Ke lohe kākou i ka huaʻōlelo "tumor" i loko o ko kākou poʻo, makaʻu koke nā kānaka a pau, ʻeā? He mea maʻamau kēlā. Akā, ʻo ka mea nui e pono ai kākou e hoʻomaopopo, ʻaʻole nā tumo āpau e ulu ana i loko o ke poʻo he maʻi kanesa. I kēia lā, e kamaʻilio kākou e pili ana i kahi tumo e ulu ana i loko o kahi gland liʻiliʻi ma lalo o ko kākou lolo, akā ʻaʻole pinepine he maʻi kanesa. Ua kapa ʻia kēia he pituitary adenoma i ka ʻepekema lapaʻau. No laila, e kamaʻilio kākou e pili ana i kēia me nā kikoʻī, me ka maʻalahi loa.
ʻO ka mea mua, e nānā kākou, he aha ka Pituitary Adenoma?
I ka ʻōlelo maʻalahi, he puʻupuʻu ka pituitary adenoma e ulu ana ma kou pituitary gland. Akā he puʻupuʻu maikaʻi ʻole ia. ʻO ia hoʻi, ʻaʻole ia e laha i nā ʻāpana ʻē aʻe o ke kino e like me ke kanesa. Akā i ka ulu ʻana o kēia mau puʻupuʻu, hiki iā lākou ke kaomi i nā ʻiʻo a me nā aʻalolo a puni. ʻO ia ka manawa e hoʻomaka ai nā hōʻailona like ʻole e ʻike ʻia.
No laila, he aha kēia kelepa pituitary?
He ʻāpana liʻiliʻi ke kelepa pituitary, he ʻano iwi ia, aia ma lalo pono o ka lolo, ma hope o ka ihu. Ua pili ia i ka hypothalamus i loko o ka lolo. ʻElua ʻāpana o kēia kelepa liʻiliʻi, ʻo ka lobe mua a me ka lobe hope. Hoʻopuka kēia mau ʻāpana ʻelua i kekahi mau hormones e pono ai ko kākou kino.
Ua like nā hormones me nā ʻelele i loko o ko kākou kino. Hele lākou ma o ke koko a kuhikuhi i ko kākou mau ʻōpū, nā ʻiʻo, a me nā ʻiʻo ʻē aʻe e hana i nā hana like ʻole.
Eia kekahi o nā hormones nui i hana ʻia e ka pituitary gland:
- ʻO ka hormone Adrenocorticotropic (ACTH)
- ʻO ka hormone antidiuretic (ADH)
- ʻO ka hormone hoʻouluulu follicle (FSH)
- ʻO ka hormone ulu (GH)
- ʻO ka hormone Luteinizing (LH)
- ʻOkitokina
- ʻO Prolactin
- ʻO ka hormone hoʻoulu thyroid (TSH)
Eia kekahi, ke hōʻailona nei ke kelepa pituitary i nā kelepa endocrine ʻē aʻe i loko o ko mākou kino e hana i nā hormones. Ua like ia me ke keʻena poʻo. No laila, ke kūkulu ʻia kahi puʻupuʻu i loko o kēia kelepa, hiki ke loli maoli ka hana o kekahi a ʻoi aku paha o kēia mau hormones.
Pehea e hoʻokaʻawale ʻia ai nā adenomas pituitary?
Hoʻokaʻawale nā kauka i kēia mau puʻupuʻu i ʻelua mau ʻano nui: ma muli o ka hana ʻana o lākou i nā hormones keu a ʻaʻole paha, a ma muli o ko lākou nui.
| Hoʻokaʻawale ʻana ma muli o ka hana ʻana o ka hormone | |
|---|---|
| ʻAno o ka puʻupuʻu | He wehewehe maʻalahi |
| Nā adenomas hana (huna) (nā ʻōpū huna-hormone) | Hoʻopuka kēia ʻano puʻupuʻu i nā hormones pituitary keu. Ma muli o ka hormone keu i hana ʻia, hiki ke loaʻa nā hōʻailona a me nā kūlana like ʻole. |
| Nā adenomas hana ʻole (ʻaʻole huna) (Nā puʻupuʻu ʻaʻole hormonal) | ʻAʻole hana kēia mau puʻupuʻu i nā hormones. Eia nō naʻe, i ko lākou ulu ʻana, hiki iā lākou ke hana i nā hōʻailona ma ke kaomi ʻana i nā aʻalolo a me nā ʻiʻo a puni. ʻO kēia ke ʻano maʻamau o ka puʻupuʻu. |
| Hoʻokaʻawale ma ka nui | |
|---|---|
| ʻAno o ka puʻupuʻu | He wehewehe maʻalahi |
| Nā Microadenomas (Microadenoma) | He mau nati kēia i liʻiliʻi ma mua o 10 millimeters, a i ʻole 1 kenimika. |
| Nā Macroadenomas (Adenoma nui) | He mau puʻupuʻu kēia i ʻoi aku ma mua o 10 milimita. ʻOi aku ka nui o lākou ma mua o nā microadenomas. Hiki i kēia mau puʻupuʻu nui ke hōʻino i ka pituitary gland, e hoʻohaʻahaʻa ana i nā pae hormone ma lalo o ka maʻamau. Ua kapa ʻia kēia kūlana he hypopituitarism . |
Ua manaʻo ʻia kēia he puʻupuʻu lolo?
ʻAe. ʻAʻole ʻo ka pituitary gland he ʻāpana o ka lolo, akā he endocrine gland i hoʻopili ʻia i ka lolo. Eia nō naʻe, manaʻo nā kauka he puʻupuʻu lolo ka pituitary adenoma. ʻO kēia ʻano puʻupuʻu he 10% wale nō o nā puʻupuʻu e ulu ana i loko o ke poʻo.
ʻO ka mea nui e hoʻomanaʻo ai, ʻoiai ua kapa ʻia kēia he "tumor lolo," ʻaʻole ia he maʻi ʻaʻai.
He aha nā hōʻailona o ka adenoma pituitary?
Hiki ke ʻokoʻa loa nā hōʻailona o kēia mau tumors, ma muli o kekahi mau kumu:
- Inā paha e ulu ana ka puʻupuʻu a e hōʻino ana i nā ʻiʻo a puni a i ʻole ka pituitary gland ponoʻī (ua kapa ʻia kēia he hopena nui).
- He puʻupuʻu hana paha ia e hūnā ana i nā hormones, a inā pēlā, ʻo wai ka hormone i hūnā ʻia me ka nui?
Nā hōʻailona o ke kaomi ma muli o ka hoʻonui ʻia ʻana o ka puʻupuʻu (Mass Effect)
He mea maʻamau kēia mau hōʻailona i nā macroadenomas (nā ʻōpū nui).
- Nā pilikia ʻike: ʻO kēia ka hōʻailona nui. Loaʻa i ka 40%-60% o nā maʻi ka nalowale o ka ʻike (ʻike pōwehiwehi, ʻike pālua). ʻO kēia no ka mea i ka ulu ʻana o ka puʻupuʻu, kaomi ia ma ka optic chiasm, kahi e hui ai nā aʻalolo optic mai ko mākou mau maka. ʻO kēia ke kumu o ka nalowale o ka ʻike peripheral, ʻoi aku hoʻi i nā maka .
- ʻEha poʻo: Hiki ke loaʻa nā ʻeha poʻo i ka wā e kaomi ai ka puʻupuʻu i nā ʻiʻo a puni. Eia nō naʻe, no ka mea he mea maʻamau loa nā ʻeha poʻo, hiki nō hoʻi ke loaʻa no nā kumu ʻē aʻe.
- Hypopituitarism: Hiki i kahi puʻupuʻu nui ke hōʻino i nā pūnaewele o ka pituitary gland, e hōʻemi ana i ka hana ʻana o hoʻokahi a ʻoi aku paha mau hormones. ʻOkoʻa nā hōʻailona o kēlā me kēia hemahema hormone.
- ʻO ka hemahema o ka hormone LH a me FSH: ʻO kēia ke kumu o ka haʻahaʻa o nā pae estrogen i nā wahine a me nā pae testosterone haʻahaʻa i nā kāne. Ua kapa ʻia kēia he hypogonadism . ʻO nā hōʻailona e komo pū me nā pōʻaiapuni menstrual kūpono ʻole, ka emi ʻana o ka libido, ka luhi, a me ka hana pono ʻole o ka moekolohe i nā kāne.
- Ka hemahema o ka hormone TSH: Ke alakaʻi nei kēia i ka emi ʻana o ka hana ʻana o ka hormone thyroid. Ua kapa ʻia kēia he hypothyroidism . Hiki i kēia ke hana i ka luhi, ka paʻa ʻana o ka ʻōpū, ka ʻili maloʻo, a me ka lohi o ka puʻuwai.
- Ka hemahema o ka hormone ACTH: ʻO ka hopena kēia i ka emi ʻana o ka hana ʻana o ka hormone cortisol. Ua kapa ʻia kēia he adrenal insufficiency . Hiki ke ʻike ʻia nā hōʻailona e like me ke koko haʻahaʻa, ka nausea, ka luaʻi ʻana, ka ʻeha o ka ʻōpū, a me ka nalowale o ka makemake e ʻai.
- Ka nele o ka hormone GH: ʻOkoʻa nā hōʻailona o ka nele o ka hormone ulu me ka makahiki. Hiki i nā pākeke ke ʻike i ka luhi a me ka nāwaliwali o nā ʻiʻo.
Nā hōʻailona i hoʻokumu ʻia e nā puʻupuʻu e hana i nā hormones keu (Functioning Adenomas)
Hoʻopuka kēia ʻano ʻōpū i ka nui o hoʻokahi a ʻoi aku paha o nā hormones, hiki ke alakaʻi i nā kūlana olakino like ʻole.
| ʻAno o ka puʻupuʻu | ʻO ke kūlana a me nā hōʻailona maʻamau |
|---|---|
| Nā Prolactinoma (Hana nui ka prolactin) | ʻO kēia ke ʻano maʻamau o ka puʻupuʻu pituitary. ʻO ka piʻi ʻana o ka nui o ka hormone prolactin (hyperprolactinemia) hiki ke hoʻoulu i ka hānau ʻole ʻana i nā kāne a me nā wahine. Eia kekahi, hiki i nā wahine hāpai ʻole ke ʻike i kahi kahe waiū mai ko lākou mau umauma (galactorrhea). |
| Nā adenoma Somatotroph (Hoʻopuka i ka hormone ulu hou aʻe) | I nā pākeke, hoʻoulu kēia i kahi maʻi i kapa ʻia ʻo acromegaly . ʻO kēia ke kumu o nā lima, nā wāwae, ka maka, a me ke poʻo e lilo i mea nui ʻē. Inā loaʻa kēia maʻi i nā keiki a me nā ʻōpio, lilo lākou i kiʻekiʻe ʻē. Ua kapa ʻia kēia he gigantism . |
| Nā adenoma corticotroph (hoʻopuka i ka ACTH hou aku) | ʻO ka nui o ka ACTH ke kumu o ka hoʻonui ʻia ʻana o ka hormone cortisol, e alakaʻi ana i kahi maʻi i kapa ʻia ʻo Cushing's syndrome . ʻO nā hōʻailona e komo pū me ke koko kiʻekiʻe, ka nāwaliwali o nā ʻiʻo, ka maʻalahi o ka palapū, nā māka kīkoʻo, a me ka maʻi diabetes type 2. |
| Nā adenoma Thyrotroph (Hoʻopuka i ka TSH hou aku) | He mea kākaʻikahi loa kēia. ʻO ka nui o ka TSH ke kumu o ka hoʻonui ʻia ʻana o nā hormones thyroid, e hana ana i kahi maʻi i kapa ʻia ʻo hyperthyroidism . ʻO nā hōʻailona e komo pū me ka piʻi ʻana o ka puʻuwai, ka pohō kaumaha, ka hou ʻana, nā lima haʻalulu, a me ka hoʻomaha ʻole. |
No ke aha i ulu ai nā adenomas pituitary?
ʻAʻole ʻike maopopo nā kānaka ʻepekema i ke kumu kikoʻī, akā ua manaʻoʻiʻo ʻia ua hana pinepine ʻia e nā loli maʻamau (mutations) i loko o kā mākou DNA . Hoʻoulu kēia mau loli i nā cell i loko o ka pituitary gland e ulu aʻe ma waho o ke kaohi a hana i kahi puʻupuʻu.
I kekahi manawa hiki ke hoʻopili ʻia kēia mau mea i nā kūlana genetic i hoʻoili ʻia ma o nā hanauna, akā ʻo ka hapa nui o ka manawa hiki mai lākou ma kahi ulia.
Pehea e ʻike ai i kēia maʻi?
E kauoha kāu kauka i nā hoʻokolohua e ʻike i kēia ma muli o kāu mau hōʻailona. I kekahi manawa, hiki ke loaʻa kēia mau puʻupuʻu i ka wā o ka scan poʻo no kekahi kumu ʻē aʻe.
Inā kānalua kāu kauka i kēia kūlana, hiki iā lākou ke kauoha i nā hoʻokolohua aʻe:
- Nā hoʻāʻo koko: Ma muli o kāu mau hōʻailona, hiki ke kauoha ʻia nā hoʻāʻo koko e nānā i nā pae hormone like ʻole.
- Nā hoʻāʻo kiʻi: Hiki i kahi MRI (Magnetic Resonance Imaging) a i ʻole CT (Computed Tomography) scan o ke poʻo ke hōʻoia i ke alo o kēia puʻupuʻu.
- Hoʻokolokolo maka: Inā he mau pilikia ʻike maka kou, e hana ʻia kahi hoʻāʻo kahua ʻike maka e nānā i ka hana o kou mau maka.
He aha nā lāʻau lapaʻau?
ʻEkolu mau koho lapaʻau no kēia: ʻoki kino, lāʻau lapaʻau, a me ka radiation therapy. Na kāu hui lapaʻau e hoʻoholo i ka lāʻau lapaʻau kūpono loa iā ʻoe ma muli o ke ʻano, ka nui, a me nā hōʻailona o kāu puʻupuʻu.
1. ʻOki kino: Inā ʻo ka puʻupuʻu ke kumu o nā hemahema hormonal a i ʻole nā pilikia ʻike, hiki i ke kauka ke ʻōlelo i ke ʻoki kino e wehe i ka ʻāpana a i ʻole ka hapa o ka puʻupuʻu.
- ʻO ke ʻano maʻamau (95%) i hoʻohana ʻia no kēia, ʻo ia ke ʻoki ʻana transsphenoidal , kahi e hoʻokomo ʻia ai kahi kāmela liʻiliʻi a me nā mea hana ma o ka ihu e wehe i ka puʻupuʻu.
- Inā nui loa ka puʻupuʻu, pono paha e hoʻohana i ke ʻoki transcranial, i hana ʻia ma o ke poʻo.
2. Lāʻau lapaʻau: Hiki ke mālama ʻia kekahi mau ʻano puʻupuʻu, ʻoiai ʻo Prolactinomas , me nā lāʻau lapaʻau. Hoʻemi kēia mau lāʻau i ka puʻupuʻu a kāohi i nā hōʻailona. ʻO ka maʻamau, hāʻawi ʻia nā lāʻau lapaʻau e like me cabergoline a i ʻole bromocriptine no kēia. Loaʻa i ka 80% o nā maʻi nā hopena maikaʻi me kēia mau lāʻau lapaʻau.
3. Lapaʻau radiation: Pili kēia i ka hoʻohana ʻana i nā kukuna X-ikehu kiʻekiʻe e hoʻēmi i ka puʻupuʻu a i ʻole e hoʻōki i kona ulu ʻana. Hana ʻia kēia me ka hoʻohana ʻana i kahi ʻano hana kūikawā i kapa ʻia ʻo stereotactic radiosurgery . Pili kēia i ke kuhikuhi ʻana i ka puʻupuʻu me nā kukuna radiation me ka hoʻēmi ʻana i ka hōʻino ʻana i nā ʻiʻo olakino a puni.
He aha ka mea e hana ʻia ma hope o ka mālama ʻana?
He maikaʻi loa ka manaʻo no kēia. Ma hope o ka wehe loa ʻia ʻana o ka puʻupuʻu me ka lāʻau lapaʻau, hiki i ka hapa nui o ka poʻe ke ola i kahi ola piha a olakino.
I kekahi manawa, hiki i ke ʻoki kino a i ʻole ka radiation therapy ke hōʻino i ka pituitary gland, e hana ana i nā pae hormone haʻahaʻa (hypopituitarism). I kēia hihia, pono paha ʻoe e lawe i nā pila pani hormone no ke koena o kou ola e pani i nā pae haʻahaʻa o nā hormones.
Hiki i kēia mau puʻupuʻu ke hana hou i kekahi manawa, no laila he mea nui loa e hele i nā hoʻokolohua lapaʻau maʻamau ma hope o ka mālama ʻana.
He aha nā pilikia e hiki mai ana inā ʻaʻole mālama ʻia?
Inā ʻaʻole mālama ʻia, hiki i nā ʻōpū nui (macropadenomas) a me nā ʻōpū hana hormone (functioning adenomas) ke hana i nā pilikia olakino koʻikoʻi.
He pilikia kakaikahi loa akā weliweli loa ka pituitary apoplexy . He kūlana kēia e pono ai ka mālama olakino ulia pōpilikia.
ʻO ka mea e hana ʻia ma ʻaneʻi, ʻo ia ke kahe koke ʻana o ke koko i loko a i waho paha o ka puʻupuʻu. Ulu koke ka puʻupuʻu a hōʻino i ka pituitary gland. ʻIke koke ʻia nā hōʻailona o kēia.
- He ʻeha poʻo koʻikoʻi loa a koke.
- ʻIke pālua a i ʻole ka hiki ʻole ke wehe i nā lihilihi ma muli o ka hana pono ʻole o nā ʻiʻo maka.
- Ka nalowale koke ʻana o ka ʻike a i ʻole ka nalowale ʻana o ka ʻike ʻaoʻao.
- Ka emi koke ʻana o ke koko, ka nausea a me ka luaʻi.
Inā ʻike ʻoe i hoʻokahi a ʻoi aku paha o kēia mau hōʻailona, pono ʻoe e hele koke i ka haukapila Emergency Department (ETU) kokoke loa. He pilikia hoʻoweliweli kēia i ke ola.
He mea maʻamau ke makaʻu i ka wā e ʻike ʻia ai ʻoe he adenoma pituitary. Akā e hoʻomanaʻo, ʻaʻole pinepine kēia mau mea he maʻi kanesa. A, me nā lāʻau lapaʻau holomua o kēia lā, hiki ke ho'ōla loa ʻia. E kamaʻilio ākea me kāu kauka a nīnau i kāu mau nīnau a pau.
Leka Lawe-Home
- He maʻi ʻoi aku ka maikaʻi o ka adenoma pituitary, no laila mai hopohopo pono ʻole.
- ʻO ke kumu nui o nā hōʻailona ka hoʻonui ʻia ʻana o ka puʻupuʻu, ke kaomi ʻana ma luna o nā aʻalolo a puni, a i ʻole nā loli i nā pae hormone.
- Mai hoʻowahāwahā i nā pilikia ʻike (ʻoi aku ka emi ʻana o ka ʻike peripheral) a me nā ʻeha poʻo mau. E ʻike koke i ke kauka.
- Aia nā lāʻau lapaʻau kūpono loa no kēia, e like me ke ʻoki kino, ka lāʻau lapaʻau, a me ka radiation therapy.
- Inā ua ʻike ʻia ʻoe me kēia maʻi, he mea nui loa ia e hahai i ka ʻōlelo aʻo a kāu kauka a hele i nā hoʻokolohua maʻamau.
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