Paraganglioma

Ko te paraganglioma he tipu o ngā pūtau ka taea te puta ki ngā wāhi rerekē o te tinana. Ko te tipu, e kiia nei ko te mate pukupuku, ka puta mai i te momo pūtau io nui e kitea puta noa i te tinana. Ko te nuinga o te wā ka tīmata ngā paraganglioma ki te    matenga, te kaki, te puku, te riu rānei.

He onge te paraganglioma. Ā, ko te nuinga o te wā, ehara i te mate pukupuku. Ki te kore te mate pukupuku he mate pukupuku, ka kiia he pai. I etahi wā, he mate pukupuku te paraganglioma. Ka taea e te mate pukupuku te horapa ki ētahi atu wāhanga o te tinana.

Kāore ngā paraganglioma i te nuinga o te wā e whai take mārama ana. Ko ētahi paraganglioma i puta mai i ngā huringa DNA e pā ana i ngā mātua ki ngā tamariki.

Ka taea e ngā paraganglioma te hanga i tetahi tau. Ko te nuinga o te wā ka kitea e ngā tohunga hauora i waenga i ngā pakeke i waenga i ngā tau 20 me te 50.

Ko te maimoatanga paraganglioma te nuinga o te wā ko te pokanga hei tango i te mate pukupuku. Ki te mea he mate pukupuku te paraganglioma, ā, ka horapa ki ētahi atu wāhi o te tinana, ka hiahiatia pea ētahi atu maimoatanga.

Ko ngā tohu o te paraganglioma ka whakawhirinaki pea ki te wāhi i tīmata ai te mate pukupuku. Ko te nuinga o ngā wāhi e tīmata ai te paraganglioma ko te ulu, te kaki, te puku, te riu rānei. Ko ētahi o ngā tohu o te paraganglioma kei te ulu, kei te kaki rānei: He tangi pūngāwerewere, he rite ki te pūngāwerewere o te toto e rere ana i roto i ngā taringa, e kiia nei ko te pulsatile tinnitus. Te raruraru ki te horomi. Te reo kōkō. Te ngaro o te rongohongo. Te pōrori o te tirohanga. Te māuiui. Ka puta pea ngā tohu o te paraganglioma kei te ulu me te kaki i te wā e tupu nui haere ana te mate pukupuku. Ka taea e te mate pukupuku te pēhi i ngā hanganga e tata ana. Ki te whakatipuhia ngā paraganglioma ki ētahi atu wāhi o te tinana, ka tino pāngia ngā tohu e ngā homoni e hangaia ana e te paraganglioma. Ko ngā homoni, e kiia nei ko ngā catecholamines, he mahi nui kei te ara o te tinana ki te ahotea. Kei roto i ēnei te adrenaline, e mohiotia ana hoki ko te homoni whawhai-rerenga. Ko ētahi o ngā tohu o ngā paraganglioma e hanga ana i ngā homoni: Te toto teitei. Te ngākau tere, te wiri, te pupuhi rānei. Te ngaro ohorere o te tae o te mata. Te werawera. Te mamae o te ulu. Te wiri kore-mana i ngā ringa, i ngā ringa rānei. Te ngoikore whānui. Ka puta mai pea ēnei tohu, ka mutu atu. Kāhore etahi tangata e whai tohu ana i te paraganglioma. Ka kite pea rātou kei a rātou ēnei mate pukupuku ina kitea e ngā whakamātautau whakaahua i mahia mō ētahi atu take ngā mate pukupuku. Whakahaere rāhui ki te taote, ki tetahi kaimahi hauora rānei mēnā kei te manukanuka koe kei a koe ngā tohu paraganglioma. He mea nui tēnei mēnā kei a koe ngā tohu paraganglioma maha i te wā kotahi. Kōrero atu ki tō kaimahi hauora mō tō tūponotanga ki te paraganglioma mēnā kei a koe te toto teitei e uaua ana ki te whakahaere. Kei roto i tēnei te toto teitei e hiahia ana ki te rongoā atu i tetahi rongoā. Kōrero atu hoki ki tō kaimahi hauora mēnā ka piki haere tō toto i te wā i te wā e ine ana koe, e tetahi kaimahi hauora rānei.

Whakakāohia he wā ki te taote, ki tetahi kaimahi hauora rānei mēnā kei te manukanuka koe kei pāngia koe e ngā tohu o te paraganglioma. He mea nui tēnei mēnā he maha ngā tohu paraganglioma kei a koe i te wā kotahi. Kōrero atu ki tō kaimahi hauora mō tō tūponotanga ki te paraganglioma mēnā kei a koe te toto teitei e uaua ana te whakahaere. Kei roto i ēnei te toto teitei e hiahia ana ki te rongoā atu i tetahi rongoā. Kōrero atu hoki ki tō kaimahi hauora mēnā ka piki haere tō toto i te wā ki te wā ina ine koe, i tetahi kaimahi hauora rānei.

Ko ngā pāngarangiōma te nuinga o te wā kaore he take mārama. I etahi wā ka rere enei mate pukupuku i roto i ngā whānau. Ka taea te whakaeke e ngā huringa DNA e tukuna ana i ngā mātua ki ngā tamariki. Engari he tokomaha ngā tāngata e pangia ana e ngā pāngarangiōma kaore he hītori whānau o ēnei mate pukupuku, ā, kaore e mōhiotia te take. He tipu o ngā pūtau te pāngarangiōma. Ka hangaia mai i tētahi momo pūtau io e kiia nei ko te pūtau chromaffin. He mahi nui ngā pūtau chromaffin i roto i te tinana, tae atu ki te whakahaere i te toto toto. Ka tīmata te pāngarangiōma ina whanake ngā pūtau chromaffin i ngā huringa i roto i ō rātou DNA. Kei roto i te DNA o te pūtau ngā tohutohu e kī ana ki te pūtau me aha. I roto i ngā pūtau hauora, ka hoatu e te DNA ngā tohutohu hei tipu me te whakaputa i te tere i whakaritea. Ka kī hoki ngā tohutohu ki ngā pūtau kia mate i te wā i whakaritea. I roto i ngā pūtau pāngarangiōma, ka hoatu e ngā huringa DNA ngā tohutohu rerekē. Ka kī ngā huringa ki ngā pūtau pāngarangiōma kia hanga he maha atu ngā pūtau tere. Ka mau tonu te ora o ngā pūtau ina mate ngā pūtau hauora. Ka puta mai i tēnei te tipu o ngā pūtau e kiia nei ko te mate pukupuku. Ko te nuinga o ngā pāngarangiōma ka noho ki te wāhi i tīmata ai. Kāore e horapa ki ētahi atu wāhanga o te tinana. Engari i etahi wā ka taea e ngā pūtau te motu atu i te pāngarangiōma ka horapa. Ina puta tēnei, ka kiia he pāngarangiōma metastatic. Ina horapa te pāngarangiōma, ka nuinga te horapa ki ngā ngota lymph tata. Ka taea hoki te horapa ki ngā pūkahukahu, ate me ngā wheua. He hononga tata te pāngarangiōma ki tētahi atu mate pukupuku onge e kiia nei ko te pheochromocytoma. He mate pukupuku te pheochromocytoma e tīmata ana i ngā pūtau chromaffin i roto i ngā whatukuhu adrenal. Ko ngā whatukuhu adrenal he rua ngā whatukuhu e noho ana i runga i ngā whatukuhu.

Kei te nui ake te tūponotanga o te paraganglioma ki ngā tāngata he hītori whānau o tēnei mate pukupuku. Ko ētahi paraganglioma ka puta mai i ngā huringa DNA e pā atu ana i ngā mātua ki ngā tamariki. Ko te whai hītori whānau o te paraganglioma pea he tohu kei te rere etahi huringa DNA i roto i tō whānau.

Ko ētahi atu āhuatanga hauora e puta mai ana i ngā huringa DNA e pā atu ana i ngā mātua ki ngā tamariki ka whakanui ake te tūponotanga o ngā paraganglioma. Kei roto i ēnei āhuatanga:

• Te mate pukupuku maha o te pūnaha endocrine, momo 2. Ka taea e te mate pukupuku maha o te pūnaha endocrine, momo 2, e kiia ana hoki ko te MEN 2, te whakaoho i ngā mate pukupuku i roto i tetahi, i te maha rānei o ngā ngota e hanga ana i ngā homoni, tae atu ki te thyroid me ngā ngota parathyroid. E rua ngā momo o te MEN 2—momo 2A me te momo 2B. Ka whakanui ake ngā momo e rua te tūponotanga o ngā paraganglioma.
• Te mate a Von Hippel-Lindau. Ka taea e te mate a Von Hippel-Lindau te whakaoho i ngā mate pukupuku me ngā cysts ki te hanga i ngā wāhanga maha o te tinana. Ko ngā wāhi pea kei roto ko te roro, te uaua o te tuaiwi me ngā whatukuhu.
• Te neurofibromatosis 1. Ka whakaoho te neurofibromatosis 1 i ngā mate pukupuku e kiia nei ko ngā neurofibromas ki te hanga i roto i te kiri. Ka taea hoki e te āhuatanga te whakaoho i ngā mate pukupuku o te uaua optic. Ko te uaua optic te uaua kei muri o te kanohi e hono ana ki te roro.
• Ngā mate pukupuku paraganglioma kua oti te whakararangi. Ka taea e ngā mate pukupuku paraganglioma kua oti te whakararangi te whakaoho i ngā pheochromocytomas, i ngā paraganglioma rānei. Ko ngā tāngata he mate pukupuku nei, he maha tonu te nui atu i te kotahi paraganglioma.
• Te Carney-Stratakis dyad. Ka whakaoho te Carney-Stratakis dyad i ngā mate pukupuku o te pūnaha kai me ngā paraganglioma.

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Kaore he uauatanga

Ko te tātaritanga o te paraganglioma e tīmata pinepine ana ki ngā whakamātautau toto me te mimi. Ka taea e ēnei whakamātautau te rapu i ngā tohu e hanga ana he pūngāwerewere i ngā homoni taapiri. Ko ētahi atu whakamātautau pea ka uru atu ngā whakamātautau whakaahua me ngā whakamātautau ira.

Ka taea e ngā whakamātautau toto me te mimi te ine i ngā taumata o ngā homoni i roto i te tinana. Ka kite pea rātou i ngā homoni catecholamine taapiri i hangaia e te paraganglioma. Ā, ka kite pea rātou i ētahi atu tohu o te paraganglioma pēnei i te pūmua e kiia nei ko te chromogranin A.

Ka tūtohu pea tō kaimahi hauora i ngā whakamātautau whakaahua mena ko ō tohu, ko te hītori whānau, ko ngā whakamātautau toto me te mimi e whakaatu ana pea kei a koe te paraganglioma. Ka taea e ēnei whakaahua te whakaatu i te wāhi me te rāhi o te pūngāwerewere. Ka āhei pea hoki te āwhina i ngā whiringa maimoatanga mōu.

Ko ēnei whakamātautau whakaahua pea ka whakamahia mō te paraganglioma:

• Ko te whakaahua pūmanawa pākahiko, e kiia ana hoki ko te MRI, e whakamahi ana i ngā ngaru reo me te mara pākahiko hei hanga i ngā whakaahua taipitopito.
• Ko te tātaritanga tomokānui rorohiko, e kiia ana hoki ko te tātaritanga CT, e whakakotahi ana i te raupapa o ngā whakaahua X-ray i tangohia mai i ngā kōrero maha a tawhio noa i te tinana.
• Ko te tātaritanga metaiodobenzylguanidine, e kiia ana hoki ko te tātaritanga MIBG, e kite ana i te tohu pākahiko i whakauruhia e tangohia ana e ngā paraganglioma.
• Ko te tātaritanga positron emission tomography, e kiia ana hoki ko te tātaritanga PET, e kite ana hoki i te tohu pākahiko e tangohia ana e te pūngāwerewere.

Ko ētahi huringa DNA i tukuna mai i ngā mātua ki ngā tamariki e āhei ake ai te hanga i ngā paraganglioma. Mena kei a koe te paraganglioma, ka tūtohu pea tō kaimahi hauora i te whakamātautau ira hei rapu i ēnei huringa DNA i roto i tō tinana. Ka taea e ngā hua o te whakamātautau ira te awhina i te kī taurangi o te hokinga mai o tō pūngāwerewere i muri i te maimoatanga.

Ka taea hoki te tirotiro i ō mātua, tamariki, me ō teina mō ngā huringa DNA e whakapiki ake ana i te tūponotanga o ngā paraganglioma. Ka tuku pea tō rōpū hauora i a koe ki te kaiāwhina ira, ki tetahi atu kaimahi hauora kua whakangungua i roto i te ira. Ka taea e tēnei tangata te āwhina i a koe me ō whānau kia whakatau ai mēnā ka whiwhi i te whakamātautau ira.

Ko te nuinga o te wā, ko te maimoatanga pararangiōma e pā ana ki te pokanga hei tango i te mate pukupuku. Mena ka hanga te mate pukupuku i ngā homoni, ka whakamahi ngā tohunga hauora i ngā rongoā hei aukati i ngā homoni tuatahi. Ki te kore e taea te tango i te pararangiōma mā te pokanga, ki te horapa rānei, pea ka hiahia koe ki ētahi atu maimoatanga. Ko ō kōwhiringa maimoatanga mō te pararangiōma e whakawhirinaki ana ki ngā take maha. Kei roto i ēnei: Kei hea te tūnga o te mate pukupuku. He pukupuku rānei, ā, kua horapa ki ētahi atu wāhanga o te tinana. He maha ake ngā homoni e hanga ana e te mate pukupuku, ā, e pā ana ki ngā tohu. Kei roto i ngā kōwhiringa maimoatanga: Ngā maimoatanga hei whakahaere i ngā homoni e hangaia ana e te mate pukupuku Mena ka hanga e tō pararangiōma ngā catecholamines nui atu, ka hiahia pea koe ki ngā maimoatanga hei aukati i ngā pānga, ki te whakaiti rānei i ngā taumata o ēnei homoni. Ka whakaitihia e ēnei maimoatanga te toto teitei, ā, ka whakahaere i ētahi atu tohu. He mea nui kia whakahaerehia te toto teitei me ngā tohu i mua i te tīmatanga o ētahi atu maimoatanga pararangiōma. Nō te mea ka taea e te maimoatanga te tuku i te mate pukupuku ki te tuku i ngā nui o ngā catecholamines, ā, ka āhei te arahi ki ngā raruraru nui. Kei roto i ngā rongoā e whakamahia ana hei whakahaere i ngā pānga catecholamine ētahi rongoā toto teitei. Kei roto i ēnei rongoā ngā kai aukati alpha, ngā kai aukati beta me ngā kai aukati kauwhata kōhatu. Kei roto i ētahi atu tikanga te kai i te kai nui i te konutai me te inu i te wai maha. Pokanga Ka taea te mahi pokanga hei tango i te pararangiōma. Ahakoa kaore e taea te tango katoa i te pararangiōma, pea ka tūtohutia e tō tohunga hauora te pokanga hei tango i te nui o te mate pukupuku. Ko te momo pokanga e whakamahia ana hei tango i te pararangiōma e whakawhirinaki ana ki te wāhi kei reira. Ko te wāhi o te mate pukupuku e whakatau ana hoki ki te momo taote e mahi ana i te mahi. Hei tauira: Ngā mate pukupuku kei te rohe o te matenga me te kaki pea ka maimoatia e ngā taote matenga me te kaki. Ngā mate pukupuku e pā ana ki te roro, te tuaiwi me ngā io pea ka maimoatia e ngā neuro-taote. Ngā mate pukupuku e pā ana ki ngā whekau e hanga ana i ngā homoni pea ka maimoatia e ngā taote endocrine. Ngā mate pukupuku e pā ana ki ngā oko toto pea ka maimoatia e ngā taote oko toto. I etahi wā, ka mahi tahi ngā taote mai i ngā tohungatanga rerekē i te wā o te pokanga pararangiōma. Rongoā radiation Ka whakamahi te rongoā radiation i ngā kauwhata kaha hei maimoatanga i ngā mate pukupuku. Ka taea te puta mai o te kaha mai i ngā X-rays, ngā protons, i ētahi atu puna rānei. Pea ka tūtohutia e tō tohunga hauora te radiation mena kaore e taea te tango katoa i tō pararangiōma mā te pokanga. Ka taea hoki e te radiation te awhina i te whakaheke i te mamae e puta mai ana i te pararangiōma e horapa ana ki ētahi atu wāhanga o te tinana. I etahi wā, ka whakamahia tētahi momo radiation motuhake e kiia nei ko te stereotactic radiosurgery hei maimoatanga i ngā pararangiōma kei te rohe o te matenga me te kaki. Ko tēnei momo radiation e āwhina ana i ngā kauwhata maha o te kaha ki te mate pukupuku. Kāore i te kaha rawa te kauwhata. Engari ko te pito kei reira ngā kauwhata e tutaki ana ka whiwhi i te nui o te radiation hei whakamate i ngā pūtau mate pukupuku. Maimoatanga ablation Ka whakamahi te maimoatanga ablation i te wera, i te makariri rānei hei whakamate i ngā pūtau mate pukupuku me te whakahaere i te tipu o te pararangiōma. Pea he kōwhiringa tēnei mena kua horapa te pararangiōma ki ētahi atu wāhanga o te tinana. Ka whakamahi te radiofrequency ablation i te kaha hiko hei whakawera i ngā pūtau mate pukupuku. Ko tētahi atu momo ablation e kiia nei ko te cryoablation e whakamahi ana i te hau makariri hei tio i ngā pūtau mate pukupuku. Chemotherapy Ko te chemotherapy he maimoatanga e whakamahi ana i ngā rongoā kaha. Mena kua horapa tō pararangiōma, pea ka tūtohutia e tō tohunga hauora te chemotherapy hei awhina i te whakaiti i ngā mate pukupuku. Mena ka hanga e tō pararangiōma ngā homoni nui atu, ka whiwhi koe i ngā rongoā hei whakahaere i ngā taumata homoni i mua i te tīmatanga o te chemotherapy. Maimoatanga e taea ana te whakaeke Ko te maimoatanga e taea ana te whakaeke e whakamahi ana i ngā rongoā e whakaeke ana i ngā matū motuhake i roto i ngā pūtau mate pukupuku. Mā te aukati i ēnei matū, ka taea e ngā maimoatanga whakaeke te whakamate i ngā pūtau mate pukupuku. Mō te pararangiōma, pea ka whakamahia ngā rongoā maimoatanga whakaeke mena kaore he kōwhiringa pokanga. Pea ka whakamahia hoki te maimoatanga whakaeke mena ka horapa te mate pukupuku ki ētahi atu wāhanga o te tinana. Maimoatanga radionuclide kaiwhiwhi peptide Ko te maimoatanga radionuclide kaiwhiwhi peptide, e kiia ana hoki ko te PRRT, e whakamahi ana i te rongoā hei tuku i te radiation tika ki ngā pūtau mate pukupuku. Ka whakakotahi te rongoā i te mea e kimi ana i ngā pūtau mate pukupuku me te mea kei roto te radiation. Ka hoatu te rongoā mā te uaua. Ka haere te rongoā puta noa i te tinana, ā, ka piri ki ngā pūtau pararangiōma. I roto i ngā rā ki ngā wiki, ka tuku te rongoā i te radiation tika ki ngā pūtau mate pukupuku. Ko tētahi rongoā e mahi ana i tēnei ara ko te lutetium Lu 177 dotatate (Lutathera). Pea ka whakamahia mena kaore he kōwhiringa pokanga, ki te horapa rānei te pararangiōma ki ētahi atu wāhanga o te tinana. Ngā whakamātautau hauora Ko ngā whakamātautau hauora ngā rangahau i ngā maimoatanga hou, i ngā huarahi hou rānei o te whakamahinga i ngā maimoatanga tawhito. Mena kei te hiahia koe ki ngā whakamātautau hauora mō te pararangiōma, korero ki tō tohunga hauora mō ō kōwhiringa. Ka taea e kōrua te whakarite i ngā painga me ngā tūponotanga o ngā maimoatanga e akohia ana e ngā kairangahau. Te tatari atawhai I etahi wā, ka tūtohu ngā tohunga hauora kia kaua e tīmata i te maimoatanga pararangiōma i te wa poto. Engari, pea ka pai ake te tirotiro i tō āhuatanga mā ngā tirotiro hauora auau. E mohiotia ana tenei ko te tatari atawhai. Hei tauira, pea he kōwhiringa te tatari atawhai mena ka tipu haere te pararangiōma, ā, kāore e pā ki ngā tohu. Ētahi atu mōhiohio Maimoatanga ablation Rongoā radiation Tono i te whakaritenga

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