Pheochromocytoma - yog dab tsi? Pheochromocytoma: cov tsos mob, mob, kev kho mob, cov duab

Tus heev fact ntawm tshwm sim ntawm hlav nyob rau hauv tib neeg lub cev, txawm benign? Nws yog twb txaus ua kev txhawj xeeb. Thiab mus rau teb rau xws li ib tug qhov tseeb yuav tsum yog ceev heev, txwv tsis pub lub ntsej muag qhov uas yuav muaj teeb meem tsub kom ho. Vim li no, nws ua rau kev nkag siab rau kawm qhov yooj yim tej yam tshwm sim ntawm cov tsos ntawm cov qog, tshwj xeeb tshaj yog yog hais tias peb tham txog ib tug tsawg daim ntawv raws li pheochromocytoma. Peb yuav tsum tsis txhob xav txog cov teebmeem ntawm foundations nyob rau hauv qhov teeb meem ntawm pej xeem cov tshuaj thiab lwm yam kev. Cov mus xyuas tus kws kho mob yog lub feem ntau txhim khu kev qha tshuaj.

Pheochromocytoma - yog dab tsi?

Qhov no lub sij hawm yuav tsum tau to taub raws li lub qog yog phem los yog benign xwm, muaj li ntawm chromaffin hlwb, uas ua catecholamines. Nws yuav ua tau ob qho tib si biogenic amines thiab peptides uas muaj xws li norepinephrine thiab dopamine.

Nyob rau hauv feem ntau (90%) ntawm no hom ntawm qog npaj nyob rau hauv lub adrenal medulla, tsawg npaum li cas nws zoo li tsau nyob rau hauv aortic lub cev, ntawm lub plab mog, plab los yog thoracic kab noj hniav. Lub rov tshwm sim ntawm ib tug pheochromocytoma nyob rau hauv lub taub hau los yog lub caj dab cheeb tsam yuav tsum tau ntaus nqi rau cov qeb ntawm kev zam.

Nyob rau hauv 10% ntawm txhua tus neeg mob no zoo mob yog ib tug phem extraadrenal localization. Yog li muaj yog zus tau tej cov dopamine. Raws li rau tus txheej txheem ntawm metastasis nyob rau hauv xws teeb meem, lub qog hlwb lub caij nplooj zeeg, feem ntau yog nyob rau hauv lub ntsws, lub siab, cov pob txha, cov leeg, thiab lub regional lymph node.

Yog vim li cas rau cov emergence thiab kev loj hlob

Muaj coob tus tau hnov txog tus kab mob no li pheochromocytoma. Yuav ua li cas nws yog, hmoov tsis, tsis txhua leej txhua tus paub. Nws yog ib qho tseem ceeb kom nkag siab txog vim li cas xws li ib tug teeb meem tshwm sim nyob rau hauv tib neeg lub cev. Thiab ces muaj ib zaug nws yuav tsum tau muab sau tseg hais tias ib tug ntshiab kev teb qhia txog qhov ua rau ntawm tsis tau. Tab sis raws li ib tug tshwm sim ntawm cov kev tshawb fawb tau tau ua tej yam lus xaus txog cov kev tshuaj ntsuam genetic xwm ntawm pheochromocytoma.

Feem ntau cov feem ntau cov kab mob no tshwm sim nyob rau hauv cov neeg muaj hnub nyoog 25 mus txog 50 xyoo. Yeej, txoj kev loj hlob ntawm no hom ntawm qog yog tsau nyob rau hauv nruab nrab-hnub nyoog cov poj niam. Yog hais tias peb tham txog cov me nyuam, xws li ib tug mob yog ntau dua nyob rau hauv cov tub hluas. Tab sis nyob rau hauv Feem ntau, pheochromocytoma mob - ib tug kuj tsis tshua muaj tshwm sim.

Yog li txog 10% ntawm tag nrho cov xov tooj ntawm tej teeb meem muaj feem rau lub familial daim ntawv. Qhov no txhais tau tias qhov no hom ntawm qog yog tam sim no nyob rau hauv tsawg kawg ib tug ntawm cov niam txiv ntawm tus neeg mob.

Ntxiv mus xyuas cov ua no yam ntawm tus kab mob, nws yog tsim nyog sau cia hais tias nws yuav ua tau ib qho ntawm lub Cheebtsam ntawm lub syndrome ntawm ntau yam endocrine neoplasia (hom 2A thiab 2B). Pheochromocytoma tsau nyob rau hauv 1% ntawm cov neeg mob mob diastolic cov ntshav siab.

symptomatology

Nyob rau hauv txoj kev tshawb no ntawm tej hlav raws li pheochromocytoma, cov tsos mob, mob thiab kev kho mob yog qhov tseem ceeb cov lus qhia blocks, uas tso cai rau yuav tau xav txog cov kev kawm los ntawm ces kaum sib txawv. Tab sis yuav tsum pib nrog lub ces ntawm tus kab mob. Symptomatology yog heev ntau haiv neeg thiab feem ntau zoo li ib tug tsawg txaus ntshai noj qab haus huv tej teeb meem.

Koj yuav tsum tau pib nrog lub fact tias muaj ib tug mob uas yog ruaj khov nyob rau hauv xws kab mob raws li pheochromocytoma. Tawg - cov no yog cov ib co ntawm cov paub txog tus mob nyob rau hauv nqe lus nug. Nws tau coj qhov chaw nyob rau hauv ib tug ruaj khov thiab krizovoe daim ntawv. Thaum ib tug mob muaj nyob rau ntawm lub catecholamine hypertensive ntsoog, ntshav siab nce heev sharply. Tab sis nyob rau hauv mezhkrizovy lub sij hawm BP yuav nyob twj ywm li qhia siv kuj siab los yog yuav nyob rau hauv lub cev ntau. Kaw mob thaum pheochromocytoma proceeded nrog rau qhov kev kub siab, tab sis tsis muaj crises.

Yog xav paub ntxiv txog Stroke

Nws ua rau kev txiav txim zoo them sai sai rau lub fact tias nrog xws li ib tug teeb meem raws li pheochromocytoma ntsoog (hypertension) yog feem ntau nrog los ntawm hnyuv, plawv, metabolic thiab Neuro-hlwb kev ntshawv siab. Hais txog txoj kev loj hlob ntawm xws li ib tug lub xeev, nws yuav tsum tau muab sau tseg hais tias nws yog tsiag ntawv los ntawm cov nram qab no cov tsos mob: mob taub hau, co, ntxhov siab vim, nyob tsis tswm, tawv nqaij daj, ntuav, tu-sauv thiab tawm hws. Tej zaum yuav muaj ib tug ua txhaum ntawm atherosclerosis, tachycardia thiab lub plawv mob.

Thaum kuaj nrog pheochromocytoma, hypertensive ntsoog yuav ntxias ntuav, xeev siab thiab lub qhov ncauj qhuav. Tab sis cov kev hloov no nyob rau hauv tus neeg mob lub xeev kev kho mob yog tsis ib txwm txwv. Nrog xws hlav feem ntau hloov lub xeev ntawm cov ntshav. Peb tham txog tej teeb meem raws li lymphocytosis, hyperglycemia, leukocytosis, thiab eosinophilia.

Crease tau ntev li ntawm ob peb feeb mus ib teev los yog ntau tshaj. Yuav kom qhov no lub xeev cov yam ntxwv yog nws npaj txhij txog shutdown. Noj nyob rau hauv cov ntshav siab kuj tshwm sim sai heev, yog li ntawd txawm muaj txoj kev pheej hmoo ntawm hypotension. Raws li ntxias cov tsos mob xws yam tej zaum yuav ua rau ib ce muaj zog, nqa tawm sib sib zog nqus palpation ntawm lub plab mog, siv cawv thiab tshuaj yeeb, hypothermia los yog overheating, ntse taw, kev xav cuam tshuam thiab lwm yam.

tshwj xeeb tshaj yog tawm tsam

Qaug dab peg yuav muaj ib tug txawv zaus. Lawv yuav tsum tau muaj 10 mus rau 15 lub sij hawm ib hnub twg los yog ib zaug ib lub hlis. Yog hais tias qhov pib ntawm kev pabcuam daws teebmeem nyob rau hauv pheochromocytoma, ces nws yuav ua rau kev txiav txim zoo los tham txog qhov tiag tiag uas yuav muaj mob stroke, ntshav nyob rau hauv lub retina, raum tsis ua hauj lwm, heart attack myocardial infarction, dissecting aneurysm ntawm lub aorta, pulmonary edema, thiab lwm leej lwm tus. Tus loj tshaj plaws mob tus mob no yog ib tug catecholamine poob siab manifests nws tus kheej los ntawm tshwm hemodynamics. Peb tham txog kev hloov hypo- thiab tawg, muaj indiscriminate nyob rau hauv qhov thiab yuav tsis tau ho.

Yog li ntawd, pheochromocytoma - yog dab tsi? Xav nws ces, yuav tsum tau them xim rau cev xeeb tub cov poj niam, vim hais tias lawv muaj xws li ib tug mob yuav masquerade li eclampsia, pre-eclampsia thiab toxaemia. Qhov tsim nyog ntawm tej tsos mob tej zaum yuav ua phiv yug tau.

Sai tau thiab ruaj khov zoo ntawm lub qog, nyob rau hauv uas cov ntshav siab yog li qhia siv kuj siab. Nyob rau hauv lub xeev no, feem ntau kaw hloov nyob rau hauv lub ob lub raum, lub fundus, thiab cov myocardium. Nws yog tseem tau cia li hloov nyob rau hauv ob peb vas, mob taub hau, qaug zog thiab txob taus. Ib tug ntawm cov 10 cov neeg mob muaj ntshav qab zib txoj kev loj hlob.

Muaj lwm yam kab mob uas feem ntau yog txuam nrog pheochromocytoma. Nws yog hais txog Raynaud lub syndrome, gallstone tus kab mob, syndrome Cushing, neurofibromatosis, thiab lwm tus neeg. Nyob rau hauv cov kev tshwm sim hais tias tsim ib tug kab mob qog hlav, mob nyob rau hauv lub plab, muaj yog metastasis rau deb nruab nrog cev, thiab ceev ceev poob phaus.

Kev soj ntsuam ces

Muaj ntau yam nta ntawm tus kab mob, uas yuav ua tau kom ib co teeb meem. Nws yog hais txog cov hauv qab no dab:

• Cov me nyuam thiaj paub hais tias nrog pheochromocytoma nyob rau hauv feem ntau muaj tawg. Ib tug peb lub hlis twg ntawm cov neeg mob nyob rau ntawm ib thaum ntxov muaj hnub nyoog yog taag polydipsia, polyuria, thiab qaug dab peg. Lwm yam tab kaum uas yuav ua rau pheochromocytoma nyob rau hauv cov me nyuam - ib tug slowdown nyob rau hauv txoj kev loj hlob. Ntxiv mus, nws yog nyob rau ntawm ib thaum ntxov muaj hnub nyoog nrog tus mob ua rau nws tus kheej xav tias ib tug muaj zog poob phaus, tawm fws, xeev siab thiab ntuav, pom tau qhov sib cuam tshuam, thiab vasomotor teeb.
• Cov poj niam uas pheochromocytoma tej zaum yuav muaj deterioration ntawm kev noj qab nyob vim lub tides. Cev xeeb tub poj niam yuav ua tau ib tug yam li eclampsia thiab pre-eclampsia.
• Nyob rau hauv tus neeg mob qhov twg lub qog yog nyob rau tom ntej mus rau lub phab ntsa ntawm lub zais zis, tso zis tej zaum yuav txuam nrog qaug dab peg. Muaj kuj yog ib tug uas yuav muaj mob hematuria, nce ntshav siab, mob taub hau, xeev siab thiab palpitations.

txoj kev mob

Nyob rau hauv thiaj li yuav paub qhov kev mob ntawm tus neeg mob uas poob siab tias tus kab mob xws li pheochromocytoma, lub xeev tsom xam lub cev yuav tsum tau teem feem nyob rau hauv cov nram qab no cov tsos mob: daj ntseg ntawm daim tawv nqaij ntawm lub ntsej muag thiab ob lub mis, nce ntshav siab, tachycardia, orthostatic hypotension.

Yog li ntawd nws yog tsim nyog yuav tsum tau ceev faj palpation ntawm cov los nyob rau hauv cov ntaub ntawv ntawm hlav nyob rau hauv lub caj dab, los yog plab mog. Ntawm kab hauv qab no yog hais tias tej yam ua yuav ua rau txoj kev loj hlob ntawm catecholamine ntsoog.

Tsis tas li ntawd, high-zoo tshuaj xyuas kab mob xws hlav yuav tsum muaj xws li ib tug mus ntsib mus rau ophthalmologist. Qhov no mob yuav ntaus nqi rau lub fact tias yuav luag 40% ntawm cov neeg kev txom nyem los ntawm tawg, hypertensive retinopathy yog kuaj, thiab ua heev.

Muaj biochemical kev mob ntawm pheochromocytoma, ib tug yees duab ntawm cov uas tso cai rau kom peb to taub lub seriousness ntawm qhov teeb meem no. Yog li ntawd peb yeej tham tsis tau txog lub zog theem ntawm catecholamines nyob rau hauv cov ntshav, zis, ntshav qab zib thiab chromogranin-A nyob rau hauv cov ntshav ntshiab. Tej zaum nws yuav yuav yam ntaub ntawv rau kev nce rau hauv lub concentration ntawm parathyroid lawm, cortisol, poov hlau, phosphorus, calcitonin, thiab lwm yam hais.

Nyob rau hauv tej yam tej yam kev mob ntawm cov neeg mob yog nqa tawm differential mob ntawm hlav. Peb yuav tau tham txog cov kab mob xws li psychosis, neurosis, kub siab, hyperthyroidism, paroxysmal tachycardia, raug kuab lom thiab irregularities nyob rau hauv lub Cns.

Nyob rau hauv kev txiav txim hom mob thiab cov neeg kawm ntawv ntawm nws txoj kev loj hlob muaj peev xwm yuav siv tau MRI thiab CT, raws li zoo raws li txoj kev tshawb no ntawm tus neeg mob lub plawv ua si. Yog hais tias pheochromocytoma yog kuaj mob, cov tsos mob, mob thiab kev kho mob - yog yam uas yeej tsis tshua muaj ntau yam li nyob rau hauv hlav ntawm ntau hom yog raws sij hawm kom paub tias cov teeb meem thiab pab kev kho mob yog tus yuam sij rau ib tug zoo tshwm sim ntawm tus ua hauj lwm nrog cov neeg mob.

Yuav ua li cas los kho

Muaj ntau ntau txoj kev ntawm cawv rau lub qog raws li phem thiab tsis yog ib tug kev hem thawj. Nyob rau hauv feem ntau tus neeg mob, phais yuav lub feem ntau muaj kuab kev txiav txim siab, yog hais tias nws twb tshwm sim pheochromocytoma. Tshem tawm yuav tsum tshwj xeeb tshaj yog yam nyob rau hauv cov ntaub ntawv ntawm ib tug mob nyob rau hauv lub adrenal caj pas.

Tab sis tej zaum yuav muaj kev zam vim cov neeg pluag mob ntawm lub plawv, cov hlab ntsha thiab ntshav siab. Kev Koom Tes kws phais neeg thaum xws mob yog heev undesirable los yog txawm tsis tsim nyog. Nws puv tawm ntau nyob rau hauv tej yam ntawm xws li ib tug mob li pheochromocytoma. Kev kho mob yog txo mus rau yeeb tshuaj kho, feem ntau yuav siv sij hawm ib tug ob peb hnub.

Cov kev siv ntau yam tshuaj rau mob neutralization implies tias tus neeg mob yuav tsum tau nyob rau hauv lub txaj, thiab nqa ib nrab-zaum txoj hauj lwm. Mus coj ib tug ntshav siab tus kws kho mob yuav muab tshuaj rau alpha-blockers. Hais dua, nws yog tshuaj xws li "Tropafen" thiab "phenoxybenzamine." Yog hais tias tus neeg mob yog tsau hypertensive ntsoog, tshuaj pleev thawj coj yuav "phentolamine" "Sodium nitroprusside" thiab lwm yam uas zoo sib xws tshuaj. Yuav ua li cas yog ib qho tseem ceeb yog qhov tseeb hais tias thaum lub sij hawm ua ntej kev kho mob yog tsim nyog los cawm tus neeg mob los ntawm lub cev qhuav dej.

siv phais

Yog hais tias pheochromocytoma twb ntes tau, cov kev kho mob siv cov riam phais neeg yog xaiv nrog kev xav txog dab tsi xyov txheej txheem yog qog. Feem ntau cov chav, transbryushinny, extraperitoneal thiab transthoracic txoj kev.

Nyob rau hauv cov kev tshwm sim hais tias tus neeg mob yog sab tom qab qhov kev xeem, cov raug nrog phais kho mob yuav tsum tau lig. Ntawm cov hoob kawm, tej zaum yuav muaj rov, tab sis lawv manifest lawv tus kheej xwb nyob rau hauv 13-15% ntawm cov neeg.

Tab sis thaum muaj ntau yam hlav, qhov teeb meem no yog ho nyuab dua. Qhov tseem tsim nyog tov yog los tshem tawm tag nrho cov hlav, tab sis qhov teeb meem lus dag nyob rau hauv lub fact tias cov tshwm sim ntawm ib tug muaj kev vam meej lub sij hawm no mas tsis tshua. Nws yog vim li no nyob rau hauv cov ntaub ntawv ntawm ntau yam pheochromocytomas phais yog nqa tawm nyob rau hauv ob peb ua sawv. Nyob rau hauv tej lub sijhawm, tsuas yog tus mob yog muab tshem tawm cov.

Raws li rau cov yam ntxwv ntawm lub lag luam, nyob rau hauv lub chav kawm ntawm nws siv yuav thov heev dua lwm yam laparotomy saib. Nws piav no mus kom ze high-uas yuav muaj extraadrenal mob localization. Nws tseem yog nqi paub tias tus tswj ntawm hemodynamic (ntshav siab thiab central venous siab) yog muaj nyob rau thoob plaws hauv cov kev pab.

Nyob rau hauv feem ntau tus neeg mob tom qab pheochromocytoma twb muab tshem tawm, ntshav siab lawm. Yog hais tias xws li ib tug tshuaj tiv thaiv ntawm tus kab mob yog tsis tam sim no, ces muaj yog txhua txhua yog vim li cas nyaj qhov tseeb ntawm lub tsim ntawm ectopic mob cov ntaub so ntswg.

Yog hais tias pheochromocytoma twb pom nyob rau hauv cev xeeb tub cov poj niam, ua ntej ua lub stabilization ntawm cov ntshav siab, thiab ces ua ib tug phais plab seem, los yog rho menyuam, thiab xwb ces tshem tawm cov qog nws tus kheej.

Nyob rau hauv cov ntaub ntawv ntawm diagnosing ib tug phem pheochromocytoma, uas lub tsev ntawm metastases tau txais cov kws khomob ( "Dacarbazine" "Vincristine", "Cyclophosphamide").

Nyob rau hauv Feem ntau, yog hais tias tus mob twb ntes tau nyob rau ntawm ib thaum ntxov rau theem, thiab tus neeg mob yog zoo npaj rau kev kho mob, qhov uas yuav los mus kov yeej qhov teeb meem no yog heev.

Yuav ua li cas yam yuav muab txhais li chiv

Nrog rau txoj kev loj hlob ntawm cov qog nyob rau hauv lub cev yog ib txwm txoj kev pheej hmoo ntawm provoking ib tug nres. Nws yog yog li ntawd ib qho tseem ceeb yuav tsum paub txog, uas tej zaum yuav ua rau aggravation ntawm lub xeev. Nws yog ib lo lus nug txog kev sib deev com, lub cev hwj tau lub cev hloov, hyperventilation, qhua thaum lub sij hawm plob tsis so tswj taw, lub cev load, puas siab puas ntsws excitation thiab siab mus rau lub cheeb tsam nyob qhov twg laus mob. Yog hais tias koj tau raug tshuaj mob nrog pheochromocytoma, tsis tau muab kev koom tes nrog haus dej haus cawv, tshwj xeeb caw thiab beer, raws li zoo raws li noj cheese.

Muaj kuj tau muab teev tus neeg mob thaum cov kev tawm tsam pib tom qab tau txais nicotine, tricyclic antidepressants, phenothiazine derivatives thiab beta-blockers.

tau

Yog li peb muaj lub ntsiab ntawm "Pheochromocytoma" twb qhia tawm. Yuav ua li cas yog nws, peb ntsia lub feem ntau nthuav dav. Nws tseem mus ua lub cuab xaus: qhov teeb meem yog ib yam nkaus thiab loj mus kho nws maj mam. Thaum thawj cov cim qhia hais tias zoo li cov tsos mob ntawm pheochromocytoma, nws yog tsim nyog los tham ib tug kws kho mob, yuav kuaj thiab pib kho mob.