#1
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Ñêóäíûé ðîñò âîëîñ íà ëèöå è ïîâûøåí ïðîëàêòèí
Çäðàâñòâóéòå. Ìåíÿ çîâóò Àðò¸ì, ìíå 21 ãîä, ðîñò 166ñì, âåñ 55êã. Îòìå÷àþ ñêóäíûé ðîñò âîëîñ íà ëèöå (ïóøîê íà ïîäáîðîäêå è ðåäêèå óñèêè). Âèäó ìàëîïîäâèæíûé îáðàç æèçíè, ñëàáàÿ ìûøå÷íàÿ ìàññà, õóäåíüêèé, ñïîðòîì íå çàíèìàþñü. Ïîñëå ðàáî÷åãî äíÿ (öåëûé äåíü çà êîìïüþòåðîì) îòìå÷àþ óâåëè÷åíèå óñòàëîñòè. Ïîçäíî è ñëîæíî çàñûïàþ, èíîãäà ïðèñóòñòâóþò ãîëîâîêðóæåíèÿ. Ñäàë àíàëèçû íà ãîðìîíû. Íà ìîìåíò ñäà÷è àíàëèçîâ ïðèíèìàë òîëüêî âèòàìèí Ä. Êîðòèçîë=443,3 (172-497), Ò4=88,7 (66-181), ÒÒÃ=5,55 (0,27-4,20), Ïðîëàêòèí=823,5 (98-456), Ýñòðàäèîë=79,04 (41,4-159) ËÃ=5,91 (1,7-8,6), ÔÑÃ=0,924 (1,5-12,4), Òåñòîñòåðîí îáùèé 5,28íã/ìë (0,025-15), ÄÃÝÀ-Ñ=263,7 (211-492), Ãëþêîçà=4,43 (3,33-5,54). ÌÐÒ ÃÌ çà ïîñëåäíèé ãîä äåëàë òðè ðàçà, òàê êàê ïî ÌÐÒ ñòàâÿò ëåéêîäèñòðîôèþ (ãåíåòè÷åñêèé àíàëèç íà ñåêâåíèðîâàíèå ïîëíîãî ýêçîìà è â äàëüíåéøåì ïåðåñìîòð "ñûðûõ äàííûõ" - áåç ïàòîëîãè÷åñêèõ ìóòàöèé), ïðî îáðàçîâàíèå ãèïîôèçà â îïèñàíèå ÌÐÒ íå áûëî íè÷åãî ñêàçàíî. Ïî ÓÇÈ ÎÁÏ - ñòåàòîç ïå÷åíè, ïîâûøåí ÀëÀÒ (ìàêñèìàëüíî áûë 82 (0-41)). Ñåé÷àñ â ïðåäåëàõ íîðìû. Ïî ÓÇÈ ÙÆ ïðèñóòñòâóåò íåáîëüøàÿ êèñòà è èìåþòñÿ íåáîëüøèå èçìåíåíèÿ â ïàðåíõèìå æåëåçû TIRADS-2. Äâà ãîäà íàçàä ñäàâàë íà ãîðìîíû: Ò3, Ò4, ÒÒÃ, Àíòè Òïî è Àíòè Òã. Áûë óâåëè÷åí òîëüêî ÒÒà 6.2, ïîñëå òð¸õìåñÿ÷íîãî ïðè¸ìà éîäîìàðèíà ÒÒà ñíèçèëñÿ äî 2,5. Âèòàìèí Ä ëåòîì áûë 11, ñåé÷àñ ÿ ïîäíÿë åãî óðîâåíü äî 35. Ïîäñêàæèòå ïîæàëóéñòà ïîâûøåíèå ïðîëàêòèíà, à òàêæå ñíèæåíèå ÔÑà ìîæåò ëè áûòü ïðè÷èíîé ïëîõîãî ðîñòà âîëîñ íà ëèöå? Ó ïàïû ðîñò âîëîñ íà ëèöå íîðìàëüíûé. À òàêæå ïîäñêàæèòå ïîæàëóéñòà, åñòü ëè íåîáõîäèìîñòü ñäàòü ìíå àíàëèç íà ìàêðîïðîëàêòèí?
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#2
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Ôðàêöèÿ ìàêðîïðîëàêòèíà îáÿçàòåëüíà ïðè îöåíêå óðîâíÿ ïðîëàêòèíà
Ýòíè÷åñêàÿ ïðèíàäëåæíîñòü? ×òî çà èäåÿ î ëåéêîäèñòðîôèè? ÌÐÒ ñ êîíòðàñòîì? Ïîëó÷àåìûå ïðåïàðàòû ? Îáùèå ïàðàìåòðû çäîðîâüÿ ?
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Ã.À. Ìåëüíè÷åíêî |
#3
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Íà ìàêðîïðîëàêòèí íå ñäàâàë, òîëüêî íà ïðîëàêòèí. Ýòíè÷åñêàÿ ïðèíàäëåæíîñòü - ìîëäàâàí. Öâåò êîæè - î÷åíü ñâåòëûé è âîëîñû òîæå ñâåòëîãî öâåòà. Ó ïàïû ðîñò âîëîñ íîðìàëüíûé, â 21 ãîä îí óæå áðèëñÿ îäèí ðàç â äâà äíÿ, íà ãðóäè âîëîñû ó íåãî íà÷àëè ðàñòè áëèæå ê 25 ãîäàì. Ó äåäóøåê òîæå ïðîáëåì íå áûëî. Íå çíàþ, åñëè ýòî âàæíî, ó ìåíÿ íàáëþäàåòñÿ òàõèêàðäèÿ, ïóëüñ â ñðåäíåì çà äåíü 95 óäàðîâ â ìèíóòó. ÀÄ 130/80.
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#4
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äîáàâëþ, ÷òî íåâûñîêèé ðîñò è âåñ, íåâûðàæåííûé/çàìåäëåííûé ðîñò âîïîñ íà ëèöå, ïîâûøåíèå ïðîëàêòèíà, ïîâûøåíèå ïå÷. ôåðìåíòîâ ìîæåò áûòü ñëåäñòâèåì àòèïè÷íîé öåëèàêèè (åñëè îòñóòñòâóåò ÆÊÒ ñèìïòîìàòèêà)
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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Âîò çàêëþ÷åíèå ÌÐÒ ÃÌ, ïðàâäà îíî íà àíãëèéñêîì ÿçûêå, åñëè íàäî ïåðåâåäó íà ðóññêèé. "Conclusion: MR imaging data suggestive of multiple periventricular leukodystrophic areas, with involvement of corpus callosum, more characteristic of hereditary leukodystrophy (more probably metachromatic leukodystrophy, dd: x-linked adrenoleukodystrophy vs leukoencephalopathy with axonal spheroids).
It is recommended the consultation of the doctor geneticist." Çà ãîä òðè ðàçà äåëàë ÌÐÒ ÃÌ, îïèñàíèå îäèíàêîâîå, òîëüêî äîïèñûâàþò, ÷òî áåç ïðîãðåññèðîâàíèÿ. Ïåðâûé ðàç ñàìîñòîÿòåëüíî ïðîø¸ë ÌÐÒ ÃÌ, òàê êàê ïðèñóòñòâîâàëè ïåðåîäè÷åñêèå ãîëîâîêðóæåíèÿ. Ðåçóëüòàò îøåëîìèë. Öåëûé ãîä â ïîèñêàõ äèàãíîçà íå ïðèíåñëè ðåçóëüòàòîâ. Ãåíåòèêà â Ãåðìàíèè è ïåðåñìîòð â ÌÃÍÖ Áî÷êîâî - áåç ïàòîëîãè÷åñêèõ ìóòàöèé. Îáùèå ïàðàìåòðû çäîðîâüÿ: (ñèìïòîìû ÿ ïåðå÷èñëèë â ïåðâîì ïîñòå: óñòàëîñòü, ñëîæíî çàñûïàþ, èíîãäà ãîëîâîêðóæåíèÿ), ïî áèîõèìèè ïîâûøåíû òîëüêî ïå÷¸íî÷íûå ïðîáû, ñòåàòîç ïå÷åíè (ãåïàòèò îòðèöàòåëüíûé). Èç ïðåïàðàòîâ ïèë ÁÀÄ NAC, ðàñòîðîïøó, êóðêóìèí. Ñåé÷àñ òîëüêî ïüþ âèòàìèí Ä3 è éîäîìàðèí. |
#6
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Findings show a bilateral decrease in cortical gray-matter and caudate nuclei volumes in CD compared to controls. Negative correlations were found between the duration of the disease and the volumes of the affected regions. Cerebellum was seemingly unaffected. In addition, significantly higher proportion of WMH was found in CD patients, specifically in bilateral frontal and occipitoparietal cortices. We observed a significant gray-matter and caudate nucleus atrophy in the CD patients in the absence of marked neurological symptoms.
--- Neurol Sci. 2013 Dec;34(12):2199-204. Silent neurological involvement in biopsy-defined coeliac patients
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Òðè ãîäà íàçàä, â ñâÿçè ñ íèçêîé ìàññîé òåëà, ÿ ñäàâàë àíòèòåëà ê ãëèàäèíó, òðàíñãëóòàìèíàçå, èììóíîãëîáóëèí À è ôàêòîð Êàñëà.  îäíîé ëàáîðàòîðèè ðåçóëüòàò áûë íà âåðõíåì ïðåäåëå íîðìû tTG IgG 0,3 (0-0,3), â äðóãîé ëàáîðàòîðèè áûë çíà÷èòåëüíî íèæå íîðìû. Îñòàëüíûå ïîêàçàòåëè àíòèòåë áûëè â íîðìå. Áîëüøå ÿ íå ïîâòîðÿë äàííûé àíàëèç.
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#8
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×àñòûå ÌÐÒ ñ êîíòðàñòîì ìîãóò ñòàòü ïðè÷èíîé îòëîæåíèÿ êîíòðàñòà â òàê íàçûâàåìîì ãëèìôàòè÷åñêîì ïðîñòðàíñòâå è ïî÷êàõ.
Ïîýòîìó ðåàëüíî íóæíî çàêëþ÷åíèå âðà÷à
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Ã.À. Ìåëüíè÷åíêî |
#9
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àíàëèç êðîâè âûëîæèòå öåëèêîì, èñêëþ÷àëè ëè âàì åøå êàêèå ìàëüàáñîðáöèè êàê âîçì. ïðè÷èíó íèçêîãî âåñà?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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Àíàëèç êðîâè íà àíòèòåëà êàñàòåëüíî öåëèàêèè: îãðîìíîå Âàì ñïàñèáî, ÷òî óäåëÿåòå ìíå âðåìÿ. Âîò ìîé ïîëíûé àíàëèç. Anti-gliadina deamidata DGP IgA <0,15 (0-0,3); Transglutaminaza tisulara tTG IgA <0,15 (0-0,3); Imunoglobulina A 1,7 (>0,8); DGP IgG 0,19 (0-0,3); tTG IgG 0,3 (0-0,3); Factor intrinsec IF IgG 0,2 (0-0,3).  äðóãîé ëàáîðàòîðèè ïåðåñëàë íà anti- transglutaminaza IgA 2,3 (<20 îòðèöàòåëüíî); IgG 1,36 (<20 îòðèöàòåëüíî).  ñâÿçè ñ íèçêèì âåñîì òàêæå ñäàâàë íà èììóíîãëîáóëèíû IgA 2,34 (0,4-3,5); IgG 10,68 (6,5-16); 1,35 (0,5-3).Òàêæå ñäàâàë íà êàëïðîòåêòèí 2,5 (<43,2). Áèîõèìèÿ ãîä íàçàä îáùèé áåëîê=80 (64-83), ìî÷åâèíà=4,4 (2,5-6,5), êðåàòèíèí=69 (80-115), ìî÷åâàÿ êèñëîòà=307 (210-420), áèëèðóáèí îáùèé=13,7 (0-17), áèëèðóáèí ñâÿçàííûé=2,8 (0-3,4), áèëèðóáèí ñâîáîäíûé=10,9 (0-17), ãëþêîçà=4,9 (3,89-5,83), ÀëÀÒ=82 (0-41), ÀñÀÒ=39 (0-40), àÀìèëàçà=36 (22-100), ÔÙ=117 (0-115), ÃÃÒÏ=25 (0-55), Õîëåñòåðîë îáùèé=3,2 (0-5,2), ËÏÂÏ=1,4 (0,91-1,56), ËÏÍÏ=1,9 (2,59-4,14), òðèãëèöåðèäû=0,44 (0-1,7), êàëèé=4,3 (3,4-5,31), íàòðèé=136 (130-152), êàëüöèé=2,45 (2,15-2,57), õëîð=97 (98-107), æåëåçî=17,8 (11,6-31,3). Íèçêèé âåñ áûë è ó ìîåãî ïàïû è äåäóøêè. Ðîñ è âåñ ïàïû áûë â 21 ãîä êàê ó ìåíÿ 55 êã è 166ñì. Ïàïà ïîñëå 30 ëåò íà÷àë íàáèðàòü êèëîãðàììû. Ïîäñêàæèòå ïîæàëóéñòà, íà ÷òî ìíå åù¸ íàäî ñäàòü, ÷òîá ïðîÿñíèòü ñèòóàöèþ?
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#11
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Àðòåì, êàê ñ ëè÷íîé è ïîëîâîé æèçíüþ ó Âàñ?
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#12
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Çàáûë íàïèñàòü ÎÀÊ: Hb=151, er=4,9, i/c=0,88, leuc=6,4, tromb=243, nes=3, seg=50, eoz=2, limf=36, mon=9, VSH=5. Âû äóìàåòå ÷òî ìíå ñòîèò ïåðåñäàòü àíàëèç íà äèàãíîñòèêó öåëèàêèè? Êàê ÿ ïîíèìàþ, ýòà ïàòîëîãèÿ ìîæåò äàâàòü íàðóøåíèÿ â ÃÌ. Îòðèöàòåëüíûé ðåçóëüòàò òðè ãîäà íàçàä íà öåëèàêèþ åù¸ íå çíà÷èò, ÷òî è ñåé÷àñ äàííàÿ ïàòîëîãèÿ îòñóòñòâóåò?
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#13
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Ïîëîâîé æèçíüþ íå æèâó, ýðåêöèÿ åñòü.
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#14
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êðîìå òîãî, ÷òî áûâàåò ñåðîíåãàòèâíûå ôîðìû öåëèàêèè, êîòîðûå âèäíû òîëüêî ïðè áèîïñèè êèøå÷íèêà, áûâàåò è íåöåëèàêèéíàÿ íåïåðåíîñèìîñòü ãëþòåíà; ïî àíàëèçàì âðîäå êàê âñå íåïëîõî, íî â ñâÿçè ñ êîðÿâûìè íîðìàìè íà áëàíêå âû íå âèäèòå, ÷òî ó âàñ ñíèæåí îáøèé õîëeñòåðèí:
Hypocholesterolemia is defined as total cholesterol (TC) and low density cholesterol (LDL-C) levels below the 5th percentile of the general population. This is adjusted for age, gender, and race. Most authors use a cut-off value between 120 mg/dl (3.1 mmol/l) and 150m/dl (3.88mmol/l).
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#15
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èç âñåõ ôîðì ìàëüàáñîðáöèè ëó÷øå âñåãî îïèñàíà öåëèàêèÿ êàê ïðè÷èíà íèçêîãî õîëåñòåðèíà:
celiac disease have lower total cholesterol levels than the general population, with the reduction greater in men (21 %) than in women (9 %). The mean total cholesterol for adults newly diagnosed with celiac disease is 4.8 (SD 1.2) mmol/l. the mucosal damage of the upper small intestine causes a proportionate cholesterol malabsorption, which is apparently the main reason for hypocholesterolemia in gluten enteropathy. òî åñòü õîëåñòåðèí ó âàñ åùå íèæå, ÷åì ó 85% ïàöèåíòîâ ñ äèàãíîñòèðîâàííîé öåëèàêèåé, ó òåõ ~15% ó êîãî îí ìåæäó 2.4-3.6, íî àíòèòåë ó âàñ íåò, õîòÿ ïîâðåæäåíèå ñëèçèñòîé êèøå÷íèêà ìîæåò îáüÿñíÿòü ïî÷åìó îí òàêîé íèçêèé â êðîâè
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |