Anei ngā whakautu ki ō pātai mō tēnei pukupuku onge e kiia nei ko Paraganglioma!

I ētahi wā ka rongo koe i te werawera nui, ka tere te pao o tō ngākau, ka pāorooro tō mahunga? Kei te rongo rānei koe i te pikinga ohorere o tō toto toto, kāore he take? Ahakoa e whakaaro ana koe he mea tūpono noa iho ēnei, i ētahi wā tera pea he take kē atu kei muri i tēnei. Ko te Paraganglioma tētahi o ngā mate onge engari he mea nui kia mōhio koe.

Nā, he aha tēnei paraganglioma?

He whakarāpopototanga noa iho, he pukupuku onge ngā paragangliomas e puta mai ana i roto i tō tinana. He maha tonu te tipu tata ki te uaua carotid, he oko toto nui i roto i tō kaki, i te taha o ngā io i roto i tō mahunga me tō kaki, i tētahi atu wāhi rānei o tō tinana. He momo pūtau motuhake ēnei pukupuku e kiia nei ko ngā pūtau chromaffin . Ka whakaputa ēnei pūtau i ngā homoni e kiia nei ko ngā catecholamines , ka tukuna ki roto i ō toto.

I mōhio koe he maha ngā momo homoni e whakaputaina ana e ngā repe adrenal, kei runga ake i ō tātou whatukuhu? Ko ēnei catecholamine he homoni e whakahaere ana i ētahi mahi tino nui i roto i tō tātou tinana. E mōhio ana koe he aha ēnei?

• Te tere o tō manawa.
• Te toto toto.
• Te taumata huka toto ('te huka toto').
• Te urupare a tō tātou tinana ki te ahotea.

Ko ngā momo matua o ngā catecholamines he mea nui ko:

• Te dopamine.
• Epinephrine (koinei te mea e kīia ana e tātou ko te adrenaline).
• Ko te norepinephrine (e kiia ana ko te noradrenaline).

Ahakoa kāore ngā paragangliomas e whanake i roto i ngā repe adrenal, ka hangaia ēnei pukupuku mai i te kiko kei roto i ngā repe adrenal. Nō reira, hei tāpiri atu ki ēnei paragangliomas, ka taea hoki e ngā homoni catecholamine te kohikohi i roto i te toto. Koinei te wā ka tīmata te puta mai o ngā tohu rerekē.

He aha te rerekētanga i waenga i te Paraganglioma me te Pheochromocytoma?

He āhua pōhēhē pea ēnei ingoa e rua, tika? He pukupuku onge te paraganglioma me te pheochromocytoma e puta mai ana i ngā pūtau chromaffin kua whakahuatia ake nei. Ko te rerekētanga matua i waenga i ngā mea e rua ko te wāhi e puta ai i roto i te tinana.

Ka puta ngā pheochromocytomas i te wāhanga waenga o tō repe adrenal, e kiia nei ko te adrenal medulla. Ka puta ngā paragangliomas i waho o te repe adrenal. He maha ngā wā ka kitea i te taha o ngā uaua, i ngā io rānei i te kaki. Koia te take i ētahi wā ka kiia ai ngā paragangliomas ko ngā 'extra-adrenal pheochromocytomas'.

He mate pukupuku te Paraganglioma?

He raruraru tēnei e pāngia ana e te tini tāngata. Ka taea e ēnei pukupuku, e kiia nei ko ngā paragangliomas, te noho hei pukupuku (kino) te noho hei pukupuku rānei (pai).I te nuinga o te wā, e 20% o ngā paragangliomas he mate pukupuku.

Engari ko te wero i konei, he uaua ki ngā tākuta te kī tika mēnā he matepukupuku te pukupuku, kāore rānei. Ara, ahakoa ka tangohia te pukupuku mā te pokanga, ā, ka tirohia tōna kiko i raro i te karuārai, i ētahi wā kāore e taea te kī tika. Nō reira, ko te paraganglioma ka kiia he matepukupuku i roto i ēnei take e whai ake nei:

• Mena kua horapa te pukupuku ki ngā kiko e karapoti ana (e kiia ana tēnei ko te 'horapa ā-rohe o te paraganglioma').
• Mena kua horapa ki ngā whekau tawhiti, pērā i ō pukahukahu, i ō wheua rānei (e kiia ana tēnei ko te 'metastasized').
• Mena kua hoki mai anō i muri i te maimoatanga tuatahi me te whakaoranga (ka kiia tēnei ko te 'hokinga mai anō').

Mena he mate pukupuku, me pēhea te horapa?

Mena he mate pukupuku tēnei paraganglioma, kāore he pūnaha whakatau taumata mōna. Engari, e whai ake nei te whakaahuatanga:

• Paraganglioma ā-rohe: Kei te kotahi anake te wāhi o te pukupuku.
• Paraganglioma rohe: Kua horapa te mate pukupuku ki ngā kōpū lymph, ki ētahi atu kiko rānei e tata ana ki te wāhi i tīmata ai.
• Paraganglioma metastatic: Kua horapa te mate pukupuku ki ētahi atu wāhanga o tō tinana, pērā i tō ate, pukahukahu, wheua, ngā kōpū lymph tawhiti rānei. I waenga i te 35% me te 50% o ngā paraganglioma mate pukupuku ka horapa (metastasize) i tēnei ara.
• Paraganglioma e hokihoki mai ana: Kua hoki mai te mate pukupuku i muri i te maimoatanga me te whakaoranga. Tērā pea kei te wāhi kotahi i mua, kei tētahi atu wāhanga rānei o te tinana.

Kia pēhea te tere o te tipu o ēnei nati?

I te nuinga o te wā, ka tino puhoi te tipu o ngā paragangliomas. Heoi, ka rerekē pea tēnei i ia tangata, i ia tangata. Tērā pea ka tere ake te tipu o ētahi tāngata.

Ko wai te mea tino pāngia e tēnei āhuatanga?

Ka taea e tēnei āhuatanga, e kiia nei ko te paraganglioma, te whakawhanake i ngā tau katoa. Heoi, he mea noa iho tēnei i roto i te hunga i waenga i te 30 me te 50 tau te pakeke. Waihoki, tata ki te 10% o ngā take e pūrongohia ana i roto i ngā tamariki.

He pēhea te noa o te Paraganglioma?

He pukupuku tino onge tēnei. E ai ki ngā tatauranga, e rua noa iho ngā tāngata i roto i te miriona ka pāngia e te paragangliomas. Nō reira, ka taea e koe te whakaaro he onge rawa tēnei.

He aha ngā tohu o te Paraganglioma?

Ko ngā tohu o ngā paragangliomas ka puta mai i te tukunga nui rawa o te adrenaline, te noradrenaline rānei kua whakahuatia ake nei ki roto i ō toto. Heoi, kāore ētahi paragangliomas e whakaputa i tēnei homoni tāpiri, nō reira kāore e puta he tohu (e kiia ana he kore tohu).

Ngā tohu e kitea whānuitia anaKo:

• Te tīmatanga ohorere o te toto toto tiketike (te toto toto tiketike).
• Te mamae o te upoko.
• Te werawera nui, kāore he take.
• He tere, he koretake te pā o te ngakau, e tino haruru ana, ā, ka rangona te pā o te manawa.
• Te āhua e wiri ana tō tinana.

Haunga ēnei, kei reira anō ētahi tohu kāore i te tino kitea :

• Te kiri mā rawa atu i tō āhua o mua.
• Whakapairuaki me/ranei te ruaki.
• Te korere.
• Te mate kōroke.
• Te huka toto tiketike (hyperglycemia).
• He hekenga ohorere o te toto toto e puta ai te whanoke ina tū koe (e kiia ana tēnei ko te orthostatic hypotension).
• Te hiroki noa iho, kāore he take.

Tērā pea ka pāngia ētahi e ēnei tohu i ētahi wā, i ētahi wā rānei. Whakaarohia, i ētahi wā kāore he he, kātahi ka puta whakarere mai ēnei tohu, kātahi ka ngaro atu i muri i tētahi wā. Koia te take i ētahi wā ka tomuri te kite i tēnei.

He aha ngā take o te paraganglioma?

I te nuinga o te wā, kāore he tino take mō ngā paragangliomas. Arā, ka puta noa mai. Heoi, tata ki te 25% ki te 35% o te tangata ka pāngia e te paragangliomas nā te mate ira e ahu mai ana i roto i ngā whānau (mate tuku iho). Ko ētahi o ēnei mate ko:

• Te mate pukupuku endocrine maha 2, momo A me B (MEN2A me MEN2B)).
• Te mate a Von Hippel-Lindau (VHL).
• Neurofibromatosis momo 1 (NF1).
• Te mate paraganglioma tuku iho.
• Ko te takirua Carney-Stratakis (e haere tahi ana te paraganglioma me te pukupuku stromal gastrointestinal (GIST)).
• Te toru o Carney (tērā pea kei roto ko te paraganglioma, te GIST, me tētahi momo pukupuku pūkahukahu e kiia nei ko te chondroma pūkahukahu).

Me pēhea te tātaritanga o te Paraganglioma?

He uaua te tautuhi i te paraganglioma nā te mea he pukupuku onge, ā, i ētahi wā kāore he tohu e puta. I ētahi wā, ka kitea e ngā tākuta te paraganglioma i a rātou e whakamātautau ana mō tētahi atu take.

Ka whakapae pea te tākuta he paraganglioma i muri i te whakaaro ki ngā āhuatanga e whai ake nei:

• Tō hītori hauora katoa, inā koa mēnā kua pāngia tētahi o tō whānau e te pheochromocytoma, te paraganglioma rānei.
• He whakamātautau tinana me te hauora katoa.
• Te āhua o ētahi tohu. Hei tauira, mēnā he toto toto tiketike tōu, kāore e taea te whakahaere mā ngā maimoatanga noa.

He aha ngā whakamātautau e mahia ana mō tēnei?

Ka whakamahia pea e tō tākuta ēnei whakamātautau me ngā tikanga hei whakatau mēnā he paraganglioma tōu:

• Whakamātautau tinana: Ka tirotirohia koe e tō tākuta, ka tirohia hoki tō hauora whānui, pērā i tō toto toto. Ka pātai atu hoki ia mō tō hītori hauora me tō whānau, inā koa ngā raruraru e pā ana ki ngā homoni.
• Whakamātautau mimi 24-hāora: Ko te tikanga o tēnei he kohikohi i tētahi tauira o tō mimi mō te wā 24-hāora, me te ine i te nui o ngā homoni adrenal e kiia nei ko ngā catecholamines. Ka rapua hoki ngā matū ka puta mai i te wā e pakaru ai ēnei homoni. Mena kei roto i tō mimi ēnei catecholamines i ngā taumata teitei ake i te tikanga, he tohu pea tēnei nō te paraganglioma.
• Ngā whakamātautau catecholamine toto: Ka ine ēnei whakamātautau i ngā taumata o ngā catecholamine i roto i tō toto. E ai ki te kōrero i mua ake nei, ka rapua hoki ngā matū e puta ana i te wā e pakaru ana ēnei homoni. Mena he nui ake i te noa te nui o ēnei i roto i te toto, he tohu pea tēnei nō te paraganglioma.
• Matawai PET (matawai tomografi tukunga positron): Ko te matawai PET he werohanga i tētahi matū irahiko haumaru (radiotracer) ki roto i tō tinana, me te tango pikitia o ō whekau me ō kiko mā te whakamahi i tētahi taputapu e kiia nei ko te matawai PET. Ka tautuhia e tēnei matawai ngā pūtau me ngā pukupuku tino kaha e mimiti ana i te matū. Ka āwhina tēnei ki te whakatau mēnā he raruraru hauora. He tino pai tēnei matawai mō te tautuhi i te wāhi o te paraganglioma.
• Matawai CT (matawai tomografi rorohiko): He tikanga te matawai CT e tango ana i tētahi raupapa hihi-X mai i ngā koki rerekē hei hanga pikitia taipitopito o roto o tō tinana. Tērā pea ka tūtohu tō tākuta i tētahi matawai CT hei āwhina i te tautuhi i te wāhi o te pukupuku (i te kaki te nuinga).
• Matawai MRI (whakaahua aukume): Ka whakamahia e te MRI he aukume, he ngaru reo irirangi, me te rorohiko hei hanga i tētahi raupapa pikitia taipitopito o roto o tō tinana. Tērā pea ka tūtohu tō tākuta i tētahi MRI hei tirotiro pai ake i te wāhi kei reira te pukupuku.

Kia kitea tō mate paraganglioma e tō tākuta, ka whakahaerehia pea e rātou ētahi atu whakamātautau hei tirotiro mēnā kua horapa ki ētahi atu wāhanga o tō tinana.

He mea tika te whakamātautau ira?

Mena ka tāpaetia koe he paraganglioma, ka tūtohu pea tō tākuta kia whai koe i te tohutohu ira hei kimi mēnā he mate tuku iho tōu, ā, kei te mōrearea koe ki te whakawhanake i ētahi atu mate pukupuku e pā ana ki taua mate.

Ka tūtohu pea tō tākuta i te whakamātautau ira i roto i ēnei take:

• Mena kei a koe, kei tētahi rānei o tō whānau ngā tohu e pā ana ki te pheochromocytoma tuku iho, te paraganglioma rānei.
• Mena he tohu kei a koe he nui ake i te noa o ngā taumata catecholamines i roto i tō toto, he tohu rānei nō te paraganglioma matepukupuku.
• Mena kua pāngia koe e te paraganglioma i mua i te 40 tau te pakeke.

Mena ka kitea e tō kaitohutohu ira ētahi huringa ira i roto i ngā hua o ō whakamātautau, tera pea ka tūtohu ia kia whakamātauria hoki ētahi atu mema o tō whānau (tae atu ki te hunga kāore he tohu engari kei te mōrearea).

Me pēhea te rongoā i te Paraganglioma?

Ko te maimoatanga o te paraganglioma e whakawhirinaki ana ki etahi mea, tae atu ki:

• Te rahi o te pukupuku.
• Ahakoa he mate pukupuku (kino) te pukupuku, he pai rānei (pai).
• Ahakoa he tohu kei a koe nā te nui o ngā taumata catecholamines.
• Kei te wāhi kotahi anake te pukupuku, kua horapa rānei (kua horapa) ki ētahi atu wāhanga o te tinana?
• Ahakoa i kitea te pukupuku mō te wā tuatahi, i ora rānei i mua, kātahi ka hoki mai anō.

Mena he paraganglioma tōu e puta ai ngā tohu nā te nui rawa o ngā homoni, ka tohua e tō tākuta he rongoā hei whakahaere i aua tohu. Kei roto i ēnei rongoā ko:

• Ngā rongoā hei whakahaere i tō toto toto, hei tauira, ngā aukati-āra .
• Ngā rongoā hei pupuri i te tere o te manawa ki te taumata noa, hei tauira, ngā beta-blockers .
• Ngā rongoā e aukati ana i ngā pānga o ngā homoni e tukuna ana e tō repe adrenal.

Ko ngā kōwhiringa maimoatanga mō te paraganglioma ko:

• Te tango pokanga i te pukupuku.
• Te rongoā irahiko.
• Te rongoā matū.
• Te rongoā whakaweti.
• Te rongoā kua arotahihia.

Māu me tō tīma hauora e whakatau te mahere maimoatanga e tino pai ana mōu me tō āhua.

Te tango pokanga o te pukupuku

Ko te pokanga te maimoatanga matua mō te paraganglioma. I te wā e pokangahia ana hei tango i te pukupuku, ka tirohia e tō taote pokanga ngā kiko e karapoti ana me ngā kōpū lymph kia kite ai mēnā kua horapa te pukupuku. Mēnā kua horapa, ka tangohia e te taote pokanga te kiko e pāngia ana, mēnā ka taea.

Ka taea te tango i te nuinga o ngā paragangliomas mā te whakamahi i ngā tikanga iti rawa te whakaekenga, pērā i te pokanga laparoscopic . Ko te tikanga o tēnei ko te hanga i ētahi tapahi iti ki tō kiri me te tango i te pukupuku mā te whakamahi i ngā taputapu motuhake. Heoi, ko ngā pukupuku nunui ake ka hiahiatia he pokanga tuwhera tuku iho.

I muri i te pokanga, ka tirohia e tō tākuta ngā taumata o ngā catecholamines i roto i tō toto, i tō mimi rānei. Mēnā ka hoki anō ngā taumata o ngā catecholamines ki te āhua noa, he tohu tēnei kua tangohia katoatia ngā pūtau paraganglioma.

Te Whakaora Irahiko

Ko te rongoā irahiko he maimoatanga mate pukupuku e whakamahi ana i ngā hihi irahiko kaha-nui hei patu i ngā pūtau mate pukupuku, hei aukati rānei i tō rātou tipu. Ka mahia tēnei me te whakaiti i te kino ki ngā kiko hauora e karapoti ana.

E rua ngā momo rongoā irahiko:

• Te rongoā irahiko o waho: Ko te whakamahi i tētahi mīhini i waho o tō tinana hei tuku i te irahiko ki te wāhi kei reira te matepukupuku.
• Te rongoā irahiko ā-roto: Ko te whakauru i tētahi matū irahiko ki roto i ngā ngira, ngā kākano, ngā waea, ngā catheter rānei, kātahi ka whakanohoia tika ki roto, ki te taha rānei o te pukupuku e te tākuta.

Ko te momo rongoā irahiko e taunakitia ana e tō tākuta, e whakawhirinaki ana ki te mea kei te rohe tō matepukupuku, kei te rohe, kei tawhiti, kua hoki mai rānei. Ko te nuinga o ngā tākuta e whakamahi ana i te rongoā irahiko hihi o waho me/ranei te rongoā 131I-MIBG hei rongoā i ngā paragangliomas matepukupuku. Ko te rongoā 131I-MIBG he tikanga e hoatu ana i tētahi matū irahiko ki ētahi momo pūtau matepukupuku, kātahi ka werohia ki roto i te tinana, ā, mā te irahiko e tukuna ana e ia ka patu i ngā pūtau.

Te rongoā matū

Ko te rongoā paerewa mō te paraganglioma metastatic ko te chemotherapy. Kei roto i tēnei ko te whakamahi i ngā rongoā hei patu i ngā pūtau matepukupuku, hei aukati i a rātou kia kore e wehewehe, hei aukati rānei i a rātou kia kore e tipu. Ko te tikanga ka tukuna te chemotherapy mā roto i te uaua. Ahakoa he maimoatanga whai hua tēnei, ka pā mai pea ngā pānga taha.

Te Whakaora Whakamutu

Ko te whakaora tangohanga he kōwhiringa maimoatanga iti rawa te whakaekenga e whakamahi ana i ngā pāmahana tino teitei, tino iti rānei hei whakangaro i ngā pukupuku. Ko ngā whakaora tangohanga e āwhina ana ki te patu i ngā pūtau matepukupuku me ngā pūtau rerekē ko:

• Te tango i ngā ngaru irirangi: Kei roto i tēnei ko te whakamahi i ngā ngaru irirangi hei whakamahana me te whakangaro i ngā pūtau matepukupuku me ngā pūtau rerekē. Ka tukuna ngā ngaru irirangi mā roto i ngā irahiko (ngā taputapu iti e kawe ana i te hiko).
• Cryoablation: Ka whakamahia e tēnei maimoatanga te hauota wai, te hauhā waro wai rānei hei whakatio me te whakangaro i ngā pūtau matepukupuku me ngā pūtau rerekē.

Te Whakaora Whaiaro

Ko te rongoā arotahi he kōwhiringa maimoatanga e whakamahi ana i ngā rongoā, i ētahi atu matū rānei hei whakaeke i ngā pūtau matepukupuku motuhake anake, me te kore e whara i ngā pūtau hauora. Ka whakamahia e ngā tākuta te rongoā arotahi hei rongoā i ngā paragangliomas tawhiti me ngā paragangliomas e hokihoki ana.

Kei te rangahau ngā kairangahau i tētahi aukati tyrosine kinase e kiia nei ko te sunitinib.Kei te rangahauhia tētahi momo rongoā hei tirotiro i te pai o tana rongoā i ngā paragangliomas tawhiti. Ko te rongoā aukati tyrosine kinase he momo rongoā arotahi e aukati ana i te tipu o te pukupuku.

Ka taea te ārai i te whanaketanga o te paraganglioma?

Engari, kāore e taea te ārai i ngā paragangliomas. Heoi, ki te mea he mate tuku iho tōu, he ira rānei e whakararu ana i a koe ki te whakawhanake i ngā paragangliomas, ka taea e te tohutohu ira te āwhina i a koe kia whakamātauria mō ngā paragangliomas, ā, tera pea ka kitea wawetia.

Kōrero ki tō tākuta mēnā kua pāngia ō whanaunga tuatahi (ngā tuākana me ngā mātua) e te paraganglioma, te pheochromocytoma rānei, me/rānei mēnā kei a koe tētahi o ēnei āhuatanga ira:

• Te mate pukupuku endocrine maha 2.
• Te mate a Von Hippel-Lindau (VHL).
• Neurofibromatosis momo 1.
• Te mate paraganglioma tuku iho.
• Te takirua o Carney-Stratakis.
• Te tokotoru o Carney.

He aha te matapae mō tēnei āhuatanga?

Ko te tirohanga mō ngā paragangliomas, arā, te tūponotanga o te ora me te oranga tonutanga, ka rerekē i runga i ētahi āhuatanga. I roto i ēnei:

• Kei hea te pukupuku i roto i tō tinana, me tōna rahi.
• Ahakoa he mate pukupuku, kua horapa rānei ki ētahi atu wāhanga o te tinana.
• I tangohia te pukupuku mā te pokanga, ā, mēnā koinā, e hia te nui o te pukupuku i tangohia i te wā o te pokanga?

Ko te hunga he paraganglioma iti kāore anō kia horapa ki ētahi atu wāhanga o te tinana (kāore anō kia horapa) , ko te ōrau oranga mō ngā tau e rima ko te 95%. Heoi, ko te hunga he paraganglioma kua hoki mai i muri i te maimoatanga tuatahi, kua horapa rānei ki ētahi atu wāhanga o te tinana (metastasized), ko te ōrau oranga mō ngā tau e rima ko te 34% me te 60% .

Waihoki, kei reira ētahi paragangliomas kino, ahakoa kāore anō kia horapa tawhiti, kāore e taea te tango katoa mā te pokanga nā te mea kua horapa tawhiti ki roto i ngā kiko e karapoti ana. I roto i ēnei āhuatanga, ka mōrearea, ka uaua hoki te rongoā i te nui rawa o te adrenaline me te noradrenaline.

Ko te mea nui, ko ngā paragangliomas, ahakoa he mate pukupuku, kāore rānei, ki te kore e rongoatia, ka pā mai he raruraru kino, tae atu ki te mate nā te nui rawa o te adrenaline me te noradrenaline e tukuna ana e rātou.

Ko ētahi o ēnei raruraru ko:

• Te mate uaua o te ngākau (cardiomyopathy).
• Te mumura o te uaua o tō ngākau ('myocarditis').
• Te toto kore e taea te whakahaere i roto i tō roro (te toto o te roro).
• Te pupūnga wai i roto i ō pukahukahu (te pupuhi pūkahukahu).
• Te whakaekenga o te ngakau ('myocardial infarction').
• Te whiu.
• Koma.
• Te mate.

Āhea ahau me toro atu ki te tākuta?

Mena kua tautuhia koe he paraganglioma, ā, ka pāngia koe e ngā tohu whakahihi, me toro atu ki tō tākuta tonu.

Ki te pāngia koe e ngā tohu o te paraganglioma, pērā i te toto toto tiketike me te ānini, kōrero ki tō tākuta. Nā te mea he onge te paraganglioma, he mea nui tonu te rongoā i te toto toto tiketike, ahakoa kāore pea koe e pāngia e taua mate.

Ki te kitea e koe tētahi o ō whanaunga tuatahi (tuākana, teina, mātua) he mate ira pēnei i te "Multiple endocrine neoplasia 2 syndrome" me te "Von Hippel-Lindau (VHL) disease" rānei, pātai atu ki tō tākuta mō ngā whakamātautau ira, nā te mea ka piki ake pea tō tūponotanga ki te whakawhanake i te paraganglioma.

He aha ngā pātai me pātai atu koe ki tō tākuta?

Mena kua tāpaetia koe he paraganglioma, he pai pea te pātai atu ki tō tākuta i ēnei pātai:

• He aha ahau i pāngia ai e te paraganglioma?
• Ka taea e aku tamariki, me/ranei aku whanaunga te pāngia e te paraganglioma?
• He aha ngā kōwhiringa maimoatanga kei a au?
• He aha ngā pānga taha o ngā maimoatanga rerekē?
• Me pēhea taku whakahaere i aku tohumate?

Hei whakamutunga, ngā mea hei maumahara (Karere hei tango ki te kāinga)

He mate onge te paraganglioma, engari he mea nui kia mōhio koe ki tēnei. Mena kei a koe ngā tohu e mau tonu ana, e uaua ana ki te mārama, inā koa te toto toto tiketike ohorere, te werawera, te tere o te manawa rānei, he mea whakaaro nui kia rapu tohutohu hauora kaua e waiho hei mea tupurangi noa iho.

Ahakoa kāore i te mōhiotia te pūtake o te paraganglioma, he hononga ki ētahi āhuatanga tuku iho. Nō reira, mēnā kua pāngia tētahi o tō whānau e te paraganglioma, e te pheochromocytoma rānei, ka taea e te whakamātautau ira te āwhina i a koe ki te kimi i tō mōrearea, me te mea hoki ka pāngia koe e ētahi atu raruraru hauora. Mēnā he pātai āu mō tēnei, kaua e mangere ki te kōrero ki tō tākuta. Kei konei rātou hei āwhina i a koe.

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