wasebusuku noma uhambo olude lwakamuva: isampula "yasebusuku kakhulu" ingathathwa ekuseni komuntu ehlola umzimba wakhe.
- Ukungcola kwesampula yamathe: okhilimu be-steroid, izinsalela ze-inhaler, ugwayi/utshwala, ukudla noma igazi elivela ezinsinini emlonyeni kungaphazamisa ukufundwa kwamathe.
- Imithi esheshisa ukusulwa kwe-dexamethasone (i-rifampicin, i-phenytoin, i-carbamazepine, i-phenobarbitone) ingenza ukuhlolwa kokucindezela kubonakale kungacindezelwanga ngokungeyikho.
Imiphumela engancishiswa ngamanga
- Noma yikuphi ukuchayeka kwe-glucocorticoid, kufaka phakathi ama-steroid aphefumulayo, awekhala, angaphakathi kwamalunga, angaphandle noma afihliwe ezithasiselo ezingenamalebula kanye neminye imithi yendabuko.
- Ukuthatha amasampula ntambama noma kusihlwa, uma i-cortisol iphansi ngokomzimba, "i-cortisol ephansi" ngo-6 ntambama ivame ukungasho lutho.
- Amaprotheni aphansi okubopha: isifo se-nephrotic, isifo sesibindi esibi kakhulu, izimo zokulahlekelwa amaprotheni kanye nesifo esibucayi kunciphisa i-cortisol ephelele kuyilapho i-cortisol yamahhala ingaba yanele.
- Ukuqoqwa komchamo okungaphelele kwamahora angama-24: isizathu esivame kakhulu se-cortisol engenayo umchamo ephansi ngendlela ekhohlisayo.
- Isifo sezinso esingamahlalakhona, okunciphisa ukukhishwa kwe-cortisol emchameni.
- Imithi evimbela ukwenziwa kwama-steroid noma ukuphazamisa ukuhlolwa okuthile, kanye nezithasiselo ze-biotin, ezingaphazamisa ukuhlolwa okuthile kwe-immunoassay.
Uma umphumela ungahambisani nesithombe somtholampilo, ukuphinda ukuhlolwa ngaphansi kwezimo ezilawulwayo kuvame ukuba nolwazi oluningi kunokusebenzisa inombolo yokuqala.
Izingozi nokuphepha
Ukusampula kwegazi
Izingozi zincane futhi ikakhulukazi zendawo: ubuhlungu obufushane, ukudumba, ikhanda elikhanyayo, kanye nokuvama kwe-hematoma encane noma, okungajwayelekile, ukutheleleka endaweni yokubhoboza. Tshela udokotela we-phlebotomist uma uthatha imithi yokunciphisa igazi noma uke waquleka ngesikhathi sokuhlolwa kwegazi ngaphambilini.
Ukuqoqwa kwamathe nomchamo
Lokhu akubandakanyi inaliti futhi akukho bungozi obungokomzimba. Inkinga enkulu iphutha lesampula kunokulimala.
Ukuhlolwa kwe-Synacthen emfushane (i-ACTH stimulation)
Ngokuvamile kubekezelelwa kahle. Ukuhlanza, ukunambitheka kwensimbi noma isicanucanu sesikhashana kungenzeka. Ukusabela kokungezwani komzimba ne-ACTH yokwenziwa akuvamile kodwa kubikwe, ngakho-ke ukuhlolwa kwenziwa lapho abasebenzi kanye nezindawo zokuvuselela umzimba zitholakala khona.
Ukuhlolwa kokucindezela i-Dexamethasone
Umthamo owodwa omncane we-steroid uvame ukuba nezigameko ezingavamile. Ukungalali okwesikhashana, ukushintsha kwemizwa noma ukwanda kwe-glucose egazini kungenzeka, okubaluleke kakhulu uma unesifo sikashukela. Tshela udokotela ocelayo uma unesifo sikashukela, ukutheleleka okusebenzayo noma isifo sengqondo ngaphambi kokuhlolwa.
Ukuhlolwa kokubekezelela i-insulin
Ngezinye izikhathi kusetshenziswa ezikhungweni ezikhethekile ukuhlola i-axis ye-HPA. Lokhu kuhlolwa kudala ngamabomu i-hypoglycemia, kuthwala ingozi yangempela, futhi kwenziwa kuphela ngokuqapha kwezokwelapha kanye nokukhishwa okucacile njengesifo senhliziyo noma ukuquleka.
Amafulege abomvu
Isimo esiphuthumayo manje
Yiya emnyangweni wezimo eziphuthumayo oseduze ngokushesha, noma ushayele izinsizakalo zezimo eziphuthumayo, uma unayo noma uthuthukise:
- Ubuthakathaka obukhulu obuhambisana nokuhlanza, ubuhlungu besisu noma besisu kanye nokuwa, inkinga ye-adrenal engaba khona, esongela impilo futhi edinga ama-steroid kanye noketshezi olufakwa ngemithambo yegazi
- Ukudideka, ukozela noma ukuquleka ngenxa yomfutho wegazi ophansi kakhulu
- I-hypoglycemia enkulu, ukuquleka noma ukungaphenduli
- Ukuntuleka kwe-adrenal okwaziwayo kanye nomkhuhlane, ukuhlanza, isifo sohudo noma ukulimala, lapho ungakwazi ukuthatha noma ukunciphisa umthamo wakho we-steroid, sebenzisa uhlelo lwakho oluphuthumayo lwe-hydrocortisone uma unalo futhi ufuna ukunakekelwa.
Ngosuku olufanayo
- Ukuhlanza okuqhubekayo noma uhudo uma uthatha indawo ye-steroid yesikhathi eside
- Ubuthakathaka obubi ngokushesha, isiyezi lapho umile, noma ukufiphala kwesikhumba okusha ngenxa yokwehla kwesisindo
- Umfutho wegazi ophakeme omusha onzima obuthakathaka bemisipha noma i-potassium ephansi kakhulu embikweni
- Ikhanda elibuhlungu elibuhlungu ngokuzumayo elihambisana nokushintsha kokubona kumuntu onesifo se-pituitary esaziwayo
I-aphoyintimenti ejwayelekile
- Ukukhathala okuqhubekayo, ukushintsha kwesisindo, ukushintsha kwemizwa, ukuya esikhathini okungajwayelekile noma ukushintsha kwezinwele ngaphandle kwalezi zimpawu ezingenhla
- Umphumela we-cortisol ongajwayelekile ongenazo izimpawu, ukuze ubuyekezwe kahle
- Imibuzo mayelana nokunciphisa ukwelashwa kwe-steroid yesikhathi eside, ngodokotela, ayikaze ibe yodwa
Izimo ezikhethekile
ukukhulelwa
I-Cortisol, i-cortisol-binding globulin kanye ne-cortisol yamahhala yomchamo konke kuyanda njengoba ukukhulelwa kuqhubeka. Ukuhlolwa kokucindezela i-Dexamethasone akwenzi kahle ekukhulelweni. Ukuxilongwa kokukhulelwa kuncike ekuchazeni kochwepheshe, futhi izinketho zokuthatha izithombe nazo ziyalungiswa.
Izingane
Ukwehluleka kokukhula, ukubambezeleka kokuthomba noma amaphethini okushintsha isisindo angachazeki yizinkomba ezibalulekile ezinganeni. Izikhawu zokubhekisela, imithamo yokuhlolwa kokukhuthazwa kanye nomthamo wesampula kuncike eminyakeni ethile.
Abantu abadala abadala
Izimpawu zokweqisa noma ukuntuleka kwe-cortisol zihambisana kakhulu nezinye izimo ezihlobene nobudala kanye ne-polypharmacy. Ukubuyekezwa kwemithi ngokucophelela kuyingxenye yokuchazwa.
Abantu abathola ukwelashwa kwe-steroid isikhathi eside
Ama-steroid esikhathi eside e-asthma, i-arthritis, isifo sesikhumba, i-nephrotic syndrome noma ukufakelwa kwezicubu acindezela i-axis ye-HPA. I-cortisol ephansi kulesi simo ivame ukukhombisa umuthi, hhayi isifo esisha se-adrenal. Ukunciphisa ama-steroid kumele kuhlelwe ngudokotela, futhi ungadinga uhlelo lomthamo wosuku lokugula.
Ukugula okubucayi
Ukuchazwa kwe-cortisol ekunakekelweni okujulile kuyisinqumo esikhethekile; imingcele evamile kanye nokuqagela kokubopha amaprotheni akusebenzi.
Ukuhlolwa kwe-cortisol kumongo waseNdiya
- Ukuchayeka kuma-steroid okungadalulwanga kuyimbangela yangempela futhi evame ukudideka. Ama-cream e-steroid atholakala ngaphandle kwemithi yezokwelapha izimo zesikhumba, imijovo yamalunga equkethe ama-steroid, izithasiselo zejimu ezingalawulwa kanye neminye imithi ye-AYUSH engabhalwanga noma "yokuqeda ubuhlungu" ingacindezela i-cortisol noma ibangele i-iatrogenic Cushing's syndrome. Letha yonke imikhiqizo oyisebenzisayo, kufaka phakathi ukupakishwa, ekubonisaneni.
- Izimangalo zokumaketha: Umthetho waseNdiya (uMthetho Wezidakamizwa Nokwelapha Omlingo (Izikhangiso Ezingavunyelwe) ka-1954) uvimbela ukukhangisa okuthembisa ukwelashwa kwezimo ezinjalo. Ungabaza amaphakheji "okuvuselela i-adrenal" noma "okususa i-cortisol detox" athengiswa ngqo kubathengi.
- Isifo sofuba sisalokhu siyimbangela yokuntuleka kwe-adrenal eNdiya, Ngokomlando kuyinto ebalulekile, futhi i-adrenal calcification ingabonakala ekuthathweni kwezithombe. Ukwelashwa okulwa nesifo sofuba nakho kubalulekile ekuhlolweni: i-rifampicin isheshisa ukusebenza kwe-steroid futhi ingaphazamisa ukuhlolwa kwe-dexamethasone futhi yandise izidingo zokufakwa esikhundleni se-steroid.
- Isifo se-metabolic esiphansi kwe-BMI: Abantu baseNingizimu Asia bathola isifo sikashukela kanye nomfutho wegazi ophakeme ngesilinganiso esiphansi somzimba, ngakho-ke inhlanganisela yesifo sikashukela sokuqala, umfutho wegazi ophakeme kanye nokusatshalaliswa kwamafutha aphakathi kuvamile futhi ngokuvamile akuyona i-Cushing's syndrome. Ukuhlolwa kwe-cortisol kuyadingeka lapho kunezici ezithile ezihlukanisayo, njengokulunywa kalula, ubuthakathaka bemisipha eseduze noma ama-striae abanzi ansomi.
- Ukwehlukahluka kokuhlolwa: Amalabhorethri kulo lonke elaseNdiya asebenzisa abahlaziyi nezindlela ezahlukene. Ukuhlolwa kokulandelela elabhorethri elifanayo kwenza ukuqhathanisa kube nenjongo kakhudlwana.
- Ukuvikelwa kwedatha: Ulwazi lwezempilo lomuntu siqu oluqoqwe ukuze luhlolwe luhambisana noMthetho Wokuvikelwa Kwedatha Yomuntu Siqu Yedijithali waseNdiya, ka-2023. Buza ukuthi imibiko yakho kanye nedatha yobunikazi igcinwa futhi yabelwana kanjani.
Izindleko kanye nomshuwalense eNdiya
Amanani ahluka kakhulu phakathi kwezikhungo zikahulumeni, amalabhorethri azimele kanye namayunithi e-endocrine asezibhedlela, kanye naphakathi kwamadolobha. Esikhundleni sokucaphuna inani, cela isilinganiso esibhaliwe ngaphambi kokubhukha. Izici ezishintsha izindleko yilezi:
- Uhlobo lwesampula: i-cortisol eyodwa egazini iyona ndlela engabizi kakhulu; i-cortisol yamathe kanye ne-cortisol yomchamo emahoreni angama-24 ngokuvamile ibiza kakhulu ngenxa yamakhithi, ukuphathwa kanye nokuhlolwa okukhethekile.
- Inani lamasampula: Ukuhlolwa okunamandla kudinga ukudonsa okuningi, ngakho-ke izindleko ziyanda.
- Izindleko zemithi ye-ejenti evuselelayo noma ecindezelayo (i-ACTH yokwenziwa, i-dexamethasone) kanye nezindleko zokunakekelwa kwasemini noma zokuqapha.
- Indlela yokuhlola: Ukuhlolwa kwe-cortisol okusekelwe ku-mass spectrometry kuvame ukubiza ngaphezu kokuhlolwa kwe-immunoassay okuvamile futhi kungathunyelwa elabhorethri yokubhekisela.
- Ukuhlolwa okungeziwe: I-ACTH, ama-electrolyte, i-DHEAS, i-plasma renin/aldosterone, ukuhlolwa kwe-thyroid kanye nokuthwebula izithombe kunezela kakhulu.
- Ukubonisana kanye nokulandelela: Ukubuyekezwa kwe-endocrinology, ukuhlolwa okuphindaphindiwe kanye nokuthwebula izithombe kuvame ukuba yingxenye yendlela.
Ukuziphatha komshwalense kuyahlukahluka futhi: izivivinyo zokuxilonga iziguli zangaphandle azivame ukumbozwa ngaphandle kokuthi zixhunywe nokwamukelwa noma inqubomgomo enenzuzo echazwe yi-OPD. Hlola nomshwalense wakho noma ideski lomshwalense wesibhedlela ngaphambi kokuhlolwa, bese ugcina umuthi ochaza inkomba yezokwelapha.
Izinganekwane namaqiniso
| Inganekwane | Iqiniso |
|---|---|
| Ukuhlolwa kwe-cortisol kukutshela ukuthi ucindezeleke kangakanani | I-Cortisol isabela ezintweni eziningi ezifakwayo ngokomzimba. Akuyona i-stress score futhi ayikwazi ukulinganisa ukucindezeleka kwengqondo. |
| "Ukukhathala kwe-adrenal" kungaqinisekiswa yiphaneli ye-cortisol yamathe | Ukukhathala kwe-adrenal akuyona into eqashelwayo. Amaphaneli e-cortisol aqondile kumthengi awakuqinisekisi, futhi amanani abukeka ngendlela engavamile ngokuvamile abonisa isikhathi noma imithi. |
| I-cortisol evamile isho ukuthi izindlala ze-adrenal ziphilile | Inani elijwayelekile lichaza leso sampula. Ukuphazamiseka okuyingxenye noma okungahleliwe kunganikeza imiphumela evamile yokuhlolwa, futhi kungadingeka ukuhlolwa okwengeziwe. |
| I-cortisol ephezulu isho i-Cushing's syndrome | Ukugula, ubuhlungu, ukukhulelwa, ukwelashwa nge-estrogen, ukusebenzisa utshwala, ukuphelelwa umoya ngesikhathi sokulala kanye nokucindezeleka konke kungakhuphula i-cortisol ngaphandle kwe-Cushing's syndrome. |
| Amabanga okubhekisela e-Cortisol ayafana yonke indawo | Amabanga aqondene nokuhlolwa kanye nelabhorethri futhi awakwazi ukushintshaniswa phakathi kwamalabhorethri. |
| Kufanele uyeke ukuthatha imithi yakho yama-steroid ngaphambi kokuhlolwa | Ungalokothi uyeke ama-steroid wedwa. Ukuhoxa ngokuzumayo kungabangela inkinga yezindlala ze-adrenal. Ngudokotela kuphela okufanele alungise umthamo. |
| Noma yisiphi isikhathi sosuku siyasebenza ekuhlolweni kwegazi le-cortisol | Isikhathi sibalulekile ekuchazeni. Isampula engaphelelwanga isikhathi ivame ukungachazeki. |
Imibuzo ejwayelekile ukubuzwa
Yini ngempela ehlolwa ukuhlolwa kwe-cortisol?
Ukuhlolwa kwe-cortisol kulinganisa inani le-hormone i-cortisol egazini, ematheni noma emchameni. Odokotela basebenzisa ukuhlolwa kwe-cortisol ukuhlola ukuthi izindlala ze-adrenal zikhiqiza i-cortisol eningi kakhulu noma encane kakhulu, nokuthi uhlelo lokulawula i-pituitary-adrenal lusebenza njengoba kulindelekile.
Ingabe ngidinga ukuzila ukudla ukuze ngihlolwe i-cortisol?
Ukuzila ukudla akudingeki njalo ukuze kulinganiswe i-cortisol ezindaweni eziningi zokucwaninga, kodwa izidingo ziyahlukahluka ngokweyunithi kanye nokuthi ezinye izivivinyo zibhukwa kanjani ngayo. Qinisekisa nesikhungo sakho sokuqoqa. Uma uthatha i-insulin noma i-sulfonylureas futhi ucelwa ukuba uzile ukudla, buza udokotela kuqala.
Kungani kufanele kuthathwe isampula yegazi ekuseni?
I-Cortisol ilandela isigqi sansuku zonke, sifinyelela phezulu ekuseni kakhulu. Isampula yasekuseni iyiwindi elinolwazi kakhulu lapho kusolwa ukuthi kukhona ukungasebenzi kahle kwe-adrenal, ngoba inani eliphansi lasekuseni lisho lukhulu, kanti inani eliphansi lakusihlwa livame ukuba ngokomzimba futhi alinalo ulwazi.
Inqubo yonke ithatha isikhathi esingakanani?
Ukuthathwa kwegazi kuthatha imizuzu embalwa. Isampula yamathe ithatha imizuzu emibili kuya kwemihlanu ekhaya. Ukuqoqwa komchamo kwamahora angama-24 kuthatha usuku lonke. Ukuhlolwa okufushane kwe-Synacthen kuvame ukusho imizuzu engama-30 kuya kwengama-60 endaweni yokunakekelwa kwasemini, ngezinye izikhathi isikhathi eside kuye ngenqubo yendawo.
Ukuhlolwa kwe-cortisol yamathe kuhluke kanjani ekuhlolweni kwegazi?
I-cortisol yamathe ebusuku kakhulu ibuza ukuthi i-cortisol ephansi ebusuku ilahlekile yini, ngakho-ke ihlola ukuthi i-cortisol ingakanani. I-cortisol yegazi ekuseni ibuza ukuthi ukukhiqizwa kokuqala kwanele yini. Ukuhlolwa kwamathe akukwazi ukusetshenziselwa ukuthola i-cortisol ephansi.
Ingabe imithi ingashintsha umphumela wami we-cortisol?
Yebo, futhi kuzo zombili izinhlangothi. Amaphilisi aqukethe i-estrogen kanye nokukhulelwa kuphakamisa i-cortisol ephelele; ama-steroid nganoma yiluphi uhlobo, okuhlanganisa okhilimu, ama-inhaler kanye nama-steroid afihliwe kwezinye izithasiselo, yehlisa. I-Rifampicin kanye namanye ama-antiepileptics aphazamisa ukuhlolwa kwe-dexamethasone. Bhala konke okuthathayo.
I-cortisol yami yayingajwayelekile kancane kodwa ngizizwa kahle. Yini elandelayo?
Amanani e-cortisol angajwayelekile kancane avamile futhi avame ukubonisa isikhathi, imithi, indlela yokulala noma ukugula okuhambisana nesikhathi. Isinyathelo esivamile ukubuyekezwa ngudokotela ocelayo, ngezinye izikhathi ngokuhlolwa okuphindaphindiwe noma okunamandla ngaphansi kwezimo ezilawulwayo, kunokwelashwa ngokushesha.
Ingabe ukuhlolwa kwe-cortisol kusetshenziselwa ukuxilonga izinkinga ze-thyroid noma i-PCOS?
Cha. Isifo se-thyroid sihlolwa ngokuhlolwa kokusebenza kwe-thyroid, kanye ne-polycystic ovary syndrome enezindlela zokwelashwa, amazinga e-androgen kanye ne-ultrasound. Ukuhlolwa kwe-cortisol ngezinye izikhathi kuyangezwa lapho izici zibonisa i-Cushing's syndrome, engafana ne-PCOS.
Ingabe izingane zingahlolwa i-cortisol?
Yebo. Ukuhlolwa kwe-cortisol yezingane kusetshenziselwa ukungasebenzi kahle kwe-adrenal okusolwayo, ukulandelwa kwe-congenital adrenal hyperplasia kanye nokucindezelwa okuhlobene ne-steroid. Imithamo yokuhlolwa kokukhuthazwa, amavolumu esampula kanye nezikhawu zokubhekisela zincike eminyakeni ethile futhi kufanele zigadwe udokotela wezingane noma udokotela we-endocrinologist wezingane.
Imithombo
- Isiqondiso somkhuba wezokwelapha se-Endocrine Society mayelana nokuxilongwa kwe-Cushing's syndrome
- Isiqondiso somkhuba wezokwelapha se-Endocrine Society mayelana nokuxilongwa nokwelashwa kokuntuleka kwe-adrenal okuyinhloko
- I-European Society of Endocrinology kanye nesiqondiso se-ENSAT mayelana nokuphathwa kwama-adrenal incidentalomas
- Ulwazi lwesiguli se-National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) mayelana ne-Cushing's syndrome kanye nokungasebenzi kahle kwe-adrenal
- Umthetho Wezidakamizwa Nemithi Yomlingo (Izikhangiso Ezingaphikiswa), ka-1954, kaHulumeni waseNdiya
- Umthetho Wokuvikelwa Kwedatha Yomuntu Siqu Yedijithali, 2023, Uhulumeni waseNdiya
