Hỏi : (BS H. / Hà Nội)
Thưa thầy cho con hỏi về bệnh lý U tuyến yên, nguyên nhân và phác đồ điều trị ạ
Trả lời : (Wambuakim)
OK con, nhưng trả lời câu hỏi có nội dung khá lớn thế này một cách giản đơn thì khó biểu đạt hết nội hàm của vấn đề. Thầy quyết định trích luôn một phần Theory Y Dược Học Lượng Tử của Thầy, có tham khảo dữ liệu hiện tại ở VN cho con dễ đọc, dễ tiếp thu nhé.
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U TUYẾN YÊN – NGUYÊN NHÂN, BỆNH CHỨNG VÀ ĐIỀU TRỊ
(trich theo Theory U tuyến yên và ung thư tuyến yên của Wambuakim (2007 – 2016)
Định nghĩa
U tuyến yên là khối u tăng trưởng bất thường phát triển trong tuyến yên. Một số khối u tuyến yên làm cho tuyến yên sản xuất quá nhiều hormone điều hoà chức năng quan trọng của cơ thể. Các khối u tuyến yên khác có thể hạn chế chức năng bình thường của tuyến yên, gây ra sản xuất hạn chế của kích thích tố.
Đại đa số các khối u tuyến yên là tăng trưởng không phải ung thư (u tuyến). U tuyến vẫn còn giới hạn trong tuyến yên hoặc các mô xung quanh và không lan sang các bộ phận khác của cơ thể.
Điều trị các khối u tuyến yên liên quan đến việc lựa chọn, hoặc loại bỏ khối u hoặc kiểm soát sự tăng trưởng của nó. Cũng có thể cần thuốc để điều chỉnh sản xuất hormone quá cao hoặc quá thấp.
Các triệu chứng
Khối u tuyến yên có thể gây ra rắc rối về thể chất và sinh hóa. Các khối u tuyến yên lớn – khoảng 3 / 4 inch (19 mm) hoặc lớn hơn – được gọi là macroadenomas. Khối u nhỏ được gọi là microadenomas. Macroadenomas có thể gây chèn ép trên phần còn lại của tuyến yên và các cấu trúc gần đó.
Các triệu chứng liên quan đến áp lực khối u
Các dấu hiệu và triệu chứng của áp lực từ khối u tuyến yên có thể bao gồm:
– Nhức đầu.
– Mất tầm nhìn, đặc biệt là mất thị giác ngoại vi.
– Buồn nôn và ói mửa.
Các triệu chứng của thiếu hormone tuyến yên
– Mệt mỏi.
– Điểm đặt yếu.
– Không dung nạp lạnh.
– Táo bón.
– Huyết áp thấp.
– Cơ thể rụng lông, tóc.
– Rối loạn chức năng tình dục hoặc mất khả năng tình dục.
– Giảm cân hoặc tăng cân ngoài ý muốn.
Các triệu chứng liên quan đến thay đổi mức hormone
1/. Một số khối u tuyến yên, được gọi là khối u chức năng, còn sản xuất kích thích tố. Nói chung, điều này gây ra dư thừa các kích thích tố, trong đó có các hiệu ứng sinh hóa khác nhau. Các loại khối u hoạt động trong tuyến yên gây ra các dấu hiệu và triệu chứng cụ thể.
2/. Khối u tiết Adrenocorticotropic hormone (ACTH). U sản xuất ACTH, kích thích tuyến thượng thận sản xuất các hormone cortisol. Hội chứng Cushing là kết quả của tuyến thượng thận sản xuất quá nhiều cortisol. Các dấu hiệu và triệu chứng của hội chứng Cushing có thể bao gồm:
– Chất béo tích tụ quanh eo và lưng trên.
– Khuôn mặt to tròn.
– Bướu đặc trưng trên phần trên của lưng.
– Tăng huyết áp.
– Nhược cơ.
– Bầm tím.
– Dải dấu.
– Mỏng da.
Các khối u tuyến yên tiết ra nội tiết tố tăng trưởng. Những u này sản xuất ra hormone tăng trưởng quá mức. Các hiệu ứng dư thừa hormone tăng trưởng (acromegaly) có thể bao gồm:
– Mặt thô.
– Bàn tay và bàn chân to ra.
– Đổ mồ hôi quá nhiều.
– Tăng huyết áp.
– Vấn đề về tim.
– Thoái hóa khớp.
– Răng không thẳng hàng (malocclusion).
– Tăng tốc và tăng trưởng quá mức (khổng lồ) có thể xảy ra ở trẻ em và thanh thiếu niên.
– Các khối u tiết ra prolactin. Sản xuất thừa prolactin từ một khối u tuyến yên (prolactinoma) có thể gây ra sự sụt giảm mức hormone giới tính – estrogen ở phụ nữ và testosterone ở nam giới. Quá nhiều prolactin trong máu (hyperprolactinemia) có thể ảnh hưởng đến nam giới và phụ nữ khác nhau.
Ở phụ nữ, khối u tuyến yên có thể gây ra:
– Kinh nguyệt không đều (oligomenorrhea).
– Vô kinh.
– Sữa non chảy ra từ vú (galactorrhea).
Ở nam giới, khối u sản xuất prolactin có thể gây ra suy sinh dục. Các dấu hiệu và triệu chứng có thể bao gồm:
– Vú to ra (gynecomastia).
– Rối loạn dương cương (ED).
– Giảm lông trên cơ thể.
– Mất bản lĩnh đàn ông, mất khả năng tình dục.
Các khối u tiết ra nội tiết tố kích thích tuyến giáp. Khi một khối u tuyến yên kích thích tuyến giáp sản xuất hormone tuyến giáp quá nhiều – hormone thyroxine. Đây là một nguyên nhân hiếm gặp của cường giáp, hoặc bệnh tuyến giáp hoạt động quá mức. Cường giáp có thể đẩy nhanh sự trao đổi chất của cơ thể, gây ra:
– Đột ngột tăng hoặc giảm cân.
– Nhịp tim nhanh hoặc nhịp tim không đều.
– Căng thẳng hoặc khó chịu.
Nếu phát triển các dấu hiệu và triệu chứng có thể liên kết với một khối u tuyến yên, cần xác định nguyên nhân chính xác. Các khối u tuyến yên thường có thể điều tiết hormone hiệu quả, để hàm lượng hormone trở về bình thường và giảm các dấu hiệu và triệu chứng.
Nếu tìm hiểu và biết nhiều vấn đề nội tiết có yếu tố gia đình, hãy đề cập về các xét nghiệm định kỳ có thể giúp phát hiện khối u tuyến yên sớm.
Nguyên nhân
Nguyên nhân của tăng trưởng tế bào không kiểm soát ở tuyến yên, tạo ra khối u vẫn chưa được khám phá. Tuyến yên là tuyến hình hạt đậu nhỏ nằm ở đáy não, hơi phía sau mũi và giữa hai tai. Mặc dù kích thước của nó nhỏ, tuyến yên ảnh hưởng gần như tất cả các bộ phận của cơ thể. Các hormone mà nó tạo ra giúp điều chỉnh các chức năng quan trọng bậc nhất, chẳng hạn như tăng trưởng, và sinh sản.
Tỷ lệ nhỏ các trường hợp khối u tuyến yên có tính gia đình, nhưng hầu hết không có yếu tố di truyền rõ ràng. Tuy nhiên, các nhà khoa học nghi ngờ sự thay đổi di truyền đóng vai trò quan trọng trong cách phát triển các khối u tuyến yên.
Yếu tố nguy cơ
Mặc dù khối u tuyến yên có thể xảy ra ở mọi lứa tuổi, chúng thường xảy ra ở người lớn tuổi. Những người có tiền sử một số vấn đề di truyền, ví dụ như nội tiết nhiều, MEN I, có nguy cơ khối u tuyến yên gia tăng. Trong MEN I, nhiều khối u xuất hiện ở các tuyến khác nhau của hệ thống nội tiết. Thử nghiệm di truyền có sẵn cho các rối loạn này.
Các biến chứng
Các khối u tuyến yên thường không phát triển lây lan rộng. Tuy nhiên, bất lợi có thể ảnh hưởng đến sức khỏe, có thể gây ra:
– Mất tầm nhìn. Khối u tuyến yên có thể gây áp lực chèn ép lên các dây thần kinh thị giác gần tuyến yên, và gây mất thị lực.
– Thiếu hụt hormone. Sự hiện diện của khối u tuyến yên hoặc loại bỏ vĩnh viễn có thể thay đổi hormone, có thể cần phải được thay thế bằng thuốc nội tiết tố.
– Đột ngột chảy máu khối u. Hiếm gặp là biến chứng nghiêm trọng của khối u tuyến yên là chảy máu khối u. Điều này thường đi kèm với nhức đầu dữ dội và vấn đề tầm nhìn bất ngờ – bao gồm giảm tầm nhìn, tầm nhìn đôi và mí mắt rủ xuống – triệu chứng của tuyến yên sản xuất hormone ít (suy tuyến yên), chẳng hạn như hoa mắt, nôn mửa, không dung nạp lạnh, khát nước quá mức và mệt mỏi. Chảu máu khối u tuyến yên cần được điều trị khẩn cấp, với corticosteroid và có thể phẫu thuật.
– Đái tháo nhạt. Đây là một biến chứng có thể có của một khối u tuyến yên lớn hoặc của một số phương pháp điều trị cho các khối u tuyến yên. Không nên nhầm lẫn với các bệnh đái tháo đường thường gặp, trong đó bao gồm lượng đường cao trong máu và nước tiểu, đái tháo nhạt là kết quả của việc tạo ra quá ít vasopressin tuyến yên, kiểm soát nồng độ của nước tiểu ở thận. Bệnh đái tháo nhạt gây ra quá nhiều nước tiểu và khát nghiêm trọng, có thể dẫn đến mất nước.
Kiểm tra và chẩn đoán
BV có thể tiến hành xét nghiệm để chẩn đoán khối u tuyến yên bao gồm:
– Xét nghiệm máu và nước tiểu. Kiểm tra các mẫu máu và nước tiểu có thể xác định xem có thừa hoặc thiếu hụt hormone.
– Chụp ảnh não. Cắt lớp vi tính (CT) hoặc chụp cộng hưởng từ (MRI) não có thể giúp bác sĩ đánh giá vị trí và kích thước của khối u tuyến yên.
– Kiểm tra tầm nhìn. Có thể xác định xem sự phát triển của khối u tuyến yên có làm suy giảm thị lực hoặc tầm nhìn ngoại vi.
– Ngoài ra, có thể thử nghiệm nội tiết rộng rãi hơn.
Phương pháp điều trị và thuốc
Điều trị khối u tuyến yên phụ thuộc vào loại khối u, kích thước và mức độ của nó. Tuổi và sức khỏe tổng thể cũng là những yếu tố. Bởi vì các khối u tuyến yên có thể gây ra vấn đề nghiêm trọng khi gây áp lực chèn ép lên não, điều trị thường là cần thiết. Phát hiện sớm khối u tuyến yên là chìa khóa để điều trị thành công.
Điều trị bao gồm nhóm các chuyên gia y tế, có thể bao gồm bác sĩ phẫu thuật não (phẫu thuật thần kinh), chuyên gia hệ thống nội tiết và hệ thống chuyên khoa thần kinh. Các bác sĩ thường sử dụng phẫu thuật, bức xạ, và thuốc, hoặc một mình hoặc kết hợp, để điều trị khối u tuyến yên để sản xuất nội tiết tố trở lại mức bình thường.
Tóm lại là cũng chưa có phương pháp điều trị tuyến yên nào thống nhất và có hiệu quả.
Phẫu thuật
Phẫu thuật cắt bỏ khối u tuyến yên thường là cần thiết nếu khối u đã chèn ép dây thần kinh thị giác, có thể gây mất thị lực, hoặc nếu các khối u sản xuất quá mức một số hormone. Sự thành công của phẫu thuật phụ thuộc vào loại khối u, vị trí của nó, kích thước của nó, và khối u đã xâm lấn mô xung quanh. Hai kỹ thuật chính của phẫu thuật để điều trị các khối u tuyến yên là:
Phương pháp nội soi. Với phương pháp này, bác sĩ thường có thể đạt được và loại bỏ khối u qua xoang mũi và không có vết mổ bên ngoài. Không ảnh hưởng đến phần khác của não, và không nhìn thấy vết sẹo. Tuy nhiên, khối u lớn rất có thể khó khăn để loại bỏ với thủ tục này, đặc biệt là khi khối u đã xâm lấn các dây thần kinh gần đó hoặc mô não.
Phương pháp tiếp cận. Trong thủ tục này, khối u được cắt bỏ qua phần trên của sọ bằng cách rạch một đường ở da đầu. Tiếp cận dễ dàng hơn với các khối u lớn hoặc phức tạp bằng cách sử dụng thủ tục này.
Xạ trị
Xạ trị sử dụng năng lượng cao để tiêu diệt các khối u. Nó có thể được sử dụng sau khi phẫu thuật hoặc một mình như là điều trị chính nếu phẫu thuật không phải là một lựa chọn. Xạ trị có thể có lợi nếu khối u vẫn tiếp diễn hoặc trở lại sau khi phẫu thuật và gây ra các dấu hiệu và triệu chứng mà thuốc không giảm. Phương pháp xạ trị bao gồm:
Tia bức xạ bên ngoài. Hình thức trị liệu bức xạ này cung cấp bức xạ trong từng bước nhỏ trong một khoảng thời gian. Một loạt các phương pháp điều trị, thường là năm lần một tuần trong từ bốn đến sáu tuần, được thực hiện trên cơ sở bệnh nhân ngoại trú. Điều trị này thường có hiệu quả, có thể mất nhiều năm để hoàn toàn kiểm soát sự phát triển khối u và sản xuất hormone. Xạ trị cũng có thể thiệt hại tế bào tuyến yên bình thường và mô não bình thường, đặc biệt là gần tuyến yên.
Xạ phẫu định vị. Đây là loại trị liệu tia bức xạ tập trung chính xác vào khối u mà không có vết mổ. Chùm bức xạ được đưa vào khối u chính xác số lượng và kích thước với sự trợ giúp của chụp ảnh kỹ thuật. Với xạ phẫu định vị, các bức xạ tiếp xúc với các mô lành xung quanh khối u ở mức tối thiểu, giảm nguy cơ thiệt hại cho các mô bình thường. Những lợi ích của xạ phẫu định vị, giống như những tia bức xạ bên ngoài, thường hiệu quả không ngay lập tức và có thể mất vài tháng hoặc nhiều năm để có đủ hiệu quả. Tuy nhiên, các bác sĩ không thể sử dụng liệu pháp này nếu các khối u là rất gần với các dây thần kinh thị giác hoặc các cấu trúc nhạy cảm khác.
Xạ trị có tác dụng rất hạn chế trong điều trị khối u tuyến yên. Theo thống kê đến 2015 thì ở Mỹ có chưa đến 1% tỷ lệ thành công xạ trị khối u tuyến yên. Tác dụng phụ do xạ trị tuyến yên gây ra là mất trí nhớ, mất sức sống, tử vong hoặc nhiễm xạ gây sợ hãi và áp lực tinh thần đối với bệnh nhân có khối u tuyến yên hoặc ung thư tuyến yên.
Thuốc men
Điều trị bằng thuốc có thể giúp ngăn chặn sự tiết hormone dư thừa và đôi khi giảm tiết và kích thước khối u tuyến yên:
Các khối u tiết Prolactin (prolactinomas). Các thuốc bromocripxine (Parlodel) và cabergoline (Dostinex) có thể điều trị các loại khối u bằng cách giảm tiết prolactin và thường làm giảm kích thước của khối u. Các thuốc này thường rất hiệu quả trong điều trị các loại khối u mà phẫu thuật không cần thiết.
Các khối u tiết ra nội tiết tố tăng trưởng. Hai loại thuốc có sẵn cho các loại khối u tuyến yên này. Thuốc được gọi là chất tương tự somatostatin (Sandostatin,…) làm cho giảm sản xuất hormone tăng trưởng và có thể làm giảm kích thước của khối u này. Pegvisomant (Somavert) chặn ảnh hưởng của hormone tăng trưởng dư thừa trên cơ thể. Những thuốc này đặc biệt hữu ích nếu phẫu thuật đã không thành công.
Nếu khối u tuyến yên đã điều trị gây nên giảm sản xuất hormone, hoặc nếu loại bỏ khối u tuyến yên đã giảm sản xuất hormone, có thể cần dùng hormone thay thế để duy trì mức hormone bình thường.
Tóm lại, thuốc men Tây Y trong điều trị khối u tuyến yên chỉ là giải pháp tình thế, “gặp đâu đánh đấy, đau đâu chữa đấy” và chưa hề có bài bản.
Cảnh giác chờ đợi
Trong cảnh giác chờ đợi – còn được gọi là quan sát, có thể cần thường xuyên xét nghiệm để theo dõi những dấu hiệu của sự tiến triển của khối u tuyến yên. Cảnh giác chờ đợi, trong đó có việc không điều trị y tế, có thể là một lựa chọn nếu khối u không gây ra bất kỳ dấu hiệu hoặc triệu chứng.
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