Omwana wo akula mangu nnyo? Ka tuyige ku gigantism!

Oluusi abaana baffe bakula mangu nnyo, si bwe kiri? Naye si kya bulijjo nti zikula mu bwangu nga ziwanvuye nnyo okusinga abaana abalala, nga zirina ebitundu by’omubiri ebinene. Kino kiyinza okuba nga kiva ku mbeera etali ya bulijjo nnyo. Leero tugenda kwogera ku mbeera ng’eno, nga eno ye ‘Gigantism’.

‘Obunene’ kye ki?

Mu ngeri ennyangu, obulwadde bwa gigantism mbeera etatera kubaawo ng’omwana oba omuvubuka akola obusimu obuyitibwa growth hormone (GH) obuyitiridde . Eno y’ensonga lwaki abaana bano bakula nnyo okusinga abalala. Mu budde obwabulijjo, obusimu buno obw’okukula (GH) bukolebwa akatundu akatono aka sayizi y’entangawuuzi akasangibwa wansi w’obwongo bwaffe. Kiyitibwa ekitundu ekiyitibwa pituitary gland. Kyokka singa ekizimba ekitono kikula mu nseke eno, kisobola okukola obusimu obukula (GH) bungi okusinga bwe kyetaagisa. Awo we wabaawo obunene (gigantism).

Ensigo ya Pituitary Gland ntono esangibwa ku musingi gw’obwongo, wansi wa Hypothalamus. Mu butuufu kifulumya obusimu nga 8. Growth Hormone (GH) y’emu ku zo.

Growth Hormone, era emanyiddwa nga Human Growth Hormone (hGH) yeetaagibwa nnyo mu kukula kw’abaana. Kikwata ebitundu by’omubiri bingi era kiyamba omwana okukula obulungi. Naye waliwo ebika ebimu eby’ebipande ebikula mu magumba gaffe ebiyitibwa Epiphyses/Growth Plates, era bwe bimala okuggalwa ddala (i.e. oluvannyuma lw’okuvubuka), obusimu obukula (GH) teyongera ku buwanvu. Kye kikola kwe kukuuma ensengekera n’enkyukakyuka y’amagumba, eggumba n’ebitundu ebirala. Obusimu buno obw’okukula (GH) bukwatagana nnyo n’obusimu obuyitibwa Insulin-like Growth Factor 1 (IGF1), obukolebwa ekibumba kyaffe. Bino byombi byonna awamu biyamba mu kukula n’okukyusakyusa mu mubiri.

Obulwadde bwa Gigantism mbeera omubiri mwe gukola obusimu obuyitibwa growth hormone (GH) obuyitiridde, ekivaako ebinywa, amagumba n’ebitundu ebiyunga ebinywa okukula amangu. Kino kivaamu obuwanvu obutali bwa bulijjo n’enkyukakyuka eziwerako mu bitundu ebigonvu eby’omubiri. Singa tebajjanjabwa, abantu abamu abalina obulwadde bwa gigantism basobola okukula ne basukka ffuuti 8 obuwanvu.

N’olwekyo kikulu nnyo okuzuula obulwadde buno n’otandika okubujjanjaba amangu ddala nga bwe kisoboka mu mbeera y’obunene.

Njawulo ki eriwo wakati wa ‘Gigantism’ ne ‘Acromegaly’?

Gigantism ne acromegaly zombi mbeera eziva ku busimu bw’okukula obuyitiridde (GH). Enjawulo eri nti ani agifuna. Obulwadde bwa Acromegaly bukosa abantu abakulu. Obunene bukwata abaana n’abavubuka abakulu abakyakula, kwe kugamba, abatannaba kutuuka mu myaka gya buvubuka.

Mu ngeri ennyangu, obunene (gigantism) bubaawo nga emiwendo gy’obusimu obukula (GH) gyeyongera nga ebipande by’okukula mu magumba g’abaana tebinnaggalawo (i.e., ng’obuvubuka tebunnaggwa).

Singa obusimu bwo obw’okukula (GH) bweyongera oluvannyuma lw’obupande bwo obw’okukula okuggalawo, kiyinza okuvaako obulwadde bwa acromegaly. Tojja kukula, naye GH eyitiridde esobola okukosa enkula y’amagumba go, obunene bw’ebitundu byo, n’embeera endala ez’obulamu.

Obulwadde bwa gigantism mbeera etatera kulabika nnyo okusinga acromegaly.

Ani afuna obunene? Kitera kitya?

Wadde nga eno mbeera ya bbula nnyo, obunene busobola okukula mu mwana yenna nga obupande bwe obw’okukula tebunnaggalawo (i.e., tebannaba kumaliriza buvubuka). Businga kubeera mu balenzi okusinga mu bawala.

Gigantism mu butuufu mbeera ya bbula nnyo nnyo. Okugeza, n’okutuusa kati abantu nga 100 bokka be baakakwatibwa mu Amerika. N’olwekyo oyinza okulowooza ku ngeri gye kitali kya bulijjo.

Okukula okwa bulijjo kubaawo kutya mu baana? Njawulo ki eriwo ku gigantism?

Obusimu bw’okukula (GH) bwe bufuga okukula mu buto. Kwe kugamba, kifuga enkyukakyuka mu mubiri ate nga kireeta okukula okupima mu magumba, ebinywa n’ebitundu by’omubiri. Mu budde obwabulijjo, okukula nkola enywevu okutuusa ng’omwana atuuse mu myaka gy’obuvubuka.

Mu kiseera ky’obuvubuka, okufulumya obusimu bw’okwegatta (estrogen ne testosterone) kweyongera nnyo. Kino kireetera epiphyses (growth plates) ku nkomerero z’amagumba amawanvu ag’omwana okuggalawo mpolampola. Epiphyses bwe ziggalawo ddala, kwe kugamba, obuvubuka bwe buwedde, okukula kw’obuwanvu kukoma.

Engeri omwana gy’akula amangu n’obuwanvu bwe obusembayo oluvannyuma lw’okutuuka mu myaka gy’obuvubuka, bisalibwawo okugatta obuzaale obuwerako bw’asikira okuva mu bazadde be, ensonga z’obutonde bw’ensi n’ekikula kye.

Mu mbeera y’obunene (gigantism), omwana akula mangu nnyo, era nga muwanvu nnyo okusinga abaana abalala ab’emyaka n’ekikula kye kimu. Kyokka, obubonero bw’obunene mu kusooka buyinza okulabika ng’okukula kw’abaana okwa bulijjo, ekizibuwalira abazadde okukimanya.

Bw’oba ​​olina ekibuuzo kyonna oba ekikweraliikiriza ku ngeri omwana wo gy’akulamu, kakasa nti oyogera n’omusawo we.

Bubonero ki obulaga nti omuntu alina obunene (gigantism)?

Obunene buva ku busimu obuyitibwa growth hormone (GH) obuyitiridde. Ate era, ekizimba mu nseke z’omubiri (pituitary gland) kiyinza okussa akazito ku bwongo n’ebitundu by’obusimu ebiriraanyewo, ne kireetawo obubonero obumu. Akabonero akakulu ak’obunene (gigantism) kwe kukula ekisusse.Abaana abalina obunene (gigantism) bakula mangu nnyo mu buwanvu.

Ng’oggyeeko okuba omuwanvu ennyo/okusinga emyaka gy’omuntu, engeri z’omubiri ezirabibwa mu bunene (gigantism) mulimu:

• Ekyenyi ekirabika ennyo n’akawanga akamanyiddwa ennyo.
• Okubeera n’ebituli wakati w’amannyo.
• Okugonza kw’ebifaananyi bya ffeesi.
• Emikono n’ebigere ebinene, n’engalo enzito.

Obubonero obulala obuyinza okulabibwa mulimu:

• Okugaziwa kw’ebitundu by’omunda naddala omutima gw’omwana.
• Okutuuyana ennyo (hyperhidrosis).
• Okulaba emirundi ebiri oba obuzibu mu kulaba okw’okumpi.
• Okulumizibwa omutwe.
• Obulumi mu binywa.
• Okulwawo okutuuka mu myaka gy’obuvubuka.
• Okugenda mu nsonga ezitali za bulijjo.
• Ebizibu mu tulo, okugeza, okusannyalala mu tulo.
• Obunafu bw’ebinywa.

Omwana wo bw’aba n’obubonero buno, kikulu nnyo okwogera n’omusawo amangu ddala nga bwe kisoboka.

Biki ebivaako obunene?

Obulwadde bwa gigantism butera okuva ku kizimba ekitali kya bulabe (pituitary adenoma) mu nseke y’omwana. Kino kireeta okufulumya obusimu obuyitibwa growth hormone (GH) obuyitiridde. Abaana abalina obulwadde bwa gigantism bwe bazuulibwa, kumpi bulijjo baba n’ekizimba ekinene ekiyitibwa pituitary adenoma (ekizimba kya mm 10 oba okusingawo), ekiyitibwa macroadenoma. Obulwadde bwa gigantism era buyinza okuva ku kugaziwa kw’endwadde z’omu lubuto ekiyitibwa pituitary hyperplasia.

Abaana bangi abalina obulwadde bwa gigantism balina enkyukakyuka mu buzaale ekivaako ekizimba mu pituitary. Enkyukakyuka y’obuzaale esinga okukwatagana n’obuzaale obunene (gigantism) y’enkyukakyuka oba okuggyibwawo mu buzaale bwa AIP. Kino kikosa abantu nga 29% abalina obulwadde bwa gigantism.

Obulwadde bwa gigantism era busobola okubaawo ng’ekimu ku bizibu by’obuzaale ebiwerako ebitali bimu nnyo eby’okwongera ku bulabe bw’okufuna ekizimba mu pituitary ekifulumya obusimu obukula (GH). Ebimu ku bizibu bino mulimu:

• Carney complex: Eno mbeera ya buzaale ekosa langi y’olususu era ereeta ebizimba ebitali birungi mu lususu, omutima n’enkola y’omubiri. Abantu nga 10% ku 13% abalina Carney complex bafuna growth hormone (GH)-secreting pituitary adenomas, ezitera okukula mpola.
• Obulwadde bwa McCune-Albright:Eno mbeera ya buzaale ekosa amagumba, olususu n’enkola y’omubiri. Kireeta amabala aga café-au-lait ku lususu, enkovu mu magumba, n’okukula amangu. Ebitundu 20% ku 30% ku bantu abalina obulwadde bwa McCune-Albright syndrome balina obusimu bw’okukula obusukkiridde (GH). Kino kitera okuva ku kugaziwa (hyperplasia) kw’endwadde z’omu lubuto, oba okuzimba omubiri (pituitary adenoma).
• Multiple Endocrine Neoplasias (MEN) ebika 1 oba 4: Zino mbeera za buzaale. Mu mbeera eno, endwadde zo emu oba eziwera ez’omubiri zikola ekisusse, oba ekizimba ne kivaamu. Kino kiyinza okuzingiramu ekizimba mu pituitary ekifulumya obusimu obukula (GH).
• Neurofibromatosis: Eno mbeera ya buzaale eyitibwa neurocutaneous disorders. Bino bikosa olususu n’obusimu. Embeera zino ziva ku kweyongera mu ngeri etaali ya bulijjo mu kukula kw’obutoffaali. Kino kiyinza okuvaako ebizimba okutondebwawo mu mubiri gwonna. Mu bino biyinza okuli ekizimba ekifulumya obusimu obukula (GH).
• Family Isolated Pituitary Adenomas (FIPA): Eno mbeera ya nsikirano. Kizingiramu okukula kw’obulwadde bwa pituitary adenomas. Mu bino biyinza okuli obutoffaali obukola obusimu obukula (GH)-secreting adenomas.

Obulwadde bwa gigantism buzuulibwa butya?

Gigantism eyinza okuba enzibu katono okuzuula kubanga mbeera ya bbula nnyo, era kubanga omutindo gw’okukula kw’abaana guyinza okwawukana ennyo olw’obuzaale n’obutonde.

Mu budde obutuufu, abasawo bateebereza obuwanvu bw’omwana ng’obuwanvu bw’omwana busukka emirundi esatu ku buwanvu bwa wakati okusinziira ku kikula kye n’emyaka gye, oba obuwanvu bwa bulijjo obubaliriddwa okuva ku buwanvu bwa bazadde b’omwana.

Singa omusawo w’omwana wo ateebereza nti omwana wo alina obulwadde bwa gigantism, kirabika ajja kukuweereza ew’omusawo w’endwadde z’omu lubuto (omusawo mukugu mu ndwadde ezeekuusa ku busimu). Omusawo ajja kukola okuzuula obulwadde bw’omwana wo ng’asinziira ku byafaayo by’obujjanjabi bw’omwana wo, ebyafaayo by’obujjanjabi bw’amaka, okukeberebwa omubiri mu bujjuvu, n’okukeberebwa okw’enjawulo ng’okukebera omusaayi n’okukebera ebifaananyi.

Bikebere ki ebikozesebwa okuzuula obulwadde bwa gigantism?

Singa omusawo w’omwana wo ateebereza nti alina obulwadde bwa gigantism, ebigezo bino wammanga biyinza okukolebwa okukakasa embeera eno:

• Okukebera mu musaayi Growth Hormone ne IGF-1 (Insulin-like Growth Factor 1): Okukebera kuno kupima emiwendo gy’obusimu obw’enjawulo mu musaayi oguggyiddwa mu musuwa gw’omwana. Singa emiwendo giba waggulu okusinga ku gya bulijjo, kiyinza okuba akabonero k’obunene.
• Glucose Tolerance Test: Okukebera kuno kupima engeri obusimu bw’omwana bw’akula gye bukwatamu glucose. Ku kukebera kuno, omusawo aggya omusaayi mu musuwa mu biseera eby’enjawulo ng’omwana amaze okunywa eddagala lya glucose (ssukaali).
• Okukebera ebifaananyi: Singa okukebera omusaayi kukakasa nti omwana wo alina obulwadde bwa gigantism, omusawo wo ajja kutera okukuwa amagezi okukebera MRI (Magnetic Resonance Imaging) oba CT (Computed Tomography). Bano basobola okulaba obulungi obunene n’ekifo ekizimba ky’omu lubuto we kiri. Era zisobola okuyamba okuzuula obujjanjabi obutuufu obwetaagisa.

Singa omwana wo azuulibwa ng’alina obulwadde bwa gigantism, omusawo ayinza okwongera okukeberebwa okulaba oba embeera eno ekosezza ebitundu by’omubiri ebirala. Ebigezo bino biyinza okuli:

• Echocardiogram okukebera oba waliwo obuzibu ku mutima.
• Okukebera okunoonyereza ku tulo okulaba oba olina obulwadde bw’okusannyalala mu tulo.
• X-ray oba DEXA/DXA scan okukebera obulamu bw’amagumba go.

Obunene bujjanjabwa butya?

Ebigendererwa ebikulu eby’okujjanjaba obunene (gigantism) bye bino:

• Okufuga obulungi emiwendo gya ‘growth hormone’ (GH) ne ‘insulin-like growth factor 1’ (IGF1).
• Okuddukanya okukula kw’ekizimba kya ‘pituitary tumor’.
• Okukendeeza ku buzibu bw’ekizimba ky’omubiri (pituitary tumor) ku bitundu by’obwongo ebiriraanyewo n’obusimu bw’amaaso.
• Okujjanjaba oba okukendeeza ku bikolwa by’obusimu obukula (GH) ku nkola z’omubiri endala.

Abasawo batera okukozesa obujjanjabi obw’omugatte ku gigantism , ng’okulongoosa n’obujjanjabi obw’amasannyalaze bye bisinga okujjanjaba.

Wadde nga waliwo eddagala erikola obulungi okujjanjaba obusimu bw’okukula (GH) obusukkiridde mu bantu abakulu (acromegaly), ebikosa eddagala lino ku baana tebinnaba kunoonyezebwa bulungi.

Okulongoosa obulwadde bwa Gigantism

Okulongoosa bwe bujjanjabi obusinga okukozesebwa ku bulwadde bwa gigantism. Ekigendererwa kwe kuggyawo ekizimba ky’omu lubuto oba okukendeeza ku bunene bwakyo. Olw’okuba ekizimba ky’omu lubuto ekivaako okuzimba ekinene kitera okuba ekinene, omwana ayinza okwetaaga okulongoosebwa emirundi mingi okusobola okufuga obulungi emiwendo gy’obusimu obukula (GH).

Omusawo alongoosa omwana wo ayinza okukozesa enkola y’okulongoosa eyitibwa transsphenoidal surgery okuggyawo ekizimba mu pituitary. Kino kizingiramu okulongoosa ng’oyita mu nnyindo y’omwana wo n’oyita mu sphenoid sinus (ekituli mu kiwanga emabega w’ennyindo, wansi w’obwongo).

Obujjanjabi bw’amasannyalaze (Radiation Therapy) eri Obulwadde bwa Gigantism

Singa okulongoosebwa kulemererwa okukendeeza ku busimu obuyamba omuntu okukula, obujjanjabi obuyitibwa radiation therapy buyinza okuyamba. Kino kizingiramu okukozesa ebyuma eby’enjawulo okugenderera emisinde gy’obusannyalazo ku kizimba. Obujjanjabi buno bukola mpola. Kiyinza okwetaagisa okujjanjabibwa emirundi egiwerako, nga wakati w’owummudde ebiseera ebiwanvu. Era kiyinza okutwala emyaka egiwerako okulaba ebivaamu mu bujjuvu.

Bizibu ki ebiva mu bujjanjabi?

Olw’okulongoosebwa ne/oba obujjanjabi obw’amasannyalaze, abantu nga 60% abalina obulwadde bwa gigantism bafuna embeera eyitibwa hypopituitarism oluvannyuma lw’okujjanjabwa. Kino kye kiseera obusimu obumu, obuwerako oba bwonna obukolebwa enseke z’omubiri (pituitary gland) bwe butakolebwa bulungi. Obulwadde bwa Hypopituitarism bujjanjabwa n’eddagala erikyusa obusimu.

Ebizibu ebiyinza okuva mu kulongoosebwa okuggyawo ekizimba ky’omu lubuto mulimu:

• Okuvaamu omusaayi.
• Amazzi g’omu bwongo (CSF) gakulukuta.
• Obulwadde bw’okuzimba omutwe (omusujja gw’obwongo).
• Okufiirwa sodium (omunnyo) n’amazzi mu mubiri.

Ebizibu ebiva mu bujjanjabi bw’amasannyalaze biyinza okuli:

• Okuzaala Okukosebwa.
• Okubulwa okulaba n’okwonooneka kw’obwongo (rare).
• Okutondebwa kw’ekizimba oluvannyuma lw’emyaka egiwerako oluvannyuma lw’okujjanjabwa (tekitera kubaawo).

Obunene busobola okuziyizibwa? Prognosis eri etya?

Ebyembi tewali ky’oyinza kukola kuziyiza bunene bwa maanyi. Kyokka, okuzuula amangu kikulu nnyo. Obujjanjabi nga bukyali busobola okuyamba okuziyiza oba okuzzaawo enkyukakyuka ezireetera omwana wo okubeera omuwanvu ennyo.

Enteebereza y’abaana n’abavubuka abakulu abazuuliddwa nga balina obulwadde bwa gigantism esinziira ku bintu ebiwerako:

• Obulwadde bwe bwazuulibwa nga bukyali oba nga bulwawo.
• Obujjanjabi bukola butya mu kuddukanya obusimu bw’okukula?
• Oba waliwo ebizibu ebikwatagana n’obunene (gigantism).

Okutwalira awamu, abantu abakadde nga bazuuliddwa batera okuba n‟ebizibu bingi okusinga abo abazuulibwa nga bakyali bato. Kino kirabika kiva ku kumala ebbanga eddene ng’akozesa obusimu bw’okukula n’ekirungo ekikula ekiringa insulini 1 (IGF1).

N’olwekyo, bw’olaba enkyukakyuka ezitali za bulijjo, ezitasuubirwa mu nkula y’omwana wo ne/oba mu ngeri y’omubiri, kyetaagisa okwogera n’omusawo we amangu ddala nga bwe kisoboka.

Omuntu alina obunene (gigantism) awangaala ki? Bizibu ki ebiyinza okubaawo okumala ebbanga eddene?

Okuzuula amangu n’okujjanjaba obulwadde bwa gigantism kyetaagisa okuziyiza obuwanvu obusukkiridde n’ebizibu ebibukwatako n’okwongera ku bulamu bw’omuntu.

Singa tebujjanjabwa, gigantism ekwatagana n’ebizibu ebinene era omuwendo gw’abafa guyinza okutuuka ku mirundi ebiri ku gwa bulijjo.

Ebizibu ebiwangaala abantu abamu abalina obulwadde bwa gigantism bye bafuna olw’obuwanvu bwabwe obuyitiridde n’ekikolwa okutwalira awamu eky’okubeera n’obusimu bw’okukula obuyitiridde mulimu:

• Obuzibu okutambula (Mobility) olw’obunafu bw’ebinywa.
• Osteoarthritis (okuzimba ebinywa).
• Peripheral Neuropathy (obuzibu bw’obusimu obw’okumpi).
• 'Obulwadde bw'okusannyalala mu tulo'.
• Omutima okugaziwa (cardiomegaly) n’obuzibu mu valve y’omutima.
• Ebizibu ebiva mu nkyukakyuka mu mubiri nga Ssukaali ow’ekika eky’okubiri.

Okugatta ku ekyo, omutindo gw’obulamu bw’abantu abalina obulwadde bwa gigantism obutajjanjabiddwa guyinza okukendeera olw’obuzibu mu mirimu gya buli lunaku ng’okugula engoye n’okutambula olw’okuba abawanvu ennyo.

Ddi lw’osaanidde okulaba omusawo w’omwana wo ku nsonga z’obunene?

Singa omwana wo azuuliddwa ng’alina obulwadde bwa gigantism, ajja kwetaaga okulaba omusawo we ne/oba omusawo w’endwadde z’omu lubuto buli kiseera okulondoola enkulaakulana y’obujjanjabi n’okukakasa nti obusimu bwe buli mu nteeko.

Bw’olaba enkyukakyuka yonna mu kigero ky’okukula kw’omwana wo ne/oba engeri z’omubiri gwe, kikulu okwogera n’omusawo w’omwana wo amangu ddala nga bwe kisoboka. Wadde ng’obunene (gigantism) tebusuubirwa kuba buvaako, kirungi okunoonyereza ku nkyukakyuka zonna eziteeberezebwa. Obulwadde bwa gigantism businga kuzuulibwa nga bukyali, era abantu abalina obulwadde bwa gigantism batera okubeera mu bulamu obulungi. Bw’oba ​​olina ekibuuzo kyonna ku nkula y’omwana wo, totya kubuuza musawo wo. Baliwo okukuyamba.

Ebintu ebikulu by'olina okujjukira (Take-Home Message)

Obunene (gigantism) mbeera etatera kubaawo naye nga eyinza okuba ey’amaanyi. Ekisinga obukulu kwe kufuna amagezi mu bwangu omusawo singa olaba ekintu kyonna ekitali kya bulijjo oba ekikwekengera ku nkula y’omwana wo, gamba ng’okukula amangu okusinga bwe kyali kisuubirwa oba okuba n’ebitundu by’omubiri ebinene.

Jjukira nti okuzuula amangu n’okujjanjabibwa kyongera nnyo emikisa gy’omwana wo okubeera mu bulamu obulungi era obwa bulijjo. Tofaayo, abasawo baliwo okukuyamba n'omwana wo. Yogera nabo ku kintu kyonna ekikweraliikiriza.

` Gigantism, Growth Hormone, Pituitary Gland, Okukula mu baana, Okwongera obuwanvu, Acromegaly