zabolevaniya nadpochechnikov

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zabolevaniya nadpochechnikov zabolevaniya nadpochechnikov gormoni kori nadpochechnikov mojno razdelit na 3 osnovnix klassa: glyukokortikoidi – kortizol, kortikosteron – puchkovaya zona mineralkortikoidi – aldesteron, dezoksikortikosteron - klubochkovaya zona androgeni funktsiya nadpochechnikov v norme nadpochechniki produtsiruyut: - katexolamini (a, na, dofamin) - glyukokortikoidi (kortizol, kortizon) - mineralokortikoidi (aldosteron) - polovie gormoni (androgeni, progestini) nadpochechniki reguliruyutsya: simpaticheskoy nervnoy sistemoy aktg angiotenzinom 2 (at2) natriyureticheskimi gormonami utrom – maksimum sekretsii gormonov, nochyu - minimum zabolevaniya nadpochechnikov s giperfunktsiey: - pervichniy giperaldosteronizm - pervichniy giperkortitsizm - feoxromotsitoma - viriliziruyushie opuxoli s gipofunktsiey: nadpochechnikovaya nedostatochnost – ostraya, xronicheskaya s neizmenennoy funktsiey – nefunktsioniruyushie adenomi, adrenoblastomi naibolee aktivniy mineralokortikoid– aldosteron glavniy regulyator sekretsii –at2 glavniy organ-mishen - pochki mexanizmi deystviya aldosterona v pochkax reabsorbtsiyu natriya sekretsiyu kaliya sekretsiyu ionov vodoroda pervichniy giperaldosteronizm (sindrom kona) okolo 1% ot vsex sluchaev ag m:j = 1:3. vozrast 30-40 let v 60% – dobrokachestvennaya adenoma (aldosteroma) v 40%–dvustoronnyaya giperplaziya np (dgnp) …

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pervolemiya iz-za zaderjki natriya i vodi – otsk giperchuvstvitelnost kardiomiotsitov k katexolaminam – sv otek stenki sosudov - opss xarakteristiki ag pri sindrome kona stabilnie, ochen visokie tsifri ad gipertenzivnix jalob malo – «tixaya» gipertenziya preimushestvenno diastolicheskoe ad popitka lechit ag diuretikami vizivaet «vyaliy paralich» prichini vtorichnogo giperaldosteronizma giperreninovaya forma essentsialnoy arterialnoy gipertenzii pochechnaya arterialnaya gipertenziya zastoynaya serdechnaya nedostatochnost sindromi giperproduktsii aktg dlitelnoe lechenie diuretikami dlitelniy priem estrogenov klimaktericheskiy period diagnostika sindroma kona skrining-metod: k+ v krovi ( 15% ot isxodnoy mt ag + neob'yasnimaya lixoradka sinxronnost tsifr ad i glikemii ad posle fizicheskix nagruzok ili vo vremya narkoza diagnostika feoxromotsitomi vizualizatsiya adenomi np sutochnaya ekskretsiya metanefrinov s mochoy > 2 mg ili vanililmindalnoy kisloti > 14 mg sutochnaya ekskretsiya katexolaminov s mochoy >240 mkg uroven ka v krovi: na >12 nmol/l i/ili adrenalin >1,1 nmol/l test podavleniya s klofelinom (0,3 mg) - otritsatelniy (% ka v krovi ostaetsya prejney) …

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onicheskoy nedostatochnosti np 60% - autoimmunniy adrenalit razrushaetsya korkoviy sloy, a mozgovoy ostaetsya soxrannim. gkk i mkk , a ka v norme 30% - infektsiya: tbc, mikozi, tsmv, vich 10% - mts kartsinom legkogo, kishechnika, mol. jelez redko – gipotireoz (nb!),priem ketokonazola, rifampitsina, amiloidoz, gemoxromatoz autoimmunniy poliglandulyarniy sindrom nasleduemiy defekt apgs tipa 2 (sindrom shmidta).zabolevayut v 20-40 l - pervichnaya nedostatochnostyu np s gipogonadizmom - sd tipa 1 - ait s gipotireozom - miasteniya, vitiligo apgs tipa 1 - kandidoz koji i slizistix (s mladenchestva) - pervichnaya nedostatochnost np (pozdno) - gipopatatireoz patogenez xronicheskoy nedostatochnosti np defitsit mineralokortikoidov giponatriemiya obezvojivanie arterialnaya gipotenziya patogenez xronicheskoy nedostatochnosti np defitsit glyukokortikoidov: - immunodefitsit - zatyajnie vospalitelnie protsessi - allergicheskie reaktsii - nedostatochnost glyukoneogeneza gipoglikemiya slabost poxudanie patogenez xronicheskoy nedostatochnosti np defitsit katexolaminov preobladanie parasimpatiki bradikardiya gipotenziya klinika pervichnoy xronicheskoy nedostatochnosti np rezkaya slabost, usilivayushayasya k kontsu dnya pristupi slabosti, ostrogo goloda, potlivosti pri …

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i gipofiza (operatsii, vospalenie, luch. terapiya) otlichiya ot pervichnoy nedostatochnosti np: 1) net giperpigmentatsii 2) net elektrolitnix rasstroystv diagnostika xronicheskoy nedostatochnosti np kortizol v siv. utrom <140nmol/l aktg - pervichnaya, - vtorichnaya otsenka funkts. rezervov np – infuziya aktg 2-5 dney i opredelenie kortizola at k antigenam np. isklyuchenie tbc. vizualizatsiya np ne nujna lechenie xronicheskoy nedostatochnosti np dieta s visokim soderjaniem natriya prednizolon vnutr 7,5 mg utrom i 2,5 mg dnem fludrokortizon (kortinef) 0,05-2 mg utrom mkk ne vsegda nujni. instruktsiya dlya bolnogo o lechenii vo vremya nagruzok na np. doma-ampuli gidrokortizona pri tyajelix infektsiyax, stresse, operatsiyax – gidrokortizon 100 mg v/v kajdie 8 ch.

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zabolevaniya nadpochechnikov zabolevaniya nadpochechnikov gormoni kori nadpochechnikov mojno razdelit na 3 osnovnix klassa: glyukokortikoidi – kortizol, kortikosteron – puchkovaya zona mineralkortikoidi – aldesteron, dezoksikortikosteron - klubochkovaya zona androgeni funktsiya nadpochechnikov v norme nadpochechniki produtsiruyut: - katexolamini (a, na, dofamin) - glyukokortikoidi (kortizol, kortizon) - mineralokortikoidi (aldosteron) - polovie gormoni (androgeni, progestini) nadpochechniki reguliruyutsya: simpaticheskoy nervnoy sistemoy aktg angiotenzinom 2 (at2) natriyureticheskimi gormonami utrom – maksimum sekretsii gormonov, nochyu - minimum zabolevaniya nadpochechnikov s giperfunktsiey: - pervichniy giperaldosteronizm - pervichniy giperkortitsizm - feoxromotsitoma - viriliziruyushie ...

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