Ua ʻike anei ʻoe i ka poniuniu koke, ka māmā o ke poʻo, a me nā palpitations, e like me ka wā e hāʻule ai kou kō koko? I kekahi manawa manaʻo ʻoe ua pōloli wale nō kēia mau mea, akā i kekahi manawa, aia paha kekahi kumu ʻē aʻe no kēia. I kēia lā, e kamaʻilio mākou e pili ana i kahi maʻi kakaʻikahi akā koʻikoʻi e makaʻala ai. ʻO ia ke ʻano i kapa ʻia ʻo insulinoma.
He aha kēia ʻano insulinoma?
I ka ʻōlelo maʻalahi, he puʻupuʻu liʻiliʻi ka insulinoma, ʻaʻole ia he maʻi kanesa e ulu ana i loko o kā mākou pancreas. I kēia manawa ke noʻonoʻo nei paha ʻoe i ke ʻano o kēia pancreas. He ʻōkana liʻiliʻi akā koʻikoʻi loa ka pancreas i loko o ko mākou ʻōpū, ma hope o ka ʻōpū. Hoʻopuka ia i nā enzymes e kōkua iā mākou e hoʻoheheʻe i ka meaʻai a mākou e ʻai ai, a me kahi hormone i kapa ʻia ʻo insulin, ka mea e kaohi i ko mākou pae kō koko.
No laila, ke ulu kēia insulinoma, hoʻokuʻu ʻia ka insulin i loko o ko kākou koko ma mua o ka mea e pono ai. Ua like ia me kahi piula wai i paʻa e kahe mau ana.
ʻO kēia mau insulinomas he ʻano puʻupuʻu neuroendocrine e ulu ana i loko o ka pancreas i kapa ʻia ʻo Pancreatic Neuroendocrine Tumors (pNETs). He mau puʻupuʻu kakaikahi kēia. ʻO ka mea maikaʻi loa , ʻo 85% a 90% o kēia mau insulinomas he nonmetastatic/indolent. ʻO ia hoʻi, ʻaʻole lākou e laha i nā ʻāpana ʻē aʻe o ke kino ma waho o ka pancreas. Eia naʻe, he kakaikahi loa, hiki iā lākou ke lilo i metastatic/aggressive. Inā hana lākou, ʻoi aku ka nui o ka laha ʻana i nā lymph nodes kokoke a me ke akepaʻa.
Pehea ka hopena o ka insulinoma i ke kino?
Ua ʻōlelo mua wau he puʻupuʻu ka insulinoma e hana nui ana i ka insulin. No laila, he aha ka mea e hana ai ke nui ka insulin? ʻO ka hana nui o ka insulin, ʻo ia ke lawe i ke kō (kapa mākou iā ia he glucose) i loko o ke koko i loko o nā ʻāpana. A laila loaʻa i nā ʻāpana ka ikehu. Akā i ka wā e nui ai ka insulin, emi koke ka nui o ke kō i loko o ke koko. Kāhea mākou i kēia ʻano he hypoglycemia . Ma ka ʻōlelo Sinhala, ʻo ia hoʻi ka emi ʻana o ke kō koko.
Ke hāʻule kou kō koko e like me kēia, hoʻomaka ʻoe e ʻike i nā hōʻailona.
E noʻonoʻo, ua ʻai ʻoe i ka ʻaina kakahiaka, ua hele i ke keʻena, a ke hana nei. I ka manawa koke, ua ʻeha ʻoe, ua hou, ua poniuniu, a ua māmā ke poʻo. Me he mea lā ua luhi a pōloli ʻoe.
I nā manawa e like me kēia, inā ʻoe e ʻai koke a inu paha i kahi mea ʻono, e like me ka wai ʻāpala, ke kīʻaha tī me ke kō, a i ʻole ka maiʻa, e hoʻomaka ʻoe e ʻoluʻolu ma hope o kekahi manawa.
Akā, ʻo ka loaʻa ʻana o ke kō koko haʻahaʻa e like me kēia, ʻoiai me ka ʻike ʻole i ke kumu a me ka ʻike ʻole i ka wā e hiki hou mai ai, he mea weliweli maoli ia. No laila, he manaʻo maikaʻi e mālama mau i kahi meaʻai liʻiliʻi, e like me ka toffee, kokoke. Eia kekahi, inā ua loaʻa iā ʻoe kēia ʻike, pono ʻoe e ʻike i ke kauka i ka wā hikiwawe loa a haʻi iā lākou e pili ana i ia mea.
He aha nā hōʻailona o kēia?
ʻO ka hōʻailona nui o ka insulinoma, e like me ka mea i ʻōlelo ʻia ma mua, ʻo ia ke kō koko haʻahaʻa (hypoglycemia). Hiki i kēia ke hana i nā ʻano hōʻailona like ʻole.
Nā hōʻailona maʻamau:
ʻO kēia nā hōʻailona mua āu e ʻike ai:
- Ka huikau a paʻakikī paha i ka noʻonoʻo ʻana: Me he mea lā e wili ana kou poʻo, ʻaʻole hiki iā ʻoe ke noʻonoʻo i kāu mea e hana nei.
- Hou: Hou wale nō, he hou anu paha.
- Nā palpitations o ka puʻuwai: Manaʻo ʻoe e like me ʻoe ke lohe nei i kou puʻuwai e kuʻi ana.
- Hopohopo a huhū paha: He ʻano hopohopo wale nō, huhū maʻalahi.
- Haʻalulu: Manaʻo ia e haʻalulu ana kou mau lālā.
- Pololi loa.
Nā hōʻailona koʻikoʻi:
Inā hāʻule haʻahaʻa loa kou pae kō koko, hiki i ke kūlana ke lilo i mea koʻikoʻi. Hiki iā ʻoe ke ʻike i nā hōʻailona e like me:
- Nā loli o ka ʻike: Lilo ka ʻike i mea pōwehiwehi, e like me ka ʻike ʻana i ʻelua mau mea i ka manawa hoʻokahi.
- Nā pilikia ma ka ʻōlelo: ka slurring o nā huaʻōlelo, ka hiki ʻole ke ʻōlelo maopopo.
- Nalowale ke kaulike a i ʻole ka hoʻonohonoho ʻana: Ke kūpikipikiʻō nei i ka wā e hele ana, e neʻe ana i mua a i mua i ka wā e hiki aku ai i kahi mea.
- Nā hopu ʻana: Hiki ke hele mai me he mea lā he maʻi lā.
- Ka nalowale o ka ʻike: Hiki paha iā ʻoe ke maʻule a hāʻule.
ʻO ka hapa pinepine, ʻike ka poʻe me ka insulinoma i kēia kō koko haʻahaʻa i ke kakahiaka, ʻo ia hoʻi, ma hope o ke ala ʻana ma hope o kekahi mau hola o ka hoʻokē ʻai ʻana ma hope o ka ʻaina ahiahi. Kāhea mākou i kēia "hoʻokē hypoglycemia". Eia nō naʻe, hiki i kekahi poʻe ke ʻike i kēia kō koko haʻahaʻa ma hope koke iho o ka ʻai ʻana.
He mea nui loa kēia: ʻO ka haʻahaʻa mau o ke kō koko hiki ke hoʻopilikia i kāu mau hana o kēlā me kēia lā, a i kekahi manawa hiki ke alakaʻi i ka hōʻino ʻana o ka lolo, ka coma, a me ka make. No laila, inā loaʻa iā ʻoe nā hōʻailona o ke kō koko haʻahaʻa, e ʻike pono i ke kauka.
No ke aha e ulu ai kēia insulinoma?
ʻO kaʻoiaʻiʻo, ʻaʻole i maopopo i nā kānaka noiʻi ke kumu e māhele koke ai a hoʻonui ʻia nā pūnaewele hana insulin i loko o ka pancreas me ke kaohi ʻole, e hana ana i kēia puʻupuʻu.
Akā, hoʻokahi mea i ʻike ʻia. ʻO ia hoʻi, ʻo kēia kūlana i kapa ʻia ʻo insulinoma i kekahi manawa i kapa ʻia ʻo Multiple Endocrine Neoplasia type 1, a i ʻole (MEN1).Hiki nō hoʻi ke pili pū me kahi maʻi hoʻoilina i kapa ʻia ʻo insulinoma. ʻO kēia ka wā e hoʻokumu ʻia ai nā ʻōpū ma kekahi mau kelepa hana hormone i loko o ko mākou kino (no ka laʻana, ka kelepa pituitary, ke kelepa parathyroid, ka pancreas). ʻAʻole nā insulinomas āpau i hoʻokumu ʻia e MEN1, akā 5% a 10% o nā insulinomas āpau i hoʻokumu ʻia e MEN1.
Inā ua haʻi ʻia e nā kauka i kou ʻohana, e like me kou makuahine, kou makuakāne, a i ʻole nā kaikaina, ua loaʻa iā lākou ke ʻano (MEN1), pono ʻoe e kamaʻilio me kāu kauka e pili ana i ka hoʻāʻo ʻana i ka genetic . Hiki i kēia ke kōkua iā ʻoe e ʻike inā loaʻa iā ʻoe ke ʻano. Inā loaʻa iā ʻoe (MEN1), hiki i kēia mau hoʻāʻo ke kōkua i ka ʻike ʻana i kēia mau puʻupuʻu ma mua o ko lākou ulu ʻana.
Pehea e ʻike ai nā kauka i kēia?
Ke hele ʻoe i ke kauka, e nīnau lākou iā ʻoe e pili ana i kāu mau hōʻailona a nānā iā ʻoe. ʻEkolu mau hōʻailona nui e hōʻike ana he insulinoma kou. Kāhea mākou i kēia mau mea ʻo Whipple's triad .
ʻo lākou:
1. Loaʻa nā hōʻailona o ke kō koko haʻahaʻa (e like me ka dizziness a me ka hou ʻana, e like me ka mea i ʻōlelo ʻia ma mua)
2. He hoʻāʻo e hōʻoia ana ua haʻahaʻa ke kō koko. (ʻO ka maʻamau, hōʻike kahi hoʻāʻo kuʻi manamana lima i kahi pae kō koko ma lalo o 55 mg/dL)
3. Hoʻomaikaʻi nā hōʻailona ke ʻai ʻoe a inu paha i kahi mea i loaʻa ke kō (carbohydrates).
Inā loaʻa iā ʻoe kēia mau hōʻailona ʻekolu a pau, hiki i kāu kauka ke kānalua he insulinoma. A laila e kauoha ʻo ia i kekahi mau hoʻokolohua hou aʻe e hōʻoia i ka maʻi.
Hoʻāʻo wikiwiki 72-hola
ʻO kēia ka hoʻāʻo nui, "maʻamau gula" no ka insulinoma. Pono ʻoe e hoʻokē ʻai a hiki i 72 mau hola. Akā, mai hopohopo, hana ʻia kēia ma ka haukapila, ma lalo o ka nānā ʻana a ke kauka a kahu maʻi paha. ʻAʻole ʻoe hoʻokahi.
Ke hoʻokē ʻai ʻoe e like me kēia, hāʻule kou pae kō koko a hoʻomaka ʻoe e ʻike i nā hōʻailona, e lawe nā kauka i kahi hāpana koko mai ou aku a hoʻāʻo no kēia mau mea:
- Pae kō koko
- Pae insulin
- Pae Proinsulin
- Pae C-peptide
- Pae Beta-hydroxybutyrate
- Ka pae Sulfonylurea (hoʻohana ʻia kēia e nānā i ke alo o kekahi mau lāʻau lapaʻau i hoʻohana ʻia e mālama i ka maʻi diabetes i loko o ke koko)
Ma hope o ka lawe ʻana i ke koko, e mālama nā kauka i kou kō koko haʻahaʻa. Hiki i nā hopena o kēia mau hoʻokolohua ke kōkua i ka hoʻoholo ʻana inā paha ma muli o ka nui o ka insulin kou kō koko haʻahaʻa (kapa mākou i kēia hyperinsulinemia).
He aha nā hoʻokolohua ʻē aʻe i hana ʻia? (Nā hoʻokolohua kiʻi)
Inā hōʻike ka hoʻāʻo hoʻokē ʻai 72-hola i kahi insulinoma, ʻo ka hana aʻe e hoʻoholo ai i kahi o ka puʻupuʻu i loko o ka pancreas a pehea kona nui. Hiki i kēia ke pili i hoʻokahi a ʻoi aku paha o nā scans aʻe:
- Nānā CT
- Nānā MRI
- ʻO ke kiʻi ultrasound ʻōpū
- ʻO ka ultrasound Endoscopic (EUS): Ma kēia, ua hoʻokomo ʻia kahi ʻōmole me kahi kāmela liʻiliʻi ma ka waha a piʻi pololei i ka pancreas.
Inā ʻaʻole hiki i kēia mau scan ke kuhikuhi pololei i kahi o ka puʻupuʻu, hiki i kāu kauka ke kauoha i kahi hoʻokolohua kūikawā ʻē aʻe i kapa ʻia he hoʻokolohua hoʻoulu calcium arterial selective. He hoʻokolohua paʻakikī kēia.
He aha ka lāʻau lapaʻau no kēia?
ʻO ka nūhou maikaʻi, hiki ke ho'ōla loa ʻia ka hapa nui o nā insulinomas me ke ʻoki ʻana, ʻoiai inā ʻaʻole i pālahalaha ka puʻupuʻu i nā wahi ʻē aʻe (nonmetastatic).
ʻO ka mea nui ka hana ʻoki kino.
Aia kekahi mau ʻano hana ʻoki kino. Na kāu kauka e hoʻoholo i ke ʻano hana ʻoki kino kūpono iā ʻoe ma muli o ke ʻano, kahi, a me ka nui o kou puʻupuʻu.
- Enucleation: Pili kēia i ka wehe ʻana i ka puʻupuʻu me ka ʻole o ka hōʻino nui ʻana i ka pancreas, e like me ka wehe pono ʻana i ka yolk mai ka hua manu i hoʻolapalapa ʻia.
- ʻO ka pancreatectomy hapa: E like me ka inoa e hōʻike nei, pili kēia i ka ʻoki ʻana a me ka wehe ʻana i kahi ʻāpana o ka pancreas kahi i loaʻa ai ka puʻupuʻu.
- ʻO ke ʻoki kino ʻo Whipple: He ʻoki kino nui kēia. Hana ʻia ia ke pālahalaha ka puʻupuʻu (metastatic). Pili ia i ka wehe ʻana i kahi ʻāpana o ka pancreas a me kekahi mau ʻiʻo kokoke.
Loaʻa i kēlā me kēia ʻoki kino kekahi mau pilikia. E wehewehe kāu kauka iā lākou āpau iā ʻoe.
Pehea e kaohi ai i ke kō koko haʻahaʻa ma mua o ke ʻoki ʻana a inā ʻaʻole hiki ke ʻoki ʻana?
A hiki i ka wā o ke ʻoki ʻana, a inā ʻaʻole hiki ke ʻoki ʻia no kekahi kumu, he mea nui loa ia e kaohi i kou pae kō koko.
- E nānā pinepine i kou pae kō koko: Hiki i kāu kauka ke ʻōlelo aku iā ʻoe e hoʻohana i kahi ʻōnaehana Continuous Glucose Monitoring (CGM) . Hiki i kēia ke kōkua iā ʻoe e nānā mau i kou pae kō koko. Hiki i kēia ke kōkua iā ʻoe e ʻike i nā pae kō koko haʻahaʻa i ka wā mua, ʻoiai i ka pō.
Akā e hoʻomanaʻo, ʻaʻole hoʻohana ʻia kēia `(CGM)` no ka ʻike ʻana i nā kūlana e like me ka insulinoma, akā no ka nānā ʻana i ka maʻi ke hōʻoia ʻia.
- Nā hoʻololi ʻana i ka ʻai: ʻO ka ʻai ʻana i nā meaʻai i nā manawa maʻamau, ʻoiai nā kalapona paʻakikī (e.g., berena palaoa piha, laiki ʻeleʻele, mea kanu), hiki ke kōkua i ka pale ʻana i ka emi koke ʻana o ke kō koko. ʻO ka ʻai ʻana i kahi meaʻai māmā ma mua o ka hiamoe ʻana hiki ke kōkua i kekahi poʻe.
- ʻO ka glucose intravenous (IV glucose): Inā he haʻahaʻa loa kou kō koko, hiki ke hāʻawi ʻia iā ʻoe ka glucose ma o ka saline ma ka haukapila.
- Nā ʻano lāʻau lapaʻau:
- Diazoxide: Hiki i kēia lāʻau lapaʻau ke kāohi i ka hoʻokuʻu ʻia ʻana o ka insulin mai ka pancreas. Hiki iā ia ke hoʻonui i ka hoʻokuʻu ʻia ʻana o ka glucagon (ka mea e hoʻonui ai i nā pae kō koko) mai ke akepaʻa.
- ʻO Octreotide lāua ʻo Lanreotide: Kōkua pū kēia mau lāʻau lapaʻau i ka hōʻemi ʻana i ka hoʻokuʻu ʻana o ka insulin mai kekahi mau insulinomas.
He mea nui loa ka lawe mau ʻana i kahi kāleka hōʻoia lapaʻau e hōʻike ana he haʻahaʻa kou maʻi kō koko. Ma kēlā ala, inā loaʻa koke iā ʻoe ka pilikia, hiki i kekahi ke kōkua koke iā ʻoe. Eia kekahi, e hoʻomaopopo i kou ʻohana a me nā hoaaloha e pili ana i kēia a pehea e hiki ai iā lākou ke kōkua.
He aha ka mea e hana ai inā ua pālahalaha ka puʻupuʻu (metastatic)?
He mea kākaʻikahi loa, inā ua pālahalaha ka insulinoma i nā ʻāpana ʻē aʻe o ke kino (metastatic), hiki i nā kauka ke hoʻohui i ke ʻoki kino me nā lāʻau lapaʻau ʻē aʻe. A i ʻole, inā ʻaʻole hiki ke ʻoki kino, hiki ke hoʻohana ʻia kēia lāʻau lapaʻau.
- ʻO ka Peptide Receptor Radionuclide Therapy (PRRT)
- Hoʻōla i kuhikuhi ʻia
- Kemoterapia
He mau lāʻau lapaʻau paʻakikī kēia, a na kāu kauka e wehewehe iā ʻoe.
Hiki ke ho'ōla ʻia kēia?
ʻAe! Hiki ke ho'ōla loa ʻia ka Insulinoma me ke ʻoki kino. Ua hōʻike ʻia kekahi noiʻi he 87% o ka poʻe i hana ʻia ke ʻoki kino no ka insulinoma nonmetastatic e ola ana he 10 mau makahiki ma hope o ka hōʻoia ʻana. He helu maikaʻi loa kēlā.
Eia nō naʻe, inā ua pālahalaha ka puʻupuʻu (metastatic), ua ʻōlelo ʻia ka nui o ke ola ʻana he 10 makahiki ma kahi o 33%. Akā e hoʻomanaʻo, he mau kuhi maʻamau wale nō kēia. Ma muli o kou kūlana, hiki i kāu hui lapaʻau ke hāʻawi iā ʻoe i ka ʻike pololei.
He ʻoiaʻiʻo hiki i ka huaʻōlelo "tumor" ke hoʻoweliweli iā mākou. ʻOi loa aku i ka wā he maʻi laha ʻole e like me ka insulinoma. Akā ʻo ka mea maikaʻi loa, hiki ke mālama ʻia ka hapa nui o kēia mau mea me ke ʻoki kino. Eia naʻe, ʻaʻole maʻalahi ka ʻike ʻana he maʻi laha ʻole kou e pono ai ke ʻoki kino. Akā, ʻaʻole ʻoe hoʻokahi. E noho mau ana kāu hui lapaʻau nou, e pane ana i kāu mau nīnau, a e kākoʻo ana iā ʻoe. Inā ʻoe e kaumaha nei i ka naʻau, e kamaʻilio pū me kāu kauka e pili ana i kēlā a e ʻike e pili ana i nā lawelawe hiki iā ʻoe ke loaʻa ke kōkua mai.
Nā mea nui loa āu e hoʻomanaʻo ai (Leka Lawe-Home)
ʻAe, eia nā mea nui e pono ai ʻoe e hoʻomanaʻo mai kā mākou i kamaʻilio ai i kēia lā:
- He puʻupuʻu maikaʻi ʻole ka insulinoma (ʻo ka hapa nui he maikaʻi ʻole) e ulu ana i loko o ka pancreas. Hoʻopuka ia i ka nui o ka insulin.
- Hiki i kēia ke hana i ka hāʻule koke ʻana o ke kō koko (hypoglycemia). Hiki i kēia ke hana i nā hōʻailona e like me ka poniuniu, ka hou ʻana, a me ka palpitations.
- Inā loaʻa pinepine iā ʻoe kēia mau hōʻailona, e ʻike pono i ke kauka.
- Hiki ke ʻike ʻia kēia ma o nā hoʻokolohua kūikawā (hoʻāʻo hoʻokē ʻai 72-hola, nā scan).
- ʻO ke ʻoki kino ka lāʻau lapaʻau nui. I ka hapanui o nā hihia, ʻo ka hopena o kēia he ho'ōla piha.
- Ma mua o ke ʻoki ʻana, a inā ʻaʻole hiki ke ʻoki ʻia, hiki iā ʻoe ke kaohi i nā pae kō koko haʻahaʻa ma o ka ʻai a me ka lāʻau lapaʻau.
- ʻOiai he mea kakaikahi kēia, hiki ke hoʻokō ʻia nā hopena maikaʻi inā ʻike mua ʻia a mālama pono ʻia.
Mai hopohopo, e like me nā maʻi ʻē aʻe, aia kahi lāʻau no kēia. ʻO ka mea nui loa, ʻo ia ka hoʻolohe ʻana i nā hōʻailona a me ka ʻimi ʻana i ke kōkua lapaʻau i ka wā hikiwawe loa.
ʻInsulinoma , pancreas, insulin, kō koko haʻahaʻa, hypoglycemia, puʻupuʻu, hormone, maʻi ʻaʻai pancreatic
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