Ingabe uzizwa ubanda ngokuzumayo, ujuluka, futhi unesiyezi? Kungaba yi-insulinoma! Ake sixoxe ngalokhu.

Wake waba nesiyezi esingazelelwe, ikhanda elibuhlungu, kanye nokushaya kwenhliziyo, njengalapho ushukela wakho wegazi wehla? Ngezinye izikhathi ucabanga ukuthi lezi zinto zibangelwa nje ukuthi ulambile, kodwa akuvamile, kungaba nesinye isizathu salokhu. Namuhla, sizokhuluma ngesimo esingavamile kodwa esibalulekile okufanele usiqaphele. Leso yisimo esibizwa ngokuthi i-insulinoma.

Iyini le insulinoma?

Kalula nje, i-insulinoma iyisimila esincane, esingesona umdlavuza esikhula kuma-pancreas ethu. Manje ungase uzibuze ukuthi iyini le-pancreas. I-pancreas iyisitho esincane kodwa esibaluleke kakhulu esitholakala ngaphakathi esiswini sethu, ngemuva kwesisu. Ikhiqiza ama-enzyme asisiza ukugaya ukudla esikudlayo, kanye ne-hormone ebizwa ngokuthi i-insulin, elawula amazinga ethu kashukela egazini.

Ngakho-ke, lapho kuvela le insulinoma, ibangela ukuthi kukhishwe i-insulin eningi egazini lethu kunalokho okufanele. Kufana nepompo yamanzi evalekile ehlala ivuza.

Lawa ma-insulinoma awuhlobo lwesimila se-neuroendocrine esikhula kuma-pancreas esibizwa ngokuthi ama-Pancreatic Neuroendocrine Tumors (pNETs). Lawa ama-tumors angavamile. Ingxenye engcono kakhulu ukuthi ama-85% kuya ku-90% ala ma-insulinoma awawona ama-metastatic/ayisebenzi. Lokhu kusho ukuthi awasabalali kwezinye izingxenye zomzimba ngaphandle kwama-pancreas. Kodwa-ke, akuvamile kakhulu, angaba ama-metastatic/abe nolaka. Uma enza kanjalo, cishe asakazekela kuma-lymph node aseduze nasesibindini.

I-insulinoma ithinta kanjani umzimba?

Ngishilo ngaphambilini ukuthi i-insulinoma iyisimila esikhiqiza i-insulin eningi kakhulu. Ngakho-ke, kwenzekani uma kune-insulin eningi kakhulu? Umsebenzi oyinhloko we-insulin ukuthatha ushukela (siwubiza nangokuthi i-glucose) egazini uwuyise emangqamuzaneni. Ngemuva kwalokho amangqamuzane athola amandla. Kodwa uma kune-insulin eningi kakhulu, inani likashukela egazini liyehla ngokuzumayo. Lesi simo sisibiza ngokuthi i-hypoglycemia . NgesiSinhala, kusho ukwehla kukashukela egazini.

Uma ushukela wakho wegazi wehla kanje, uqala ukuzwa izimpawu.

Cabanga nje, usudlile isidlo sasekuseni, uye ehhovisi, futhi usebenza. Kungazelelwe, uzizwa ubuhlungu, ujuluka, unesiyezi, futhi unekhanda elibuhlungu. Kufana nokuthi ukhathele futhi ulambile.

Ngezikhathi ezinjengalezi, uma udla noma uphuza into emnandi ngokushesha, njengejusi lama-apula, inkomishi yetiye enoshukela, noma ubhanana, uzoqala ukuzizwa ungcono ngemva kwesikhashana.

Kodwa, ukuba noshukela ophansi kanje egazini, ikakhulukazi ngaphandle kokwazi imbangela nokungazi ukuthi kuzophinde kwenzeke nini, kuyesabeka ngempela. Ngakho-ke, kuwumqondo omuhle ukugcina ukudla okulula okuncane, njenge-toffee, eduze. Futhi, uma uke waba nalokhu, kufanele ubonane nodokotela ngokushesha okukhulu bese umtshela ngakho.

Ziyini izimpawu zalokhu?

Uphawu oluyinhloko lwe-insulinoma, njengoba kushiwo ngaphambili, ushukela wegazi ophansi (i-hypoglycemia). Lokhu kungabangela izimpawu ezahlukahlukene.

Izimpawu ezivamile:

Lezi izimpawu zokuqala ongase uzibone:

• Ukudideka noma ubunzima bokugxila: Njengokungathi ikhanda lakho liyazungeza, awukwazi ukugxila kulokho okwenzayo.
• Ukujuluka: Ukujuluka nje, mhlawumbe ukujuluka okubandayo.
• Ukushaya kwenhliziyo: Uzizwa sengathi uyayizwa inhliziyo yakho ishaya.
• Ukukhathazeka noma ukucasuka: Isimo sokwethuka nje, esithukuthela kalula.
• Ukuthuthumela: Kuzwakala sengathi izitho zakho ziyathuthumela.
• Ukuzizwa ulambile kakhulu.

Izimpawu ezinkulu:

Uma izinga likashukela egazini lakho lehla kakhulu, isimo singaba sibi kakhulu. Ungase ube nezimpawu ezifana nalezi:

• Umbono uyashintsha: Umbono uba lufifi, njengokubona izinto ezimbili ngesikhathi esisodwa.
• Ubunzima bokukhuluma: ukungakwazi ukukhuluma kahle, ukungakwazi ukukhuluma kahle.
• Ukulahlekelwa ibhalansi noma ukuhambisana: Ukuzulazula lapho uhamba, ukunyakazisa emuva naphambili lapho ufinyelela okuthile.
• Ukuquleka: Kungafika njengokuquleka.
• Ukulahlekelwa ingqondo: Ungase uquleke futhi uwe.

Ngokuvamile, abantu abane-insulinoma babhekana nalolu shukela wegazi ophansi ekuseni, okungukuthi, ngemva kokuvuka ngemva kwamahora ambalwa okuzila ukudla ngemva kwesidlo sakusihlwa. Lokhu sikubiza ngokuthi "i-hypoglycemia yokuzila ukudla". Kodwa-ke, abanye abantu bangaba nalo shukela wegazi ophansi ngisho nangemva nje kokudla.

Lokhu kubaluleke kakhulu: Amazinga kashukela egazini aphansi njalo angaphazamisa imisebenzi yakho yansuku zonke, futhi ngezinye izikhathi angaholela ekulimaleni kobuchopho, ekomeni, ngisho nasekufeni. Ngakho-ke, uma unezimpawu zikashukela wegazi ophansi, qiniseka ukuthi ubona udokotela.

Kungani kuvela le insulinoma?

Eqinisweni, abacwaningi abakakatholi ukuthi kungani amangqamuzana akhiqiza i-insulin kuma-pancreas ehlukana ngokuzumayo futhi aphindaphindeke ngokungalawuleki, okwakha lesi simila.

Kodwa into eyodwa etholakele. Okusho ukuthi, lesi simo esibizwa ngokuthi i-insulinoma ngezinye izikhathi sibizwa ngokuthi i-Multiple Endocrine Neoplasia type 1, noma (MEN1).Kungahlotshaniswa nesimo sofuzo esibizwa ngokuthi i-insulinoma. Lokhu kwenzeka lapho kwakheka izimila ezinhlangeni eziningana ezikhiqiza ama-hormone emzimbeni wethu (isibonelo, indlala ye-pituitary, indlala ye-parathyroid, i-pancreas). Akuwona wonke ama-insulinoma abangelwa yi-MEN1, kodwa u-5% kuya ku-10% wawo wonke ama-insulinoma abangelwa yi-MEN1.

Uma amalungu omndeni wakho, njengomama wakho, ubaba, noma izingane zakini, etshelwe odokotela ukuthi analesi simo (MEN1), kufanele ukhulume nodokotela wakho mayelana nokuhlolwa kofuzo . Lokhu kungakusiza ukuthola ukuthi unalesi simo yini. Uma unayo (MEN1), lezi zivivinyo zingasiza futhi ekuboneni lezi zimila ngaphambi kokuba zikhule.

Odokotela bakuthola kanjani lokhu?

Uma uya kudokotela, bazokubuza ngezimpawu zakho futhi bakuhlole. Kunezibonakaliso ezintathu eziyinhloko ezibonisa ukuthi une-insulinoma. Lezi sizibiza ngokuthi i-Whipple's triad .

Kunjalo:

1. Ukuba nezimpawu zoshukela ophansi egazini (njengesiyezi nokujuluka, njengoba kushiwo ngaphambili)

2. Ukuhlolwa okuqinisekisa ukuthi izinga likashukela egazini liphansi. (Ngokuvamile, ukuhlolwa komunwe okufakwayo kukhombisa izinga likashukela egazini elingaphansi kuka-55 mg/dL)

3. Izimpawu ziyathuthuka uma udla noma uphuza okuthile okunoshukela (ama-carbohydrate).

Uma unazo zonke lezi zimpawu ezintathu, udokotela wakho angase asole ukuthi une-insulinoma. Uzobe eseyala ukuthi kwenziwe ezinye izivivinyo ezimbalwa ukuqinisekisa ukuthi unesifo.

Ukuhlolwa okusheshayo kwamahora angu-72

Lesi yisilingo esiyinhloko, "esijwayelekile" se-insulinoma. Sidinga ukuthi uzile ukudla amahora angafika kwangu-72. Kodwa ungakhathazeki, lokhu kwenziwa esibhedlela, ngaphansi kokuqondisa kukadokotela noma umhlengikazi. Awuwedwa.

Uma uzila ukudla kanje, amazinga kashukela egazini lakho ehla bese uqala ukuzwa izimpawu, odokotela bazokuthatha isampula yegazi kuwe bese behlola okulandelayo:

• Izinga likashukela egazini
• Izinga le-insulin
• Izinga le-proinsulin
• Izinga le-C-peptide
• Izinga le-Beta-hydroxybutyrate
• Izinga le-sulfonylurea (lokhu kusetshenziselwa ukuhlola ukuthi kukhona yini imithi ethile esetshenziselwa ukwelapha isifo sikashukela egazini)

Ngemva kokuthatha igazi, odokotela bazokulapha ushukela wakho wegazi ophansi. Imiphumela yalezi zivivinyo ingasiza ekunqumeni ukuthi ushukela wakho wegazi ophansi ubangelwa yi-insulin eningi kakhulu (lokhu sikubiza ngokuthi i-hyperinsulinemia).

Yiziphi ezinye izivivinyo ezenziwayo? (Ukuhlolwa kwezithombe)

Uma ukuhlolwa kokuzila ukudla kwamahora angu-72 kubonisa ukuthi une-insulinoma, isinyathelo esilandelayo ukuthola ukuthi isimila sikuphi ku-pancreas nokuthi sikhulu kangakanani. Lokhu kungabandakanya okukodwa noma ngaphezulu kwalokhu okulandelayo:

• Ukuskena kwe-CT
• Ukuskena kwe-MRI
• Ukuskena kwe-ultrasound yesisu
• I-Endoscopic ultrasound (EUS): Lokhu kuhilela ukufaka ipayipi elinekhamera encane ngomlomo bese ubheka i-pancreas.

Uma lezi ziskeni zingakwazi ukukhomba indawo eqondile yesimila, udokotela wakho angase akucele olunye ukuhlolwa okukhethekile okubizwa ngokuthi ukuhlolwa kwe-calcium stimulation test ekhethiwe. Lokhu ukuhlolwa okuyinkimbinkimbi kakhulu.

Iyini indlela yokwelapha lokhu?

Izindaba ezinhle ukuthi ama-insulinoma amaningi angelapheka ngokuphelele ngokuhlinzwa, ikakhulukazi uma isimila singakasabalali kwezinye izindawo (ezingenayo i-metastatic).

Into eyinhloko ukuhlinzwa.

Kunezinhlobo eziningana zokuhlinzwa. Udokotela wakho uzonquma ukuthi yikuphi ukuhlinzwa okufanele wena ngokusekelwe ohlotsheni, indawo, kanye nosayizi wesimila sakho.

• Ukususwa kwezicubu: Lokhu kuhilela ukususa isimila kuphela ngaphandle kokubangela umonakalo omkhulu ku-pancreas, njengokususa ngokucophelela i-yolk kuphela eqandeni elibilisiwe.
• Ukususwa kwe-pancreat okuyingxenye: Njengoba igama lisho, lokhu kuhilela ukusika nokususa ingxenye ye-pancreas lapho kukhona khona isimila.
• Ukuhlinzwa kwe-Whipple: Lokhu ukuhlinzwa okukhulu. Kwenziwa lapho isimila sesisakazeke (i-metastatic). Kuhilela ukususa ingxenye ye-pancreas kanye nezicubu ezithile eziseduze.

Ukuhlinzwa ngakunye kunezingozi ezithile. Udokotela wakho uzokuchazela zonke.

Ungalawula kanjani ushukela wegazi ophansi ngaphambi kokuhlinzwa nokuthi ukuhlinzwa akunakwenzeka yini?

Kuze kube yilapho uhlinzwa, noma uma ukuhlinzwa kungenzeki ngesizathu esithile, kubaluleke kakhulu ukulawula ushukela wakho wegazi ophansi.

• Hlola amazinga kashukela egazini lakho njalo: Udokotela wakho angase akuncome ukuthi usebenzise uhlelo lwe-Continuous Glucose Monitoring (CGM) . Lokhu kungakusiza ukuthi uqaphe amazinga kashukela egazini lakho njalo. Lokhu kungakusiza ukuthi uthole amazinga kashukela egazini aphansi kusenesikhathi, ikakhulukazi ebusuku.

Kodwa khumbula, le `(CGM)` ayisetshenziselwa ukuthola izimo ezifana ne-insulinoma, kodwa isetshenziselwa ukuqapha lesi sifo uma sesiqinisekisiwe.

• Izinguquko ekudleni: Ukudla ukudla ngezikhathi ezivamile, ikakhulukazi ama-carbohydrate ayinkimbinkimbi (isib., isinkwa esiphelele, ilayisi elinsundu, imifino), kungasiza ekuvimbeleni ukwehla okungazelelwe kukashukela egazini. Ukudla ukudla okulula okuncane ngaphambi kokulala kungasiza nabanye abantu.
• I-glucose efakwa emthanjeni (i-IV glucose): Uma ushukela wakho wegazi uphansi kakhulu, ungase unikezwe i-glucose nge-saline esibhedlela.
• Izinhlobo zemithi:
• I-Diazoxide: Lo muthi ungalawula ukukhishwa kwe-insulini kusuka ku-pancreas. Ungakhulisa nokukhishwa kwe-glucagon (okwandisa amazinga kashukela egazini) esibindini.
• I-Octreotide ne-Lanreotide: Le mithi isiza futhi ekunciphiseni ukukhishwa kwe-insulin kwamanye ama-insulinoma.

Kubaluleke kakhulu ukuthi uhlale uphethe ikhadi lokuzazisa lezokwelapha elisho ukuthi unesifo sikashukela esiphansi egazini. Ngaleyo ndlela, uma uhlangabezana nenkinga ngokuzumayo, othile angakusiza ngokushesha. Futhi, yazisa umndeni wakho nabangani bakho ngalokhu nokuthi bangakusiza kanjani.

Yini okufanele uyenze uma isimila sesisabalele (sisakazeke kakhulu)?

Akuvamile kakhulu, uma i-insulinoma isisabalale kwezinye izingxenye zomzimba (i-metastatic), odokotela bangase bahlanganise ukuhlinzwa nezinye izindlela zokwelapha. Noma, uma ukuhlinzwa kungenzeki, lokhu kwelashwa kwezokwelapha kungasetshenziswa.

• Ukwelashwa Nge-Radionuclide Ye-Peptide Receptor (PRRT)
• Ukwelashwa okuqondiwe
• Ukwelashwa ngamakhemikhali

Lezi izindlela zokwelapha eziyinkimbinkimbi, udokotela wakho azochaza kuwe.

Ingabe lokhu kungelapheka?

Yebo! I-Insulinoma ivame ukwelapheka ngokuphelele ngokuhlinzwa. Ucwaningo olulodwa lubonise ukuthi abantu abangu-87% abahlinzwa i-insulinoma engeyona eye-metastatic babesaphila eminyakeni eyi-10 ngemuva kokuxilongwa. Leso yisilinganiso esihle kakhulu.

Kodwa-ke, uma isimila sesisabalele (sisakazeke kakhulu), izinga lokusinda kweminyaka eyi-10 kuthiwa lingama-33%. Kodwa khumbula, lokhu kumane kuyizilinganiso ezijwayelekile. Kuye ngesimo sakho, ithimba lakho lezokwelapha lingakunikeza ulwazi olunembile kakhulu.

Kuyiqiniso ukuthi igama elithi "isimila" lingasesabisa. Ikakhulukazi uma kuyisimo esingavamile njenge-insulinoma. Kodwa ingxenye engcono kakhulu ukuthi iningi lalezi zingelashwa ngokuhlinzwa. Noma kunjalo, akulula ukuthola ukuthi unesifo esingavamile esidinga ukuhlinzwa. Kodwa awuwedwa. Ithimba lakho lezokwelapha lizohlala likhona ukuze likusize, liphendule imibuzo yakho, futhi likusekele. Uma uzizwa ucindezelekile ngokomzwelo, khuluma nodokotela wakho ngalokho futhi uthole ngezinsizakalo ongathola usizo kuzo.

Izinto ezibaluleke kakhulu okufanele uzikhumbule (Umyalezo Wokuya Ekhaya)

Kulungile, ngakho-ke, kusukela kulokho esikhulume ngakho namuhla, lezi yizinto ezibaluleke kakhulu okudingeka uzikhumbule:

• I-insulinoma iyisimila esingenabungozi (ikakhulukazi esingenabungozi) esikhula e-pancreas. Sikhiqiza i-insulin eningi kakhulu.
• Lokhu kungabangela ukwehla okungazelelwe kukashukela egazini (hypoglycemia). Lokhu kungabangela izimpawu ezifana nesiyezi, ukujuluka, kanye nokushaya kwenhliziyo.
• Uma uhlangabezana nalezi zimpawu njalo, qiniseka ukuthi ubona udokotela.
• Lokhu kungatholakala ngokuhlolwa okukhethekile (ukuhlolwa kokuzila ukudla kwamahora angu-72, amaskeni).
• Ukwelashwa okuyinhloko ukuhlinzwa. Ezimweni eziningi, lokhu kuphumela ekwelapheni okuphelele.
• Ngaphambi kokuhlinzwa, noma uma ukuhlinzwa kungenzeki, ungalawula amazinga kashukela aphansi egazini ngokudla kanye nemithi.
• Nakuba lesi kuyisimo esingavamile, imiphumela emihle ingatholakala uma iqashelwa kusenesikhathi futhi iphathwa kahle.

Ungakhathazeki, njenganoma yisiphi esinye isifo, kukhona ukwelashwa kwalokhu. Into ebaluleke kakhulu ukunaka izimpawu bese ucela iseluleko sezokwelapha ngokushesha okukhulu.

I- Insulinoma, i-pancreas, i-insulin, ushukela wegazi ophansi, i-hypoglycemia, isimila, i-hormone, umdlavuza we-pancreas