ʻO ka insulinoma pancreatic: hōʻailona, ke kumu, ke nānā ʻana, ka mālama ʻana, ka hopena

ʻO ka Insulinoma kahi maʻiʻoki o ka pancreas (pancreas) e ulu ana mai nā beta beta, nā mokupuni o Langerhans. Ma ke kūlohelohe, e pili ana ia i nā ʻano endocrine, ʻo ia hoʻi, he ʻano hana ka hormone. ʻOkoʻa ia i loko o ia mea i hana ʻia ai ka nui o ka insulin i loko o kahi nui i kāohi ʻole ʻia, ma muli o ka hyperinsulinism a, ma muli o kēia, hypoglycemia.

Pau nā ʻōuli a me kona inoa i pili i kēia. ʻO ka maʻamau ʻo ka paʻa, hoʻokahi, akā ma nā hihia he 105 i hiki ke hoʻonui ʻia. He ʻoki pono kāna hana hormonal. I nā 85-90% o nā hihia he maleʻe, a ma loko wale nō 10-15% he mea ʻino ia. Hiki iā ia ke ulu i kēlā me kēia makahiki, ʻoiai hoʻi i nā pēpē, akā loaʻa kēia kaʻa. ʻOi aku ka maʻamau ma hope o 45 mau makahiki, i nā wāhine 4 mau manawa pinepine pinepine.

Hiki i ka insulin ke ulu ma kahi o nā pancreas, akā ʻoi aku ka nui o kona ʻāpana caudal. I ka 1% o nā hihia, ʻo ka wahi e ectical a i ʻole extrapancreatic - ka puka o ka spleen, ka ʻōpū o ka ʻōpū a me ka duodenum, i loko o ka ate.

ʻO ka maʻamau, ʻaʻole ʻo ka nui o ka pīpī ma mua o 2 cm (no ka nui ke malignant). ʻO ka mākaukau o ka maʻi he 1 mau maʻi pākahi mau miliona.ʻO kēlā helu helu liʻiliʻi e kumu i nā hana hewa a me nā ʻano kūpono ʻole, a nui nā kauka ʻaʻole i hālāwai me ia i kā lākou hana.

ʻO kahi hana maʻi-hana ikaika

Loaʻa nā maʻi kaila pancreatic āpau - 1-3 mau hihia / miliona. Inā i ka kāne ke hana lākou i ka 3,5%, i nā wahine - a ʻo 16%. ʻO ka hapa nui o lākou he endocrine. Nā kikowaena o ka laulā he 0.5 cm a 15 cm. ʻO nā neoplasma benign pancreatic wale nō e mālama wale ʻia e nā maʻi maʻi. Wahi a ka ʻōlelo pohihihi o nā hormones, ua hoʻokaʻawale ʻia lākou i nā ʻano:

hana i ka insulin - 75%,
ʻO VIPoma (ʻoi aku ka pinepine, ma 70% o nā hihia, hele mai i loko o nā wahine ma hope o 45) - e hana ana i ka peptide ʻōpū o ka vasoactive,
gastrinoma (pili hou i nā kāne o nā ʻelemakule),
glucagonoma - ʻo ke alapine he 1 hihia i ka 20 miliona, ʻoi aku ka nui o ka manawa o ka poʻe wahine, ma ka 80% mau hewa ia.

Nā Hoʻolālā Insulinoma

ʻOiai ka manaʻo o ka insulinoma he mauʻano maʻamau loa, he mea paʻakikī loa ia. ʻO ka hana hoʻomālamalama ʻole i ka insulin e ka mākeke e alakaʻi i kahi kahe nui o ka glucose i ke koko (hypoglycemia), ke kumu kēia o ka maʻi. Aia nō i ka helu helu, ka nui a me ka hana o ka foci ʻoi. ʻAʻole mākou e poina e hoʻomau i ka hoʻoneʻe ʻia o ka hormone e nā sela olakino o ka pancreas.

Hoʻopilikia ka hypoglycemia

ʻO ka mea nui, ka hōʻailona koʻikoʻi o ka maʻi maʻi, ka poʻe hōʻeuʻeu o ka hypoglycemia acute, hiki iā lākou ke hōʻike iā lākou iho i nā ʻano like ʻole. I ka nui o nā hihia, hoʻoulu kekahi hoʻouka i ke kakahiaka nui, ma kahi ʻōpū ʻole, i ka wā e nui ai ka manawa ma hope o ka ʻaina hope a me ka haʻahaʻa o ke koko koko.

He mea paʻakikī ke ala i kahi kanaka i ke kakahiaka i ka wā o ka hoʻouka ʻana, ma hope o ke ala ʻana e hiki iā ia ke hoʻomau i ka hauʻoli no ka manawa lōʻihi, hiki ʻole iā ia ke pane iki i nā nīnau maʻalahi, a hana i nā ʻano kūpono. He mau hōʻailona kēia o ka nūhou o ka naʻau ma muli o ka kaila kalaiwa o ka ʻōnaehana o ka puni.

Hiki ke ʻike ʻia i nā hopena kaua i ke kakahiaka, akā i ka lā hoʻi, ʻoiai inā he nui ka manawa ma waena o ka pāʻina, me ke kaumaha kino a me ka noʻonoʻo. Hypoglycemia akena e hele pū ʻia e ka hoouka ʻana o kahi kuehu psychomotor. Hiki i nā mea maʻi ke hōʻike aku i ka hoʻohālikelike, hoʻohiki, hoʻopio ʻana i kekahi mea, ʻaʻole pane iki i nā nīnau, i waho ke ʻano he ʻano ʻawaʻawa nui.

Eia kekahi, loaʻa i nā mea maʻi ke hopu ʻia i ka epileptiform, he ahonui kūlohiwi lōʻihi, nā neʻe ʻana a me ka hoʻonaninani ʻana i nā ʻōiwi o nā iwi, a me ka haʻalulu ʻana i nā manamana lima. Hiki i nā mea maʻi ke hoʻopiʻi e "hoʻoiho ʻia lākou i loko o kahi maʻi", a laila i loko o kahi anuanu, ka manawa, ka manaʻo o ka nele o ka ea, kahi ʻano hopohopo ʻole.

ʻO ka holomua o ka hypoglycemia hiki ke alakaʻi i ka hohonu nui o ka ʻike, me ka ʻole o ka hāʻawi ʻana i ka mālama lapaʻau, make ka mea maʻi.

Wā kikowaena

ʻO nā hōʻailona i hiki ke ʻike i ka poʻe maʻi me ka insulinoma i ka wā lawelima, ʻaʻole ia i kikoʻī a ma ka hapa nui ke ʻano o ka neurological ma ke ʻano, kahi paʻakikī ka hana i ka maʻi kūpono.

Me ka hypoglycemia lohi, e hōʻeha nā kino cranial, ʻo ia ka maka a me ka glossopharyngeal. Hiki i kēia ke ʻike e ka neʻe ʻana o ka maka, ka ʻalike o nā lehelehe nasolabial, kaʻi ʻana i nā kihi o ka waha, ka nalo ʻana o nā mea hoʻohālikelike, ka lacrimation, ka ʻōpū ʻōpala, nā ʻano o nā hōʻeha ma ka wahi o ke aʻa a me nā aʻa oʻa. Ma ke nānā ʻana, ʻike paha ke kauka i ke ʻano o kekahi mau palanui neʻe i ka poʻe iʻike i nā poʻe olakino. Hoʻomaopopo ka poʻe maʻi i ka palupalu i ka hoʻomanaʻo a me ka nānā ʻana, lilo ia i mea paʻakikī iā lākou e hana i ka hana maʻamau, aia ka manaʻo ʻole i nā mea e hana nei. Hiki ke ʻike ʻia nā ʻano neʻe like me kēlā me nā hōʻiliʻili liʻiliʻi.

Ma muli o kēlā mau hōʻailona nonspecific o ka maʻi, ua mālama pinepine ʻia ka poʻe maʻi no ka manawa lōʻihi e nā neuropathologists a me nā psychiatrists.

Diagnosis o ka insulinoma

ʻO kahi hōʻike hōʻike keu e ʻike ʻia ana kahi pōpoki ma kahi ʻōpū ʻole i ke kakahiaka, ma hope o ka hoʻoluhi ʻana i ka ʻai, ka hana kino, ma mua o menstruation i loko o nā wahine e pono ke ʻāpono i ka loaʻa ʻana o kēia ʻano maʻi i ka mea maʻi.

Aia kekahi triad o nā hōʻailona e hiki ai i ke kānalua i ka neoplasm huna huna.

hookeai
koko koko i ka manawa o ka hoʻouka ʻana ma lalo o 2.7 mmol / l,
ka hoʻopiʻi ʻana o ka hopena glucose i ka mea maʻi i waho o ka hoʻouka ʻia.

I ka wā o kahi hoʻouka, ua hoʻoholo ʻia ka pae o ka insulin i ke koko, maʻa mau ʻia kēia hōʻailona ma ka pae haʻahaʻa haʻahaʻa. Pēlā nō hoʻi ka waiwai prognostic ka wehewehe ʻana o ka mea huna o ka proinsulin a me C-peptide.

ʻO ka mea nui o ka neoplasms ka mea liʻiliʻi loa i ka nui, ʻo ka maʻi ʻona ʻana a me ka tomography compute he uninformative.

I kēia manawa, ʻike ʻia ka angiography pancreatic i hoʻokahi o ka ʻoi aku ka hopena o ka maʻi diagnostic ʻano ʻoiai, ʻo ka mea ke kī pinepine ʻo nā tumors i kahi vascular ākea. Hāʻawi kēia iā ʻoe i ka hoʻoholo pono ʻana i ka wahi a me ka nui o ka insulinomas.

Insulinoma: hana

I ka nui o nā hihia, hele lākou i ka hoʻomaʻamaʻa ʻana i nā inikini, ka lawe ʻana i ke kuʻekuʻe e alakaʻi i ka hōʻola hou ʻana i ka mea maʻi.

Inā hiki ʻole ke hoʻomaʻamaʻa lāʻau lapaʻau, ʻōlelo ʻia nā mea maʻi i ka lapaʻau ʻana i ka lāʻau lapaʻau e hoʻōla ana i ka huna ʻana i ka insulin a me ka hoʻolohi ʻana i ka ulu ʻana o ke ana a me nā metastases. ʻO ke kōʻai pinepine pinepine i ka meaʻai o ka ʻai a i ʻole ka hoʻomaka ʻana o ka glucose e pono ʻia no ka pale ʻana i ka hoʻoulu ʻana o ka hypoglycemia.

ʻO wai ke kauka e hoʻopili ai

Inā loaʻa he ʻano maʻamau ka pōloli o kekahi kanaka, nā wīwī o nā aʻalā, nā huhū, ke poʻo, ka hope o ka lethargy a i ʻole hoʻi nā luhi o ka ʻike, pono ia e hoʻopili i kahi endocrinologist. Eia kekahi, pono e noi ʻia he kūkākūkā neurologist. Hoʻomaʻi pinepine ʻia ka mālama ʻana i nā insulinomas e ka lāʻau lapaʻau.

ʻO ka insulin hoʻonāukiuki ʻia e ke kino hiki ke hoʻoulu ʻia e nā kumu like ʻole. ʻO ka hypoglycemia (kahi kūlana i hōʻemi ʻia e ka nui o ka insulin), ʻo ia ka hōʻailona mua e pili ana i ka maʻi benign, ka insulinoma, ua ʻike ʻia i ke kino o ka mea maʻi.

ʻAʻole loaʻa nā insulinoma, no laila ʻaʻole hiki ke hoʻopili ʻia i ka nui o nā papa maʻamau. Ma ke kānāwai, ulu ia i nā kānaka ma luna o 45 mau makahiki. Hiki ke ulu i ka Insulinoma i loko o kahi ulu palupalu, akā aia kēia ma kahi o 7% o nā mea maʻi.

ʻO ke hiʻohiʻona o ke kuʻekuʻe e alakaʻi i nā maʻi hormonal, ma muli o ka hoʻonui ʻana i ka synthesis o ka insulin. ʻO ka nui o ka insulin e mau loa a hoʻopaʻa ʻia paha i ka hypoglycemia.

ʻO nā hōʻailona aʻe e kōkua i ka hoʻoholo ʻana i ka hypoglycemia:

migraine a me ka luhi,
nāwaliwali koke ʻole a me ka pohō,
lēʻo ke kauā,
ke hoʻonui nei i ka pōloli
hopohopo o ke kaumaha.

Inā ʻaʻole kū kēia kūlana i ka manawa, e hoʻohiolo ka nui o nā glucose.

Pēlā, ʻike mua kahi kiniki e hoʻoneʻe ana i ka hana ʻana o ka insulin a hana i ka hypoglycemia. ʻAʻole maopopo i nā kumu o ke ʻano o nā insulin.

ʻElua mau maʻi o ka maʻi

ʻO kahi ʻōpiopio benign he maʻi endocrinological a mālama ʻia e kahi endocrinologist. ʻO ka neoplasm e hoʻoulu ai i ka hoʻopili ʻana o ka synthesis o nā hormones, no laila ke koho ʻia ka lāʻau maʻi e ka endocrinologist. ʻO ka koʻikoʻi nui o ka insulin benign o ka hoʻomohala ʻana o ka hypoglycemia. Hiki ke hōʻemi i ka hoʻoliʻiliʻi hāliʻi i ka hopena maikaʻi ʻole, a hiki i kahi coma, hiki ke make.

Hoʻohui i ka hormonal, hiki i ka isnulloma ke ʻano oncological ʻano. I kēia hihia, aia kekahi kuleana o ka metastasis, e like me i kekahi neoplasm malignant.

ʻO ke wahi o ka insulinoma ka pancreas, no laila ke loaʻa nei ka maʻi me ka nānā ʻana i ka pancreas a me ka hoʻoholo ʻana i ke ʻano o ka kiko.

Hoʻomaopopo o ka Insulinomas

Hoʻokomo ka insulin pancreatic i ka ʻōnaehana endocrine a ka mea maʻi. No laila, ke piʻi nui nei nā hōʻailona kumu nui o ka maʻi ma ka makemake a me ka momona nui i ka mea maʻi.

Nā hōʻailona o ka hypoglycemia e kipa i ka mea maʻi i ke ahiahi ma hope. Hoʻopau kēia no kaʻai nui ʻana i ke ao. E like me ke kānāwai, ua nalowale ka hypoglycemia iā ia i ka pō, a i ke kakahiaka o ka mea hou ke ea maikaʻi. ʻO kēlā mau maʻi ka manaʻo e alakaʻi i ka hōʻike ʻana o nā maʻi e mālama pono i ko lākou olakino ponoʻī a makemake e ʻike i ke kauka.

Hoʻopili i nā ʻōnaehana endocrine, keʻae ʻia ka insulinoma i ka hana o ka ʻōnaehana o ka mea maʻi.

Nā hōʻailona o ka maʻi mai ka ʻoihana endocrine:

ka hoʻomohala ʻana o ka tachycardia,
panic attack (lele adrenaline hana),
kahe kahel
nā wīwī puʻe.

Ua ʻōleʻa ka pahuhopu i ke neoplasm me nā hōʻailona aʻe:

nāwaliwali, nawaliwali a me nā migraine,
pūhuna hoʻāhewa ʻole
paʻuhi paʻa ʻole.

No laila, ʻo ka pancreatic insulinoma (neoplasm) mau hōʻailona like me ka hypoglycemia. Inā ʻike ʻia lākou, pono e kipa koke i kahi kauka. Hiki i ka hypoglycemia ke komohana, kahi, e hoʻonāukiuki i ka hōʻeha ʻana i ka puʻuwai. No ka mea e pili ana ka maʻi maʻi i ka poʻe ma kahi ʻelemakule, hiki i kēia kūlana ke ola.

ʻO ka maʻi hoʻoliʻi o ka maʻi

Lawe ʻia kahi hoʻonaninani o ka insulinoma e ka endocrinologist. Mālama i ka manawa kūpono i kahi hopena kūpono a me ka mālama pono.

ka hopena o ka pae insulin,
ka hoʻopaʻa ʻana i ka io pancreatic,
ka hoʻoholo ʻana i ka pae koko glucose,
ʻO ka ultrasound pancreatic,
i hoʻohui ʻia o ka tomaki o ka pancreas.

Hāʻawi ʻia kēlā mau ʻōleʻa kiʻekiʻe i kēlā me kēia nui i nā loli nui i ka hoʻonā ʻana o ka insulin a me ka hoʻokaʻawale ʻana i nā glucose. ʻO ka hoʻoweliweli ʻana o ka pancreas e hiki ai ke hoʻoholo i ke ʻano o ka insulinoma.

Pehea ka hana ʻana

Inā kānalua ʻoe he maʻiomaomaomaomaʻo, inā he mau mau hōʻailona o ka hypoglycemia, pono ʻoe e hele i ke kauka a ua hoʻomaʻamaʻa mākaʻina loa iā ʻoe.

Inā i hoʻopaʻa ʻia ka isnullinoma e ka maʻi maʻi, hoʻomaka ka mālama ʻana ma hope o ke hoʻoholo ʻana i ke ʻano o ka huki. Hoʻopili koke ʻia kahi wili manu benign. Hoʻomaʻo hou ka mālama ʻana i ka hoʻopau ʻana i nā hōʻailona o ka hypoglycemia a me kona mau hopena. ʻO ka hana pinepine ka mea e hoʻopiʻi ai i ka nui o nā hoʻopiʻi, no laila ke komo pū ka mālama ʻana i ko lākou hoʻopau. Pono ke hoʻomaʻamaʻa ʻana i ka ʻōlelo a ke kanaka neʻe ʻana, no ka mea, ʻo ka hā pinepine e hāʻawi pinepine i nā hoʻopiʻi i ka ʻōnaehana.

E like me ke kānāwai, pane maikaʻi a isulinoma i ka mālama ʻana. ʻO ka hoʻihoʻi hou o ka papa patele i nā hanana koʻikoʻi loa.

Pono pū kekahi insulin me ka hoʻomaʻamaʻa kūlohelohe, akā ma kēia hihia ʻaʻohe mea loea e hōʻoia i kahi hopena kūleʻa o ka hoʻomehana. Hoʻomau ʻia ka mālama ʻia e kahi mea maʻi.

Inā he kānalua nā manaʻo o ka insulin, ʻaʻole pono ʻoe e kali e hele i ka ʻōpala ke hele pono ʻia. Hiki i ke kipa hele ʻana i ke kauka ke mālama i ke ola o ka mea maʻi.

I ka manawa hea e ʻike ai i kahi kauka?

ʻO ka mālama ʻana i ka manawa kūpono a me ka maʻi maʻi e ʻae ʻia i ka manawa e hoʻomaopopo ai i ka insulin, me ka hōʻino. Aia ka hopena o ka hopena holoʻokoʻa ma ka wikiwiki o ka mea maʻi me ka insulinoma ino hewa e huli i kahi loea.

Ke hele mai nā hōʻailona mua o ka hypoglycemia, pono ka kipa ʻana o ka endocrinologist.

ʻO ka wehewehe ʻana o ke kaʻi i nā wā mua e kōkua i ke pale ʻana i ka hoʻomohala ʻana o ka metastases a hoʻomaʻamaʻa i ka manawa me ke ʻano maʻi maʻi maʻi.

ʻAʻole ʻoe e noʻonoʻo he maikaʻi ʻole ka benign isnullinoma. Ma waho o ke ʻano hoʻonaʻauao koʻikoʻi, e māhuahua ka piʻi o ka hypoglycemia, a hoʻopiha ʻia kēia me nā hoʻopiʻi koʻikoʻi, a hiki i kahi coma. Aia kekahi mau manawa i hāʻule ai ka mea maʻi, a hele i ke kauka, a ma ka manawa wale nō i ʻike ʻia ai ka insulinoma.

Hōʻalo a me ka prognosis

Ma ke kānāwai, ke kōkua nei i ka manawa pono o ka insulinomas e kōkua ai e pale aku i ka hoʻohemo hou o ka maʻi. Eia nō naʻe, ma hope o ka lawe ʻana i ka isnullinoma, maʻi pinepine ʻia ka maʻi pancreatic e like me ka pancreatitis. Pono lākou i kahi lōʻihi lōʻihi a me ka pono, a me ke ʻano o ke ola ʻana a me ka hoʻoponopono ʻana i ka meaʻai.

ʻAʻole i ʻike ʻia nā kumu no ka hoʻomohala ʻana i ka neoplasm, no laila, ʻaʻohe i nā hana pale. ʻAʻole hiki iā ia ke pale i ke kūkulu ʻana o kahi ʻōpala, akā naʻe, me ka mālama pono ʻana i kou olakino ponoʻī, hiki iā ʻoe ke ʻike i ka manawa a me ka mālama ʻana i ka mālama ʻana.

He mea nui ia e hoʻopaʻa pinepine i nā pae glucose o ke koko a nānā i ka nui o ka insulin i hana ʻia e ka pancreas. He mea lawa paha i ke kanaka olakino e lawe i nā hoʻokolohua hoʻokahi manawa ma ke kauʻana e ʻike i ke kiʻekiʻe o ka hormone a me ke kōpaʻa koko a hiki ke ʻoluʻolu no kona olakino.

I mea e ʻike ai ka prognosis, pono e hoʻomaopopo ʻia i ka insulinoma - pehea e maopopo ai ia ia a me kēlā mea. Inā he kūleʻa ke kūleʻa, ke ola holoʻokoʻa ka 70% o nā hihia, akā hoʻopaʻa ʻia ka mea maʻi me ka endocrinologist o ka'āina i kona ola a pau a mai kēlā manawa kēia manawa e hoʻomaʻamaʻa i kahi maʻi pancreatic. I ka 30% o nā hihia, ʻike ʻia kahi hoʻomaha o ka maʻi.

Inā he maʻi ka maʻi ʻōpili, ʻaʻole like ka maʻi āpau e like me kā mākou e makemake ai. I nā hihia ʻelua ma waho o ʻekolu, ʻaʻole hiki ke hoʻopau ʻia. Kūle pinepine ka maʻi ma muli o ka hopena o ka hopena ma ka 40% o nā maʻi i pau ai ka maʻi i ka make.

ʻO ka Insulinoma ka papa maʻamau ʻo ka endocrine pancreatic. Hoʻomaopopo ia no 70-75% o nā Tumina Hoʻoikaika o kēia ʻano. He pākahi ka Insulinoma a lehulehu, ma 1-5% o nā hihia, ʻo ka ʻōpū he wahi e loaʻa ai i ka adenomatosis endocrine lehulehu. Hiki iā ia i kekahi mau makahiki, akā ʻoi aku hoʻi i nā manawa - i nā kānaka 40-60 mau makahiki, a me ka ʻike like ʻole ma nā kāne a me nā wahine. Kūʻai nui nā kumela manu (ma kahi o 90% o nā hihia). Hiki ke hoʻopaʻa ʻia ka Insulinoma ma kekahi wahi o ka pancreas. Ma kahi o 1% o nā maʻi, aia ka extrapancreatically i loaʻa i ka omentum, ʻōpū o ka ʻōpū, duodenum, spleen gate a me nā wahi ʻē aʻe. ʻO ka nui o ke kōpō e hoʻololi mai i kekahi mau kenekulia a 15 cm ka lōʻihi, ʻoi aku ka 1-2 cm.
ʻO ka hapa nui o nā sela i loko o nā mākeke he mau papa B, akā aia nō kekahi pū kekahi, nā cell me nā granule secretory, e like me nā cell o nā kahakui excretory. Hiki i ka insulinomaʻino ke hāʻawi i ka metastases i nā kumuwaiwai ʻē aʻe, akā ʻo ka pinepine o ka puʻu.

ʻO nā mea nui nui i ka pathogenetic i ka insulinoma me ka hoʻomohala ʻole a me ka hoʻokahe ʻia o ka insulin, me ke ʻano o ka glucose o ke koko (me ka nui o ka hoʻoulu ʻana o ka insulin e nā cell tumor, hiki i kā lākou hiki ke waiho i kahi propeptide a ua hoʻemi ʻia ka peptide). Ke ala nei mai ka hyperinsulinism e loaʻa i ka hapa nui o nā hōʻailona lapaʻau.

Me nā pūlima insulin, hiki i nā insulinomas ke hua ʻia i loko o nā nui nui a me nā peptides ʻē aʻe - glucagon, PP.

ʻO nā kumu o ka insulinoma:

ʻO ka manawa koke ma hope o ka loaʻa ʻana o ka insulin e Bunting a me West i ka makahiki 1921, ʻike ʻia nā hōʻailona o kona overdose i ka hoʻohana ʻana i nā lāʻau kūloko i nā mea maʻi me ka maʻi mellitus. ʻAʻole kēia i hana iā Harris i ka hoʻolālā ʻana i ka manaʻo o ka hypoglycemia spontan i hoʻomaka ʻia e ka piʻi mau ʻana o ka haki o kēia hormone. Nui nā hoʻāʻo ʻana e ʻike a me ka mālama ʻana i ka insulin i ka 1929, i ka manawa i ʻike ʻia ʻo Graham ka mea hou e hoʻōla i kahi nīnūnū o ka insulin.

ʻAʻohe mea kānalua i ka hōʻailona o ka insulinoma e pili pū me kāna hana hormonal. ʻO ka Hyperinsulinism kahi kumu nui o ka pathogenetic ma muli o ka maʻi āpau o ka maʻi o ka maʻi. ʻO ka huna mau ʻana i ka insulin, ʻaʻole i hoʻolohe i nā ʻenehana e hana ai i ka glucose homeostasis, alakaʻi i ka hoʻomohala ʻana o ka hypoglycemia, pono ke kō o ke koko no ka hana maʻamau o nā iwi āpau a me nā kiko, ʻoi loa ka lolo, ka mea e hoʻohana ai i cortex i ʻoi aku me ka ikaika ma mua o nā mea ola ʻē aʻe. Ma aneʻi 20% o nā glucose āpau e komo ana i ke kino e hoʻolilo ʻia ma ka hana o ka lolo. ʻO ka ʻike nui o ka lolo i ka hypoglycemia ma muli o ke kīpē ʻana, i ka ʻokoʻa i nā kiko o ke kino a pau, ʻaʻole i kaʻu ka hoʻokaʻawale o ka pale a hiki ʻole ke hoʻohana i ka nalo momona kūlohelohe i ke kumu o ka ikehu. Ke waiho ka glucose i loko o ka cortex cerebral no 5-7 mau minuke, hiki ke hoʻololi ʻia nā loli i loko o kāna mau ʻāpana, a me nā mea iʻike nui ʻia o ka make nui.

Me ka hoʻohaʻahaʻa ʻana i nā pae o ka glucose i ka hypoglycemia, ke nānā ʻia nā hana i ka nānāʻana i ka glycogenolysis, gluconeogenesis, ka hoʻoneʻe ʻana o nā momona momona ʻokoʻa, a me ka ketogenesis. Hāpai kēia mau mīkini i ka nui o ka hormone 4 - norepinephrine, glucagon, cortisol a me nā ulu ulu. ʻIke ʻia, ʻo ka mea mua wale nō o ia mea ke hōʻike i nā hōʻike pilikino. Inā hele koke ka hopena i ka hypoglycemia ma ka hoʻokuʻu ʻana o ka norepinephrine, a laila e hoʻomohala ana ka mea maʻi i ka nāwaliwali, e palu ana, e hopohopo ana me ka pōloli, ʻo nā hōʻailona mai ke kikowaena kūloko o ka hanana ʻana o ka hōʻeha, ka ʻike pālua, ka ʻano kīnā ʻole, nalowale o ka ʻike. Ke ulu ulu nei ka hypoglycemia, e loli ʻole nā loli a pili i ka pūnaehana nūnū, a ua hemahema ka react (ma ka norepinephrine).

Ho'ōla lāʻau Insulinoma:

No ka koho ʻana:

Inā hoʻomau ka hypoglycemia, hiki ke hoʻohana ʻia ka diazoxide me kahi maʻi pākahi o 1.5 mg / kg maʻa mau he 2 i kekahi lā i ka lā me ka natriuretics. Hiki ke hoʻonui ʻia ka nui i ka 4 mg / kg. ʻAʻole paʻa loa kahi hoʻohālikelike o somatostatin octreotide (100-500 μg subcutaneously 2-3 mau lā i ka lā) a pono e noʻonoʻo ʻia kona hoʻohana ʻana i nā maʻi me ka hypoglycemia e hoʻomau, e pale ana iā iazoxide. ʻO nā mea maʻi i mālama ʻia me ka octreotide i mea kūpono e hiki ke kuhikuhi i ka intramuscularly 20-30 mg hoʻokahi i ka lā. I ka wa e hoʻohana ai i ka octreotide, pono i nā mea maʻi e hoʻonohonoho hou i nā enzyme pancreatic, no ka mea e pale ai i ka mea huna o nā papa pancreatic. ʻO nā lāʻau'ē aʻe e loaʻa ana kahi hopena liʻiliʻi a me ka hopena i ka huna ʻana i ka insulin e komo ai i ka verapamil, diltiazem, a me ka phenytoin.

Inā hoʻomau nā hōʻailona o nā insulin, hiki ke hoʻohana i ka chemotherapy, akā ua palena nā mea pono. Hoʻohana ka Streptozotocin i 30% o nā hihia, a me ka hui pū ʻana me 5-fluorouracil, hiki ke kūpono i ka 60% me kahi lōʻihi a hiki i ka 2 mau makahiki. ʻO nā lāʻau'ē aʻe e komo ai me doxorubicin, chlorozotocin, a me interferon.

ʻO ka Insulinoma kahi mākela hormonal ikaika e hoʻoulu ʻia e nā b cell, nā mokupuni o Langerhans, nā pancreas, e hūnā ana i ka insulin nui, ka mea hiki ʻole ke alakaʻi i ka hypoglycemia.

Aia he benign (i ka 85-90% o nā hihia) a i ʻole nā maʻi manuahi hewa (i ka 10-15% o nā hihia). Hoʻohana ʻia ka maʻi i ka poʻe ma waena o 25 a 55 mau makahiki. No kēlā mau mea ʻōpio, ʻaʻole weliweli ka maʻi.

Loaʻa paha nā wahine i ka insulinoma ma mua o nā kāne.

Hiki i nā Insulinomas ke loaʻa i loko o kekahi wahi o ka pancreas, i kekahi mau mea ke kū ʻia i ka paia o ka ʻōpū. ʻO kona ʻāpana he 1.5 - 2 cm.

Nā hiʻohiʻona o ka maʻi

Aia nā huaʻōlelo o Insulinoma:

ke hoʻonui ʻana i ka insulinoma e hoʻonui i ka hoʻonui nui aʻe o ka insulin a me kahi hoʻohaʻahaʻa i ke kō koko. Hoʻokomo wale ka Insulinoma i nā manawa a pau ʻole ke ʻano o ke kino.
ua manaʻo ʻia nā ʻōlima o ka lolo i ka maʻalahi o ka hypoglycemia, no ka mea, he glucose lākou ka nui o ka ikehu,
me ka insulinoma, neuroglycopenia e kū nei, a me ka lōʻihi o ka hypoglycemia, hōʻike ʻia ka hoʻopiʻi ʻana me CNS.
emi ke aniani o ke koko, akā e emi nō ka synthesis o ka insulin. ʻO kēia kahi hopena o ka hoʻoponopono maʻamau o ka hana a ka hana metabolism. I loko o kahi poho, me ka hoʻohaʻahaʻa ʻana i ke kō, ʻaʻole i emi ka synthesis o ka insulin,
me nā haole hypoglycemia, ʻaʻole komo nā hormones noradrenaline i ke kahe koko, ʻike ʻia nā hōʻailona adrenergic,
hana ka insulinoma me ka hoʻokaʻawale, pale a hoʻokaʻawale i nā insulin i nā ʻano like ʻole. Mālama ʻo ia i ke koena o ka kelepa,
ua like ka helehelena o ke akea me ke ano o ka pili i pili,
ʻO ka insulinoma he ʻano o ka insuloma pancreatic a hoʻopaʻa ʻia i ka ICD,
1 ka poʻe mai loko mai o 1.25 miliona mau kānaka ka maʻi i kēia maʻi maʻi.

ʻO ka pathogenesis o ka hypoglycemia me ka insulinoma

ʻO ka Insulinoma kahi tumi e hoʻoili ai i kahi hormone. ʻO kaʻoiaʻiʻo o nā cell cancer me ka insulinoma he hana i ʻole ka palena, hana lākou i kahi ala ʻole, ma muli o ke ʻano o ka pae o ka glucose i ke koko. Hoʻokomo ka kiniki i ka nui o ka insulin, kahi e hoʻokaʻawale i ke kukuna o ka glucose i ke koko. ʻO ka hypoglycemia a me ka hyperinsulinism nā hopena nui o ka pathogenetic i ka maʻi.

ʻO nā pathogenesis o ka insulinoma i nā maʻi maʻi like, akā like paha nā hōʻailona o ka hoʻomohala ʻana o ka maʻi. Kēia mau ʻōlima ma muli o ka mea i kēlā me kēia kanaka ke ʻano o ka naʻau e like me ka insulin a me hypoglycemia. ʻO ka hapa nui, ʻo ka hemahema o ka glucose i loko o ke koko e manaʻo ai ʻo ia ma ke ʻano o ka lolo. ʻO kēia ke kumu o ka loaʻa ʻole o ka wai i ka glucose, ʻaʻole hiki iā ʻoe ke hoʻohana i nā momona momona e like me kahi mea no ke kumu o kahi ikehu.

Hoʻomuka no ka insulin

Inā he keʻena paha ke kūleʻa, a laila ma hope o ka neʻe ʻana i ke ʻano o nā lāʻau radical (hana e hoʻoneʻe i ke kani), hoʻomaʻi hou ka mea maʻi. Ke loaʻa nei i ka maʻi kūlohelohe kahiendocrine, e kūleʻa hoʻi ka lāʻau lapaʻau i ka insulinoma.

Ke hōʻeha ka pila, ʻoi aku ka koʻikoʻi o ka prognosis o ka mālamaʻana. Aia ia ma ke kahua o ka ʻōpū, a me ka nui o nā lesi. He mea nui ka pōmaikaʻi o nā lāʻau chemotherapeutic - e hilinaʻi ana i kēlā me kēia hihia kūikawā o ka maʻi a me ka ʻike ʻana o ka nukū i nā lāʻau. Hoʻomaʻama pinepine nā 60% o nā mea maʻi i ka streptozocyton, inā ʻaʻole pili ka palupalu i kēia lāʻau lapaʻau, hoʻohana ʻia ka adriamycin. E like me ka hōʻike ʻana o ka hoʻomaʻamaʻa, ʻo ka kūleʻa o ka hana lapaʻau ʻana o nā insulinomas e loaʻa i ka 90% o nā hihia, ʻoiai ʻo ka make i ka wā o ka hana hōʻeha ma ka 5-10%

Hoʻohana ʻia

ʻO ka lāʻau maʻi maʻi e pili ana i ka hana e wehe ai i ka ʻōpū. Hiki i ka mea maʻi ke hōʻole i ke kau ʻana e wehe i ka ʻōpū. Pēlā nō, ʻaʻole i hoʻohana ʻia ka lāʻau lapaʻau i mua o nā mea hoʻohālikelike i hoʻopuni ʻia o kahi ʻano kino.

Aia ka luhi i ka huʻu o ka pancreas, hana ʻia ka hana ma ka ʻoki ʻana i kahi ʻāpana o nā io o ke kino a hemo i ka ʻōpū. I nā hihia a benign ka insulinoma a loaʻa i loko o ke kino a poʻo paha i ka nui o ka glandula thyroid, hana ʻia ka enucleation (tumor husking). Inā hōʻeha ʻia kahi ʻōpiopio me nā maʻi a he hiki ʻole ke hoʻokaʻawale loa, ua hoʻohana kekahi ʻano hana me ka lāʻau lapaʻau. Hoʻokomo pū kekahi lāʻau lapaʻau e lawe i nā lāʻau lapaʻau e like me diazoxide (proglycem, hyperstat) a i ʻole octreatide (sandostatin). ʻO ka lawe ʻana i kēia mau lāʻau ka hopena i ka emi ʻana o ka hana hana insulin, a me ke koi ʻana hoʻi i ka hoʻoulu ʻana o ka hypoglycemia.

ʻO ka mālama ʻana

Me ka mālama ʻana i ka insulinomas, ka hopena ma hope o ka hopena: hōʻoluʻolu a me ka pale ʻana o ka hypoglycemia, a me nā hopena ma ke kaʻina.

I nā hihia ʻaʻole i hiki ke mālama maʻi radical, no ka laʻana, kahi maʻi hōʻeha me nā lepoki he nui, ua kau ʻia nā hōʻailona hōʻailona maʻi. Kahi ʻano hana i loko o ka hoʻohana nui ʻana i nā minamina ole. Inā hikiʻole ke hoʻomaʻamaʻa i ka pae o ka hana o ka insulin e nā lāʻau lapaʻau, hoʻoholo ʻia ka mea maʻi i ka chemotherapy, a laila no ka polychemotherapy.

Hiki iā ʻoe ke ʻike maʻalahi i nā lāʻau lapaʻau e mālama i nā insulinomas ma Moscow i kā mākou pūnaewele.

E hoʻokomo i kāu ʻikepili a e kamaʻilio mākou me kā mākou poʻe loea e hāʻawi iā ʻoe i nā ʻōlelo aʻo ʻole e pili ana i nā pilikia e pili ana iā ʻoe.

- He ʻano ʻano ikaika kēiaʻano o ka ʻōpū e pili pono i nā mokupuni pancreatic (islets of Langerhans). Hoʻopilikia ʻia ia i nā pū o nā beta, ma muli o ka hana ʻole i hoʻomau ʻia a me ka komo ʻana o ka insulin i loko o ke koko e hele nei. Kēia neoplasms hiki i ke benign (ma 70% o nā hihia) a i ʻole ka adenocarcinomas. Loaʻa kahi hope loa o 6 cm a ʻoi aku paha.

Aia kekahi ʻano ʻē aʻe o ka tumneka pancreatic (insulomas) e ulu ana mai nā alpha, delta, a me nā pūpili PP. I kēia hihia, ua hua ʻia nā ʻano ʻē aʻe: polipuna pancreatic, gastrin, serotonin, somatostatin a me adrenocorticotropic hormone. Hoʻokomo ʻia ka Insulinoma i nā maʻi maʻi 35 a 60 mau makahiki, i loko - paʻakikī loa. E maʻi nui nā kāne a ʻoi aku ka manawa 2 ma mua o ka wahine.

ʻAʻole maʻi Insulinoma he maʻi hoʻoilina, paʻakikī loa ia. ʻOiai ka etiology i maopopo ʻole. Ua hōʻike ʻia ua hoʻonā pinepine ʻia nā tumi pancreatic e ka hoʻohaʻahaʻa haʻahaʻa i ke koko, kahi e hoʻoneʻe ʻia e ka hoʻonāʻana o ka insulin. Hiki i ka hypoglycemia ke ʻano i loko o nā kūlana:

ka nele o ka ulu ʻana o ka hormone ulu, i hōʻemi ʻia e ka emi ʻana o ka hana o ke alo o ka mua hipiponi (ke alakaʻi nei i ka hana o ka insulin),
ka nele o ka cortex adrenal (ʻoi a i ʻole ka lolo), e alakaʻi i ka emi ʻana o ka glucocorticoids a me ka hoʻolilo ʻana i ka nui o ke kō i loko o ke koko,
luhi ʻia nā maʻi ʻeha e ka wīwī a ka pōloli,
my myemaema, ma muli o nā haʻahaʻa haʻahaʻa o nā mea thyroid e hāpai i ke kiʻekiʻe o ka glucose,
inā hoʻopili maikaʻi ʻia ka ʻaʻai kino e ke kino.
nā maʻi pāpaʻi i hōʻeha ʻia e nā mea ʻino
hopohopo i ke aniani (no ka nalowale i ka makemake),
ʻōpū i loko o ka ʻōpū o ka ʻōpū,
enterocolitis.

ʻO ka insuloma pancreatic e hoʻopilikia pinepine ʻia i ka huelo a i ʻole kahi kino o kahi mea maʻi. Kuhi loa i loaʻa ma waho o ka kelepona, hoʻokumu ʻia i ke kiko o ka ectopic (ʻokoʻa). I ke ka nānā, he hāhā poʻokela, a ʻano ka lōʻihi o kona kūkaʻe mai ka 0.5 a 8 cm. Ke keʻokeʻo, hina a ʻulaʻula paha ke kala o ke koʻi.

ʻO nā manawa pinepine, ʻike ʻia ka insulinomases, hoʻokahi wale nō nā hihia maʻamau i loaʻa i nā ʻano like ʻole. Hōʻike ʻia ka ʻaʻa palu e ka hoʻomohala ulu, ʻike iki ka metastases a loaʻa i nā ʻano hana ʻino wale nō.

ʻO nā hoʻomohala a me nā hōʻailona o ka maʻi

Me ka insulinoma pancreatic, nā hōʻailona ma muli o nā bouts o ka hypoglycemia. ʻO kēia ke kumu o ka hoʻonui nui o ka insulin e ka hoʻi, me ka ʻike ʻole o ka pae o ka glucose i ke koko. I nā poʻe olakino, me ka hāʻule o ka pae o ka glucose (no ka laʻana, me ka), he ʻike nui loa i ka nui o ka insulin. Me ka insulinoma, ʻaʻole holo pono kēia ʻano hana, ʻoiai ka mea e hoʻopilikia ai e ka insulin tumor. Mālama kēia i nā kūlana no ka hoʻouka ʻana me ka hoʻouka kaua hypoglycemic.

ʻO ka hypoglycemia kahi paʻakikī o nā hōʻailona e hele mai ana ma muli o ka nānāʻoleʻana i ka hana o ka hoʻoponopono o ka glucose i loko o ke koko. Hoʻoulu ia i ka wā e hāʻule ai ke kō i ke kō ma ka 2.5 mmol / L.

Hoʻomaopopo ʻia ka maʻi maʻi, hypoglycemia e ka hoʻomohala ʻana o nā pilikia o ka neuropsychiatric a me ka hoʻonui ʻana o ka nui o nā hormones: norepinephrine, cortisol, glucagon. Hoʻonui nā norepinephrine i nā kiu o ka maloʻo, haʻalulu i nā limu a me nā angina pectoris. Hoʻomaʻamaʻa wale nā mea ʻino i ke ʻano a ma ke ʻano o ka hana ʻana i nā palapala ʻeha koʻikoʻi.

I ka maʻi āpau me ka insulinoma, loaʻa ka Whipple triad, aia kahi hōʻailona nei:

ka hōʻike ʻana i nā pilikia neuropsychiatric i ka wā wikiwiki,
ka hūnā koko i lalo o 2.7 mmol / l,
i hiki ai ke hoʻopau i ka hoʻoulu ʻana a hypoglycemic e ka hoʻokomo intravenous a i ʻole ka waha o ka glucose.

Hoʻopilikia ka lolo i kēia ulia, ʻo ka mea nui ka glucose o ka kumu nui o ka meaʻai. Ma nā maʻi hypoglycemia kaulike, hoʻololi nā dystrophic i ke kikowaena kūloko o ka hanana.

ʻO nā hōʻailona o ka insulinoma i ka pae latent

I nā manawa ma waena o ka hoʻouka ʻana i ka insulin, hōʻike pū ʻo ia iā ia iho ma ke ʻano o nā ʻano like ʻole a me nā maʻi ʻino. He mea nui ia e ʻike iā lākou a hiki i ke kauka ke kuhikuhi i ka lāʻau kūpono loa. I loko o ka laʻau, i loaʻa paha nā hōʻailona like ʻole i nā maʻi.

nāwaliwali o nā ʻōpū a i ʻole nā ʻehaʻeha ʻē aʻe (ataxia),
lie kanikela
ka hoʻolilo ʻana i ka hoʻomanaʻo a me ka noʻonoʻo,
ʻike maka
moena puʻu
nā hana heʻe o ka neʻe ʻana o ka hoʻopili ʻana i ka wāwae,
nystagmus
māhuahua mau momona a me ke ʻano o ka nui o ke kaumaha,
nā hana moepolohe.

ʻO ka insulin ke kumu o ka maʻi islet is-hormone aktives o ka pancreas e hua ana i ka nui o ka insulin. Hoʻonui pinepine ʻia ka maʻi maʻi i ka wā waena a me nā wahine ʻelemakule. ʻO ka insulin i ka 70% o nā hihia he mau samign tumors o ka liʻiliʻi (hōʻemi ma mua o 6 cm) ka nui. ʻO ke koena 30% o nā neoplasms no nā hana kino.

ʻO ka neoplasm kahi hana hoʻōla o ka hormone neʻe o ka mea huna-digestive organ, ʻoi e hana i ka nui o ka insulin. Manaʻo kēia kaʻina maikaʻi loa i nā kānaka, no ka mea, ka nui o ka nui o ke kō i loko o ke koko hoʻonāukiuki i ka nui o ka nui o ka glucose, a me kona hemahema ke alakaʻi i ka hypoglycemia, i hele pū me nā pilikia olakino koʻikoʻi. Hoʻopili aku i kēia, ʻo ka insulinoma pancreatic i ka loaʻa ʻole o ka lawa kūpono e hiki ai i ka malignancy ikaika.

Ma kēia ʻano manuahi, ʻike ka poʻe loea i kekahi mau hiʻohiʻona morphological e kōkua ana i kona ʻike.

ka neoplasm i ke ʻano o ka ndo popo i loaʻa i ka capsule, kahi paʻakikī e hōʻike iā ia a i ʻole ka hōʻino,
ʻokoʻa ke kala o ka iʻa mai ka mākeke kukui i ka brown;
ʻaʻole iʻoi aku ka nui o ke kaʻe ʻaila ma kahi o 5 cm.

Hiki i kahi neoplasm e hana i kahi nui o ka inikini ke kū aʻe i kekahi ʻāpana o ke kelepona, akā maʻamau ka mea i loaʻa i loko o ke kino o ka pancreas.ʻO ka ʻoiaʻiʻo o ka maʻi pancreatic cell i kū mai a hoʻomaka i ka ulu ʻana e hōʻike ʻia e nā hiʻohiʻona o nā metastases ikaika i hana ai i ka lymph nodes, māmā, nodes, a me nā puʻupaʻa.

Kahi papaʻaila

No ka koho ʻana i nā taktika therapeutic, pono ke hoʻoholo ʻana i ke ʻano o ka neoplasm.

No kēia kumuhana, ma ke ʻano lapaʻau e pili ana, e hoʻokaʻawale ʻia ai ka ʻano o kēia maʻi

ʻO ka mea mua, ua hoʻoneʻe ʻia kahi tumomo insulinomaona e like me ke ʻano o ka lawehala ʻana. Ma 90% o nā hihia, hōʻike ʻia nā maʻi i kahi neoplasm benign, a ʻo ke koena he 10% ka helu no.
Wahi a ke ʻano o ka hoʻolaha ʻana i ka organ parenchyma, hiki i nā mea maʻamau ke noho wale (hoʻokahi) a me ka nui. Nui mau nā mea maʻa ʻole a ke ʻole o ka hōʻino ʻole, a ʻo nā mea hope loa, he mau nodules pali liʻiliʻi e hōʻiliʻili ʻia i loko o nā ʻili o ka hoʻomaka.
Aia ma kahi o ka ʻāpana o ka pancreas ka pohō, ka huna ʻana o ka insulin o ke poʻo, ka ʻili a me ke kino. No kēlā me kēia ʻano neoplasm, kūpono kahi ʻano lapaʻau kūpono e hiki ke hōʻalo a hoʻopau paha i ke kaʻina pili.

Hypoglycemia me ka insulinoma

ʻO kēia ʻano pathological, e hele pū ana me ka huna-huna huna, kū i ke kiʻi o ke kahe nui ʻana i ka nui o ka glucose koko. I ke kino o ke kanaka olakino, me ka hoʻohaʻahaʻa ʻana i nā pae o ka glucose koko, ka hoʻouluʻana o insulin, pono no kona hoʻouka ʻana, e emi nō hoʻi. Inā hōʻino ʻia nā cell-huna huna e ka haki, ua pilikia ke kaʻina kūlohelohe, a me kahi kahe o ke kō koko, ʻaʻole e pau ka mea huna.

ʻO ka hoʻomohala ʻana o ka hypoglycemia me ka insulinoma e pili pono ana i kēia ʻano pathological, ʻo ia hoʻi, ka nui a me ka paʻa ʻole o ka hoʻoulu ʻia ʻana o ka insulin e nā keʻena kūloko i hoʻopau ʻia i ka wa e hala ʻole ana i alakaʻi i kahi kūlana pōʻino. Hōʻike ʻia ka hoʻouka ʻana o ka hypoglycemia i ka manawa ke hoʻokuʻu ʻia nei kahi haki huna-kiwi i kahi hapa o ka insulin i ke koko.

Hiki iā ʻoe ke hoʻoholo i ka hoʻomaka ʻana o kahi kūlana weliweli e ka hiʻohiʻona o nā hōʻailona aʻe nei:

pololi, a pōloli
tachycardia a me ka haʻalulu o ke kino holoʻokoʻa,
ka hoʻohilahila ʻole ʻana a me ka makaʻu.
ka haʻi ʻana o ke ʻano, ka nānā ʻana a me ka hoʻāhewa ʻole.
ʻO ka hoʻokuʻu o ka nui o ke kulu, ka umauma palu (ka palu ma ka lae).

I nā hihia koʻikoʻi, ka insulin pancreatic, i hele pū ʻia e hypoglycemia, hiki i ke kanaka ke hoʻomōhala i ka holo a me ka coma.

Nā kumu o Insulinoma

ʻAʻole hiki i nā poʻe loea ke inoa i kahi kumu hilinaʻi e hoʻonāukiuki i ka nānā ʻana o kahiʻano hāmeʻa huna haki o ka hormone, akā naʻe, e like me ka hapa nui o ka poʻe oncologists, ʻo ka hilinaʻi hormonal ka mea nui i hoʻomaka i kona hoʻomohala ʻana. Ke alakaʻi aku nei ka Insulinoma i ka luku ʻia o nā polapena beta i ka ʻōpū o ke kūpaʻa, ma muli o kahi i pau ʻole ai kekahi mau mea i ʻōlelo ʻia. ʻO ka ulu ʻia mai o kahi hemahema a hoʻomaka i ke kaʻina hana o ka hoʻonā ʻana i nā cell.

I waena o nā helu lehulehu e pili ana i ka hopena, ʻike ka poʻe loea i nā kumu like i kū i ka insulin, ʻo ia nā mea nui:

nā hana hoʻohaunaele i ka hana o ka ʻōnaehana endocrine i hoʻopili ʻia me nā hana hewa o nā kelepa adrenal a me ka lepa pituitary.
ʻākī palā ʻo kahi ʻōpū ʻeha a i ʻole ulī duodenal hoʻi,
hoopoino a ʻona paha i ka hoʻopā leʻaila
nā maʻi paʻa
ka huka ʻana i nā mea ʻona,
cachexia (luhi nui),
nā mea ʻai ʻai.

Nā hōʻailona a me ka hōʻike ʻana o nā insulinomas

Nā hōʻailona a me ka hōʻike ʻana o ka maʻi

ʻO ka hōʻike ʻana i nā hōʻailona o kahi kūlana pathological maikaʻi ʻaʻole i hilinaʻi nui i ka pae o ka hana o ka hormonal o ka huki. Hiki i ka maʻi ke holo malu, me ka hōʻike ʻole ʻana i nā hōʻailona maikaʻi ʻole, a i ʻole nā mea i hōʻike. ʻO ka poʻe maʻi me ka insulinoma e ʻike i kahi ʻano mau o ka pōloli, ka mea e hoʻonāukiuki iā lākou e ʻai i nā nui o nā kīnā (nā mane, kīlea). Hōʻike ʻia lākou e halihali i kēia mau sweets me lākou e hiki ai i ka hoʻopau manawa i ka hoʻomaka ʻana mai kahi hoʻouka.

ʻO nā hōʻailona o ka insulinoma e noʻonoʻo pono ʻia:

maʻi ka maʻi, hōʻike ʻia nā nāwaliwali a nāwaliwali mau ʻana,
hoonui
haʻalulu (yeast) o nā wāwae,
a me ka ili o ka ʻili,
tachycardia.

Hoʻopili ʻia kēia mau hōʻailona insulinoma e nā hōʻailona o ka hōʻino i ka ʻūhū hema o ka lolo: lohi ka hele ʻana o nā noʻonoʻo, hōʻemi ka nānā ʻana, ʻike pinepine nā lela hoʻomanaʻo. I nā pilikia koʻikoʻi, ʻike ʻia ka uluʻana o nā amnesia a me nā maʻi noʻonoʻo.

Wikiō ʻativelelo

ʻO ka insulinoma pancreatic kahi mea maʻi e hiki ai ke hūnā i ka nui o ka insulin. Hiki i kēia ke alakaʻi i ka hoʻouka hypoglycemia i nā maʻi. ʻO ka mea hope loa he glucose koko haʻahaʻa.

I ka manawa pinepine, ʻo ka ʻano o kēia ʻano maʻi i ulu ai i nā poʻe he 25 a i 55 makahiki. ʻO ia hoʻi, e pili ana kēia maʻi i ka poʻe i kahi makahiki ʻoi loa ka hana. I ka wā kamaliʻi a me ka ʻōpio, ua ʻike ʻole ʻia ka insulinoma.

I ka nui o nā hihia, ʻo ka insulinoma he maʻi benign. Ma nā hihia koʻikoʻi loa, ʻo ka insulinoma kekahi o nā hōʻailona o ka adenomatosis endocrine lehulehu.

I ka nui, nā insulinoma i hōʻea i ka 1.5-2cm, a hiki ke hoʻomohala i kēlā me kēia wahi o ka pancreas:

ʻO ka mea pōʻino, ʻaʻole i maopopo nā kumu kumu o ka hoʻomohala ʻana i nā insulin. He nui ka poʻe e manaʻo nei ka hoʻomohala ʻana i nā māla no ka predisposition genetic, nā hana maikaʻi, nā mea maikaʻi ʻole o waho a me ka pohō o nā hana pono. Eia nō naʻe, ʻo nā kumu āpau o luna wale nō ka hypotheses wale nō.

Nā hōʻailona hōʻailona a me nā hōʻailona o ka maʻi

Ke hoʻomau nei ka insulin insulin pancreatic me nā hōʻailona ʻano e like me kēia:

Hoʻokumu ʻia ka hypoglycemia i ka piʻi ʻana o ka insulin i ke koko o ka mea maʻi,
ka hopena o nā hōʻeha kūpono ʻole hou ʻana i ka nawaliwali ākea a me ka luhi,
palpitations puʻuwai (tachycardia),
hoʻonui hoʻonui ʻia
hopohopo a makaʻu
ka ʻike nui ʻana o ka pōloli nui.

Hoʻopau wale nā hōʻailona āpau o luna ma hope o ka ʻai ʻana i nā maʻi. ʻO ka papa nui loa o ka maʻi e noʻonoʻo ʻia ai i nā poʻe maʻi ʻaʻole i manaʻo i ke ʻano o ka hypoglycemia. No kēia kumu, ʻaʻole hiki i nā mea maʻi ke ʻai i ka manawa e hoʻomaʻamaʻa i ko lākou ʻano.

Ke emi ka pae ʻana o ke koko, e lilo paha i ka maʻi o ka mea maʻi. Hoʻoweliweli ʻia lākou e nā ʻenehana, kahi i hoʻopili ʻia e nā kiʻi kuhihewa maikaʻi loa. Aia ka hoʻopulapule maikaʻi, salivation, ʻike maka ʻelua. Hiki i ka mea maʻi ke lawe ikaika i ka meaʻai mai nā poʻe ʻē aʻe. Me ka emi nui o ka glucose o ke koko, e piʻi ana ka nui o ke kani moliki, e ulu ana kahi epileptic.

Ke piʻi nei ke koko, piʻi ka poʻe haumāna a hoʻonui i ka tachycardia. Inā ʻaʻole hāʻawi ʻia ka mea maʻi me ka mālama lapaʻau manawa kūpono, hiki mai i kahi comog hypoglycemic coma. Ua nalowale ka ʻike ʻike, hoʻōla nā haumāna, hoʻemi ka leo kani, ʻōlohelohe i ka luhi, ka naʻau a me ka hoʻouluulu ʻana o ka laʻe i hāʻule, ka hāʻule ʻana o ke koko.

Inā hele mai kahi comog hypoglycemic, hiki i ka mea maʻi ke hoʻomohala i ka edema cerebral.

Ma kahi o nā hoʻouka ʻana o ka hypoglycemia, kahi hōʻailona nui o ka insulinoma e manaʻo ʻia ana he nui ka nui o ke kaumaha o ke kino (ke kūkulu ʻana i ka momona o ka momona).

ʻO kahi mea nui i ka manawa kūpono o ka maʻi mai ka pale i ka pale ʻana i ka maʻi hypoglycemia a pale i ka hoʻomohala ʻana i ka coma a me ka psychosis. ʻO ka hemahema o ka glucose e hoʻopilikia i nā neurons ute. No kēia kumu, ʻo ka hōʻeha pinepine me ka maʻi maʻi e hoʻonāukiuki i ka hoʻomohala ʻana i kahi hōʻailona hoʻomanawanui, parkinsonism, a me ka encircal encephalopathy. Me ka hoʻouka kaua hypoglycemic, hoʻomohala ʻia ka myocardial infarction.

Ma hope o ka hana e hoʻoneʻe i ka ʻōpū, hiki i nā hōʻailona o ka encephalopathy a me kahi hoʻohaʻahaʻa i ka naʻauao. Hiki i kēia ke lilo i ka nalowale o nā loea aʻo i ka kūlana kūlana.

Hiki i nā ʻōmeʻa pinepine o ka hypoglycemia i ke kāne ke alakaʻi i ka hemahema.

ʻO ka maʻi maʻi

ʻO ka hoʻomaʻamaʻa nui loa no ka insulinomasia ka hoʻomaʻamaʻa. I ka wā o ka hōʻemi, wehe ʻia nā insulin. Loaʻa ka nui o ka hana ma ke ʻano o ka nui a me kahi o ka ʻōpū.

Hoʻohana ʻia nā ʻano ʻoihana ʻikepili e pau ai nā insulinomas:

insulinomectomy (nukula)
maʻi ʻaʻa pancreatic,

Hōʻikeʻia ka maikaʻi o ka hana ma ka hoʻoholo ʻana i ka pae o ka glucose i ke koko i ka wā o ka hana.

Ma waena o nā hoʻopiʻi postoperative hiki ke hoʻomaopopo ʻia:

Inā ʻaʻole hiki ke hana no ka hana no kekahi kumu, ua ʻōlelo ʻia ka mālama mālama ʻana no ka mālama ʻana.

Kuhi ʻia ka ʻano kumu o ka mālama conservative.

aha kūpono no ka maʻi o ka mea maʻi,
ka hoʻolilo ʻana i ka manawa hypoglycemic attack,
nā lāʻau lapaʻau e hoʻomaikaʻi i nā kaʻina metabolic i loko o ka lolo.

ʻO ka hōʻemi ʻana i ka hoʻoulu ʻia ʻana o nā hoʻouka hypoglycemia e hoʻohana ana i kahi kīʻaha a i ʻole ke aniani o ke kīʻaha wela. Inā he kuee i ka ʻike o ka mea maʻi, ua kuhikuhi ke kauka i ka hopena o ka glucose intravenous.

Inā hoʻokomo ʻia ka mea maʻi e ka hoʻouka ʻana o ka psychosis, hoʻoikaika nui e kāhea i ke kaʻa ʻokoʻa.

ʻO ka hoʻomaikaʻi ʻana i ka maʻi

I ka nui o nā hihia, ma hope o ka hana e hoʻoneʻe i ka ʻōpū, aloha nā prognosis a nāu hou ka mea maʻi.

ʻAʻole kiʻekiʻe nā maʻi postoperative. Kūkulu pinepine kahi hoʻomaha. Me nā insulin hoʻonāukiuki kino, maikaʻi ʻole ka prognosis.

Pono ka poʻe me ka maʻi e hoʻopaʻa ʻia me ka endocrinologist a me ka neurologist, ʻai i ka pāʻina kūpono, a hoʻopoina e pili ana i nā hana ʻino. Eia nō hoʻi, pono lākou e nānā i kahi maʻi kino i kēlā me kēia makahiki a nānā i ka pae o ka glucose i ke koko.

He nui o mākou, ʻoiai ʻole e pili ana i ka lāʻau lapaʻau, ʻike ʻia nā ʻōlelo olakino i loaʻa ka huaʻōlelo ʻo "ohm" i pili me ke maʻi maʻi. ʻOkoʻa ka Insulinoma. I ka hapa nui, ʻo ia kahi mākēnē o ka pancreas, ʻo ia hoʻi nā mea huna e hūnā ana i nā hormones (beta cell o nā islets o Langerhans), a loaʻa iā ia ka hapa nui o ka lelo o ka huelo. ʻOi aku ka liʻiliʻi, hoʻomohala ʻia nā neoplasms e hana mai i nā ʻokoʻa ʻē aʻe a hiki i nā ʻīpuka o ka spleen, ate, nā peina a me nā mea kino ʻē aʻe. I ka hapa nui o nā hihia, he benign kēia ʻaʻa, ʻoiai ʻo ka ʻano like ʻole o ka hoʻomohala ʻana o ka maʻi, akā naʻe, pili pū kekahi.

Kāhea ʻia kēia ʻōhapaina i ka insulinoma no ka mea paʻa ʻole kāna mau kelepona i ka nui o ka insulin i loko o ke kahawai, kahi nui o ka hoʻoponopono ʻana i ka ʻaila ketemona. ʻO ia me ka hoʻokuʻu mau ʻana i ʻole ka maʻamau o kēia hormone e pili ana nā hōʻailona nui o ka maʻi.

Hoʻomaʻi pinepine ʻia ka maʻi i ka poʻe i nā makahiki 30 a 50 paha, akā naʻe, hiki i ka insulinoma ke hōʻea i kēlā me kēia makahiki, a ʻo nā hihia o kona hūnā ʻia, ʻoiai i nā pēpē. ʻAʻole kēia maʻi o kekahi o nā maʻi maʻamau, no laila, ʻike pinepine ʻia nā kauka he mea maʻamau loa ʻole, ʻaʻohe ʻike i ka maʻi ʻana a me ka mālama ʻana i nā insulin. No kēia kumu, aia kahi hopena kiʻekiʻe o kahi maʻi nānā hewa a me ke koho ʻana i ka hana kūpono ʻole.

ʻO kaʻikepili a me ka anatomy o ka pancreas

ʻO ka pancreas ka mea koʻikoʻi kūloko pilikino i loko o nā kānaka. He huina ex ex a me ka endocrine. Hoʻōla ia i nā enzyme digestive (trypsin, chymotrypsin, amylase, lipase) a me nā hormones (glucagon a me insulin) no ka hana metabolism. Hōʻike ka Insulin i ka glucose, a me ka glucagon, ma ke ʻano ke piʻi ʻana o ka ulu. ʻAʻole maʻamau kana mau ʻīlio ʻana, no laila ke ʻike nei i kona wahi a me nā hōʻailona.

Aia i hea ka pancreas a pehea e mālama ai iā ia? Hoʻopili ʻia ia i loko o ka ʻōpū o ka ʻōpū ma hope o ka ʻōpū, pili iā ia a me ka duodenum kokoke, ma ka pae o 2 mau hulu lumbar vertebrae.

Hoʻopili ʻo KDP ma nā kelepona i ke ʻano o nā kāmaʻa kaila. ʻO ka nui o ka umauma makua a hiki i 20-25 cm, ke kaupaona - 70-80 g. He poʻo, ke kino a me ka huelo.

Hiki ke poʻo i ka dile bile, ka huelo ma kahi o ka spleen e hele ana ma lalo o ka hypochondrium hema. I ka nānā ʻia ʻana mai ke alo aku, e pili ka 10 cm i luna o ka pulu. No ke aha ke ʻike i kēia? No ka mea, e hāʻule pololei nā hōʻeha i ka wā o kona ʻaʻa.

Maʻi maʻi pancreatic

Nui nā maʻi i ka pancreas a mālama ʻia ka mālama ʻana i nā maʻi. Akā, ʻaʻole pili kēia i nā mea kani. Eia wale nā mea ʻae. Pehea e hōʻeha ai nā pancreas (nā hōʻailona)? I nā hana hoʻopihapiha, ʻo nā mea maʻamau loa he mau hōʻeha a me nā hana hōʻemi. ʻAʻohe ʻanoʻokoʻa o ka wahine. Hoʻohālike ʻia ka ʻeha me kona ʻano kāʻei a hoʻopaʻa ʻia i ka hypochondrium hema. ʻAʻole pili paha ia i ka ʻaʻai ʻai, mālama pinepine ʻia e ka nausea, i ka manawa ākea ka luaʻi o nā kūmikō.

ʻAnuʻu palau mau ʻia ka ʻono ʻole a i ʻole i ka ia, ʻūhū, ke kui ʻana i ka ʻōpū, a me ka ʻaʻa, he paʻa ʻole. I nā laikini, loaʻa pinepine nā admixtures o ka momona a i ʻole ka Undigested i ka meaʻai.

Eia kekahi, i ka mumū oʻeha, ua hōʻailona nā hōʻailona o ka hoʻohālikelike i ke ʻano o ke poʻo o ka poʻo, tachycardia, nāwaliwali a me ka huki, a hiki ke piʻi mai ka wela. Ua hoʻonuiʻia ke ake.

Pehea e hana ai ka pancreas (nā hōʻailona) i ka maʻi pancreatitis maʻi? Eia maʻa iki ka ʻeha o ka hōʻeha, akā pili pinepine ʻia a me nā hala ʻole i ka mea ʻai. ʻO ka pōʻino o ka pancreatitis maʻi waʻa ke hiki iā ia ke alakaʻi i ka hoʻomohala ʻana o nā tumors i ka aʻalani.

Hoʻolaha o ka insulin

ʻAʻole maopopo ʻia nā kumu kumu o ka insulin pancreatic i kēia lā. Hoʻomaopopo kekahi poʻe noiʻi i ka mana o kahi predisposition genetic.

Akā, ʻike ʻia nā mea i kūleʻa ai kahi pilikia:

hana hoʻopunipuni o ka aʻi kūloko o ka adrenal a me ka gland pituitary,
ʻeha ka ʻōpū a i ʻole duodenum,
hanaʻino i ka pancreas, kemika a hoʻokolohua paha,
paloma luhi
ka luhiluhi o ke kino,
nā mea ʻai ʻai.

Nā hiʻohiʻona Tumor

Pono ka morphology ʻaʻa e hōʻike iā ia: aia ka ʻano ke ʻano o ka naps encapsulated kikowaena, ʻaʻole ʻike koke kēia i ka pae o kāna benignity. ʻO kona kala mai ka polani a i ka brown, me ka hōʻino he mau poʻo ʻōmaʻomaʻo ka ʻulaʻula. ʻAʻole eʻoi aku ka nui o ka 5 cm. I ka wā o ka hoʻoneʻe, nā metastases i loko o ka nīnoho lymph, nā māmā, nā node, a me nā leʻa, a he hormon-aktif hoʻi, e ʻike ʻia ana.

ʻO nā hopena o Insulinomas

Hiki i ka hopena o ka insulinoma pancreatic ke hopohopo i kāna ʻāpana a me ke kaumaha. ʻO ka hoʻohuli maoli ke hoʻohaunaele nei ia; i ka 10% mau hihia. Akā inā ʻaʻole e hana kēia, ua hoʻomaopopo ʻia:

Nā hopena neʻe me ka hana ʻole o ka hana o ka facial a me ka glossopharyngeal nerve
memo hoʻonaninani, ʻike, ʻike āheʻe,
hiki ke pale ʻia i nā kāne,
ʻopi momona.

Hiki i ke ʻano o ka hypoglycemia ke alakaʻi i ka hoʻomohala ʻana i ka coma, kaʻuokala miʻiona.

Nā ʻano kākoi

ʻOi aku ka makemake o ka maʻi maʻi maʻa mau, nā ʻano: enucleation (tumor husking), resection pancreatic, pancreatoduodenal resection a piha pancreatectomy paha, i.e. pani piha. Ma keʻano holoʻokoʻa, mahele mau nā kaʻina ma nā pancreas e like me ka paʻakikī.

Akā inā hiki i kahi kanaka ke noho me kahi pancreas ma hope o ke kaʻina hana e hiki ʻole ke wānana. ʻO nā hopena maikaʻi aʻe e pili wale i ke kino, ʻoi aku ka nui o ka hapa nui o nā hōʻeha. Kuhi ka nui o ka hana i ke kahua o ka insulinoma a me kona nui.

Hoʻoholo ʻia ka pae glucose i loko o ka dinamics pololei i ka wā o ka hana. I 10% o nā hihia, hāʻawi nā hana i nā hoʻopiʻi: fistulas a me nā nīna o ka umauma ʻōpū, peritonitis, pancreatitis, abscesses, pancreatic necrosis (alakaʻi i ka make). ʻAʻole hana ʻia ka hana inā ʻaʻole makemake ka mea maʻi iā ia nei a aia paha kekahi mau ala āpau.

Hiki i ke kanaka ke noho me kahi pancreas? ʻOiaʻiʻo, ʻae! Akāʻo ke kumuhana wale i kahi ola olakino a hoʻokō me nā ʻōlelo a pau a ke kauka.

Inā hōʻeha ke kuhi, loaʻa nā metastases lehulehu a lilo i hiki ke lawelawe, kauoha ʻia ka chemotherapy. Lawe ʻia e Streptozotocin, 5-fluorouracil, Doxorubicin, etc. ʻO ka Chemotherapy hiki ke kōkua wale mai i 60% o nā hihia: ua wehewehe ʻia kēia kālā e ke ʻano maikaʻi iā Streptozotocin. I nā hihia o ka ʻōpū o ka insensitivity iā Streptozotocin, ua hoʻololi ʻia me Adriamycin.

Inā ʻaʻole hiki ke hoʻomaʻamaʻa, ua pale ʻia ka hypoglycemia. No kēia mea, ua hoʻohana ʻia nā ʻaole hyperglycemic (adrenaline, noradrenaline, glucagon, corticosteroids).

No ka hoʻokuʻu ʻana i ka hana o ka insulin, ua kuhikuhi ʻia ʻo "Diazoxide" ("Proglikem", "Hyperstat") a i ʻole ʻo "Octreotide (sandostatin) ka hoʻēmi ʻana i ka hōʻeha o ka hoʻouka ʻana o hypoglycemia. Akā, loaʻa i ka hui GCS nā hopena ʻaoʻao - no kā lākou hopena maikaʻi, e pono ai nā dosis a hiki i nā neuroendocrine ke hoʻomohala. nā maʻi o ke ʻano o ka maʻi Cush.

Meaʻai no ka insulin

ʻAi wale ka ʻai ʻana i ka ʻai. Me ka insulinoma, pono e haʻalele ka mea maʻi e hoʻohana i ka hoʻohana ʻana i ka paʻakai, ka uahi, kao, ka momona a me ka meaʻai i loko, a me ka hōʻemi ʻana i nā mea ʻawaʻawa a me nā keke.

ʻO ka makemake loa kēlā mau meaʻai āpau i loaʻa ka fiber. ʻO nā kape māmā māmā (maʻalahi). ʻO kēia nā kō, nā keke, nā pōpoki, nā pōpoki, a me nā huahana me nā GKI kiʻekiʻe: nā ʻuala, ka berena keʻokeʻo, nā muffins, ka waiū piha.

Ua hoʻoikaika ʻia ke ʻano inu wai, pono ʻoe e inu i ka liʻiliʻi o 2 lita o ka wai maʻemaʻe i kēlā me kēia lā, akā ʻaʻohe hihia e inu i ka kofe a me ka momona momona.

Me nā inumene benign, ka pakeneka o ka hoʻihoʻi ma 80% o nā hihia. I 3% o nā hihia, hiki ke hoʻomaha hou. ʻO ke kino make he 5-10%. Me nā insulinomas ectopic, kuhikuhi wale ʻia ka mālama mālama ʻana.

I ka hihia o ka pancreatic malignancy me ka hōʻino kino ʻana i ka insulin, ka prognosis e hilinaʻi i ka metastases a me ka localization o ka ʻōpū ponoʻī. ʻO ka hapa nui o ka hōʻino i ka 10%. 2 mau makahiki ola ʻoi paha e pili ana i 60%. Mai ke manawa o ka hōʻike ʻana i ka insulinoma, ua kau ʻia ka mea maʻi i kahi hoʻopaʻa olakino olakino e kekahi endocrinologist a me ka neurologist.