Hirsutism ndi matenda omwe amakhudza amayi okha, omwe amadziwika ndi kuwonjezeka kwa tsitsi la ndevu, chiuno ...

Tanthauzo la hirsutism

Izi ndizowonjezereka kukula kwa tsitsi m'madera aamuna (ndevu, torso, nsana, etc.) kuyambira unyamata kapena mwadzidzidzi mwa mkazi wamkulu.

Hirsutism kapena tsitsi lambiri?

Timasiyanitsa hirsutism ndi kukula kwa tsitsi labwinobwino (mikono, miyendo, ndi zina) zotchedwa hypertrichosis. Tsitsi lochokera ku hypertrichosis limangokhudza malo abwinobwino mwa amayi, koma tsitsi limakhala lalitali, lokhuthala komanso lokhuthala kuposa nthawi zonse. 

Mosiyana ndi hirsutism, hyperpilosity iyi nthawi zambiri imakhalapo paubwana ndipo imakhudza amuna ndi akazi. Hypertrichosis nthawi zambiri imapezeka m'mabanja ndipo imapezeka kumadera a Mediterranean komanso mu bulauni. Chifukwa chake, chithandizo chamankhwala sichothandiza ndipo kuchotsa tsitsi la laser nthawi zambiri kumaperekedwa.

Hirsutism ndi chiwonetsero cha momwe mahomoni achimuna amakhudzira thupi lachikazi. Pali mitundu itatu yayikulu ya mahomoni omwe amatha kukhudza kukula kwa tsitsi m'magawo aamuna mwa amayi:

Mahomoni achimuna ochokera ku ovary (testosterone ndi Delta 4 Androstenedione):

Kuwonjezeka kwawo kungakhale chiwonetsero cha chotupa cha m'chiberekero chomwe chimatulutsa mahomoni achimunawa kapena pafupipafupi ma microcysts omwe amatuluka m'matumbo am'mimba omwe amatulutsa mahomoniwa (micropolycystic ovary syndrome). Pakachitika kukwera kwa serum testosterone kapena Delta 4-androstenedione milingo, adokotala amalangiza endovaginal ultrasound kuyang'ana ma pathologies awiriwa (micropolycystic ovaries kapena chotupa cha ovarian).

Mahomoni achimuna ochokera ku adrenal gland

Iyi ndi SDHA ya De Hydroepi Androsterone Sulfate yotulutsidwa ndi chotupa cha adrenal ndipo nthawi zambiri imakhala yogwira ntchito ya adrenal hyperandrogenism ndi kuwonjezeka kwapang'onopang'ono kwa katulutsidwe ka 17 hydroxyprogesterone (17-OHP) kenaka kumafuna kuyesa kolimbikitsa ndi Synacthène® kuti atsimikizire matenda. Nthawi zambiri, chifukwa amawunikiridwa mwadongosolo pakubadwa ndi chitsanzo cha magazi kuchokera pachidendene pa tsiku la 3 la moyo poyeza mlingo wa 17 hydroxyprogesterone (17-OHP) m'magazi, kusokonezeka kungakhale kobadwa nako: ndizochitika za congenital. adrenal hyperplasia ndi kuchepa kwa 21-hydroxylase yolumikizidwa ndi kusintha kwa jini yake pa chromosome 6.

Cortisol

Kuwonjezeka kwa cortisol m'magazi (Cushing's syndrome) kungakhale chifukwa chogwiritsa ntchito nthawi yayitali corticosteroids, chotupa cha adrenal chotulutsa cortisol, kapena chotupa chomwe chimatulutsa ACTH (hormone yomwe imatulutsa cortisol kuchokera ku adrenal gland).

Zomwe zimayambitsa zotupa nthawi zambiri zimayamba mwadzidzidzi mwa mzimayi wamkulu, pomwe hirsutism yomwe imapezeka paunyamata nthawi zambiri imachitika chifukwa cha minyewa yam'mimba kapena adrenal hyperandrogenism.

Ndi mlingo wabwinobwino wa mahomoni komanso ultrasound ya ovarian, imatchedwa idiopathic hirsutism.

Pochita, motero, pamaso pa hirsutism, dokotala amafunsa mlingo wa magazi a testosterone, Delta 4-androstenedione, SDHA ndi 17-hydroxyprogesterone (ndi Synacthène® mayeso ngati ali okwera kwambiri), cortiluria ngati akukayikira Cushing. ndi ovarian ultrasound.

Mlingo uyenera kufunidwa popanda kumwa cortisone, popanda kulera kwa mahomoni kwa miyezi itatu. Ayenera kuchitidwa m'mawa pafupifupi 8 koloko m'mawa ndi limodzi mwa masiku asanu ndi limodzi oyambirira a kuzungulira (siziyenera kupemphedwa m'zaka zitatu zoyambirira za nthawi yaunyamata chifukwa ndizosafunika).

Tsitsi lolimba kumaso, thorax, kumbuyo ... mwa akazi.

Dokotala amayang'ana zizindikiro zina zokhudzana ndi hyperandrogenism (kuchuluka kwa mahomoni achimuna): hyperseborrhea, ziphuphu zakumaso, androgenetic alopecia kapena dazi, matenda a msambo ... kapena virilization (clitoral hypertrophy, mawu akuya ndi osamveka). Zizindikirozi zikuwonetsa kuchuluka kwa mahomoni m'magazi ndipo chifukwa chake samatsutsana mokomera idiopathic hirsutism.

Kuyamba kwadzidzidzi kwa zizindikiro izi m'malo moloza chotupa pomwe kukhazikitsidwa kwawo pang'onopang'ono kuyambira paunyamata kumakomera ovarian kapena adrenal hyperandrogenism, kapena ngakhale idiopathic hirsutism ngati mayeso ali abwinobwino.

Zowopsa

Zomwe zimayambitsa hirsutism mwa akazi ndizo:

• kumwa cortisone kwa miyezi ingapo (Cushing's syndrome)
• kunenepa kwambiri: kumatha kuwonetsa vuto la cortisol kapena kukhala gawo la polycystic ovary syndrome. Koma tikudziwanso kuti mafuta ali ndi chizolowezi cholimbikitsa kagayidwe ka mahomoni achimuna.
• mbiri ya banja la hirsutism

Kusintha komanso zovuta zomwe zingachitike

Hirsutism yolumikizidwa ndi chotupa imayika anthu pachiwopsezo chokhudzana ndi chotupacho, makamaka ngati chili choyipa (chiwopsezo cha metastases, ndi zina zambiri).

Hirsutism, kaya yotupa kapena yogwira ntchito, kuwonjezera pa kusokoneza kwake, nthawi zambiri imakhala yovuta chifukwa cha ziphuphu, folliculitis, dazi mwa amayi ...

Chithandizo cha hirsutism chimachokera ku chithandizo cha zomwe zimayambitsa komanso kuphatikiza kwa anti-androgens ndi kuchotsa tsitsi kapena njira zowonongeka.

Chithandizo cha chifukwa

Kuchotsedwa kwa chotupa cha ovarian kapena adrenal, chotupa chotulutsa ACTH (nthawi zambiri chimakhala m'mapapo)… ngati kuli kofunikira.

Kuphatikiza kwa njira ya depilation kapena depilation ndi anti-androgen

Kuchotsa tsitsi kapena njira zochotsera tsitsi ziyenera kuphatikizidwa ndi mankhwala odana ndi androgen kuti achepetse chiopsezo cha kumeranso kwatsitsi.

Kuchotsa tsitsi ndi depilation

Njira zambiri zitha kugwiritsidwa ntchito monga kuthira tsitsi, kumeta, zokometsera zotulutsa, phula kapena kuchotsa tsitsi lamagetsi muofesi ya dermatologist zomwe zimakhala zowawa komanso zotopetsa.

Pali zonona zochokera ku eflornithine, antiparasitic molekyulu yomwe, yogwiritsidwa ntchito kwanuko, imalepheretsa ornithine decarboxylase, puloteni yomwe imakhudzidwa ndi kupanga tsitsi ndi follicle ya tsitsi. Iyi ndi Vaniqa® yomwe, yogwiritsidwa ntchito kawiri pa tsiku, imachepetsa kukula kwa tsitsi.

Kuchotsa tsitsi kwa laser kumasonyezedwa ngati pali hirsutism yambiri. Zimaphatikizidwa ndi mankhwala odana ndi androgen kuti apewe kuyambiranso.

Anti androgens

Mawu akuti anti-androgen amatanthauza kuti molekyulu imalepheretsa kumangidwa kwa testosterone (kuti ikhale yeniyeni 5-dihydrotestosterone) ku cholandirira chake. Monga testosterone sakhalanso ndi mwayi wopeza ma receptor ake mutsitsi, sichingakhalenso ndi zotsatira zolimbikitsa.

Pali mitundu iwiri yogwiritsidwa ntchito muzochita:

• cyproterone acetate (Androcur®) imabwezeredwa ku France chifukwa chosonyeza hirsutism. Kuphatikiza pa ntchito yake yoletsa anti-androgen receptor blocking, ilinso ndi antigonadotropic effect (imachepetsa kupanga kwa androgens pochepetsa kukondoweza kwa pituitary) komanso kuletsa kwa 5-dihydrotestosterone / receptor complex pamlingo wa mapuloteni omangira androgen. .

Ndi progestogen yomwe nthawi zambiri imayenera kuphatikizidwa ndi estrogen kuti itsanzire ma hormonal m'thupi mwa amayi: dokotala nthawi zambiri amapereka piritsi la Androcur® 50 mg / tsiku limodzi ndi estrogen yachilengedwe papiritsi, gel kapena chigamba, masiku makumi awiri. mwa makumi awiri mphambu eyiti.

Kuwongolera kwa hirsutism kumawonedwa pambuyo pa miyezi 6 ya chithandizo.

• spironolactone (Aldactone®), okodzetsa, atha kuperekedwa popanda zilembo. Kupatula kutsekereza kwake kwa anti-androgenic receptor, kumalepheretsa kaphatikizidwe ka testosterone. Dokotala amatchula mapiritsi awiri patsiku la 50 kapena 75 mg kuti akwaniritse mlingo wa tsiku ndi tsiku wa 100 mpaka 150 mg / tsiku, osakaniza, masiku khumi ndi asanu pa mwezi, ndi osakhala androgenic progestogen kuti asawonongeke. Mofanana ndi cyproterone acetate, zotsatira zake zimayamba kuonekera pokhapokha miyezi 6 ya chithandizo, nthawi zina pachaka.