B\u1ec7nh th\u01b0\u1eddng x\u1ea3y ra \u1edf tu\u1ed5i thi\u1ebfu ni\u00ean, trong \u0111\u1ed9 tu\u1ed5i t\u1eeb 3 \u2013 15. \u0110a s\u1ed1 nh\u1eefng tr\u01b0\u1eddng h\u1ee3p c\u00f3 tri\u1ec7u ch\u1ee9ng tr\u01b0\u1edbc tu\u1ed5i 30. T\u1ec9 l\u1ec7 nam gi\u1edbi v\u00e0 n\u1eef gi\u1edbi m\u1eafc b\u1ec7nh t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau.<\/p>\n
\u0110\u1eb7c tr\u01b0ng l\u00e2m s\u00e0ng c\u1ee7a b\u1ec7nh l\u00e0 t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng ti\u1ebfn tri\u1ec3n l\u00e0nh t\u00ednh, bi\u1ebfn d\u1ea1ng x\u01b0\u01a1ng, \u0111au x\u01b0\u01a1ng, g\u00e3y x\u01b0\u01a1ng<\/a>.<\/p>\n Lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a \u0111\u1ed9t bi\u1ebfn ng\u1eabu nhi\u00ean gen GNAS \u1edf v\u1ecb tr\u00ed nhi\u1ec5m s\u1eafc th\u1ec3 20q13.2 \u2013 q13.3 (m\u00e3 h\u00f3a cho ti\u1ec3u \u0111\u01a1n v\u1ecb \u03b1 c\u1ee7a th\u1ee5 th\u1ec3 protein k\u1ebft h\u1ee3p Gs) c\u1ee7a t\u1ea1o c\u1ed1t b\u00e0o. Trong x\u01b0\u01a1ng, c\u00e1c t\u00edn hi\u1ec7u Gs\u03b1 c\u1ea5u th\u00e0nh d\u1eabn \u0111\u1ebfn s\u1ef1 bi\u1ec7t h\u00f3a v\u00e0 t\u0103ng sinh c\u1ee7a c\u00e1c t\u1ea1o c\u1ed1t b\u00e0o. C\u00e1c t\u1ea1o c\u1ed1t b\u00e0o \u00edt bi\u1ec7t h\u00f3a n\u00e0y c\u00f2n t\u0103ng s\u1ea3n xu\u1ea5t interleukin IL-6, l\u00e0m t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c t\u1ebf b\u00e0o h\u1ee7y x\u01b0\u01a1ng, g\u00e2y n\u00ean c\u00e1c t\u1ed5n th\u01b0\u01a1ng ti\u00eau x\u01b0\u01a1ng d\u01b0\u1edbi d\u1ea1ng c\u00e1c h\u1ed1c x\u01b0\u01a1ng trong m\u00f4 x\u01a1 c\u0169ng nh\u01b0 trong x\u01b0\u01a1ng l\u00e0nh quanh \u0111\u00f3. M\u1ed9t ho\u1eb7c nhi\u1ec1u v\u00f9ng x\u01b0\u01a1ng kh\u00f4ng tr\u01b0\u1edfng th\u00e0nh b\u00ecnh th\u01b0\u1eddng v\u00e0 v\u1eabn \u1edf d\u1ea1ng b\u00e8 x\u01b0\u01a1ng non, kho\u00e1ng h\u00f3a k\u00e9m s\u1eafp x\u1ebfp b\u1ea5t th\u01b0\u1eddng, r\u1ea3i r\u00e1c trong m\u00f4 s\u1ee3i lo\u1ea1n s\u1ea3n. Khi x\u01b0\u01a1ng ph\u00e1t tri\u1ec3n, m\u00f4 x\u01a1 m\u1ec1m lan r\u1ed9ng, l\u00e0m x\u01b0\u01a1ng y\u1ebfu \u0111i, bi\u1ebfn d\u1ea1ng v\u00e0 d\u1ec5 g\u00e3y.<\/p>\n Thu\u1eadt ng\u1eef lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng \u0111\u01b0\u1ee3c Lichtenstein<\/a> \u0111\u1eb7t t\u00ean v\u00e0o n\u0103m 1938. M\u1ed9t ho\u1eb7c nhi\u1ec1u v\u00f9ng x\u01b0\u01a1ng kh\u00f4ng tr\u01b0\u1edfng th\u00e0nh b\u00ecnh th\u01b0\u1eddng v\u00e0 v\u1eabn \u1edf d\u1ea1ng b\u00e8 x\u01b0\u01a1ng non, kho\u00e1ng h\u00f3a k\u00e9m s\u1eafp x\u1ebfp b\u1ea5t th\u01b0\u1eddng, r\u1ea3i r\u00e1c trong m\u00f4 s\u1ee3i lo\u1ea1n s\u1ea3n. Khi x\u01b0\u01a1ng ph\u00e1t tri\u1ec3n, m\u00f4 x\u01a1 m\u1ec1m lan r\u1ed9ng, l\u00e0m x\u01b0\u01a1ng y\u1ebfu \u0111i, bi\u1ebfn d\u1ea1ng v\u00e0 d\u1ec5 g\u00e3y.<\/p>\n C\u00e1c t\u1ebf b\u00e0o m\u00f4 t\u1ebf b\u00e0o t\u1ee7y x\u01b0\u01a1ng trong ch\u1ee9ng lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng t\u1ea1o ra l\u01b0\u1ee3ng d\u01b0 th\u1eeba c\u1ee7a y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng hormone \u0111i\u1ec1u h\u00f2a phosphat-23 (FGF23), d\u1eabn \u0111\u1ebfn m\u1ea5t phosphate trong n\u01b0\u1edbc ti\u1ec3u. B\u1ec7nh nh\u00e2n b\u1ecb gi\u1ea3m phosphat m\u00e1u c\u00f3 th\u1ec3 b\u1ecb c\u00f2i x\u01b0\u01a1ng, nhuy\u1ec5n x\u01b0\u01a1ng v\u00e0 \u0111au x\u01b0\u01a1ng.<\/p>\n Ch\u1ee7 y\u1ebfu d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 c\u00e1c th\u0103m d\u00f2 ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh, \u0111\u1eb7c bi\u1ec7t l\u00e0 h\u00ecnh \u1ea3nh X-quang<\/a> \u0111\u1eb7c tr\u01b0ng.<\/p>\n 1. L\u00e2m s\u00e0ng<\/strong><\/p>\n C\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng r\u1ea5t phong ph\u00fa, \u0111a d\u1ea1ng, t\u1eeb m\u1ed9t t\u1ed5n th\u01b0\u01a1ng \u0111\u01a1n \u0111\u1ed9c, kh\u00f4ng tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n t\u00ecnh c\u1edd, \u0111\u1ebfn b\u1ec7nh m\u1ea5t kh\u1ea3 n\u0103ng nghi\u00eam tr\u1ecdng li\u00ean quan \u0111\u1ebfn to\u00e0n b\u1ed9 khung x\u01b0\u01a1ng v\u00e0 d\u1eabn \u0111\u1ebfn m\u1ea5t th\u1ecb l\u1ef1c, th\u00ednh gi\u00e1c v\u00e0\/ho\u1eb7c v\u1eadn \u0111\u1ed9ng.<\/p>\n Lo\u1ea1n s\u1ea3n x\u01b0\u01a1ng c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf nhi\u1ec1u x\u01b0\u01a1ng hay ch\u1ec9 \u1edf m\u1ed9t x\u01b0\u01a1ng, do v\u1eady, c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00e1c nhau:<\/p>\n + \u0110au x\u01b0\u01a1ng, th\u01b0\u1eddng \u0111au \u00e2m \u1ec9 nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh<\/p>\n + S\u01b0ng n\u1ec1<\/p>\n + Bi\u1ebfn d\u1ea1ng x\u01b0\u01a1ng<\/p>\n + G\u00e3y x\u01b0\u01a1ng b\u1ec7nh l\u00fd, \u0111\u1eb7c bi\u1ec7t \u1edf tay v\u00e0 ch\u00e2n (H\u00ecnh 34.1)<\/p>\n + Kh\u00f3 kh\u0103n khi \u0111i l\u1ea1i, v\u1eb9o x\u01b0\u01a1ng ch\u00e2n<\/p>\n + C\u00f2i x\u01b0\u01a1ng<\/p>\n + Bi\u1ebfn ch\u1ee9ng ung th\u01b0 x\u01b0\u01a1ng (sarcom x\u01b0\u01a1ng, sarcom s\u1ee3i, sarcom s\u1ee5n).<\/p>\n + C\u00e1c x\u01b0\u01a1ng th\u01b0\u1eddng b\u1ecb \u1ea3nh h\u01b0\u1edfng: x\u01b0\u01a1ng \u0111\u00f9i, x\u01b0\u01a1ng ch\u00e0y,\u00a0 \u00a0x\u01b0\u01a1ng c\u00e1nh tay, h\u1ed9p s\u1ecd, x\u01b0\u01a1ng s\u01b0\u1eddn, khung ch\u1eadu,…<\/p>\n <\/p>\n + T\u1ed5n th\u01b0\u01a1ng ngo\u00e0i x\u01b0\u01a1ng: trong s\u1ed1 \u00edt c\u00e1c tr\u01b0\u1eddng h\u1ee3p, lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p v\u1edbi b\u1ea5t th\u01b0\u1eddng n\u1ed9i ti\u1ebft (d\u1eady th\u00ec s\u1edbm, c\u01b0\u1eddng gi\u00e1p, c\u01b0\u1eddng c\u1eadn gi\u00e1p, h\u1ed9i ch\u1ee9ng Cushing, t\u1ed5n th\u01b0\u01a1ng tuy\u1ebfn y\u00ean), m\u1ea3ng s\u1eafc t\u1ed1 da. \u0110au x\u01b0\u01a1ng t\u0103ng c\u0169ng c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn s\u1ef1 thay \u0111\u1ed5i n\u1ed9i ti\u1ebft t\u1ed1 b\u00ecnh th\u01b0\u1eddng c\u1ee7a chu k\u1ef3 kinh nguy\u1ec7t ho\u1eb7c mang thai.<\/p>\n 2. C\u1eadn l\u00e2m s\u00e0ng<\/strong><\/p>\n CT-scan: \u0111\u00e1nh gi\u00e1 ti\u1ebfn tri\u1ec3n c\u1ee7a t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng v\u1ecb tr\u00ed ph\u1ee9c t\u1ea1p nh\u01b0 c\u1ed9t s\u1ed1ng, khung ch\u1eadu, l\u1ed3ng ng\u1ef1c hay x\u01b0\u01a1ng s\u1ecd m\u1eb7t, c\u0169ng nh\u01b0 lan r\u1ed9ng t\u1ed5n th\u01b0\u01a1ng ra ph\u1ea7n m\u1ec1m c\u1ea1nh c\u1ed9t s\u1ed1ng.<\/p>\n H\u00ccNH<\/strong><\/p>\n X\u00e9t nghi\u1ec7m m\u00e1u: t\u0103ng n\u1ed3ng \u0111\u1ed9 men phosphatase ki\u1ec1m. X\u00e9t nghi\u1ec7m n\u01b0\u1edbc ti\u1ec3u cho th\u1ea5y t\u0103ng n\u1ed3ng \u0111\u1ed9 hydroxyprolin. Tuy nhi\u00ean, c\u00e1c b\u1ea5t th\u01b0\u1eddng n\u00e0y kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng.<\/p>\n – Th\u1ec3 m\u1ed9t \u1ed5:\u00a0<\/strong>h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n ch\u1ec9 c\u00f3 t\u1ed5n th\u01b0\u01a1ng m\u1ed9t x\u01b0\u01a1ng ( 70% c\u00e1c tr\u01b0\u1eddng h\u1ee3p )<\/p>\n B\u1ec7nh th\u01b0\u1eddng ph\u00e1t hi\u1ec7n \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, trong \u0111\u1ed9 tu\u1ed5i 20 \u2013 30. T\u1ed5n th\u01b0\u01a1ng c\u00f3 th\u1ec3 kh\u00f4ng c\u00f3 tri\u1ec7u tr\u1ee9ng, ho\u1eb7c \u0111au x\u01b0\u01a1ng t\u1ea1i ch\u1ed7, hay d\u1ec5 g\u00e3y x\u01b0\u01a1ng. C\u00e1c x\u01b0\u01a1ng hay b\u1ecb t\u1ed5n th\u01b0\u01a1ng nh\u1ea5t l\u00e0 x\u01b0\u01a1ng s\u01b0\u1eddn, x\u01b0\u01a1ng s\u1ecd, m\u1eb7t, \u0111\u1eb7c bi\u1ec7t x\u01b0\u01a1ng h\u00e0m, h\u00e0nh x\u01b0\u01a1ng hay th\u00e2n x\u01b0\u01a1ng c\u1ee7a \u0111\u1ea7u tr\u00ean x\u01b0\u01a1ng \u0111\u00f9i hay x\u01b0\u01a1ng ch\u00e0y. \u00d0a s\u1ed1 (95%) b\u1ec7nh t\u1ef1 \u1ed5n \u0111\u1ecbnh sau khi tr\u01b0\u1edfng th\u00e0nh, t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng l\u1edbn l\u00ean n\u1eefa.<\/p>\n – Th\u1ec3 \u0111a \u1ed5\u00a0<\/strong>( 30% tr\u01b0\u1eddng h\u1ee3p )<\/p>\n B\u1ec7nh n\u1eb7ng h\u01a1n v\u1edbi t\u1ed5n th\u01b0\u01a1ng nhi\u1ec1u n\u01a1i v\u00e0 lan r\u1ed9ng, g\u00e2y nhi\u1ec1u tri\u1ec7u ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng. B\u1ec7nh th\u01b0\u1eddng ph\u00e1t hi\u1ec7n s\u1edbm d\u01b0\u1edbi 10 tu\u1ed5i. Th\u01b0\u1eddng l\u00e0 m\u1ed9t ph\u00eda c\u1ee7a c\u01a1 th\u1ec3 b\u1ecb m\u1eafc b\u1ec7nh. Tuy nhi\u00ean, kho\u1ea3ng 1\/4 b\u1ec7nh nh\u00e2n t\u1ed5n th\u01b0\u01a1ng d\u1ea1ng \u0111a x\u01b0\u01a1ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng h\u01a1n m\u1ed9t n\u1eeda khung x\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t \u1edf chi d\u01b0\u1edbi. T\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng m\u1eb7t s\u1ecd g\u1eb7p \u1edf 1\/2 b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng nhi\u1ec1u n\u01a1i. Khi t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng s\u1ecd, m\u1eb7t b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng ch\u00e8n \u00e9p th\u1ea7n kinh m\u1ea1ch m\u00e1u nh\u01b0: \u0111au \u0111\u1ea7u, \u00f9 tai, m\u1ea5t th\u1ecb gi\u00e1c, b\u1ea5t th\u01b0\u1eddng th\u1ea7n kinh s\u1ecd n\u00e3o, th\u1eadm ch\u00ed ch\u1ea3y m\u00e1u s\u1ecd n\u00e3o t\u1ef1 ph\u00e1t. Lo\u1ea1n s\u1ea3n x\u01b0\u01a1ng th\u00e1i d\u01b0\u01a1ng, th\u01b0\u1eddng \u1ea3nh h\u01b0\u1edfng k\u00eanh th\u00ednh gi\u00e1c c\u00f3 th\u1ec3 gi\u1ea3m th\u00ednh l\u1ef1c v\u00e0 b\u1ecbt t\u1eafc h\u1ed1c tai ngo\u00e0i, th\u01b0\u1eddng g\u1eb7p h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc h\u1ed9i ch\u1ee9ng McCune-Albright li\u00ean quan \u0111\u1ebfn d\u01b0 th\u1eeba hormone t\u0103ng tr\u01b0\u1edfng.<\/p>\n Th\u1ec3 \u0111a \u1ed5 c\u00f3 th\u1ec3 k\u1ebft h\u1ee3p d\u1eady th\u00ec s\u1edbm, lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng v\u00e0 \u0111\u00e1m da m\u00e0u c\u00e0 ph\u00ea s\u1eefa, g\u1ecdi l\u00e0 h\u1ed9i ch\u1ee9ng Albright hay u nh\u1ea7y trong c\u01a1 v\u00e2n (h\u1ed9i ch\u1ee9ng Mazabraud).<\/p>\n Lo\u1ea1n s\u1ea3n s\u1ee3i th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn c\u1ed9t s\u1ed1ng, c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn v\u1eb9o c\u1ed9t s\u1ed1ng, trong tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm g\u1eb7p c\u00f3 th\u1ec3 nghi\u00eam tr\u1ecdng. Kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb, v\u1eb9o c\u1ed9t s\u1ed1ng ti\u1ebfn tri\u1ec3n l\u00e0 m\u1ed9t trong s\u1ed1 \u00edt c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a ch\u1ee9ng lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong s\u1edbm.<\/p>\n V\u1ec1 m\u1eb7t ti\u00ean l\u01b0\u1ee3ng: th\u1ec3 m\u1ed9t \u1ed5 c\u00f3 ti\u00ean l\u01b0\u1ee3ng t\u1ed1t. T\u1ed5n th\u01b0\u01a1ng \u0111a \u1ed5 c\u00f3 xu h\u01b0\u1edbng ti\u1ebfn tri\u1ec3n n\u1eb7ng l\u00ean, \u0111\u00f4i khi c\u00f3 th\u1ec3 b\u1ecb \u00e1c t\u00ednh h\u00f3a th\u00e0nh sarcom x\u01b0\u01a1ng hay sarcom s\u1ee3i.<\/p>\n Ch\u01b0a c\u00f3 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u ch\u1eefa kh\u1ecfi b\u1ec7nh. B\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng kh\u00f4ng c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb, ch\u1ec9 c\u1ea7n theo d\u00f5i. H\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3 \u0111i\u1ec1u tr\u1ecb g\u00ec \u0111\u1ed1i v\u1edbi c\u00e1c t\u1ed5n th\u01b0\u01a1ng da ho\u1eb7c t\u00ecnh tr\u1ea1ng d\u1eady th\u00ec s\u1edbm. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng nh\u1eb1m gi\u1ea3i quy\u1ebft c\u00e1c t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng v\u00e0 t\u00f9y theo th\u1ec3 b\u1ec7nh m\u1ed9t ho\u1eb7c nhi\u1ec1u x\u01b0\u01a1ng. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng tia x\u1ea1 v\u00ec c\u00f3 th\u1ec3 chuy\u1ec3n d\u1ea1ng th\u00e0nh sarcom x\u01b0\u01a1ng. H\u00f3a tr\u1ecb kh\u00f4ng c\u00f3 k\u1ebft qu\u1ea3.<\/p>\n \u0110i\u1ec1u tr\u1ecb bao g\u1ed3m c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n v\u00e0 ngo\u1ea1i khoa, t\u00f9y theo v\u1ecb tr\u00ed v\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng x\u01b0\u01a1ng. B\u1ec7nh nh\u00e2n c\u1ea7n \u0111\u01b0\u1ee3c ph\u1ea3i theo d\u00f5i 6 th\u00e1ng m\u1ed9t l\u1ea7n, kh\u00e1m l\u00e2m s\u00e0ng, l\u00e0m c\u00e1c x\u00e9t nghi\u1ec7m v\u00e0 X-quang \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u01b0 ch\u00e8n \u00e9p th\u1ea7n kinh th\u1ecb gi\u00e1c.<\/p>\n + Gi\u1ea3m \u0111au x\u01b0\u01a1ng:<\/p>\n Thu\u1ed1c gi\u1ea3m \u0111au th\u00f4ng th\u01b0\u1eddng. S\u1eed d\u1ee5ng thu\u1ed1c theo b\u1eadc thang c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi. Ch\u1ecdn m\u1ed9t trong c\u00e1c thu\u1ed1c sau:<\/p>\n C\u00f3 th\u1ec3 d\u00f9ng c\u00e1c thu\u1ed1c nh\u00f3m bisphosphonat \u0111\u1ec3 gi\u1ea3m \u0111au x\u01b0\u01a1ng m\u1ea1n t\u00ednh, t\u0103ng m\u1eadt \u0111\u1ed9 x\u01b0\u01a1ng c\u1ed9t s\u1ed1ng v\u00e0 x\u01b0\u01a1ng \u0111\u00f9i, l\u00e0m gi\u1ea3m nguy c\u01a1 g\u00e3y x\u01b0\u01a1ng:<\/p>\n B\u1ed5 sung calci v\u00e0 vitamin D khi \u0111i\u1ec1u tr\u1ecb biphosphonat \u0111\u1ec3 tr\u00e1nh c\u01b0\u1eddng c\u1eadn gi\u00e1p th\u1ee9 ph\u00e1t:<\/p>\n Calcitonin ch\u1ec9 c\u00f3 t\u00e1c d\u1ee5ng \u1edf th\u1ec3 \u0111a \u1ed5 c\u00f3 k\u00e8m \u0111au x\u01b0\u01a1ng v\u00e0 t\u0103ng phosphatse ki\u1ec1m:<\/p>\n Qu\u1ea3n l\u00fd n\u1ed9i ti\u1ebft l\u00e0 m\u1ed9t th\u00e0nh ph\u1ea7n quan tr\u1ecdng c\u1ee7a qu\u1ea3n l\u00fd trong lo\u1ea1n s\u1ea3n x\u01b0\u01a1ng. T\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n m\u1eafc ch\u1ee9ng lo\u1ea1n s\u1ea3n s\u1ee3i n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh n\u1ed9i ti\u1ebft li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng McCune-Albright. \u0110\u1eb7c bi\u1ec7t, s\u1ef1 d\u01b0 th\u1eeba hormone t\u0103ng tr\u01b0\u1edfng kh\u00f4ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam ch\u1ee9ng lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng s\u1ecd v\u00e0 l\u00e0m t\u0103ng nguy c\u01a1 m\u00f9 l\u00f2a. \u0110i\u1ec1u tr\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n n\u1ed9i ti\u1ebft nh\u01b0: h\u1ed9i ch\u1ee9ng c\u01b0\u1eddng gi\u00e1p tr\u1ea1ng, h\u1ed9i ch\u1ee9ng Cushing, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/a>, d\u1eady th\u00ec s\u1edbm k\u00e8m theo b\u1eb1ng c\u00e1c thu\u1ed1c th\u00edch h\u1ee3p hay ph\u1eabu thu\u1eadt n\u1ebfu c\u00f3 ch\u1ec9 \u0111\u1ecbnh.<\/p>\n M\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa l\u00e0 d\u1ef1 ph\u00f2ng v\u00e0 \u0111i\u1ec1u tr\u1ecb c\u00e1c bi\u1ebfn d\u1ea1ng x\u01b0\u01a1ng n\u1eb7ng v\u00e0 g\u00e3y x\u01b0\u01a1ng, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c x\u01b0\u01a1ng ch\u1ecbu t\u1ea3i; kh\u1eafc ph\u1ee5c s\u1ef1 kh\u00e1c nhau \u0111\u1ed9 d\u00e0i chi d\u01b0\u1edbi; gi\u1ea3i ph\u00f3ng ch\u00e8n \u00e9p th\u1ea7n kinh, \u0111\u1eb7c bi\u1ec7t \u1edf v\u00f9ng s\u1ecd m\u1eb7t. \u0110i\u1ec1u tr\u1ecb c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m u\u1ed1n th\u1eb3ng v\u00e0 l\u00e0m m\u1ea1nh x\u01b0\u01a1ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng.<\/p>\n TI\u1ebeN TRI\u1ec2N V\u00c0 BI\u1ebeN CH\u1ee8NG<\/p>\n B\u1ec7nh nh\u00e2n c\u1ea7n \u0111eo n\u1eb9p \u0111\u1ec3 d\u1ef1 ph\u00f2ng g\u00e3y x\u01b0\u01a1ng. C\u00f3 ch\u1ebf \u0111\u1ed9 sinh ho\u1ea1t v\u1eadn \u0111\u1ed9ng h\u1ee3p l\u00fd. Tr\u00e1nh mang v\u00e1c, lao \u0111\u1ed9ng n\u1eb7ng. Ph\u00f2ng tr\u00e1nh ng\u00e3. C\u1ea7n t\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 sau 1 \u2013 3 th\u00e1ng, t\u00f9y theo t\u00ecnh tr\u1ea1ng b\u1ec7nh.<\/p>\n <\/p>\n <\/p>\n","protected":false},"featured_media":1365,"comment_status":"open","ping_status":"closed","template":"","tags":[134,122],"chuyen-muc":[61],"class_list":["post-1323","bai-giang","type-bai-giang","status-publish","has-post-thumbnail","hentry","tag-loan-san","tag-loan-san-xo-xuong","chuyen-muc-benh-ly"],"_links":{"self":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1323","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang"}],"about":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/types\/bai-giang"}],"replies":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/comments?post=1323"}],"version-history":[{"count":0,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/bai-giang\/1323\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media\/1365"}],"wp:attachment":[{"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/media?parent=1323"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/tags?post=1323"},{"taxonomy":"chuyen-muc","embeddable":true,"href":"https:\/\/bsvothanhtoan.com\/en\/wp-json\/wp\/v2\/chuyen-muc?post=1323"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}NGUY\u00caN NH\u00c2N, B\u1ec6NH SINH<\/h2>\n
CH\u1ea8N \u0110O\u00c1N<\/h2>\n
Ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh<\/h3>\n
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![\"Lo\u1ea1n](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/Loan-san-xo-xuong-o-xuong-dui.-Phim-X-quang-cho-thay-gay-xuong-o-vi-tri-dinh-mui-ten-1-220x300.png\" "\\"\\"")
![\"Lo\u1ea1n](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/loan-san-xo-xuong-ham-tren-300x214.jpg\" "\\"\\"")
\n(c) X-quang cho th\u1ea5y ph\u00e1 h\u1ee7y x\u01b0\u01a1ng h\u00e0m tr\u00ean, (d) Nh\u00ecn t\u1eeb khoang mi\u1ec7ng t\u1ed5n th\u01b0\u01a1ng \u2013 L\u01b0\u1ee3ng x\u01b0\u01a1ng b\u1ecb lo\u1ea1i b\u1ecf, (e) X-quang s\u1ecd sau ph\u1eabu thu\u1eadt, (f) H\u00ecnh sau ph\u1eabu thu\u1eadt. Ngu\u1ed3n: Lo\u1ea1n s\u1ea3n x\u01a1 x\u01b0\u01a1ng s\u1ecd: Ph\u1eabu thu\u1eadt v\u00e0 t\u1ed5ng quan t\u00e0i li\u1ec7u \u2013 Original article \u2013 practice guidelines (2013)<\/em><\/figcaption><\/figure><\/p>\n\n
![\"Picture4\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/Picture4-300x152.jpg\" "\\"\\"")
![\"Picture5\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/Picture5-216x300.jpg\" "\\"\\"")
\nth\u1eaft l\u01b0ng v\u00e0 x\u01b0\u01a1ng \u0111\u00f9i tr\u00e1i [4]<\/figcaption><\/figure><\/p>\n\n
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![\"Picture6\"](\"https:\/\/bsvothanhtoan.com\/wp-content\/uploads\/2023\/04\/Picture6-300x200.jpg\" "\\"\\"")
Ch\u1ea9n \u0111o\u00e1n th\u1ec3 b\u1ec7nh<\/h3>\n
Ch\u1ea9n \u0111o\u00e1n ph\u00e2n bi\u1ec7t<\/h3>\n
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\u0110I\u1ec0U TR\u1eca<\/h2>\n
Nguy\u00ean t\u1eafc chung<\/h3>\n
\u0110i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3<\/h3>\n
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PH\u00d2NG B\u1ec6NH<\/h2>\n