Hirsutism waa cudur ku dhaca dumarka oo kaliya, waxaa lagu gartaa kororka timaha gadhka, jeexjeexyada… isha inta badan dhibaatada nafsiyeed ee ugu weyn ee haweenka ay saameeyeen.

Qeexida hirsutism

Tani waa korriinka la buunbuuniyay ee koritaanka timaha ee meelaha ragga (gadhka, jirrada, dhabarka, iwm.) laga bilaabo qaan-gaarnimada ama si lama filaan ah haweeney qaangaar ah.

Hirsutism ama timo xad dhaaf ah?

Waxaan kala soocnaa hirsutism ka kororka koritaanka timaha caadiga ah (gacmaha, lugaha, iwm.) ee loo yaqaan hypertrichosis. Sidaa darteed timaha ka imanaya hypertrichosis waxay saameeyaan oo keliya meelaha caadiga ah ee haweenka, laakiin timuhu waa ka dheer yihiin, ka dhumuc weyn yihiin sida caadiga ah. 

Si ka duwan hirsutism-ka, hyperpilosity-gan wuxuu inta badan ka jiraa carruurnimada wuxuuna saameeyaa labada jinsi. Hypertrichosis inta badan waa qoys waxayna ku badan tahay hareeraha badda Mediterranean-ka iyo browns. Sidaa darteed daawaynta hormoonnada ma aha mid waxtar leh waxaana guud ahaan la bixiyaa timaha laysarka.

Hirsutism waa muujinta saamaynta hormoonnada ragga ee noolaha dumarka. Waxaa jira saddex nooc oo hormoonno ah oo saameyn ku yeelan kara koritaanka timaha ee meelaha ragga ee haweenka:

Hormoonnada ragga ee ugxan-sidaha (testosterone iyo Delta 4 Androstenedione):

Korodhkoodu waxa uu noqon karaa ka tarjumaysa burada ugxansidaha soo saaraysa hormoonnadan ragga ah ama in ka badan oo microcysts ah oo ku jira ugxan-sidaha soo daaya hormoonnadan (micropolycystic ovary syndrome). Haddii ay dhacdo in kor u kaca ee testosterone serum ama Delta 4-androstenedione heerarka, dhakhtarku qorayaa ultrasound endovaginal si ay u raadiyaan kuwan pathologies (micropolycystic ugxansidaha ama buro ugxansidaha).

Hormoonnada ragga ee qanjidhada adrenal

Tani waa SDHA loogu talagalay De Hydroepi Androsterone Sulfate oo ay qarisay buro adrenal ah oo marar badan waa hyperandrogenism adrenal functional by koror dhexdhexaad ah ee dheecaanka 17 hydroxyprogesterone (17-OHP) ka dibna u baahan baaritaan kicinta Synacthène® si loo xaqiijiyo ogaanshaha. Marar dhif ah, sababtoo ah si nidaamsan ayaa loo baari karaa marka dhalashada iyadoo laga qaaday muunad dhiig ah oo laga qaaday ciribta maalinta 3aad ee nolosha iyadoo la cabbirayo heerka 17 hydroxyprogesterone (17-OHP) ee dhiigga, cilladdu waxay noqon kartaa mid lagu dhasho: waa ficillada lagu dhasho. hyperplasia adrenal by 21-hydroxylase yaraanta oo ku xidhan isbeddelka hidde-sideheeda koromosoomyada 6.

Cortisol

Korodhka cortisol ee dhiiga (Cushing's syndrome) waxa laga yaabaa inay sabab u tahay isticmaalka dheeraadka ah ee corticosteroids, buro adrenal soo daynaysa cortisol, ama buro soo daaya ACTH (hormoon ka soo saara cortisol qanjirka adrenal).

Sababaha burooyinka ayaa badanaa si lama filaan ah ugu bilaabma haweeney qaangaar ah, halka hirsutism-ka ku jira qaan-gaarnimada ay inta badan sabab u tahay ugxan-sidaha shaqeynaya ama adrenal hyperandrogenism.

Qiyaasaha hormoonnada caadiga ah iyo ultrasound-ka caadiga ah ee ugxan-sidaha, waxaa loo yaqaannaa hirsutism idiopathic.

Dhaqan ahaan, sidaas darteed, joogitaanka hirsutism, dhakhtarku wuxuu ku weydiinayaa qiyaasta dhiigga ee testosterone, Delta 4-androstenedione, SDHA iyo 17-hydroxyprogesterone (oo leh baaritaanka Synacthène® haddii ay dhexdhexaad tahay), cortisoluria haddii ay dhacdo in lagu tuhunsan yahay Cushing. iyo ultrasound ugxansidaha.

Qiyaasaha waa in la codsadaa iyada oo aan la qaadan cortisone, iyada oo aan hormoon la'aanta ka hortagga uurka lahayn muddo saddex bilood ah. Waa in la sameeyaa subaxda ku dhawaad ​​8 subaxnimo iyo mid ka mid ah lixda maalmood ee ugu horreeya wareegga wareegga (waa in aan la codsan inta lagu jiro saddexda sano ee ugu horreeya xilliga dhallinta maadaama aysan khusayn).

Timaha adag ee wejiga, dhumucda, dhabarka… dumarka.

Dhakhtarku waxa uu raadiyaa calaamado kale oo ku xidhan hyperandrogenism (kor u kaca hormoonnada ragga): hyperseborrhea, finan, alopecia androgenetic alopecia ama bidaarta, cilladaha caadada… Calaamadahani waxay muujinayaan kor u kaca heerarka hoormoonka ee dhiigga, sidaas darteed ha ku doodin inay doorbidaan hirsutism idiopathic.

Bilawga lama filaanka ah ee calaamadahaan waxay tilmaamayaan buro halka ay si tartiib tartiib ah u rakiban yihiin qaan-gaarnimada ay aad ugu jecel yihiin ugxan-sidaha shaqada ama adrenal hyperandrogenism, ama xitaa hirsutism idiopathic haddii baaritaanadu caadi yihiin.

Waxyaabaha khatarta

Waxyaabaha halista u ah hirsutism ee haweenka waxaa ka mid ah:

• qaadashada cortisone dhowr bilood (Cushing's syndrome)
• buurnaanta: waxay ka tarjumaysaa dhibaatada cortisol ama waxay noqon kartaa qayb ka mid ah xanuunka polycystic ovary syndrome. Laakiin waxaan sidoo kale ognahay in dufanku uu u janjeero inuu kor u qaado dheef-shiid kiimikaadka hormoonnada labka ah.
• taariikhda qoyska hirsutism

Evolution iyo dhibaatooyinka suurtagalka ah

Hirsutism oo ku xidhan buro waxay dadka u soo bandhigtaa khataro la xidhiidha buro lafteeda, gaar ahaan haddii ay tahay mid xun (khatarta metastases, iwm.)

Hirsutism, ha ahaato mid buro ama mid shaqaynaysa, marka lagu daro raaxo-darradeeda bilicda leh, waxaa inta badan dhiba finan, folliculitis, bidaarta dumarka…

Daaweynta hirsutism waxay ku salaysan tahay daaweynta sababta iyo isku darka qaadashada anti-androgens iyo timaha ka saarista ama farsamooyinka depilation.

Daaweynta sababta

Ka saarida burada ugxansidaha ama qanjidhada adrenal, burada sirta ACTH (badanaa waxay ku taal sambabada)… haddii loo baahdo.

Isku darka depiration ama farsamada depiring iyo anti-androgen

Farsamooyinka timaha ka saarista ama goynta waa in lagu daraa daaweynta hormoonnada anti-androgen si loo xaddido khatarta timaha qallafsan.

Timaha oo laga jaro iyo dabar go'a

Farsamo badan ayaa loo isticmaali karaa sida timaha oo la xiirido, xiirashada, kiriimyada depilatory, dhumucyada ama xitaa ka saarista timaha korontada ee xafiiska dhakhtarka maqaarka taas oo ah xanuun iyo daal.

Waxaa jira kareem ku salaysan eflornithine, unug ka hortag ah parasitic kaas oo, lagu dabaqo gudaha, joojiya ornithine decarboxylase, enzyme ku lug leh soo saarista timaha ee timaha follicle. Kani waa Vaniqa®, oo la marsado laba jeer maalintii, yaraynaysaa koritaanka timaha.

Timaha laser-ka-saarista waxaa lagu tilmaamaa kiisaska hirsutism ballaaran. Waxaa lagu daraa daaweynta anti-androgen si looga hortago soo noqoshada.

Anti-androgens

Ereyga anti-androgen macnaheedu waa in molecule uu xannibo isku-xidhka testosterone (si uu u noqdo 5-dihydrotestosterone saxda ah) soo-dhoweeyaha. Sida testosterone mar dambe ma ay helaan reseptors ay timaha, waxa ay mar dambe ma yeelan karaan saamayn kicinta ah.

Waxaa jira laba siyaabood oo hadda loo isticmaalo:

• cyproterone acetate (Androcur®) ayaa lagu soo celiyaa gudaha Faransiiska calaamadda hirsutism. Waxa intaa dheer in ay anti-androgen receptor xannibaya dhaqdhaqaaqa, waxa kale oo uu leeyahay saamayn antigonadotropic (waxa ay yaraynaysaa wax soo saarka androgens by yaraynta kicinta pituitary) iyo xannibaadda 5-dihydrotestosterone / receptor adag heerka of borotiinka xidha androgen. .

Waa progestogen oo ay tahay in inta badan lagu daro estrogen si ay u ekaato wareegga hormoonnada dabiiciga ah ee haweenka: dhakhtarku wuxuu inta badan qoraa kiniin Androcur® 50 mg / maalintii oo lagu daray estrogen dabiici ah oo kiniin ah, jel ama patch, labaatan maalmood. sideed iyo labaatan ka mid ah.

Hagaajinta hirsutism-ka waxa la arkaa kaliya 6 bilood oo daaweyn ah kadib.

• spironolactone (Aldactone®), durayo, ayaa lagu siin karaa calaamad ka baxsan. Ka sokow saamaynta xannibaadda receptor anti-androgenic, waxay joojisaa isku-darka testosterone. Dhakhtarku wuxuu qorayaa laba kiniin oo ah 50 ama 75 mg maalintii si loo gaaro qiyaasta maalinlaha ah ee 100 ilaa 150 mg / maalin, isku darka, shan iyo toban maalmood bishii, oo leh progestogen aan-androgenic ah si looga fogaado khalkhalka wareegga. Sida acetate cyproterone, saameyntu waxay bilaabataa in la arko kaliya 6 bilood ka dib daaweynta, mararka qaarkood sannadkii.