Feokromositoma

Feokromositoma

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Definisi

Feokromostioma adalah tumor langka yang biasanya jinak (non-kanker) yang bertumbuh pada kelenjar adrenal. Anda memiliki dua kelenjar adrenal yang terletak di atas masing-masing ginjal. Kelenjar adrenal merupakan bagian dari sistem endokrin tubuh (yang memproduksi hormon).

Biasanya, feokromositoma tumbuh hanya pada satu kelenjar adrenal. Namun, tumor juga dapat tumbuh pada kedua kelenjar.

 

Penyebab

Para peneliti tidak mengetahui pasti apa yang menyebabkan feokromositoma. Tumor berkembang pada sel yang disebut sel kromafin, yang berada pada pusat kelenjar adrenal. Sel ini melepaskan hormon tertentu, terutama adrenalin (epinefrin) dan noradrenalin (norepinefrin). Hormon ini membantu mengontrol banyak fungsi tubuh, seperti detak jantung, tekanan darah, dan gula darah.

Adrenalin dan noradrenalin menyebabkan peningkatan tekanan darah dan kecepatan detak jantung. Feokromositoma menyebabkan pelepasan hormon ini menjadi lebih banyak dan pada situasi yang tidak dibutuhkan.

Kebanyakan sel kromafin berada pada kelenjar adrenal. Namun beberapa klister sel ini juga terdapat pada jantung, kepala, leher, kandung kemih, dinding belakang perut, dan spenajang tulang belakang. Tumor sel kromafin yang berada di luar kelenjar adrenal disebut paraganglioma. Tumor ini dapat menyebabkan efek yang sama terhadap tubuh seperti feokromositoma.

 

Faktor Risiko

Kebanyakan feokromositoma ditemukan pada orang berusia 20 sampai 50 tahun. Namun, tumor dapat berkembang pada usia berapapun.

Orang yang memiliki penyakit keturunan langka tertentu memiliki peningkatan risiko mengalami feokromositoma atau paraganglioma. Tumor yang berkaitan dengan kelainan ini lebih mungkin bersifat ganas. Tumor juga lebih mungkin terjadi pada kedua kelenjar adrenal. Kelainan genetik ini meliputi:

  • Neoplasia endokrin multipel tipe 2, suatu kondisi yang menyebabkan tumor pada lebih dari satu bagian sistem endokrin. Terdapat dua tipe yaitu tipe 2A dan tipe 2B yang keduanya berkaitan dengan feokromositoma. Tumor lainnya yang berkaitan dengan kondisi ini dapat muncul pada bagian tubuh lainnya, termasuk pada tiroid, paratiroid, bibir, lidah, dan sistem pencernaan
  • Penyakit von Hippel-Lindau dapat menyebabkan tumor pada banyak lokasi, termasuk sistem saraf pusat, sistem endokrin, pankreas, dan ginjal
  • Neurofibromatosis 1 menyebabkan banyak tumor pada kulit (neurofibroma), bercak kulit pigmentasi, dan tumor pada saraf penglihatan
  • Sindrom paraganglioma herediter yang merupakan kelainan bawaan yang menyebabkan feokromositoma atau paraganglioma

 

Gejala

Tanda dan gejala feokromositoma yang sering terjadi meliputi:

  • Tekanan darah tinggi
  • Sakit kepala
  • Keringat berlebihan
  • Detak jantung cepat
  • Tremor
  • Pucat
  • Sesak nafas
  • Gejala seperti serangan panik

Tanda dan gejala yang lebih jarang terjadi dapat meliputi:

  • Kecemasan
  • Pandangan buram
  • Konstipasi
  • Penurunan berat badan

Gejala feokromositoma dapat berlangsung terus menerus, atau dapat terjadi atau memberat pada waktu tertentu. Hal ini disebut dengan spells. Spells dapat terjadi akibat aktivitas atau kondisi, makanan tinggi zat yang memengaruhi tekanan darah (tiramin), dan obat-obatan.

Aktivitas atau kondisi tertentu dapat menyebabkan perburukan gejala, seperti:

  • Aktivitas fisik berat
  • Cemas atau stres
  • Perubahan posisi tubuh, misalnya dari duduk ke berbaring atau berdiri
  • Persalinan
  • Operasi dan obat yang menyebabkan Anda tidur saat operasi (anestesia)

Makanan tinggi tiramin, suatu zat yang memengaruhi tekanan darah, juga dapat menyebabkan perburukan gejala. Tiramin sering ditemukan pada makanan fermentasi, diasamkan, diawetkan, terlalu matang, atau basi. Contohnya terdapat pada makanan:

  • Keju
  • Bir dan anggur
  • Cokelat
  • Daging kering atau asap

Obat tertentu yang dapat memperburuk gejala meliputi:

  • Monoamine oxidase inhibitors (MAOIs), seperti fenelzin, transilpromin, dan isokarboksazid
  • Stimulan, seperti amfetamin atau kokain

 

Diagnosis

Untuk mendiagnosis feokromositoma, dokter kemungkinan akan melakukan beberapa tes.

  • Tes laboratorium untuk mengukur kadar adrenalin, noradrenalin, atau zat yang merupakan produk sampingan hormon ini dalam tubuh Anda:
    • Tes urin 24 jam. pada tes ini, Anda mengumpulkan sampel urin setiap Anda berkemih selama periode 24 jam
    • Tes darah
  • Pemeriksaan radiologi. Jika hasil tes darah menunjukan adanya feokromositoma atau paraganglioma, dokter kemungkinan akan melakukan satu atau lebih pemeriksaan radiologi untuk menemukan kemungkinan adanya tumor. Pemeriksaan ini meliputi:
    • CT scan
    • MRI
    • M-iodobenzylguanidine (MIBG), suatu teknologi scan yang dapat mendeteksi sejumlah kecil zat radioaktif yang disuntikan yang diambil oleh feokromositoma atau paraganglioma
    • PET scan, yang mendeteksi zat radioaktif yang diambil oleh tumor
  • Tes genetik. Dokter dapat merekomendasikan tes genetik untuk menentukan apakah feokromositoma berkaitan dengan kelainan bawaan. Informasi mengenai kemungkinan adanya faktor genetik dapat penting karena:
    • Beberapa kelainan bawaan dapat menyebabkan beragam kondisi medis, sehingga hasil pemeriksaan dapat mengindikasikan keperluan untuk pemerikaan kelainan lainnya
    • Beberapa kelainan lebih mungkin untuk kambuh kembali atau menjadi kanker, sehingga hasil tes Anda dapat memengaruhi keputusan terapi atau perencanaan jangka panjang untuk memantau kesehatan Anda
    • Hasil tes dapat mengindikasikan bahwa anggota keluarga lainnya juga harus diperiksa untuk adanya feokromositoma atau kondisi terkait lainnya

 

Tata Laksana

Terapi primer untuk feokromositoma adalah operasi untuk mengangkat tumor. Sebelum menjalani operasi, dokter akan meresepkan obat penurun tekanan darah spesifik.

Pada kebanyakan kasus, dokter akan mengangkat seluruh kelenjar adrenal dengan feokromositoma. Namun, dokter juga dapat hanya mengangkat tumor dan meninggalkan jaringan kelenjar adrenal yang sehat. Hal ini dapat dilakukan jika kelenjar adrenal yang satu juga telah diangkat atau terdapat tumor pada kedua kelenjar adrenal.

Jika tumor bersifat ganas, tumor dan jaringan kanker lainnya akan diangkat.

Terapi untuk tumor ganas dan kanker yang sudah menyebar pada tubuh dapat meliputi:

  • Terapi target menggunakan obat atau zat yang fokus pada abnormalitas spesifik pada sel kanker yang memungkinkannya untuk bertahan hidup
  • Kemoterapi menggunakan obat kuat yang membunuh sel kanker yang bertumbuh cepat
  • Terapi radiasi yang dapat memperbaiki gejala tumor yang menyebar ke tulang dan menyebabkan nyeri

 

Komplikasi

Tekanan darah tinggi dapat merusak organ, terutama jantung dan pembuluh darah, otak, dan ginjal. Kerusakan ini dapat menyebabkan beberapa kondisi kritis, seperti:

  • Penyakit jantung
  • Strok
  • Gagal ginjal
  • Gangguan pada saraf mata

Meskipun jarang, feokromositoma dapat bersifat ganas dan sel ganas ini menyebar ke bagian tubuh lainnya. Sel kanker dari feokromositoma atau paraganglioma paling sering menyebar ke sistem getah bening, tulang, hati, atau paru.

 

Baca Juga: Gagal Ginjal Akut - Definisi, Penyebab, Gejala, dan Pengobatannya

 

Pencegahan

Anda tidak dapat mencegah feokromositoma. Namun, jika Anda berisiko terkena feokromositoma akibat sindrom dan penyakit genetik bawaan, konseling genetik dapat membantu skrining awal feokromositoma dan membantu Anda menanganinya pada fase dini.

 

Kapan Harus ke Dokter?

Temui dokter jika hal dibawah ini terjadi pada Anda:

  • Sulit mengontrol tekanan darah tinggi dengan terapi yang diberikan
  • Spells tekanan darah tinggi yang memburuk
  • Riwayat keluarga dengan feokromositoma
  • Riwayat keluarga dengan kelainan genetik yang berkaitan seperti neoplasia endokrin multipel tipe 2, penyakit von Hippel-Lindau, sindrom paraganglioma herediter, atau neurofibromatosis 1

 

Mau tahu informasi seputar penyakit lainnya? Cek di sini, ya!

 

 

Writer : dr Tea Karina Sudharso
Editor :
  • dr. Monica Salim
Last Updated : Selasa, 11 Juni 2024 | 06:44

Pheochromocytoma (2022) Mayo Clinic. Mayo Foundation for Medical Education and Research. Available at: https://www.mayoclinic.org/diseases-conditions/pheochromocytoma/symptoms-causes/syc-20355367 (Accessed: April 14, 2023). 

Pheochromocytoma: Causes, symptoms & treatment (2022) Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/23373-pheochromocytoma#prevention (Accessed: April 14, 2023). 

Pheochromocytoma (2020) National Cancer Institute. Available at: https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-endocrine-tumor/pheochromocytoma (Accessed: April 14, 2023). 

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      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • WebController.php#377aicare_prod_new139msselect * from `posts` where `status` = 1 and `publish_date` <= '2025-01-12 20:36:08' and `content_type` = 'article' order by RAND() limit 7
      Bindings
      • 0: 1
      • 1: 2025-01-12 20:36:08
      • 2: article
      Hints
      • Use SELECT * only if you need all columns from table
      • ORDER BY RAND() is slow, try to avoid if you can. You can read this or this
      Backtrace
      • app/Http/Controllers/WebController.php:377
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • WebController.php#391aicare_prod_new9.48msupdate `posts` set `views_count` = 733 where `id` = 6977
      Bindings
      • 0: 733
      • 1: 6977
      Backtrace
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • ActivityLogger.php#174aicare_prod_new6.07msinsert into `activity_log` (`log_name`, `properties`, `batch_uuid`, `event`, `subject_id`, `subject_type`, `description`, `updated_at`, `created_at`) values ('default', '[]', null, 'updated', 6977, 'App\\Models\\Admin\\Post', 'updated', '2025-01-12 20:36:08', '2025-01-12 20:36:08')
      Bindings
      • 0: default
      • 1: []
      • 2: 
      • 3: updated
      • 4: 6977
      • 5: App\Models\Admin\Post
      • 6: updated
      • 7: 2025-01-12 20:36:08
      • 8: 2025-01-12 20:36:08
      Backtrace
      • vendor/spatie/laravel-activitylog/src/ActivityLogger.php:174
      • vendor/spatie/laravel-activitylog/src/Traits/LogsActivity.php:88
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
    • single-post-healthpedia.blade.php#37aicare_prod_new1.24msselect * from `users` where `users`.`id` = 31 limit 1
      Bindings
      • 0: 31
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.single-post-healthpedia:37
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new10.22msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 1703 and `categories`.`deleted_at` is null
      Bindings
      • 0: 1703
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.91msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 4950 and `categories`.`deleted_at` is null
      Bindings
      • 0: 4950
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new6.94msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 64 and `categories`.`deleted_at` is null
      Bindings
      • 0: 64
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.25msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 858 and `categories`.`deleted_at` is null
      Bindings
      • 0: 858
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#11aicare_prod_new1.06msselect * from `categories` where `categories`.`id` = 4 and `categories`.`deleted_at` is null limit 1
      Bindings
      • 0: 4
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.partials.article-popular:11
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.94msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8723 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8723
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.95msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 7807 and `categories`.`deleted_at` is null
      Bindings
      • 0: 7807
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new9.28msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 5298 and `categories`.`deleted_at` is null
      Bindings
      • 0: 5298
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.29msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2805 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2805
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new8.59msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2472 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2472
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new8.56msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 6536 and `categories`.`deleted_at` is null
      Bindings
      • 0: 6536
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new8.05msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 6132 and `categories`.`deleted_at` is null
      Bindings
      • 0: 6132
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new9.07msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 5802 and `categories`.`deleted_at` is null
      Bindings
      • 0: 5802
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#122aicare_prod_new1.19msselect * from `pages` where `slug` = 'about-us' limit 1
      Bindings
      • 0: about-us
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:122
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#547aicare_prod_new970μsselect * from `faqs` limit 1
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:547
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#551aicare_prod_new1.37msselect * from `term_policies`
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      Backtrace
      • view::layouts.v2.web_layout:551
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    App\Models\Admin\Post
    27Post.php#?
    App\Models\Admin\Category
    24Category.php#?
    App\User
    4User.php#?
    App\Models\Admin\Tag
    3Tag.php#?
    App\Models\TermPolicy
    3TermPolicy.php#?
    App\Models\Admin\Page
    1Page.php#?
    App\Models\Admin\Faq
    1Faq.php#?
        locale
        id
        _token
        9HqcpinO5rDPLHXbktTwGmzuOmobRkf0Q26Bge19
        _previous
        array:1 [ "url" => "https://ai-care.atmatech.id/healthpedia-penyakit/feokromositoma" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        path_info
        /healthpedia-penyakit/feokromositoma
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:20 [ "priority" => array:1 [ 0 => "u=0, i" ] "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""HeadlessChrome";v="129", "Not=A?Brand";v="8", "Chromium";v="129"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] "connection" => array:1 [ 0 => "close" ] "x-real-ip" => array:1 [ 0 => "18.116.52.234" ] "x-forwarded-for" => array:1 [ 0 => "18.116.52.234" ] "x-forwarded-proto" => array:1 [ 0 => "https" ] "x-forwarded-scheme" => array:1 [ 0 => "https" ] "host" => array:1 [ 0 => "ai-care.atmatech.id" ] ]
        request_cookies
        []
        
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