Nthawi zambiri, zinthu zochuluka mosiyanasiyana zimapezeka m'thupi la munthu. Zonse ndi zogwirizana kwambiri, ndipo kusinthasintha kwa magawo awo kungawonetse kukula kwa mavuto akulu azaumoyo. Chifukwa chake chimodzi mwazowonetsa zomwe zimayenera kusungidwa kosasunthika nthawi zonse ndi kuchuluka kwa mahomoni, kuphatikizapo insulin. Ichi ndi mahomoni opangidwa ndi kapamba, ndipo ndikofunikira pakukhazikitsa njira za metabolic. Ndi kuchuluka kwachilendo kwa chiwerengero chake, hyperinsulinemia imapezeka, zomwe zimayambitsa ndi zizindikiro za matenda oterowo zidzalingaliridwa, ndipo tithandizanso momwe chithandizo chake komanso matenda ake amachitikira.

Pali zifukwa zingapo zomwe zingayambitse kuchuluka kwa insulini m'magazi, ndi zinthu zingapo zomwe zingachititse kuti pakhale kuphwanya lamulo kotere.

Chifukwa chake kuwonjezeka kwachilendo kwa insulini kungafotokozedwe ndikupanga kochulukirapo, kuchepa kwa kuchuluka kapena chidwi cha insulin receptors. Nthawi zina zimafanana ndi zomwe zimachitika chifukwa cha kusokonezeka kwa mamolekyulu a glucose kapena kufalikira kwa ma cell mu gululi la intracellular, pomwe glucose sangalowe mu cell.

Pankhani yomwe ikudziwikiratu, madokotala anazindikira kuti kuthekera kwa kuchuluka kwa insulini kumaonekera mwa anthu omwe ali ndi chikhalidwe chobadwa nacho. Chifukwa chake mwa odwala omwe ali ndi ma antijeni a HLA, hyperinsulinemia imakonda kulembedwa. Kuphatikiza apo, mwayi wokhala ndi matenda oterewa umawonjezeka ndikazindikira matenda a shuga.

Zinthu zomwe zitha kudziwikiratu zimaphatikizaponso zolephera pamlingo wapakati wanjala ndi kukhuthala. Komanso ziwerengero zimawonetsa kuti kuchuluka kwachulukidwe ka insulin mthupi kaŵirikaŵiri kumalembedwa kwambiri mwa akazi kuposa amuna. Kuchita masewera olimbitsa thupi pang'ono komanso kukhalapo kwa zizolowezi zingapo zoyipa zomwe zimayimiriridwa ndi kusuta, kumwa mowa, ndi zina zotere.

Komanso, kuchuluka kwa insulini kumawonjezeka ndi zaka. Ndipo pali ubale woonekeratu pakati pa matenda awa komanso kunenepa kwambiri. Kupatula apo, minofu ya adipose mu mawonekedwe ake imakhala gawo lopatula komanso lodziimira la endocrine lomwe limatha kupanga zinthu zambiri zogwira ntchito ndikusunga mahomoni ena pawokha. Ndipo kupezeka kwa kuchuluka kwa mafuta kumapangitsa kuti chitetezo chama cell chikhale ndi mphamvu ya insulin, yomwe mwachilengedwe imawonjezera kupanga.

Nthawi zina kuwonjezeka kwa m'magulu a insulin kumalumikizidwa ndi kupezeka kwa atherosulinosis, komwe kumakhala koopsa. Atherosclerosis imatha kuyambitsa matenda a mtima, kuwonongeka kwa ubongo, kutsika kwamitsempha yamagazi, ndi zina zambiri.

Madokotala ati zomwe zimathandizira kuti hyperinsulinemia iphatikizidwe ndi kusintha kwa msambo ndi polycystic ovary syndrome.

Kuchuluka kwachulukidwe ka insulin kumatha kuonekanso kwa odwala omwe ali ndi matenda oopsa komanso mwa omwe amakakamizidwa kuti azitenga mahomoni pafupipafupi, thiazide diuretics, kapena beta-blockers.

Ndi kuchuluka kwachulukidwe ka insulin m'magazi, matenda osiyanasiyana amatha kuchitika. Nthawi zambiri, matenda oterewa amadzipangitsa kuti azimva bwino ndi maonekedwe a mafuta pamimba, komanso theka lam'mimba. Zizindikiro zapamwamba za hyperinsulinemia zimawonetsedwa ndikuwonetsa ludzu losatha, ndipo nthawi zambiri - kuwonjezeka kwa kuthamanga kwa magazi.Odwala ambiri omwe ali ndi hyperinsulinemia amadandaula za kupweteka kwa minofu, chizungulire, kusokoneza kwambiri, kufooka kwambiri komanso ngakhale kuperewera.

Nthawi zina, kupezeka kwa insulin kopitilira muyeso kumatha kuwonetseredwa ndi kuwonongeka kwa khungu, khungu ndi kuwuma kwambiri kwa khungu, mawonekedwe a masamba otambalala pamimba ndi ntchafu, kudzimbidwa komanso kupweteka m'mafupa.

Pofuna kudziwa molondola zifukwa zowonjezera kuchuluka kwa insulini ndikusankha njira zoyenera kwambiri zowakonzera, kuunika kwathunthu kwa thupi kumachitika. Odwala omwe amakayikira vutoli, adziwe kuchuluka kwa mahomoni m'thupi. Nthawi yomweyo, mulingo wa insulin wokha, komanso enanso walembedwa - TSH, cortisol, ACTH, prolactin, aldosterone ndi renin. Kuwunika kwatsiku ndi tsiku kwa zizindikiro za kuthamanga kwa magazi kumachitika, kulemera kwa thupi kulembedwa, ma ultrasound ndikuwunika magazi angapo. Kuzindikira kwa hyperinsulinemia kungafune kuyesedwa kwa CT kapena MRI ya pituitary gland kuti itulutse matenda a Itsenko-Cushing.

Ndi kuwonjezeka kwa kuchuluka kwa insulini m'magazi, odwala amawonetsedwa zakudya zopatsa thanzi, zomwe zimatha kuchepetsa thupi. Dokotala akutsimikizira kuti muchepetse kuchuluka kwa zopatsa mphamvu za tsiku ndi tsiku kangapo ndikuchepetsa kwambiri kuchuluka kwa chakudya chamafuta. Amafunikanso kuwonjezera zolimbitsa thupi tsiku lonse.

Ponena za kukonza kwa mankhwala, mankhwala amasankhidwa payekha payekhapayekha, kutengera matendawa. Wodwala akakhala ndi nkhawa za kuchuluka kwa shuga, amamuika wothandizira wa hypoglycemic, woyimiriridwa ndi Biguanides ndi thiazolidines. Kuphatikiza apo, mankhwalawa amagwiritsidwa ntchito kupangira magazi, kutsitsa cholesterol, kuchepetsa kulakalaka komanso kukonza kagayidwe.

Chithandizo cha hyperinsulinemia chitha kuchitidwa motsogozedwa ndi endocrinologist ndi akatswiri ena akatswiri.

Hyperinsulinism (insulinoma) ndi chotupa chofala kwambiri cha neuroendocrine (NEO), chomwe chimakhala mpaka 70-75% ya neuroendocrine neoplasms (milandu ya 2-4 pa 1 miliyoni miliyoni). Ma insulin-secreting zotupa nthawi zambiri zimawonetsedwa ndi chizindikiro zovuta za organic hyperinsulinism, zomwe zimapangitsa kuti mu 5-7% ya milandu ikhoza kukhalanso microadenomatosis, hyperplasia ndi neogeneis ya pancreatic islet cell (nezidioblastosis). Organic hyperinsulinism mu 10-15% ya milandu ndi mawonekedwe a mtundu 1 syndrome (Wermer's syndrome). Vermeer syndrome, imaphatikizidwanso ndi insulinoma mu 30% ya odwala.

Nthawi zambiri, insulinomas imapezeka mu kapamba - mu 95-99% ya milandu, yokhala ndi pafupipafupi m'madipatimenti ake onse. Makamaka, ma insulinomas a extrapancreatic amatha kutulutsa m'mimba, duodenum, khungu, ileamu, colon yopinduka, omentum yaing'ono, chikhodzodzo, ndi zipata za ndulu. Makulidwe omwe amafotokozedwa ndi insulin amasiyana pamtunda wamtunda wa 0,2 mpaka 10cm kapena kuposerapo, koma m'mimba mwake mpaka 70% ya iwo sapitilira 1.5 cm, ndichifukwa chake zovuta zovuta kuzidziwitsidwa zimayambitsa. Monga lamulo, chotupachi ndi chimodzi (chokha), ndipo zotupa zingapo zimapezeka mu zosaposa 15% za odwala. Ma insulinomas oopsa amapezeka mu 10% ya milandu ndipo nthawi zambiri amaphatikizana ndi chiwindi kapena ma lymph node.

Mawonetseredwe azachipatala a chotupacho ndi chifukwa cha ntchito yake ya mahomoni, ndiko kuti, katulutsidwe kenakake ka insulin. Ntchito yake yayikulu m thupi ndikuwunika kuchuluka kwa shuga m'magazi ndikumayendetsa kudzera mumitsempha yama cell. Kuphatikiza apo, timadzi timene timakhudzana ndi mayendedwe amtundu wa K + ndi amino acid, komanso zimakhudza mafuta ndi metabolism ya protein. Chofunikira kwambiri pakulimbitsa thupi kwa insulin katulutsidwe ndikuwonjezera kuchuluka kwa shuga m'magazi.Kuzungulira kwa glucose chifukwa cha kusala kwachangu ndi 80-100 mg%, ndipo kumasulidwa kwakukulu kumachitika pang'onopang'ono wama 300-500 mg%.

Odwala ndi insulinomas, kuchuluka kwa insulin katemera kumachitika osati kokha chifukwa cha kuphatikizika kwambiri ndi chotupacho, komanso ndi kukanika kwa chinsinsi cha ma cell a p-cell, omwe sasiya kutulutsa insulin panthawi yotsika glucose m'magazi. Pankhaniyi, limodzi ndi mtundu wabwinobwino wa mahomoni, kuchuluka kwakukulu kwa proinsulin kumapangidwa, pomwe kubisala kwa C-peptide kumakhala kochepa, komwe kumayambitsa kuchepa (kuyerekeza ndi kwanthawi yayitali) pakati pa C-peptide ndi insulin.

Hyperinsulinism imathandizira kuti glycogen iwonjezeke m'chiwindi ndi minofu. Zotsatira zake, kuchuluka kwa glucose (glycogenolysis blockade) kosakwanira kumalowa m'magazi. Kuchepa kofooka kwa ubongo ndi ma carbohydrate sikumapereka mphamvu zake ndipo, chifukwa, kumayambitsa encephalopathy (kawirikawiri mpaka 20% ya glucose onse omwe thupi limagwiritsa ntchito ubongo umagwiritsidwa ntchito pakugwira ntchito kwa ubongo). Choyamba, maselo a kortex amakhudzidwa, mpaka kufa kwawo. Kupezeka kosakwanira kwa shuga ndi okosijeni kuubongo kumayambitsa kukhudzika kwamanjenje yamafundo ndi kuwonjezeka kwamatumbo amwazi, omwe amawonetsedwa kwambiri ndi kufooka, thukuta, tachycardia, nkhawa, kusakwiya, kunjenjemera kwa malekezero. Kuchepetsa makutidwe a oxidative ndikusokoneza chifukwa cha hypoglycemia yamitundu yonse ya kagayidwe mu ubongo kumayambitsa kutayika kwa kamvekedwe kabwino ndi makoma amitsempha yamagazi, omwe, pamodzi ndi kuchuluka kwa magazi kupita ku ubongo chifukwa cha kuphipha kwa zotumphukira za m'mitsempha, kumabweretsa edema, komanso njira za atrophic komanso zodetsa nkhawa mu ubongo.

Tiyenera kukumbukira kuti zochitika za hypoglycemic zimatha kukhala chiwonetsero cha matenda ena a ziwalo zamkati ndi zochitika zina zogwira ntchito. Nthawi zambiri, yogwira hyperinsulinism (yachiwiri) imawonedwa pakudya, kuwonongeka kwambiri (aimpso glucosuria, kutsegula m'mimba, mkaka wa m'mawere) kapena kugwiritsa ntchito kwambiri ma carbohydrate (makonzedwe a insulin, insulin, matenda oyamba chifukwa cha antibodies a insulin ndi receptors ake, cachexia). Owonjezera-pancreatic hypoglycemia ndi kuwonjezeka kwa insulin ndende nthawi zina kumayamba chifukwa cha kuponderezedwa kwa glycogenolysis chifukwa cha kuwonongeka kwa chiwindi (hepatitis, khansa ya chiwindi), zotupa zina zoyipa (khansa ya impso, adrenal glands, fibrosarcoma), kuchepa kwa secretion ya mahomoni a mahomoni (ACTH, cortisol), myxedema.

Zizindikiro zoyenera za matendawa zimadziwika ndi Whipple triad, wofotokozedwa mu 1944:

chitukuko cha kuukira kwa zokha hypoglycemia pamimba yopanda kanthu kapena pambuyo kuchita masewera olimbitsa thupi kuti muthe kudziwa,
kutsika kwa shuga m'magazi pakuwukira (pansipa 2.2 mmol / l).

Hyperinsulinemia imayambitsa, zizindikiro, chithandizo, kuzindikira

Pali zifukwa zingapo zomwe zingayambitse kuchuluka kwa insulini m'magazi, ndi zinthu zingapo zomwe zingachititse kuti pakhale kuphwanya lamulo kotere.

Madokotala ati zomwe zimathandizira kuti hyperinsulinemia iphatikizidwe ndi kusintha kwa msambo ndi polycystic ovary syndrome.

Ndi kuchuluka kwachulukidwe ka insulin m'magazi, matenda osiyanasiyana amatha kuchitika. Nthawi zambiri, matenda oterewa amadzipangitsa kuti azimva bwino ndi maonekedwe a mafuta pamimba, komanso theka lam'mimba. Zizindikiro zapamwamba za hyperinsulinemia zimawonetsedwa ndikuwonetsa ludzu losatha, ndipo nthawi zambiri - kuwonjezeka kwa kuthamanga kwa magazi. Odwala ambiri omwe ali ndi hyperinsulinemia amadandaula za kupweteka kwa minofu, chizungulire, kusokoneza kwambiri, kufooka kwambiri komanso ngakhale kuperewera.

Ndi kuwonjezeka kwa kuchuluka kwa insulini m'magazi, odwala amawonetsedwa zakudya zopatsa thanzi, zomwe zimatha kuchepetsa thupi.Dokotala akutsimikizira kuti muchepetse kuchuluka kwa zopatsa mphamvu za tsiku ndi tsiku kangapo ndikuchepetsa kwambiri kuchuluka kwa chakudya chamafuta. Amafunikanso kuwonjezera zolimbitsa thupi tsiku lonse.

Chithandizo cha hyperinsulinemia chitha kuchitidwa motsogozedwa ndi endocrinologist ndi akatswiri ena akatswiri.

Zopweteka
Zofooka
Chizungulire
Pakamwa pakamwa
Kugona
Khungu lowuma
Kupweteka kwa minofu
Ludzu lalikulu
Chisoni
Masomphenya otsika
Kunenepa kwambiri
Lethargy
Maonekedwe a totambalala matanda
Kusokonezeka kwa m'mimba
Khungu limachita khungu

Hyperinsulinemia ndi matenda opatsirana omwe amadziwika ndi kuchuluka kwa insulin komanso shuga yochepa ya magazi. Njira yothandizirana ndi zoterezi imatha kubweretsa osati chododometsa pakugwira ntchito kwina kwa machitidwe ena a mthupi, komanso chiwopsezo cha hypoglycemic, chomwe chokha chomwe chili pachiwopsezo cha moyo wa munthu.

Mawonekedwe obadwa nawo a hyperinsulinemia ndi osowa kwambiri, pomwe amapezeka amapezeka, nthawi zambiri, ali ndi zaka 35-50. Amadziwikanso kuti azimayi amakonda kutenga matenda otere.

Chithunzi chachipatala cha matenda azachipatalachi ndichachikhalidwe chachilendo, chifukwa, pakuwonetsetsa, dokotala amatha kugwiritsa ntchito njira zofufuzira zasayansi ndi zothandizira. Nthawi zina, matenda osiyanasiyana amafunikira.

Chithandizo cha hyperinsulinism chimachokera ku mankhwala, kudya komanso kuchita masewera olimbitsa thupi. Ndi zoletsedwa kuchitira zochiritsa mwakufuna kwanu.

Hyperinsulinemia imatha kukhala chifukwa cha zotsatirazi zotsatsa:

kuchepa kwa chidwi cha insulin receptors kapena kuchuluka kwawo,
kupanga kwambiri kwa insulin chifukwa cha njira zina za thupi.
kuchuluka kwa mamolekyu a shuga,
Kulephera posayina mu foni.

Zomwe zimapangitsa kukonzekera kwa njira yotereyi ndi izi:

kubadwa kwamtundu wamatenda amtunduwu,
kunenepa
kumwa mankhwala a mahomoni ndi mankhwala ena "olemetsa",
ochepa matenda oopsa
kusintha kwa thupi
pamaso pa polycystic ovary syndrome,
ukalamba
kupezeka kwa zizolowezi zoipa monga kusuta fodya komanso uchidakwa.
zolimbitsa thupi
mbiri ya atherosulinosis,
kuperewera kwa zakudya m'thupi.

Nthawi zina, zomwe ndizosowa kwambiri, zomwe zimayambitsa hyperinsulinemia sizitha kukhazikitsidwa.

Kutengera zomwe zimayambitsa endocrinology, ndi mitundu iwiri yokha ya chipatala ichi chomwe chimadziwika:

Fomu yoyamba ija imagawidwa m'magulu ang'onoang'ono:

Tiyenera kudziwa kuti mawonekedwe oyambilira a pathological awa amadziwika ndi maphunziro owopsa komanso chiwopsezo chotenga zovuta zazikulu.

Njira yachiwiri yachipatala ya matendawa imagawidwanso m'magulu angapo:

extrapancreatic
zothandiza
wachibale.

Pankhaniyi, kukokoloka kumachitika kawirikawiri, m'malo mosamala malangizo onse a dokotala.

Pa magawo oyambirira a chitukuko, zizindikiro za njirayi zimatsala pang'ono kuzimiririka, zomwe zimayambitsa kuzengereza kuzindikirika komanso kulandira chithandizo mosayembekezereka.

Pamene matenda azachipatala akuchulukirachulukira, zizindikiro zotsatirazi zingakhalepo:

ludzu losalekeza, koma limawuma mkamwa.
kunenepa kwam'mimba, ndiko kuti, mafuta amadzaza pamimba ndi m'chiuno,
chizungulire
kupweteka kwa minofu
kufooka, ulesi, ulesi,
kugona
khungu ndi kuuma kwa khungu,
zovuta m'matumbo am'mimba,
kuwonongeka kwamawonekedwe
kupweteka kwa molumikizana
Mapangidwe otambasuka chizindikiro pamimba ndi miyendo.

Chifukwa chakuti zizindikiro za matendawa ndi zopanda pake, muyenera kulumikizana ndi adotolo / chipatala kuti mupeze chithandizo choyambirira posachedwa.

Kuunika koyambirira kumachitika ndi katswiri wamba. Mankhwala ena amatha kuchitika ndi akatswiri angapo, chifukwa matenda amisempha amayambitsa magwiridwe antchito osiyanasiyana a mthupi.

Pulogalamu yodziwitsa ena ikhoza kukhala ndi njira zotsatirazi:

muyezo wa tsiku ndi tsiku wamagazi,
UAC NDI TANK,
urinalysis
Ultrasound
scintigraphy,
MRI yaubongo.

Kutengera ndi zotsatira za phunzirolo, dokotala amatha kudziwa zenizeni za matendawo ndipo, motero, amupatseni mankhwala othandiza.

Poterepa, maziko a mankhwalawa ndi chakudya chamagulu, chifukwa amakulolani kuti muchepetse kulemera kwambiri kwa thupi ndikulepheretsa kukula kwamavuto okhudzana ndi izi. Kuphatikiza apo, adotolo atha kukulemberani mankhwala otsatirawa:

achina,
kutsitsa cholesterol,
kuti muchepetse kulakalaka,
kagayidwe
antihypertensives

Zakudyazi zimaperekedwa ndi dokotala aliyense payekha ndipo ziyenera kuwonedwa pafupipafupi.

Malinga ngati malingaliro onse a dotolo akwaniritsidwa kwathunthu, zovuta zitha kupewedwa.

Monga prophylaxis, munthu ayenera kutsatira malangizo onse okhudzana ndi moyo wathanzi, makamaka chakudya choyenera.

Ngati mukuganiza kuti muli nacho Hyperinsulinemia ndipo zizindikiro zodziwika ndi matendawa, ndiye kuti madokotala amatha kukuthandizani: wa endocrinologist, wothandizira, wazachipatala.

Tiperekanso kugwiritsa ntchito ntchito yathu yofufuzira matenda omwe ali pa intaneti, yomwe imasankha matenda omwe angakhalepo kutengera ndi zomwe zalowetsedwa.

Matenda otopa kwambiri (abbr. CFS) ndi mkhalidwe womwe kufooka kwamthupi ndi kwakuthupi kumachitika chifukwa cha zinthu zosadziwika ndipo kumatenga miyezi isanu ndi umodzi kapena kupitirira apo. Matenda otopa kwambiri, zomwe zimayesedwa kuti zimagwirizanitsidwa kwakanthawi ndi matenda opatsirana, zimagwirizana kwambiri ndi kuthamanga kwa moyo wa anthu komanso kuchuluka kwachidziwitso komwe kumamuvutitsa munthu pakuzindikira.

Catarrhal tonillitis (pachimake tonsillopharyngitis) ndi njira ya m'magazi yomwe imayambitsidwa ndi microflora ya pathogenic, komanso kukhudza zigawo zapamwamba za mucosa wam'mero. Mtunduwu, malinga ndi terminology yamankhwala, umatchedwanso erythematous. Mwa mitundu yonse ya angina, iyi imawonedwa ngati yosavuta, koma izi sizitanthauza kuti sizikufunika kuthandizidwa. Momwe mungachiritsire zilonda zam'mimba za m'mimba zitha kuuzidwa dokotala moyenera atatha kudziwa bwino matenda. Ndizofunikanso kudziwa kuti mankhwala osokoneza bongo sikuti nthawi zonse amafunikira kuthandizira matenda.

Hypervitaminosis ndi matenda omwe amachititsa kuchuluka kwa ichi kapena kuti mavitaminiwo alowe mthupi. Posachedwa, matenda oterewa afala kwambiri, popeza kugwiritsa ntchito mankhwala othandizira a Vitamini kukufalikira.

Matenda a shuga m'magulu a amuna ndi matenda a endocrine system, kumbuyo komwe kumakhala kuphwanya kusintha kwa madzi ndi michere m'thupi la munthu.Izi zimabweretsa kukanika kwa pancreatic, yomwe imayang'anira kupanga mahomoni ofunikira - insulin, chifukwa chomwe shuga sichisintha kukhala glucose ndikudziunjikira m'magazi.

Q fever ndi matenda achilengedwe oopsa opatsirana, a gulu la riketitsi, ali ndi mayina ena (matenda a Burnet, Q-fever, coxiellosis). Rickettsioses imaphatikizana ndi mabakiteriya ena osagwirizana ndi chilengedwe ndi kupangika kwa spore, omwe, akazilowetsa, amayambitsa matenda.

Pogwiritsa ntchito masewera olimbitsa thupi komanso kudziletsa, anthu ambiri amatha kuchita popanda mankhwala.

Dedov I., Jorgens V., Starostina V., Kronsbein P., Antsiferov M., Berger M. Ndingatani odwala matenda ashuga. Kwa odwala matenda a shuga omwe salandila insulin. All-Union Endocrinological Sayansi Center ya Academy of Medical Sayansi ya USSR. University Medical Clinic, Dusseldorf, Germany, masamba 107. Kufalitsa ndi chaka chosindikizidwa sizinafotokozeredwe (mwina bukuli lidasindikizidwa mu 1990).
Onipko, V.D. Buku la odwala matenda a shuga mellitus / V.D. Onipko. - Moscow: Nyali, 2001 .-- 192 p.
Berger M., Starostina EG, Jorgens V., Dedov I. Mchitidwe wa insulin, Springer, 1994.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka patsamba lino kuti athetse zovuta koma osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusaitiyi, kufunsana ndi akatswiri ndizofunikira nthawi zonse.

Hyperinsulinemia ndi chiyani: Zizindikiro ndi kuwazindikira. Kodi hyperinsulinemia ndi chiyani ndipo ndi chifukwa chiyani?

Hyperinsulinemia ndi njira ya m'magazi momwe kuchuluka kwa insulin kwamankhwala kumajambulidwa. Izi zitha kukhala chifukwa cha zolakwika za receptor, mapangidwe olakwika a insulin, komanso mayendedwe a shuga. Kuti mupeze matendawa, maphunziro a mahomoni, ultrasound, CT, MRI amagwiritsidwa ntchito. Mankhwalawa amayenera kuteteza kulemera kwa thupi mwakuchita masewera olimbitsa thupi, zakudya, komanso mankhwala.

Zomwe zimachitika

Pali zifukwa zinayi zazikulu zomwe zimatsogolera ku hyperinsulinemia:

Mapangidwe a insulin yachilendo.
Kuchuluka kwa mphamvu kapena chidwi cha insulin receptors.
Kusokonezeka kwa mamolekyulu a shuga.
Kuwonetsedwa mosavomerezeka mu cell ya cell (cholumikizira cha GLUT4 sichikugwira ntchito ndipo glucose sangathe kulowa mu cell).

Zakutsogolo

Kuchepa kwa kuchuluka kwa insulin kumawonjezeka mwa anthu:

Ndi cholowa chamtsogolo. Zapezeka kuti anthu omwe ali ndi HLA antijeni amatha kukhala hyperinsulinulin. Komanso, mwayi waukulu wodwala ngati abale anu apamtima amadwala matenda ashuga.
Ndi kuphwanya kwa malamulo apakati pa njala ndi satiety.
Mkazi wamkazi.
Ndi zolimbitsa thupi.
Ndi kukhalapo kwa zizolowezi zoipa (kusuta, kumwa).
Ukalamba.
Zambiri. Adipose minofu ndi gawo lodziyimira endocrine. Imapanga zinthu zosiyanasiyana zogwira ntchito ndipo ndi gawo lamahomoni. Kukhalapo kwa mafuta owonjezera thupi kumabweretsa kusatetezeka kwawo ku zotsatira za insulin. Chifukwa cha izi, kupanga kwake kumawonjezeka.
Ndi kukhalapo kwa atherosulinosis. Zimabweretsa matenda a mtima, kuwonongeka kwa ubongo, matenda amitsempha yamagawo am'munsi.
Mu nthawi ya kusamba.
Ndi polycystic ovary syndrome.
Ndi ochepa matenda oopsa.
Nthawi zonse amatenga mahomoni, thiazide diuretics, beta-blockers.

Zonsezi pamwambapa zimakhudza kufalitsa kwa ma cell mumaselo. Zifukwa zina zitatu zowonjezera kuchuluka kwa insulin ndizosowa.

Zotheka

Matenda a shuga.
Kunenepa kwambiri
Hypoglycemic chikomokere.
Chiwopsezo cha kuwonongeka kwa mtima ndi mitsempha yamagazi chimakulanso.

M'magawo oyamba, hyperinsulinemia siziwonetsa. M'tsogolomu, madandaulo oterewa amawonekera:

kuchuluka kwa mafuta pamimba ndi pamimba,
kuthamanga kwa magazi
ludzu
kupweteka kwa minofu
chizungulire
zosokoneza
kufooka, ulesi.

Hypersecretion ya insulin ikhoza kukhala yogwirizana ndi majini kapena matenda osowa. Kenako zizindikiro zotsatirazi zikuwonekera: kuperewera kwamaso, khungu ndi khungu lowuma, mawonekedwe a otambasuka pamimba ndi m'chiuno, kudzimbidwa, kupweteka kwa mafupa.

Zizindikiro

Popeza matendawa amakhudza machitidwe onse a thupi ndipo amakhudzana ndi matenda ambiri (mtima, mitsempha yamagazi), kufufuza kwathunthu kumachitika. Mulinso:

Kuwona kuchuluka kwa mahomoni - insulin, cortisol, chithokomiro chotulutsa, prolactin, ACTH, aldosterone, renin.
Kuyang'anira tsiku lililonse kuthamanga kwa magazi.
Kudziwitsa zolimbitsa thupi komanso kuchuluka kwa chiuno kuzungulira m'chiuno.
Urinalysis kuti mudziwe microalbuminuria.
Ultrasound ya kapamba, chiwindi, impso.
Kuyesa kwa magazi pa biochemical - cholesterol yathunthu, triglycerides, lipoproteins yotsika komanso yayikulu, kuthamanga kwa glucose komanso kuchita masewera olimbitsa thupi.
CT, MRI ya zotupa ndi ma adrenal tiziwopsezo kupatula matenda a Itsenko-Cushing.

Hyperinsulinemia imafunikira kuthandizira osati kokha ndi endocrinologist, komanso ndi mtima, katswiri wa zakudya, ndi psychotherapist.

Njira zochizira

Chofunikira kwambiri pa mankhwalawa ndi zakudya. Cholinga chake ndikuchepetsa thupi. Kutengera mtundu wa ntchito (yam'maganizo kapena yakuthupi), zopatsa mphamvu zama calorie zimachepetsedwa kangapo. Kuchepetsa zamankhwala mu chakudya. Amasinthidwa ndi zipatso ndi ndiwo zamasamba. Onjezerani zolimbitsa thupi tsiku lonse. Kudya kumayenera kuchitika maola anayi aliwonse pang'ono.

Kuwonjezeka kwa zolimbitsa thupi kumalimbikitsidwa chifukwa choyenda, kusambira, aerobics, yoga. Mitundu yamphamvu yokhazikika imatha kukulitsa vutoli ndikupangitsa vuto lalikulu kwambiri. Mphamvu yamaphunziro iyenera kukula pang'onopang'ono. Kumbukirani kuti kudya zokha ndi masewera olimbitsa thupi zomwe zingayambitse kusintha.

Pali mawonekedwe a mankhwalawa a hyperinsulinemia ali mwana. Popeza thupi lomwe limakula limafunikira michere kuti likule, chakudya sicholimba. Zakudyazo zimaphatikizapo maofesi a multivitamin ndi zinthu zina (calcium, iron).

Chithandizo cha mankhwalawa chimaphatikizapo mankhwala ogwiritsira ntchito nthawi yayitali:

Othandizira a Hypoglycemic omwe ali ndi kuchuluka kwa shuga (biguanides, thiazolidines).
Ma antihypertensives omwe amateteza kuthamanga kwa magazi komanso kuchepetsa chiopsezo cha zovuta (kugunda kwa mtima, kugunda kwa mtima). Magulu othandizira omwe ali ndi mankhwala: ACE inhibitors, sartans, othandizira calcium. Cholinga cha mankhwalawa ndikuchepetsa kupanikizika kwa systolic pansi pa 130 mmHg, ndi kukakamiza kwa diastolic pansi pa 80 mmHg.
Kutsitsa cholesterol - ma statins, ma fiber.
Mankhwala osokoneza bongo omwe amachepetsa chilimbikitso ndi serotonin reuptake inhibitors, m'matumbo inhibitors omwe amathetsa mafuta.
Metabolic - alpha lipoic acid, yomwe imathandiza kugwiritsa ntchito shuga ndikuchotsa cholesterol yowonjezera.

Kupewa

Mutha kuletsa kukula kwa matendawa mwakutsatira malangizo osavuta: musagwiritse ntchito mafuta osanenepetsa komanso shuga, idyani masamba obiriwira okwanira ndi zipatso, kuyenda osachepera mphindi 30 patsiku, ndi kulimbana ndi zizolowezi zoyipa.

Pomaliza, ziyenera kunenedwa kuti hyperinsulinemia ndi chiopsezo chofunikira cha matenda a shuga, stroke, kugunda kwa mtima. Kuzindikiritsa matendawa kumafuna kuunikiridwa mozama kuti mudziwe chomwe chimayambitsa komanso kusankha chithandizo chokwanira. Samalirani thanzi lanu!

Kodi kuchuluka kwawonjezereka kapena kuwonjezereka kwamankhwala a insulin m'magazi.

Kuchuluka kwa timadzi timeneti kumapangitsa kuchuluka kwa shuga, komwe kumayambitsa kuperewera kwa shuga, komanso kumayambitsa kuperewera kwa mpweya waubongo, komwe kumayambitsa kuphwanya kwamanjenje.

Matendawa amafala kwambiri mwa akazi ndipo amapezeka azaka za 26 mpaka 55. Kuukira kwa hypoglycemia, monga lamulo, kumawonekera m'mawa pambuyo pothamanga mokwanira. Matendawa amatha kugwira ntchito ndipo amadzionetsera nthawi yomweyo, masana.

Hyperinsulinism imatha kupangitsa kuti anthu azikhala ndi njala nthawi yayitali. Zina zofunika pakuwonetsa matendawa zimatha kukhala zochitika zosiyanasiyana zolimbitsa thupi komanso zokumana nazo m'maganizo. Mwa akazi, zizindikiro zobwereza za matendawa zimachitika pokhapokha ngati nthawi yotsala isanakwane.

Zizindikiro za Hyperinsulinism zili ndi izi:

njala yosatha
kutuluka thukuta kwambiri
kufooka wamba
tachycardia
womvera
paresthesia
diplopia
kumakhala ndi mantha osaneneka
kusokonezeka kwa malingaliro
kugwedezeka kwa manja ndi miyendo yake,
zochita zosakhudzidwa
dysarthria.

Komabe, zizindikirazi ndi zoyambira, ndipo ngati simungazichiritse ndikupitiliza kunyalanyaza matendawa, zotsatira zake zimakhala zokulirapo.

Mtheradi hyperinsulinism imawonetsedwa ndi zizindikiro zotsatirazi:

kulephera kwadzidzidzi
chikomokere ndi hypothermia,
coma ndi hyporeflexia,
tonic kukokana
kukokana kwamankhwala.

Kukomoka koteroko kumachitika kaŵirikaŵiri pambuyo poti mwadzidzidzi watha kuzindikira.

Asanayambe kuukira, zizindikiro zotsatirazi zimawonekera:

utachepetsa kukumbukira
kusakhazikika mtima
kunyalanyaza kwathunthu ena
kutayika kwa maluso aukadaulo,
paresthesia
Zizindikiro za kuperewera kwa piramidi,
zamatsenga.

Chifukwa cha chizindikiro, chomwe chimapangitsa kuti anthu azikhala ndi njala nthawi zambiri, munthu nthawi zambiri amakhala wonenepa kwambiri.

Mavuto

Zoyambirira zimachitika pakadutsa kanthawi kochepa kuchokera kuukira, zimaphatikizapo:

Izi zimachitika chifukwa chakuchepa kwambiri kwa kagayidwe kamunthu ka mu mtima ndi ubongo wa munthu. Mlandu woopsa ukhoza kubweretsa kukula kwa hypoglycemic coma.

Pambuyo pake zovuta zimayamba kuonekera patapita nthawi yayitali. Nthawi zambiri pakatha miyezi yochepa, kapena patatha zaka ziwiri kapena zitatu. Zizindikiro zodziwika za zovuta zakumapeto ndi parkinsonism, kukumbukira kwamkati ndi kuyankhula.

Mu ana, kobadwa nako hyperinsulinism mu 30% ya milandu imayambitsa matenda a hypoxia a ubongo. Chifukwa chake hyperinsulinism mwa ana imatha kubweretsa kuchepa kwa kukhazikika kwa malingaliro.

Hyperinsulinism: chithandizo ndi kupewa

Kutengera zifukwa zomwe zinayambitsa kuwonekera kwa hyperinsulinemia, njira zochizira matendawa zimatsimikizika. Chifukwa chake, pankhani ya organic genesis, mankhwala othandizira opaleshoni ndi mankhwala.

Muli mukukoka kwa neoplasms, kupatula pang'ono kwa kapamba, kapena chizimba chonse.

Monga lamulo, atachitapo kanthu pakuchita opaleshoni, wodwalayo amakhala ndi kuchepa kwa magazi (hyperglycemia), chifukwa chake, mankhwala omwe amadza pambuyo pake komanso zakudya zotsika zamoto zimachitika. Matendawa amatenga mwezi pambuyo pa opareshoni.

Pankhani ya zotupa zosagwiritsidwa ntchito, palliative mankhwala ndi mankhwala, omwe umalimbana ndi kupewa hypoglycemia. Ngati wodwala ali ndi neoplasms yoyipa, ndiye kuti amafunikira chemotherapy.

Ngati wodwala ali ndi hyperinsulinism yothandiza, ndiye kuti chithandizo choyambirira chimakhala ndi matenda omwe adayambitsa.

Woopsa matenda ndi pambuyo pake kukula chikomokere, mankhwala ikuchitika mu malo osamalira odwala, detoxation kulowetsedwa mankhwala ikuchitika,adrenaline jekeseni ndipo. Panthawi yogwidwa komanso ndi psychomotor overexcitation, majekiti osokoneza bongo ndi jekeseni ya tranquilizer amasonyezedwa.

Pofuna kutaya chikumbumtima, wodwalayo ayenera kulowa 40% shuga.

Makanema okhudzana nawo

Kodi hyperinsulinism ndi njira yochotsera nthawi zonse njala, mutha kudziwa kanema uyu:

Titha kunena za hyperinsulinism kuti uwu ndi matenda omwe ungayambitse zovuta zazikulu. Amakhala ngati mtundu wa hypoglycemia. M'malo mwake, matendawa ndi omwe amasiyana kwambiri ndi matenda ashuga, chifukwa ndi omwe amapanga insulin kapena kupezeka kwake kwathunthu, ndipo ndi hyperinsulinism - kuchuluka kapena kotheratu. Kwenikweni, kuzindikira kumeneku kumapangidwa ndi gawo la akazi.

Hyperinsulinism imadziwika ndi kuchepa kwa shuga m'magazi chifukwa chakuwonjezera kwathunthu kapena wachibale pakupezeka kwa insulin. Matendawa amawonekera nthawi zambiri azaka zapakati pa 40 ndi 50. Odwala amakhala ndi vuto la njala, kusowa chidwi, chizungulire, mutu, kugona, tachycardia, kunjenjemera miyendo ndi thupi lonse, kukula kwa ziwiya zotumphukira, thukuta, komanso kusokonezeka kwa malingaliro. Kuukira kwa hypoglycemia kumayamba chifukwa cholimbitsa thupi kwambiri kapena kumatha kudya nthawi yayitali. Kuphatikiza apo, zinthu zomwe zatchulidwa pamwambazi zimakulirakulira, kusintha kwamanjenje, kuperewera, kukokana, kugona kwambiri, ndipo pamapeto pake, kukomoka komwe kumatha kupangitsa kuti wodwalayo asalowe shuga m'mitsempha nthawi yayitali. Pankhaniyi, glycemia amachepetsa mpaka 60-20 ndi ochepera shuga% mg.

Nthawi zambiri odwala amawayang'anira ndikuwathandizidwa ndi azamisala.

Matendawa amadziwika ndi Whiple triad (onani). Ndi matendawa, kulemera kwa odwala kumawonjezeka chifukwa chodya pafupipafupi.

Kusiyanitsa pakati pa organic and functional hyperinsulinism. Choyambitsa chachikulu cha hyperinsulinism ndi benign islet adenoma. Chotupa chikhoza kupezeka kunja kwa kapamba. Khansa ya zisumbu za Langerhans ndizofala. Hyperplasia yazovala zamatumbo zingayende limodzi ndi kuchuluka kwa insulin. Nthawi yomweyo, hyperinsulinism imatha kuchitika popanda zotupa zakanyumba. Fomuyi imatchedwa functional hyperinsulinism. Mwina zimachitika chifukwa kudya zakudya zamafuta ochulukitsa kumakwiyitsa mitsempha ya vagus ndikuwonjezera katemera wa insulin.

Hyperinsulinism imatha kupangidwanso ndi matenda ena amanjenje yapakati, ndi chiwindi chogwira ntchito, kuchepa kwa mphamvu ya adrenal, nthawi yayitali yokhala ndi carbohydrate, pakagwiritsidwe ntchito kazakudya zam'mimba, matenda a shuga a impso, kapamba, pancreatitis.

Kuti musiyanitse pakati pa mitundu yodwala ndi yogwira matendawa, glycemia imapangidwanso masana limodzi ndi shuga komanso insulin ndi adrenaline mayeso. Organic hyperinsulinism imayamba chifukwa cha kupanga insulin mwadzidzidzi komanso kosakwanira, komwe sikimalipiridwa ndi maulamuliro a hypoglycemic. Ntchito hyperinsulinism imayambitsidwa ndi kukula kwa hyperinsulinism chifukwa cha kusakwanira kotunga shuga kapena kuphwanya kwa dongosolo la neuroendocrine hypoglycemic. Ntchito hyperinsulinism nthawi zambiri imawonedwa m'chipatala cha matenda osiyanasiyana okhala ndi vuto logaya. Kuphwanya njira zomwe zimayendetsa kagayidwe kazakudya zimatha kupezekanso pokhudzana ndi kulowa kwadzidzidzi kwa glucose m'magazi, monga kugwa kwa hypoglycemic kwa odwala omwe akutsatiridwa ndi chapamimba.

Kukula kwa hypoglycemia ndi hyperinsulinism kumayambira pazizindikiro zochokera ku ubongo wamkati. Mu pathogenesis yazizindikiro izi, kuchepa kwa glycemia, kuwopsa kwa kuchuluka kwa insulin, ubongo ischemia ndi hydremia kumathandizira.

Kuzindikira Hyperinsulinism yochokera pa chotupa cha zida za islet imayikidwa pazotsatira zotsatirazi. Odwala ali ndi mbiri ya kukomoka kwambiri chifukwa cha thukuta, kunjenjemera, komanso kusazindikira. Mutha kupeza kulumikizana pakati pa chakudya ndi khunyu zomwe nthawi zambiri zimayamba musanadye chakudya cham'mawa kapena maola 3-4 mutatha kudya. Mlingo wothamanga wamagazi nthawi zambiri umakhala 70-80 mg%, ndipo pakakhala kuukira umatsikira mpaka 40-20 mg%. Mothandizidwa ndi kudya kwa carbohydrate, kuukira kumatha msanga. Panthawi yopatsirana, mutha kuyambitsa vuto pokhazikitsa dextrose.

Hyperinsulinism chifukwa cha chotupacho iyenera kusiyanitsidwa ndi hypopituitarism, momwe mulibe chakudya, odwala amachepetsa thupi, metabolism yayikulu ili pansi 20%, kuthamanga kwa magazi kumatsika, ndipo chinsinsi cha 17-ketosteroids chimachepa.

Mu matenda a Addison, mosiyana ndi hyperinsulinism, kuchepa thupi, melasma, adynamia, kuchepa kwa zotulutsa za 17-ketosteroids ndi 11-hydroxysteroids, ndi mayeso a Thorn pambuyo pakupereka adrenaline kapena adrenocorticotropic timadzi.

Spontaneous hypoglycemia nthawi zina imachitika ndi hypothyroidism, komabe, zizindikiritso za hypothyroidism - mucous edema, kupanda chidwi, kuchepa kwa kagayidwe kake komanso kudzikundikira kwa ayodini wa chithokomiro mu chithokomiro cha chithokomiro, komanso kuchuluka kwa cholesterol yamagazi - kulibe ndi hyperinsulinism.

Ndi matenda a Girke, kuthekera kwokweza glycogen ku chiwindi kumatha. Kuzindikira kumachitika pokhapokha pakuwonjezeka kwa chiwindi, kuchepa kwa shuga kumapazi, komanso kusowa kwa kuchuluka kwa shuga m'magazi ndi potaziyamu pambuyo pa adrenaline.

Ndi kuphwanya kwa dera la hypothalamic, kunenepa kwambiri, kuchepa kwa ntchito zogonana, komanso kusokonezeka kwa kagayidwe kamchere wamadzi zimadziwika.

Ntchito hyperinsulinism imapezeka ndi kupatula. Mosiyana ndi chotupa chochokera m'mimba, chiwopsezo chogwira ntchito cha hyperinsulinism chimachitika mosayenera, pafupifupi sichinachitike m'mawa asanadye. Kusala masana nthawi zina sikuyambitsa ngakhale vuto la hypoglycemic. Zovuta zina nthawi zina zimachitika chifukwa cha zomwe takumana nazo m'mutu.

Kupewa ntchito hyperinsulinism kuteteza matenda oyipitsa omwe amayambitsa, kupewa chotupa hyperinsulinism sikudziwika.

Chithandizo etiopathogenetic. Ndikulimbikitsidwanso kuti muzidya zakudya zopatsa thanzi monga mapuloteni komanso mapuloteni komanso cortisone, mahomoni a adrenocorticotropic. Ndikofunikira kupewa kuthana kwambiri ndi kuvulala kwam'mutu, ma bromides ndi ma sedatives opepuka. Kugwiritsa ntchito kwa barbiturates kuti shuga m'magazi ali osavomerezeka.

Ndi organic hyperinsulinism, chotupa chomwe chimayambitsa kukula kwa matendawa chikuyenera kuchotsedwa. Pamaso pa opareshoni, malo osungirako mafuta am'mimba amapangidwa ndikupanga zakudya zomwe zimakhala ndi mapuloteni ochulukirapo komanso mapuloteni. Tsiku loti lisanachitike opaleshoni komanso m'mawa asanachitike opaleshoni, 100 mg ya cortisone imalowetsedwa m'matumbo. Pogwira opaleshoni, kulowetsedwa kwa glucose 50% yokhala ndi 100 mg kumakhazikitsidwa.

Mankhwala osokoneza bongo a organic hyperinsulinism ndi osathandiza. Potulutsa adenomatosis ndi adenocarcinomas okhala ndi metastases, alloxan amagwiritsidwa ntchito pamlingo wa 30-50 mg pa kilogalamu imodzi ya kulemera kwa thupi la wodwalayo. Alloxan yakonzedwa mwa njira ya 50% yothetsera yomwe idakonzedwa panthawi ya kulowetsedwa kwa mtsempha. Pa mankhwala, 30-50 g ya mankhwalawa imagwiritsidwa ntchito.

Ndi hyperinsulinism yogwira, mahomoni a adrenocorticotropic amagwiritsidwa ntchito pa 40 magawo patsiku, cortisone patsiku loyamba - 100 mg 4 pa tsiku, chachiwiri - 50 mg 4 pa tsiku, ndiye 50 mg patsiku m'magawo anayi ogawanika kwa miyezi iwiri.

Ndi hypoglycemia ya pituitary chikhalidwe, ACTH ndi cortisone amagwiritsidwanso ntchito.

Chithandizo cha vuto la hypoglycemic imachitika mu 2040 ml ya 40% ya shuga m'mitsempha.Ngati wodwalayo sanazindikire, amayenera kupatsidwa mkamwa pakumwa mphindi 10 zilizonse mpaka mavutowo atha. Ndi mavuto pafupipafupi, ephedrine amatumikiridwa katatu patsiku.

Hyperinsulinism ndi matenda omwe amalumikizidwa ndi kuchuluka kwa insulin komanso kuchepa kwa shuga m'magazi. Zizindikiro za matendawa: kufooka, chizungulire, kuchuluka kwa chidwi, kunjenjemera ndi psychomotor. Mawonekedwe obadwa nawo ndi osowa kwambiri, mwa munthu mmodzi mwa 50,000 akhanda. Nthawi zambiri, omwe amatenga matendawa amatsimikizika mwa akazi azaka 35-50 zaka.

Hyperinsulinism imapezeka mkati mwa kufunsa wodwalayo ngati zizindikiro za matenda zimawululidwa, pambuyo pake kuyesedwa kochitidwa, machulukidwe a glucose amaphunziridwa mu mphamvu, ultrasound kapena tomography ya kapamba, ubongo umachitidwa.

Mapangidwe a pancreatic amatha kuthandizidwa kokha. Ndi psychology ya extrapancreatic, chithandizo chamankhwala ndicholinga chothetsa matenda oyambitsidwa ndi mawonekedwe awowo. Wodwala amapatsidwa zakudya zapadera.

Ngati chithandizo cha panthawi yake sichikupezeka, wodwalayo amatha kudwala matenda okomoka.

Congenital hyperinsulinism mwa ana ndi osowa. Zomwe zimayambitsa anomatic ndi:

matenda osiyanasiyana pokonzekera fetal,
masinthidwe amtundu
asphyxia wobadwa.

Matendawa omwe adapezeka ali ndi mitundu iwiri:

Pancreatic Zimatitsogolera ku Mtheradi.
Zosasokoneza. Zimayambitsa kuwonjezeka pang'ono kwa insulin.

Zosiyasiyana zoyambirira zimachitika chifukwa cha kukula kwa chotupa kapena chotupa chowopsa.

Zinthu zotsatirazi zimapangitsa kuti pakhale mawonekedwe osakanikirana:

kuphwanya zakudya, kusala kudya kwanthawi yayitali, kuchepa kwamadzi ambiri chifukwa cha m'mimba, kusanza kapena mkaka
zovuta zamagazi pakugwira ntchito kwa chiwindi (,) zimabweretsa mavuto mu metabolism m'thupi,
Kugwiritsa ntchito molakwika mankhwala osintha shuga m'magazi,
matenda a endocrine
kusowa kwa michere yomwe imakhudza kagayidwe kazakudya.

Kuzindikira kwa hyperinsulinism kumakhudzana ndi shuga. Glucose ndiye michere yofunika kwambiri yamkati yamanjenje, imatenga ubongo kuti ugwire ntchito moyenera. Ngati mulingo wa insulin m'magazi ukakwera ndipo glycogen imadziunjikira m'chiwindi, zoletsa njira ya glycogenolysis, izi zimapangitsa kuchepa kwa glucose.

Kutsika kwa shuga m'magazi kumapangitsa kuti kagayidwe kachakudya kazigwira, kuchepetsa mphamvu yama cell aubongo. Njira za redox zimasokonekera ndipo kuperewera kwa okosijeni m'maselo kumachepa, kuyambitsa kutopa, kugona, kuchepetsa zomwe zimachitika ndikupangitsa. Mukuchulukitsa zizindikirazo, matendawa amatha kupweteketsa mtima, komanso.

Gulu

Congenital hyperinsulinism kuchokera pakuwonekera kwa maphunzirowo atha kugawidwa m'mitundu iyi:

Fomu yochepa. Amapezeka mwa ana obadwa kwa amayi omwe ali ndi matenda osokoneza bongo a shuga.
Fomu yokhazikika. Mtunduwu umapezeka mwa akhanda. Mawonekedwe a pathology amagwirizanitsidwa ndi kubadwa kwatsopano kwa maselo am'malamulo a insulin ndi kumasulidwa kwake kosalamulirika.

Matenda omwe akupitiliza matendawa atha kugawidwa m'magulu awa:

Mtundu wamafayilo. Ili ndi mitundu inayi yomwe imagawidwa molingana ndi mtundu wa cholowa komanso wolowa mosalekeza.
Mtundu wamafuta. Mwachizolowezi, kuchepa kwamphamvu kwa michere ndi ma hyperplasia a gawo limodzi lokhala ndi zida zobayira. Kusintha kwadzidzidzi kwapezeka.
Mtundu wamagulu. Amawonetsedwa ndi zizindikiritso zopanda matenda.

Gulu logwiritsidwa ntchito nthawi zambiri, lomwe limatengera zomwe zimayambitsa matendawa:

Choyamba - kapamba, organic kapena mwamtheradi hyperinsulinism. Zotsatira za chotupa. Mu 90% ya milandu, insulini imalumpha chifukwa cha zotupa za chiberekero chochepa kwambiri ndipo sichimakonda mwa mitundu yoyipa (carcinoma). Mitundu ina yamatenda ndi yovuta kwambiri.
Yachiwiri - yogwira hyperinsulinism (wachibale kapena extrapancreatic). Mawonekedwe ake amaphatikizidwa ndi kuchepa kwa mahomoni a contra-mahormone, ma pathological mu dongosolo lamanjenje ndi chiwindi. Vuto la hypoglycemia limachitika chifukwa cha njala, mankhwala osokoneza bongo omwe amakhala ndi zotsekemera, komanso masewera olimbitsa thupi mopambanitsa.

Tanthauzo la mitundu ndi mawonekedwe a matendawa amachitika pakagwiritsidwa ntchito pozindikira.

Zizindikiro

Zizindikiro za hyperinsulinism zimadalira kuchuluka kwa kuchepetsa magazi. Kuyambitsa kuukira ndikumodzi:

kufunikira kwakuthupi, kumva njala yayikulu,
thukuta limachuluka
ambiri malaise ndi kufooka akumva
kukulitsa.

Ngati wodwala sapatsidwa chithandizo chadzidzidzi, zizindikiro zotsatirazi zimawonjezeredwa:

kutayika kwa malo mu malo,
kunjenjemera, dzanzi komanso kumangika mikono ndi miyendo.

Zizindikiro zotsatirazi zimakulitsidwa ndi zizindikilo zotere:

mantha
nkhawa
kusakhazikika
kukokana
kuwonongeka kwamawonekedwe
wodwalayo amadziona ndikugwera pansi.

Munthu ayenera kudya pafupipafupi kuti aletse zovuta zomwe zimachitika, ndipo izi zimatsogolera kunenepa.

Hyperinsulinism ili ndi madigiri atatu a chitukuko:

Digiri yosavuta. Ilibe nthawi yopatsirana komanso siyikhudza chithokomiro chotupa. Matendawa sangathenso kupitirira kamodzi pamwezi ndipo amaletsa msanga kugwiritsa ntchito mankhwala kapena kudya zakudya zotsekemera.
Digiri yapakatikati. Amadziwika ndi kukhalapo kwa kukomoka koposa pamwezi. Wodwalayo amatha kukumbukira ndipo amagwa. Munthawi yapakati povutitsidwa, kukumbukira pang'ono, kusasamala, ndi kuchepa kwa malingaliro amadziwika.
Madigiri akulu. Zimagwirizananso ndi kukokoloka pafupipafupi ndi kusazindikira komanso kusintha kosasintha kwa ubongo. Munthawi yopatsirana, kuchepa kwa kukumbukira, kunjenjemera kwa miyendo, kusuntha kwamphamvu ndi kusakwiya.

Ndikofunikira kwambiri kuyankha kuwonetseratu kwakanthawi munthawi yake, chifukwa moyo wa wodwala umadalira izi.

Zovuta zotheka

Hyperinsulinism imatha kubweretsa zovuta zazikulu komanso zosasinthika zomwe sizigwirizana ndi moyo wa wodwalayo.

Zovuta zazikulu za matendawa:

vuto la mtima
chikomokere
mavuto amakumbukidwe ndi kuyankhula,

Matendawa amatengera kudwala kwamatenda komanso zomwe zimachitika. Ngati chotupa chowoneka chikupezeka, makulidwe amachotsedwa, ndipo wodwalayo amachira milandu 90%. Ndi kuvulala kwa neoplasm komanso kulephera kugwira ntchito, kuchuluka kwa kupulumuka kumakhala kotsika.

Hyperinsulinism Chithandizo

Njira zamankhwala zimatengera zomwe zimayambitsa hyperinsulinemia. Ndi organic genesis, opaleshoni ya opaleshoni ikuwonetsedwa: kusinthanitsa pang'ono kwa kapamba kapena kapamba konse, kukokomeza kwa neoplasm. Kuchuluka kwa maopareshoni kumatsimikiziridwa ndi malo ndi kukula kwa chotupa. Pambuyo pakuchita opaleshoni, kuchepa kwa magazi kwa hyperglycemia nthawi zambiri kumadziwika, kumafunikira kukonzedwa kuchipatala komanso kudya kokhala ndi zakudya zochepa. Matenda a mtundu wa zizindikiro amapezeka mwezi umodzi atatha kulowererapo. Ndi zotupa zosagwiritsidwa ntchito, chithandizo cha palliative chikuchitika ncholinga chopewa hypoglycemia. Mu neoplasms yoyipa, chemotherapy imasonyezedwanso.

Ntchito hyperinsulinism makamaka imafunikira chithandizo cha matenda omwe amayambitsa kuchuluka kwa insulin.Odwala onse amapatsidwa zakudya zoyenera komanso kuchepa kwamphamvu kwa chakudya chamagulu (100-150 gr. Patsiku). Zokonda zimaperekedwa ku zovuta zamatumbo (mkate wa rye, supu ya tirigu wa durum, phala lonse la tirigu, mtedza). Chakudya chizikhala chopindika, nthawi 5-6 patsiku. Chifukwa chakuti kuwukira kwakanthawi kumayambitsa kukhazikitsidwa kwa mantha pakati pa odwala, kufunsira kwa katswiri wamalingaliro kumalimbikitsidwa. Ndi kukula kwa vuto la hypoglycemic, kugwiritsa ntchito chakudya cham'mimba chotsekemera (tiyi wokoma, maswiti, mkate woyera) akuwonetsedwa. Popeza simukudziwa, kupangika kwa shuga 40% ndikofunikira. Ndi kupweteka komanso kugwedezeka kwambiri kwa psychomotor, jakisoni wa bata ndi kusinkhidwa akuwonetsedwa. Chithandizo cha matenda oopsa a hyperinsulinism ndi chitukuko cha chikomokerezi chimachitika m'chipinda chosamalitsa cha anthu odwala komanso kulowetsedwa kwa detoxation, kuyambitsa glucocorticoids ndi adrenaline.

Zotsogola ndi kupewa

Kupewera kwa matenda a hypoglycemic kumaphatikiza kudya mokwanira komanso kupatula kwa maola awiri ndi atatu, kumwa madzi okwanira, kusiya zizolowezi zoyipa, ndikuwongolera kuchuluka kwa shuga. Kusamalira ndi kukonza kagayidwe kachakudya mthupi, zolimbitsa thupi zolimbitsa thupi zimalimbikitsidwa potsatira zakudya. Kukula kwa hyperinsulinism kumatengera gawo la matendawa komanso zomwe zimapangitsa insulinemia. Kuchotsa kwa benign neoplasms mu 90% ya milandu kumapereka kuchira. Zotupa zosagwira ndi zopweteka zimayambitsa kusintha kwamitsempha ndipo zimafunikira kuwunika wodwalayo nthawi zonse. Chithandizo cha matenda oyambitsidwa ndi mawonekedwe amachitidwe a hyperinsulinemia kumabweretsa kubwezeretsanso kwa zizindikiro ndi kuchira kwamtsogolo.

Etiology ndi pathogenesis

Chofunika kwambiri ndi njira yayikulu ya hyperinsulinism yoyambitsidwa ndi insuloma, yomwe nthawi zambiri imakhala yosakwatira, yosachulukitsa.

Ma insulomas omwe amagwira ntchito mosiyanasiyana amachokera ku ma cell a beta omwe amapangira zida zosiyanasiyana pakukhwima komanso kusiyana. Osowa kwambiri, amapanga kunja kwa kapamba kuchokera ku zinthu za ectopic insular. Kukula kwa insuloma nthawi zambiri kumayendetsedwa ndi kuwonjezeka kwa kuchepa kwa hyperinsulinism, ngakhale ndikuwonjezeka kwa ntchito yake, mikhalidwe imapangidwa kuti ikhale yolumikizira hypotrophy ndi hypofunction yotsala yaminyewa ina yamkati. Kukula kwa matendawa mosakayikira kumapangitsa kuwonjezeka kwa kufunika kwa thupi kwa ma carbohydrate, popeza momwe kugwiritsidwa ntchito kwa glucose kumachulukira, magwero ake a mapangidwe ake amatha, makamaka, malo ogulitsira a glycogen mu minofu, ndipo hypoglycemia imakulanso, zomwe zimayambitsa kuphwanya ntchito zosiyanasiyana za thupi. Mchitidwe wamanjenje umakhudzidwa makamaka - phylogenetically malo achichepere. Kufunika kwakukulu kwa kuperewera kwa zakudya m'thupi kumapangitsanso Hypoxia ndi vuto laubongo ndi magawo ena amomwe amanjenje amawonetsedwa mu maphunziro a histochemical a dongosolo lamanjenje. Kuchepa msanga kwa glycogen osasungidwa muubongo kumayambitsa kusokonezeka kwakukulu pakugwiritsa ntchito mpweya ndi minyewa ya ubongo, yomwe ingayambitse kusintha kosasintha mwa iyo. Mankhwala ambiri obwera chifukwa cha insulin komanso kupweteka kwa nthawi yayitali. Kutuluka kofulumira kuchokera ku kuwukira kwa hypoglycemia kumachitika chifukwa cha njira zowonjezera zomwe, makamaka, ziwalo zobisika za adrenocorticotropic timadzi, corticoids ndi adrenaline zimagwira. Glucogone, yotulutsidwa ndi ma cell a pancreatic alpha ndi maselo ofanana a m'mimba ndi mucosa yamatumbo, mwachiwonekere imaphatikizidwanso pazochita zothandizira (powonjezera ntchito yawo) ya hypoglycemia yongochitika zokha.Chifukwa chake, ngati kukhathamiritsa kwa insuloma ndikofunikira mu etiology yamatendawa, ndiye kuti kukulitsa kwa vuto la hypoglycemic kumakwanira pateni: gawo loyamba ndikupanga kuchuluka kwa insulini ndi chotupa, chachiwiri ndi hypoglycemia chifukwa cha hyperinsulinemia, chachitatu ndi kusokonekera kwa dongosolo lamanjenje pamene kufooka kwa glucose wachinayi ndikuyamba, ntchito zamanjenje, zomwe zikuwonetsedwa ndi kukhumudwa, komanso kuchepa kwa masitolo a glycogen mu minofu yaubongo - chikomokere.

Pathological anatomy ya hyperinsulinism

Ndi hyperplasia wamba yamatumbo amisempha, kapamba samawoneka wosiyana ndi abwinobwino. Macroscopically, insulomas nthawi zambiri amakhala ochepa kukula, monga lamulo, mainchesi awo amafikira masentimita 1-2 okha, osachepera 5-6 masentimita. Zotupa zazikulu nthawi zambiri zimatha kukhala zopanda mphamvu m'thupi, zopanda mphamvu, kapena zopweteka. Omaliza amakhala ma tubercles, amatha kufikira 500-800 g. Benign insulomas nthawi zambiri amasiyana mosasintha (wandiweyani, koma osati nthawi zonse) komanso utoto kuchokera pancreas, kupeza yoyera, imvi kapena yapinki.

Ma insulomas ambiri (75%) amakhala kumanzere kwa kapamba ndipo makamaka mchira wake, zomwe zimatengera zilumba zambiri zomwe zili mbali iyi ya gland. Ma insulomas nthawi zonse amakhala ndi kapisozi womveka bwino ndipo zotupa zambiri zimakhala ndi gawo pang'ono kapena ngakhale kulibe. Chodabwitsa cha insulini sichili kokha pakufunika kwa kapisolo, komanso mitundu yosiyanasiyana yama cellular, ngakhale anali ndi magawo wamba (ochokera ku maselo a beta). Izi zimapangitsa kuti chizolowezi cha morphological chizindikirike pozindikira zotupa zopanda pake kapena zoyipa, ndipo kumayambiriro kwa chitukuko, njira zodziwikiratu malire pakati pa islet hyperplasia ndi chitukuko cha blastoma ndizosakwanira.

Mwa insulomas yomwe afotokozedwa mpaka pano, osachepera 9% ndi ovulala ndipo ena mwa omwe adatsatana kale ndi metastase. Zotupa za Benign nthawi zambiri zimakhala za alveolar ndi trabecular, nthawi zambiri zomwe zimakhala za tubular ndi papillomatous. Amakhala ndi masikono ang'onoang'ono kapena masilindala, ndipo nthawi zambiri maselo a polygonal (kuchokera wamba kupita kwa atypical) okhala ndi wotumbululuka kapena alveolar cytoplasm, okhala ndi ma nuclei akulu akulu. Minofu ya interstitial imakhala ndi zizindikiro za hyalinosis ndi kapangidwe kazinthu zopangika kapena zamitundu yambiri, zotupa ndi zotupa m'matumbo. Mu zotupa zoyipa, cell atypism imachulukanso, hyperchromatosis, mitosis imawoneka, pali zizindikiro zakulowerera ndikukula kwa maselo otupa kunja kwa kapisozi, komanso kulowa kwa lumen kwa magazi ndi ziwiya zamitsempha.

Zizindikiro za Hyperinsulinism

Ndikofunikira kusiyanitsa pakati pa zisonyezo zamasiku am'mbuyomu ndi chizindikiro cha nthawi yayitali ya hypoglycemia. Zizindikiro zazikulu mu chithunzi cha matenda a hyperinsulinism ndi chizindikiro cha hyperinsulinism, chodziwika bwino kuyambira machitidwe a mankhwalawa ndi insulin, yomwe imawonedwa ndi bongo wambiri. Zonse zimatengera kuchuluka kwa hypoglycemia komanso kukonzanso thupi. Zizindikiro zofatsa zimasonyezedwa pokhapokha ngati munthu ali ndi chidwi chofuna kudya, kumva kuti ali ndi vuto la njala, kumva kutifooka m'mawa, komanso kudya patapita nthawi yayitali. Ndi kuchuluka kwa hypoglycemia, chizungulire, nthawi zambiri kutsika kwa nkhope ndikuchulukitsa thukuta, palpitations, kuzizira, chisangalalo cham'maganizo, mpaka dziko lokhala ndi manic wokhala ndi Delirium, kunjenjemera mwamalire Ndi hypoglycemia yowonjezereka, kupsinjika kwakukulu kwa mitsempha ndi chikomokere chachikulu kumachitika ndikumapuma posachedwa komanso kufooka kwa mtima.Mkhalidwe wakugona kwakukuru ndi hypoglycemia ukufanana ndi kugwa kwambiri kapena kugwedezeka, koma kumayendera limodzi ndi kufooka kwamisempha kwathunthu ndikusazindikira.

Chizindikiro cha hyperinsulinism ndi kuchepa kwa shuga m'magazi mpaka kuwonjezeka kuposa 50 mg%. Manambalawa nthawi zambiri amachokera ku 50-70 mg% kutengera nthawi yakudya komanso nthawi yovutirapo, kutsika panthawi yomwe matenda akuwadwalirana mpaka pamlingo wina kapena wina. Pa 50-60 mg% ya shuga m'magazi, khunyu limakhala losowa, nthawi zambiri pakakhala vuto, shuga amatsika mpaka 40-20 mg%, ndipo nthawi zina mpaka 15-10 ngakhale 3-2 mg%. Ndi ziwerengero zomalizira, chithunzi cha chipatala chimakhala chokwanira kufotokoza. Koma ndikokwanira kubayitsa kuchuluka kwa glucose m'mitsempha, pomwe chidziwitso cha wodwalayo chimabwezeretseka nthawi yomweyo, amakhala ngati akudzuka ku tulo tofa nato.

Nthawi zambiri mwa odwala omwe ali ndi kunenepa kwambiri amawonedwa komanso kunja amapereka chithunzi cha maluwa, anthu athanzi. Izi ndizofunikira kwambiri kwa iwo omwe amazindikira msanga kuchuluka kwa zakudya zomwe amapeza pakudya shuga ndipo poyambira oyambitsa matenda a hypoglycemia amadya pang'ono. Kupanda kutero, zochitika zopanda pake za odwala zomwe zimachitika kumayambiriro kwa kuwukira m'malo a anthu nthawi zambiri zimawatsogolera kupita kumazipatala. Pakakhala chisamaliro choyenera komanso chapanthawi yake, odwala amatha kufa kapena kulemala. Zotsatira zoyipa kwambiri za hyperinsulinism ndikusintha koipa kwamkati mwa dongosolo lamanjenje, ndikumapangitsa kusokonezeka kukumbukira, kusasamala, kusokonezeka, kuyerekezera zinthu zina komanso kusokonezeka maganizo kwaposachedwa, komanso dystrophy. Chifukwa chake, kupezeka koyambirira kokha komanso chithandizo choyenera chitha kutsimikizira kuchira kwathunthu.

Endo native hyperinsulinism imachitika pafupifupi nthawi zambiri mwa amuna ndi akazi, koma nthawi zambiri mwa achinyamata komanso azaka zapakati. Poyamba, matendawa amakhala osawoneka bwino kwambiri mpaka amayamba kugwirira ntchito m'mawa komanso pambuyo polimbitsa thupi. Kuphatikizidwa ndi kumverera kwanjala kapena kufooka, izi sizimapangitsa wodwalayo kukhala ndi lingaliro la matendawa, makamaka popeza zizindikirozi zimatha mofulumira mukatha kudya. Wodwalayo satembenukira ku chiwopsezo choyamba cha hypoglycemic, chomwe chimakonda kuchitika pambuyo pakulimbitsa thupi ndikachedwa kudya zakudya. Ndi chiwopsezo cha hyperinsulinism, kuukira kwa hypoglycemia pafupipafupi kumakhala kofupikira, zimakhala zovuta kwambiri kudzipatsa okha ndipo chithunzi cha matenda a hypoglycemic chikuwonekera bwino. Khunyu yayitali komanso yowonjezereka imafunikira thandizo lakunja ndikusiya zochepa kapena zowonjezera mu mantha. Ndi pokhapokha popewa kukula kwa kuukira komanso kutha msanga kwa hypoglycemia komwe kumayambitsa matenda oopsa a hyperinsulinism titha kuyembekezera zotsatira zabwino komanso kusintha kwa matendawa kumapeto.

Kusiyanitsa kosiyanasiyana kwa hyperinsulinism

Kuzindikira matendawa kumafunikira kufufuza kozama mbiri yamankhwala yamatenda, kuyang'anitsitsa wodwala ndi maphunziro apadera. Tiyenera kudziwa kuti ndi hypoglycemic coma chifukwa cha endo native hyperinsulinism, palibe fungo la acetone kuchokera kwa wodwala, monga momwe zimakhalira ndi chikumbumtima cha matenda ashuga. Chofunika kwambiri ndi kuyesedwa kwa shuga mkati mwa kuwukiridwa, komanso kuyesedwa ndi njala panthawi yolimbitsa thupi odwala mu nthawi yanthawi yamatendawa ndikuwonetsetsa momwe magazi amapindulira. Mwa kukulitsa nthawi yopuma pachakudya, nthawi zambiri zimayambitsa vuto la hypoglycemic, lomwe liyenera kuyimitsidwa ndi kutsekeka kwa shuga. Zitsanzo zokhala ndi glucose katundu ndi adrenaline ndizofunikanso kwambiri pakuzindikira.Mkulu wama glucose nthawi zambiri amapangitsa kuti insuloma iwonjezeke pang'ono m'matumbo a glycemic, omwe samakonda kuchita, monga momwe amachitira adrenaline. Mphepete imabwereranso msanga kapena momwe imagwera pansipa. Kudziwa bwino matenda a hyperinsulinism kumapangitsa kuti munthu adziwe zolakwika - zotupa za mu ubongo, kuledzera, kufalikira kwa ubongo, matenda amisala ndi matenda ena. Kuvuta pakusiyanitsa kwa hyperinsulinism kochokera mu hypoglycemia wa diencephalic chiyambi, ndi hypoglycemia mu hepatitis, kapamba kumatha kuyambitsa kuchepa kwa nthawi yoika chithandizo chokwanira, komanso kugwiritsa ntchito mosaganizira ndi zotsatira zoyipa kwambiri.

Kukula kwa hyperinsulinism

Mankhwala othandizira amkati hyperinsulinism, wophatikizira kuchotsedwa kwachinyengo, amapereka zotsatira zabwino, kupatula zotsatira za hypoglycemic zikuwonekera. Kumayambiriro kwa matendawa, kudaliraku ndikabwino kwambiri, ndipo mtsogolo, makamaka ngati kuchedwa kuchotsera kuukira kwa hypoglycemic kumakhala kovuta pokhudzana ndi thanzi ndi moyo. Kuchotsa kwachangu kwa matenda a hypoglycemia ndipo, makamaka, kupewa izi mwazowonjezera zomwe zimapangidwa ndizakudya zopatsa mphamvu zamthupi, zimapangitsa kuti thupi likhale lathanzi komanso nthawi yotsala ya matenda a hypoglycemic, ngakhale zimathandizira kunenepa kwambiri. Komanso, zomwe zimachitika chifukwa cha matendawa zimakhala zopanda tanthauzo ndipo chithandizo cha opaleshoni cha hyperinsulinism chimapangitsa kuti matendawa akhale abwino ngakhale atadutsa nthawi yayitali matendawo. Zizindikiro zonse za matenda a hypoglycemic zimatha, ndipo kunenepa kwambiri kumadutsanso. Popanda thandizo la panthawi yake ndi hypoglycemia yowonjezereka, chiwopsezo pamoyo wa wodwalayo chimapangidwa nthawi zonse.

Zakonzedwa ndikuwongoleredwa ndi: dokotala wa opaleshoni

Hyperinsulinism - Matenda a kuchipatala omwe amadziwika ndi kuwonjezeka kwa insulin komanso kuchepa kwa shuga m'magazi. Hypoglycemia imabweretsa kufooka, chizungulire, kulakalaka kudya, kunjenjemera, ndi psychomotor. Pakapanda kuthandizidwa panthawi yake, chikomokere chimayamba.

Kuzindikira zomwe zimayambitsa vutoli ndizokhazikitsidwa ndi chithunzi cha chipatala, zotsatira za kuyesa koyesa, kuyesa kwamphamvu kwa glucose, ultrasound kapena kusanthula kwa tomographic kwa kapamba. Chithandizo cha pancreatic neoplasms ndikuchita opareshoni.

Ndi mtundu wa extrapancreatic wa matenda, chithandizo cha matenda oyambitsidwa zimachitika, zakudya zapadera zimayikidwa.

Hyperinsulinism (matenda a hypoglycemic) ndi chinthu chobadwa nacho kapena chokhala ndi matenda amkati mwa hyperinsulinemia. Zizindikiro za matendawa adayamba kufotokozedwa koyambirira kwa zaka za zana la makumi awiri ndi dotolo waku America a Harris ndi dokotala wa opaleshoni yapakhomo Oppel.

Congenital hyperinsulinism ndi chosowa kwambiri - 1 kesi pa 50,000 yatsopano. Matendawa amapezeka ndi zaka 35-50 ndipo nthawi zambiri amakhudza azimayi.

Matenda a Hypoglycemic amapezeka ndi nthawi yosakhalapo kwa zizindikiro zazikulu (kuchotsedwa) komanso nthawi yayitali yopanga chithunzi (kuukira kwa hypoglycemia).

Zoyambitsa Hyperinsulinism

Matenda agengenital amapezeka chifukwa cha kutukuka kwa intrauterine, kufalikira kwa fetal, kusintha kwa matupi athu.

Zomwe zimayambitsa matenda a hypoglycemic omwe adagawidwa pancreatic, zimayambitsa kukulitsa kwa hyperinsulinemia kwathunthu, komanso yopanda pancreatic, ndikuwonjezera kuchuluka kwa insulin.

Pancreatic mawonekedwe a matendawa amapezeka ndi zilonda zapakhosi kapena benign neoplasms, komanso pancreatic beta cell hyperplasia. Fomu yopanda pancreatic imayamba mu zotsatirazi:

Kuphwanya zakudya.Kutopa kwa nthawi yayitali, kuchepa kwamadzi ndi glucose (kutsekula m'mimba, kusanza, kuyamwa), kuchita masewera olimbitsa thupi popanda kudya zakudya zamagulu am'thupi kumapangitsa kuchepa kwambiri kwa shuga m'magazi. Kugwiritsa ntchito mafuta ochulukitsa okwanira kumawonjezera shuga m'magazi, omwe amathandizira kupanga insulin.
Kuwonongeka kwa chiwindi cha ma etiologies osiyanasiyana (khansa, mafuta a hepatosis, cirrhosis) kumayambitsa kuchepa kwa milingo ya glycogen, kusokonezeka kwa metabolic ndi hypoglycemia.
Kudya kosaloledwa kwa mankhwala ochepetsa shuga a shuga mellitus (ma insulin, omwe amachokera ku insulin, sulfonylureas) amachititsa mankhwala osokoneza bongo a hypoglycemia.
Matenda a Endocrine omwe amatsogolera kuchepa kwa kuchuluka kwa mahomoni a contrainsulin (ACTH, cortisol): pituitary dwarfism, myxedema, matenda a Addison.
Kuperewera kwa ma enzymes okhudzana ndi glucose metabolism (hepatic phosphorylase, aimpso insulinase, glucose-6-phosphatase) kumayambitsa wachibale hyperinsulinism.

Glucose ndiye gawo lalikulu la michere chapakati ndipo ndizofunikira kuti ubongo uzigwira bwino ntchito. Miyezi yambiri ya insulin, kudzikundikira kwa glycogen m'chiwindi ndi kulepheretsa kwa glycogenolysis kumabweretsa kuchepa kwa shuga wamagazi. Hypoglycemia imayambitsa zopinga za metabolic ndi mphamvu zama cell mu ubongo.

Kukondoweza kwa dongosolo la sympathoadrenal kumachitika, kupanga catecholamines kumawonjezeka, kuukira kwa hyperinsulinism kumayamba (tachycardia, irritability, a mantha). Kuphwanya njira za redox mu thupi kumayambitsa kuchepa kwa kugwiritsa ntchito kwa okosijeni ndi maselo a chithokomiro cha m'magazi komanso kukula kwa hypoxia (kugona, kunenepa, kusayang'anira).

Kuperewera kwa shuga kumapangitsa kuphwanya njira zonse za metabolic mthupi, kuchuluka kwa magazi kupita ku ziwongo za ubongo ndi kuphipha kwa zotumphukira za m'mitsempha, zomwe zingayambitse matenda amtima.

Pamene zida zakale zaubongo zimakhudzidwa ndi njira ya pathological (medulla oblongata ndi midbrain, Varolius Bridge) malo olimbikitsa, diplopia, komanso kusokonezeka kwa kupuma ndi mtima kumakula.

Hyperinsulinemia ndi chithandizo chake

Hyperinsulinemia ndi vuto losavomerezeka la thupi momwe mulingo wa insulin mumagazi umapitilira mtengo wamba.

Ngati kapamba amatulutsa insulin yochulukirapo kwa nthawi yayitali, izi zimabweretsa kuwonongeka kwake ndi kusokonekera kwa magwiridwe antchito.

Nthawi zambiri, chifukwa cha hyperinsulinemia, kagayidwe kachakudya kagayidwe kachakudya kamene kamayambitsa matenda ashuga. Kuti mupewe izi, ndikofunikira kufunsa dokotala munthawi yofufuza mwatsatanetsatane ndikusankhidwa kwa njira zowongolera izi.

Zomwe zimapangitsa kuti insulin iwonjezeke m'magazi zimatha kusintha motere:

Kapangidwe ka kapamba ka insulin yachilendo, yomwe imasiyana mu kapangidwe kake ka amino acid, motero sikudziwika ndi thupi,
Kusokonezeka kwa ntchito ya ma receptor (malekezero omvera) kwa insulin, chifukwa chomwe sangazindikire kuchuluka kwamahomoni m'thupi, chifukwa chake mulingo wake umakhala pamwamba pa chizolowezi,
Zosokoneza pakuyenda kwa glucose m'magazi,
"Zosokonekera" mu kachitidwe kovomerezeka kazinthu zosiyanasiyana m'magawo a ma cell (chizindikiro chakuti zomwe zikubwera ndi glucose sizidutsa, ndipo khungu sililoleza kulowa).

Mwa akazi, matenda amapezeka kwambiri kuposa amuna, omwe amakhudzana ndi kusinthasintha kwa mahomoni ndi kukonzanso. Izi zili choncho makamaka kwa iwo omwe akuimira amuna kapena akazi omwe ali ndi matenda opatsitsana.

Palinso zinthu zina zosadziwika zomwe zimawonjezera mwayi wopanga hyperinsulinemia mwa anthu onse ogonana:

kumangokhala
kunenepa kwambiri
ukalamba
matenda oopsa
atherosulinosis
chizolowezi cha chibadwa
kusuta fodya komanso kumwa mowa mwauchidakwa.

Munthawi yayitali yotsogola, vuto ili silingamveke konse. Mwa akazi, hyperinsulinemia (makamaka pachiyambipo) amawonetsedwa mwachangu munthawi ya PMS, ndipo popeza zizindikiro za izi ndi zofanana, wodwalayo samawalabadira kwambiri.

Mwambiri, zizindikiro za hyperinsulinemia zimagwirizana kwambiri ndi hypoglycemia:

kufooka ndi kutopa kochulukira,
kusokonezeka m'maganizo (mkwiyo, mkwiyo, kulira),
kunjenjemera pang'ono m'thupi,
njala
mutu
ludzu lalikulu
kuthamanga kwa magazi
kulephera kulolera.

Ndi insulin yowonjezereka m'magazi, wodwalayo amayamba kulemera, pomwe palibe zakudya komanso masewera olimbitsa thupi amathandizira kuti achepetse. Mafuta pankhaniyi amadzaza m'chiuno, mozungulira pamimba ndi kumtunda.

Izi ndichifukwa choti kuchuluka kwa insulin m'magazi kumapangitsa kuti mafuta ena apangidwe mwapadera - triglycerides.

Ambiri aiwo amawonjezera minofu ya adipose ndipo, kuphatikiza, amakhudza mitsempha yamagazi.

Chifukwa cha njala yosatha panthawi ya hyperinsulinemia, munthu amayamba kudya kwambiri, zomwe zimapangitsa kuti kunenepa kwambiri ndikukula kwa matenda a shuga 2

Kodi kukana insulin ndi chiyani?

Kukana kwa insulin ndikuphwanya kukhudzidwa kwa maselo, chifukwa cha izi amaleka kuzindikira insulini ndipo samatha kuyamwa glucose.

Kuti zitsimikizire kutuluka kwa zinthu zofunikazi kulowa m'maselo, thupi limakakamizidwa nthawi zonse kuti lisungidwe kwambiri mu insulin m'magazi.

Izi zimabweretsa kuthamanga kwa magazi, kudzikundikira kwa madipoziti amafuta ndikutupa kwa minofu yofewa.

Kukana kwa insulini kumasokoneza kagayidwe kake, chifukwa chifukwa chake mitsempha ya magazi imachepetsedwa, zolembera za cholesterol zimayikidwamo. Izi zimawonjezera mwayi wokhala ndi matenda oopsa a mtima komanso matenda oopsa oopsa. Insulin imalepheretsa kuchepa kwa mafuta, chifukwa chake, pamlingo wokwezeka, munthu akupeza thupi kwambiri.

Pali lingaliro malingana ndi momwe insulin kukaniza ndi njira yotetezera yopulumutsira anthu ovulala kwambiri (mwachitsanzo, ndi njala yayitali).

Mafuta omwe anachedwa panthawi yathanzi labwino amayenera kuwonongeratu nthawi yoperewera zakudya, motero kupatsa mwayi kwa munthu kuti "akhalebe" nthawi yayitali popanda chakudya.

Koma pochita, kwa munthu wamakono m'dziko lino palibe zothandiza, chifukwa, kwenikweni, zimangoyambitsa kukula kwa kunenepa kwambiri komanso matenda osokoneza bongo omwe amadalira shuga.

Kuzindikira kwa hyperinsulinemia ndikovuta kochepa chifukwa chosowa kutsimikizika kwa chizindikirocho komanso kuti mwina sangawonekere mwachangu. Kuti muzindikire izi, njira zotsatirazi zoyeserera zalembedwa:

kutsimikiza kwa kuchuluka kwa mahomoni m'magazi (insulin, ma pituitary ndi mahomoni a chithokomiro),
MRI ya pituitary gland yothandizirana ndi vuto lina kuti atulutse chotupacho,
Ultrasound yam'mimba, makamaka, kapamba,
Ultrasound yamchiberekero cha ziwalo za azimayi (kukhazikitsa kapena kupatula ma concomitant gynecological pathologies omwe mwina ndi omwe amachititsa kuti insulin iwonjezeke).
kuthamanga kwa magazi (kuphatikiza kuwunikira tsiku lililonse pogwiritsa ntchito wowunika Holter),
kuyang'anira pafupipafupi shuga (pamimba yopanda kanthu komanso katundu).

Pazifukwa zokayikitsa pang'ono, muyenera kulumikizana ndi endocrinologist, popeza kupezeka kwa nthawi yayitali kwa matenda kumawonjezera mwayi wakuchotsa kwathunthu

Hyperinsulinemia: zimayambitsa, Zizindikiro, mankhwala, zakudya

Hyperinsulinemia iyenera kumvetsedwa ngati matenda omwe amadziwonetsa okha ngati kuchuluka kwa insulin m'magazi.Mkhalidwe wamtunduwu ungayambitse kulumikizidwa m'magulu a shuga ndi chofunikira kuti shuga ikule. Matenda ena amagwirizana kwambiri ndi matendawo - polycystosis, yomwe imayendetsedwa ndi kusokonezeka kapena ntchito:

thumba losunga mazira
adrenal kotekisi
kapamba
zodabwisa
hypothalamus.

Kuphatikiza apo, pali insulin yochulukitsa pamodzi ndi estrogens ndi androgens; zizindikiritso zonsezi ndikuwonetsa kuti hyperinsulinemia yatsala pang'ono kuyamba m'thupi la wodwalayo.

Kumayambiriro kwenikweni kwamavuto azaumoyo, matenda a metabolic amayamba kukulira, omwe amadziwika ndi kusintha kwa shuga mumagazi a munthu. Vutoli limawonedwa mutatha kudya, kuchuluka kwa glucose kukwera ndikuyambitsa hyperglycemia, ndipo uku kumatha kukhala kuyamba kwa chitukuko cha chikhalidwe monga hyperinsulinemia.

Patha kanthawi chakudya, chizindikirochi chimatsika kwambiri ndipo chimakwiyitsa kale hypoglycemia. Vuto lofanana la metabolic ndi chiyambi cha kukula kwa matenda ashuga. Nthenga za kapamba pamenepa zimayamba kuchuluka kwa insulini ndipo motero zimatha, zomwe zimapangitsa kuchepa kwa timadzi timeneti m'thupi.

Ngati mulingo wa insulin ukwera, ndiye kuti kulemera kumawonedwa, zomwe zimabweretsa kunenepa kwambiri kwamitundu yosiyanasiyana. Monga lamulo, zosanjikiza zamafuta zimamanga m'chiuno ndi m'mimba, zomwe zimawonetsa hyperinsulinemia.

Ngakhale kuti zomwe zimayambitsa vutoli zimadziwika, ndipo zizindikilozo ndizovuta kuzinyalanyaza, zimapezekabe masiku ano.

Kodi polycystic ndi hyperinsulinemia amawonetsedwa bwanji?

Hyperinsulinemia imadziwika ndi maphunziro aposachedwa, koma nthawi zina, odwala amatha kuzindikira kufooka kwa minofu, kuzizira, chizungulire, ludzu lokwanira, kusakhazikika kwa chidwi, ulesi, ndi kutopa kosalekeza, zizindikiro zonsezi ndizovuta kuphonya, kuwonjezera apo, kuzindikira amadutsa nawo kwambiri.

Ngati tirikulankhula za polycystosis, zizindikiro zake zazikulu zimawonetsedwa ndi kusakhalapo kapena kusakhazikika kwa msambo, kunenepa kwambiri, hirsutism ndi androgenic alopecia (dazi), ndipo kuwonetsa kulikonse kumafunikira chithandizo cha munthu payekha.

Nthawi zambiri, kusokonezeka kwa thumba losunga mazira kumayendetsedwa ndi ziphuphu, kukomoka, zilembo zam'mimba, kutupa, kupweteka pamimba. Kuphatikiza apo, mkazi amatha kuwona zotsatirazi ndikuwonetsa:

kusintha kwamphamvu
kupuma kwamphamvu kugona (kugona),
mantha
kuchuluka kwa mkwiyo
kukhumudwa
kugona
mphwayi.

Ngati wodwala apita kwa dokotala, ndiye kuti malo oyamba azikhala pamakina a ultrasound, omwe angapangitse mawonekedwe ambiri a cystic, kukula kwa kaphatikizidwe ka ovarian, endometrial hyperplasia mu chiberekero. Njira zoterezi zimatsatiridwa ndikumverera kowawa pamimba yotsika ndi m'chiuno, ndipo zomwe zimayambitsa ziyenera kukumbukiridwa.

Ngati simukugwirizana ndi chithandizo cha polycystic cha panthawi yake, ndiye kuti mkazi amatha kuzindikira zovuta zazikulu:

khansa yam'mimba
hyperplasia
kunenepa
khansa ya m'mawere
kuthamanga
matenda ashuga
thrombosis
sitiroko
thrombophlebitis.

Kuphatikiza pa izi, zovuta zina za matendawa zimatha kukhazikika, mwachitsanzo, kulowetsedwa m'mimba, kupweteka kwamimba, kubadwa msanga, thromboembolism, komanso dyslipidemia.

Polankhula manambala, kuchokera pa 5 mpaka 10 peresenti ya azimayi amisinkhu yosabereka amakhala ndi zotupa zamkati za polycystic, ngakhale kuti zomwe zimayambitsa vutoli ndizodziwika.

Kodi hyperinsulinemia ndi polycystosis amathandizidwa bwanji?

Ngati mayi ali ndi matendawa, ndikofunikira kuti amupatse zakudya zomwe azidzayamwa ndi adotolo komanso kulandira chithandizo chokwanira.

Ntchito yayikulu pamenepa ndi kubweretsa kulemera kwa chizolowezi.

Pachifukwachi, calorie amaletsa chakudya chama calories 1800 patsiku, chakudya chomwe chili ndi shuga wambiri pamenepa chizichita ngati mtundu wa chithandizo. Ndikofunika kuchepetsa kugwiritsa ntchito momwe mungathere:

mafuta
zonunkhira
zonunkhira
chakudya chokometsera
zakumwa zoledzeretsa.

Chakudya chimatengedwa pang'ono 6 pa tsiku. Komanso chithandizo, mankhwala a mahomoni, kutikita minofu ndi hydrotherapy titha kudziwa. Njira zonse ziyenera kuchitika moyang'aniridwa ndi dokotala.

Kodi hyperinsulinemia ndi chiyani ndipo ndi chifukwa chiyani?

Matenda ambiri osachiritsika nthawi zambiri amakhala isanayambike matenda ashuga.

Mwachitsanzo, hyperinsulinemia mwa ana ndi akulu imapezeka kawirikawiri, koma ikuwonetsa kupanga kwa mahomoni ambiri omwe angapangitse kuchepa kwa shuga, kusafa ndi mpweya wa oxygen komanso kusatha kwa machitidwe onse amkati. Kuperewera kwa njira zochizira zomwe cholinga chake kupondereza kupanga insulin zingayambitse kukula kwa matenda osokoneza bongo.

Zoyambitsa matenda

Hyperinsulinism mu terminology yamankhwala imadziwika kuti ndi matenda a matenda, zomwe zimachitika motsutsana ndi maziko a kuchuluka kwambiri kwa insulin.

Munthawi imeneyi, thupi limachepetsa phindu la shuga m'magazi. Kuperewera kwa shuga kumatha kupangitsa kuti mpweya uzikhala ndi ubongo, womwe ungayambitse kuti ntchito yamanjenje iwonongeke.

Hyperinsulism nthawi zina imakhala popanda chiwonetsero chapadera chazachipatala, koma nthawi zambiri matendawa amabweretsa kuledzera kwambiri.

Congenital Hyperinsulinism . Zimatengera kutengera kwa chibadwa. Matendawa amakula motsutsana ndi maziko a matenda omwe amapezeka m'matumbo omwe amalepheretsa kupangika kwama mahomoni.
Second Hyperinsulinism . Fomuyi imapita patsogolo chifukwa cha matenda ena omwe apangitsa kuti mahomoni azitha kutulutsa. Ntchito hyperinsulinism imakhala ndi mawonetseredwe omwe amaphatikizidwa ndi zovuta mu kagayidwe kazakudya ndipo amadziwika ndi kuwonjezeka kwadzidzidzi kwa glucose.

Zinthu zazikulu zomwe zingayambitse kuchuluka kwa mahomoni:

maselo achikondwerero opanga insulin yosayenera ndi kupangika kosadziwika komwe sikumadziwika ndi thupi,
kukana, zomwe zimapangitsa kuti mahomoni asamalamulire,
kusunthika pakugawa shuga m'magazi,
onenepa kwambiri
atherosulinosis
chibadwire
anorexia, yomwe ili ndi chikhalidwe cha neurogenic ndipo imalumikizidwa ndi lingaliro lowona mopepuka la kunenepa kwambiri kwa thupi,
zochita za oncological pamimba,
zoperewera komanso zosapatsa thanzi,
kuvutitsidwa kwa maswiti, zomwe zimapangitsa kuti glycemia iwonjezeke, ndipo, chifukwa chake, kuchuluka kwa katulutsidwe ka mahomoni.
matenda a chiwindi
mankhwala osavomerezeka a insulini kapena kumwa kwambiri mankhwala osokoneza bongo kuti muchepetse shuga, zomwe zimabweretsa mawonekedwe a hypoglycemia,
endocrine pathologies,
osakwanira enzyme zinthu nawo metabolic njira.

Zomwe zimayambitsa hyperinsulinism sizitha kudziwonetsa kwa nthawi yayitali, koma panthawi imodzimodzi zimayipitsa ntchito ya chiwalo chonse.

Magulu owopsa

Magulu otsatirawa a anthu nthawi zambiri amakhudzidwa ndi chitukuko cha hyperinsulinemia:

azimayi omwe ali ndi matenda a ovary polycystic,
anthu omwe ali ndi cholowa chamtundu wa nthendayi,
odwala matenda amisempha,
azimayi atatsala pang'ono kusamba,
anthu okalamba
Odwala omwe alibe
azimayi ndi abambo omwe amalandira mankhwala a mahomoni kapena mankhwala a beta-blocker.

Kodi matendawa ndi oopsa bwanji?

Matenda amtundu uliwonse angayambitse zovuta ngati palibe chochitika munthawi yake. Hyperinsulinemia sikuti ndi yosiyana, motero, imayendetsedwa ndi zotsatira zowopsa. Matendawa amatuluka pachimake komanso matenda osachiritsika. Kuphunzira kumene kumapangitsa kuti zinthu za mu ubongo ziwonongeke, zomwe zimakhudza gawo la psychosomatic.

zosokoneza pakugwira ntchito kwamakina ndi ziwalo zamkati,
kukula kwa matenda ashuga
kunenepa
chikomokere
kusokera mu ntchito yamtima wamtima,
encephalopathy
parkinsonism

Hyperinsulinemia yomwe imachitika paubwana imakhudza kukula kwa mwana.

Kuchiza matenda

Mankhwalawa amatengera machitidwe a matendawa, chifukwa chake amasiyanasiyana munthawi yakukhululuka ndi chikhululukiro. Pamavuto othandizirana, kugwiritsa ntchito mankhwalawa kumafunikira, ndipo nthawi yonseyo ndikokwanira kutsatira zakudya ndikuchiza matenda oyambitsa matenda a shuga.

Thandizo lakuonjezera:

idyani chakudya chambiri kapena kumwa madzi okoma, tiyi,
jekeseni shuga kuti muthe kukhazikika boma (kuchuluka kwake - 100 ml / 1 nthawi),
kumayambiriro kwa chikomokere, muyenera kuchita masewera olimbitsa thupi,
pakalibe kusintha, jakisoni wa adrenaline kapena glucagon uyenera kuperekedwa,
gwiritsani ntchito bata munthawi ya kupunthwa.

Odwala omwe ali ndi vuto lalikulu amayenera kupita kuchipatala ndi kulandira chithandizo moyang'aniridwa ndi madokotala. Ndi zotupa zokhala ndi chithokomiro, zotulutsa ndi zina zofunikira zingafunike.

Zakudya za hyperinsulinemia zimasankhidwa poganizira zovuta za matendawa. Pafupipafupi komanso kovuta kusiya kukomoka kumaphatikizapo kupezeka kwa kuchuluka kwa chakudya chamagulu m'zakudya za tsiku ndi tsiku (mpaka 450 g). Zakudya zamafuta ndi zakudya zama protein zimayenera kusungidwa m'njira yokhazikika.

Munthawi yoyenera matendawa, kuchuluka kwa chakudya chopatsa mphamvu zomwe zimalandiridwa ndi chakudya patsiku sikuyenera kupitirira 150. Maswiti, confectionery, mowa suyenera kuperekedwa ku chakudya.

Kuti muchepetse kuwonetsa kwa hyperinsulinemia, ndikofunikira kuyang'anitsitsa njira ya matenda ashuga ndikutsatira malangizo akuluakulu:

Idyani pang'ono komanso moyenera
Nthawi zonse onani kuchuluka kwa glycemia, sinthani ngati pakufunika,
samalani njira yoyenera yomwera,
khalani ndi moyo wathanzi.

Ngati kuphatikiza kwa insulin kwambiri chifukwa cha matenda enaake, ndiye kuti kupewetsa khunyu kumachepetsedwa ku chithandizo cha matenda am'mimba, omwe amakhala ngati chifukwa chachikulu cha mawonekedwe awo.

Ngati chithandizo cha panthawi yake sichikupezeka, wodwalayo amatha kudwala matenda okomoka.

Congenital hyperinsulinism mwa ana ndi osowa. Zomwe zimayambitsa anomatic ndi:

matenda osiyanasiyana pokonzekera fetal,
masinthidwe amtundu
asphyxia wobadwa.

Matendawa omwe adapezeka ali ndi mitundu iwiri:

Pancreatic Zimatitsogolera ku Mtheradi.
Zosasokoneza. Zimayambitsa kuwonjezeka pang'ono kwa insulin.

Zosiyasiyana zoyambirira zimachitika chifukwa cha kukula kwa chotupa kapena chotupa chowopsa.

Zinthu zotsatirazi zimapangitsa kuti pakhale mawonekedwe osakanikirana:

kuphwanya zakudya, kusala kudya kwanthawi yayitali, kuchepa kwamadzi ambiri chifukwa cha m'mimba, kusanza kapena mkaka
zovuta zamagazi pakugwira ntchito kwa chiwindi (,) zimabweretsa mavuto mu metabolism m'thupi,
Kugwiritsa ntchito molakwika mankhwala osintha shuga m'magazi,
matenda a endocrine
kusowa kwa michere yomwe imakhudza kagayidwe kazakudya.