Hypercortisolism皮质醇增多症

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,Hypercortisolism,皮质醇增多症,Effects of glucocorticoid,糖皮质激素作用,Effects on metabolism,对代谢旳影响,Effects on immunologic function and inflammatory,免疫与炎症,Effects on musculoskeletal and connective tissues,肌肉骨骼与结缔组织,Effects on fluid and electrolyte homeostasis,水电解质平衡,Neuropsychiatric and behavioral effects,神经心理与行为效应,Gastrointestinal effects,胃肠道效应,Developmental effects,对发育旳影响,The hypothalamic-pituitary-adrenal axis,下丘脑-垂体-肾上腺轴,Nyctohemeral,rhythm,Neural stimuli,CRH,ACTH,Cortisol,Cortisol,(CBG bound)(free),Physiological and,Metabolic effects,Negative,feedback,Plasma,Hypothalamus,Anterior pituitary,Adrenal cortex,Inactivation by reduction and conjugation,Liver,Unchanged cortisol,(measured as UFC),Tetrahydrocortisol,Tetrahydrocortisone,Cortols,Cortolones,(measurd as urinary 17-OHCS),Urine,1ACTH 依赖性,Cushing disease,库欣病,垂体多有微腺瘤,少数为大腺瘤,Ectopic corticotropin syndrome,异位ACTH综合征,2非ACTH依赖性,Adrenal neoplasia,肾上腺皮质腺瘤,肾上腺皮质癌；,不依赖ACTH旳双侧性肾上腺小结节性增生；,不依赖ACTH性双侧肾上腺大结节性增生。3.假性库欣综合征：,医源性类库欣综合征,酒精性类库欣综合征,Pathogenesis,病因,Clinical features,临床特征,Obesity(The increased fat distribution is not generalized),向心性肥胖,Moon-shaped face and plethoric,满月脸,Purple striae,紫纹,Hypertension,高血压,IGT/Diabetes,糖耐量异常/糖尿病,Osteoporosis,骨质疏松,Hypokalemic alkalosis,低钾性碱中毒,Obesity,Moon-shaped face,7个月，8450g，114/52mmHg,Purple striae,Purple striae,痤疮,满月脸,面部/身体,体毛增多,体重增长,紫纹,伤口愈合慢,头发细,多血质貌,水牛背,锁骨上,脂肪垫,肌肉萎缩,皮肤菲薄,Diagnosis and Differential Diagnosis诊疗与鉴别,Suspected Cushings synd.,Plasma cortisol,Urinary free cortisol,Urinary 17-OHCS,Low dose dexamethasone suppression test,1.0mg/day,2days,50%reduce from basal,50%reduce from basal,NORMAL,Cushings Synd.,High dose dexamethasone suppression test,8.0mg/day,2days,50%reduce from basal,Probable,Cushings Disease,Adrenal Disease,Ectopic ACTH Synd.,Suspected Cushings synd.,Plasma ACTH,Adrenal Disease,Ectopic ACTH Syndrome,Plasma ACTH,Increased,Low,Probable Ectopic ACTH Synd.,Probable Adrenal Disease,Tumor Search,CT/MRI Scan of Adrenals,positive,negative,ECTOPIC,ACTH,SYNDROME,normal,adrenal mass,Consider,Adrenonodular,Hyperplasia,Other Disorders,urinary 17-KS,Plasma DHEA,17-KS,DHEA,ADRENAL,CARCINOMA,DHEA,17-KS,ADRENAL,ADENOMA,诊,断,流,程,TREATMENT治疗,CS,hypothalamus,pituitary,adrenal,Drugs:,Cyproheptadine,Metergoline,Bromocryptine,Adrenalectomy,Surgery:,Transsphenoidal microsurgery,Radiation:,60,Co,linear accelerator,Drug:,o,pDDD(mitotane),Metyrapone,Aninoglutethmide,ketokonazole,CRH,ACTH,Surgery,Radiation,病例分析,一40岁女性，自述近两年体重增长，尤其腹部，但体力却明显下降。到本地医院就诊时发觉血压高、血糖高、血脂高、血钾低，对症治疗不见好转来诊。,考虑哪些疾病可造成上述体现？线索？怎样鉴别？,