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NHN MT TRNG HP DY TH SMNGUYN NHN TRUNG NG TR TRAI

Nguyn th Dim Chi,Nguyn th Hng H, Hong th Thu YnKhoa Nhi Bnh Vin trung ng Hu

1. PHN HNH CHNH:

H v tn: PHM NHT T.- Sinh ngy 03/10/1995.- a ch: 350/13 Phan Chu Trinh, phng An Cu, thnh ph Hu- Ngy vo vin: 19 gi ngy 23/08/2004- L do vo vin: Nn2. BNH S:Khi pht cch ngy nhp vin 3 thng vi trm ging, xut hin lng mu, c quan sinh dcnam pht trin, dng vt pht trin, c lng nch, cha xut tinh. Cch ngy nhp vin 20ngy vi au u, nn sau n, nhn m, khng lit. nh bnh nhn c i khm v iu tr bcs t, bnh khng gim, chiu nay sau khi n bnh nhn nn, vo vin. c chn on: Theodi u no, c iu tr: Chng ph no, gim vim, chuyn dch. c lm cc xt nghim

gip cho chn on.3. TIN S:Con th 1, sinh thng, thng, PARA 2002, cn nng lc sinh 2700 gr, cai sa m lc

16 thng.4. GHI NHN LC VO VIN :

Mch:83 ln/pht, Nhit : 370C, HA:120/70mmHg, cn nng:33 kg, chiu cao:133,5 cm.Thnh thong tr au u, au theo mch p, sau au u bnh nhn nn.

5. THM KHM HIN TITng trng chung kh, da nim mc hng

-Thn kinh: Tnh to, thnh thong au u, au theo mch p, sau au u bnh nhn nn.Mt nhn m, khng lit, khng c du hiu thn kinh khu tr.

-Tiu ho: Nn sau n-Dy th: Lng mu P3, th tch tinh hon 6 ml (P3).

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6. CN LM SNG23/08: CTM : Bch cu 9,9 x 109 /l ,Lymphocyte 26,4 %, Neutrophile62,7 %, Hng cu 6,8 x 1012/l, Hb 13g/dl, Hct 43,5 %.

23/08: Glucose mu : 5,5 mmol/l, in gii : Na+ 138 mmol/l,

K+

3,8 mmol/l, Ca++

1,17 mmol/l.23/08: Soi y mt: Gai th mt b, tnh mch gin ngon ngoo, vng mc ph v xuthuyt ri rc, ph gai th hon ton.

24/08: CT Scanner s no :+Ca s xng: khng thy tn thng hp s+Trc tim thuc cn quang tnh mch: C mt khi tng t trng t nhin, c vi ho

nt nh bn trong cu trc, kch thc 5,4 x 3,5 x 4 cm ngoi trc st lim no, pht trin vpha tri, gy chon ch bn cu no tri. Cu trc hnh thi, t trng ca m no, tiu nokhng thy bt thng.

+Sau tim thuc cn quang tnh mch: Khi u ngm thuc rt mnh, giu mch, khng ccu trc hoi t. M no, tiu no cn li khng thy hnh nh ngm thuc bt thng.

Kt lun: Meningioma25/08 : FSH < 0,1mIU/mlLH 4,44 mIU/mlTestosterone > 15 ng/ml

7. TM TT - BIN LUN - CHN ONQua hi bnh s, thm khm lm sng v cn lm sng, trn bnh nhn ny chng ti thy

c cc du chng v triu chng sau:

1. Du chng dy th sm:- xut hin lng mu (P3), th tch tinh hon 6 ml (P3) (>4 ml)- Cc c tnh sinh dc nam: trm ging, c quan sinh dc ngoi pht trin, dng vt pht

trin.- FSH < 0,1mIU/ml, LH 4,44 mIU/ml, Testosterone > 15 ng/ml [6 ].

2. Du chng thn kinh:Cc triu chng thn kinh ca khi u:

+ du tng p lc ni s : au u, au theo mch p, sau au u bnh nhn nn, nn ma.+ ri lon th gic (nhn m).

3. Soi y mt: Gai th mt b, tnh mch gin ngon ngoo, vng mc ph v xut huyt ri

rc, ph gai th hon ton.4. Du chng khi u no:

CT Scanner s no cho thy khi u kch thc 5,4 x 3,5 x 4 cm gy chon ch bn cuno tri. Kt lun : Meningioma.

Tiu chun chn on dy th sm (DTS): Cc du hiu sinh dc ph xut hin trc 10tui vi tr trai, trc 8 tui i vi tr gi [1].

Dy th sm thng thng c xc nh khi khi pht dy th trc 8 tui tr gi vtrc 9 tui tr trai [5 ].

Cc du hiu lm sng gi DTS:- Tng tc pht trin chiu cao

- Pht trin cc c tnh sinh dc ph :- V to, c th pht trin lng mu hoc khng ( tr gi)

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- Tinh hon >30mm (6ml), c th pht trin lng mu hoc khng (tr trai).* Phi xc nh c tui xut hin cc du hiu lm sng.Cc xt nghim cn lm sng gip chn on DTS:- Tui xng (chp c v bn tay tri)- Test ng Gn - RH

- nh lng testosterone hay estradiol- Siu m t cung - bung trng, niu bo tr gi.nh ngha dy th sm tht (DTST) : Dy th sm tht do hot ng sm ca trc h

i - tuyn yn - tuyn sinh dc [2].Chn on xc nh DTST:- Tui xng > tui thc.- Test Gn - RH: LH tng cao v cao hn FSHChn on xc nh dy th sm trung ng bng test: Tim 100 mcg GnRH, gy tng LH

nhiu hn tng FSH 20 - 40 pht sau tim 100 mcg GnRH [5].- Chiu cao t cung > 36 mm, estradiol 30 pg/ml (tr gi)- Testosterone > 0,5 ng/ml (tr trai).

Nng Testosterone c ch trong vic xc nh ngun gc ca cc triu chng dy thsm tr trai, cc gonadotropin nh FSH v LH c bit c ch nu nng vt qu 5 UI/L.y l mt ch im ca dy th sm. Nu FSH gim v LH gim km Testosterone tng cnngh n dy th sm gi, tri ngc vi dy th sm trung ng [5].

Nguyn nhn DTST:+ DTST tr gi > 80% l v cn.+ DTST tr trai 80% l do u no.Xt nghim h thng chn on hnh nh no b bng CT Scanner hay MRI[2],[5].MRI vng h i - tuyn yn gip oan chc chn on dy th sm trung ng sau khi

xt nghim cc hormone [5].Cc nguyn nhn trung ng : tn thng h thn kinh trungng, hoc tn thng tuyn yn, u tit Gonadotropin [3].

C 3 nhm nguyn nhn ca DTST:

1. NGUYN NHN DTST TI NO B* U t bo hnh sao, u thn kinh m, u t bo mm tit HCG (u tit Gonadotropin) nh

gliome, u m tha vng di i (hamartomas) v cc tn thng h thn kinh do chnthng, tia x hoc abces [5].

Cc bt thng bm sinh nh no ng thu, cc nang khoang di nhn, v cc nang trnh yn (suprasellar) cng c th ct ngang tin trnh dy th bnh thng [5].

* Khng do u: Kyste tuyn tng, no ng thu* Kch thch no b

* Chn thng no* Tin s vim mng no - vim no.2. NGUYN NHN GIA NH

3. V CN [2]Chn on DTST nguyn nhn trung ng tr trai:Trong tnh hung ny, trc vng di i - tuyn yn - tuyn sinh dc s b hot ho sm

[3],[4].Lm sng: Th tch tinh hon tng hai bn i xng khng c u ccCc vn v thn kinh: lit, ph gai th , xut huyt vng mc ...Xt nghim hormone c nng mc dy th (Testosterone >0,5 ng/ml)

Sau khi xt nghim hormone, lm MRI v /hoc test kch thch bng GnRH hoc c hai,test kch thch bng GnRH to ra p ng dy th [3].

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