库欣综合征英文版.ppt

Effects of glucocorticoidEffects on metabolismEffects on immunologic function and inflammatoryEffects on musculoskeletal and connective tissuesEffects on fluid and electrolyte homeostasisNeuropsychiatric and behavioral effectsGastrointestinal effectsDevelopmental effects Clinical featuresObesity (The increased fat distribution is not generalized)Moon-shaped face and plethoricPurple striaeHypertensionIGT OsteoporosisHypokalemic alkalosis Suspected Cushing’s synd.Plasma cortisol?Urinary free cortisol?Urinary 17-OHCS ?Low dose dexamethasone suppression test2.0mg/day?2days50% reduce from basal50% reduce from basalNORMALCushing’s Synd.High dose dexamethasone suppression test8.0mg/day?2days50% reduce from basal50% reduce from basalProbableCushing’s DiseaseAdrenal DiseaseEctopic ACTH Synd.Suspected Cushing’s synd.Plasma ACTH ? Adrenal DiseaseEctopic ACTH SyndPlasma ACTHIncreasedLowProbable Ectopic ACTH Synd.Probable Adrenal DiseaseTumor SearchCT /MRI Scan of AdrenalspositivenegativeECTOPICACTHSYNDROMEnormaladrenal massConsiderAdrenonodularHyperplasia,Other Disordersurinary 17-KSPlasma DHEA17-KS? DHEA ? ADRENALCARCINOMADHEA? ?17-KS ? ?ADRENALADENOMA Nyctohemeral rhythmNeural stimuliCRHACTHCortisol ? Cortisol(CBG bound) (free)Physiological andMetabolic effectsNegativefeedbackPlasmaHypothalamusAnterior pituitaryAdrenal cortexInactivation by reduction and conjugationLiverUnchanged cortisol(measured as urinary free cortisol)TetrahydrocortisolTetrahydrocortisoneCortols,Cortolones(measurd as urinary 17-OHCS)UrineThe hypothalamic-pituitary-adrenal axis hypothalamuspituitaryadrenalDrugs: Cyproheptadine Metergoline BromocryptineAdrenalectomySurgery:Transsphenoidal microsurgeryRadiation: 60Co linear acceleratorDrug: o,p’DDD(mitotane) Metyrapone Aninoglutethmide ketokonazoleCRHACTHCSSurgeryRadiation TREATMENT