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Cushing Syndrome презентация
Содержание
- 1. Cushing Syndrome
- 2. Cushing Syndrome Cushing's syndrome is a collection of
- 3. Adrenal gland anatomy Mineralocorticoids Glucocorticoids
- 4. Hypothalamic pituitary adrenal axis
- 5. Circadian rhythm of cortisol secretion
- 6. Classification of Cushing syndrome exogenic endogenic ACTH
- 7. Epidemiology Rare endocrine disorder 2.3/1,000,000/year Cushings
- 8. Clinical picture
- 9. Clinical picture Central obesity
- 10. Clinical picture Moon face
- 11. Clinical picture Buffalo hump
- 12. Clinical picture Striae
- 13. Clinical picture Hirsutism & acne
- 14. Complications Metabolic syndrome CVD Hypercoagulability
- 15. Laboratory Hyperglycemia Hypokalemia Metabolic alkalosis
- 16. Diagnosis UFC in 24 h urine collection
- 17. Diagnosis ACTH level in blood less
- 18. Cushing’s disease investigation
- 19. Adrenal Cushing investigation adenoma carcinoma
- 20. Bilateral inferior petrosal sinus sampling Differential diagnosis of central and ectopic Cushings
- 21. Treatment of Cushing’s disease Transohenoidal surgery Cure
- 22. Treatment of Adrenal Cushing Adrenalectomy Medical treatment (Ketoconazole, Metyrapone, Mitotane) GK supplemental treatment
- 23. Thank You!
Cushing Syndrome Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to cortisol In pituitary Cushing's, a benign pituitary adenoma secretes ACTH. This is also known as
Слайд 2Cushing Syndrome
Cushing's syndrome is a collection of signs and symptoms due to
prolonged exposure to cortisol
In pituitary Cushing's, a benign pituitary adenoma
secretes ACTH. This is also known as Cushing's
disease and is responsible for 70% of endogenous
Cushing's syndrome.
In pituitary Cushing's, a benign pituitary adenoma
secretes ACTH. This is also known as Cushing's
disease and is responsible for 70% of endogenous
Cushing's syndrome.
Слайд 3
Adrenal gland anatomy
Mineralocorticoids
Glucocorticoids
Androgens
Catecholamines
cortex
medulla
capsule
Слайд 6Classification of Cushing syndrome
exogenic
endogenic
ACTH independent
20%
ACTH dependent
80%
central
80%
ectopic
20%
adenoma 60%
carcinoma
40%
rare
2%
Macronodular adrenal hyperplasia
PPNAD
McCune-Albright
SCCA
Carcinoid
Pancreatic Ca
Medullary Ca
of thyroid
Pheochromocytoma
Pheochromocytoma
Слайд 7Epidemiology
Rare endocrine disorder 2.3/1,000,000/year
Cushings dis. 1.5/1,000,000/year, women>>men, 25-45
Adrenal adenoma 0.6/1,000,000/year, women>>men
Adrenal
carcinoma 0.2/1,000,000/year, 50% Cushing syndr. in children
Ectopic Cushing, 1% SSCA, men>women, after 50
Ectopic Cushing, 1% SSCA, men>women, after 50
Слайд 14Complications
Metabolic syndrome
CVD
Hypercoagulability & thromboembolism
Bleeding
Immunosuppression & opportunistic infections
High mortality
Слайд 15Laboratory
Hyperglycemia
Hypokalemia
Metabolic alkalosis
Leucocytosis, neutropenia, eosinophilia
High non-supressible level of cortisol in blood/urine
Слайд 16Diagnosis
UFC in 24 h urine collection (twice)
Normal less than 150 nmol
(50 mkg)/24 h
Late evening salivary cortisol
Normal less than 4 nmol/l (150 ng/dl)
Late evening serum cortisol
Overnight Dexamethasone Test
Normal less than 50 nmol/l (1.8 nmkg/dl)
Late evening salivary cortisol
Normal less than 4 nmol/l (150 ng/dl)
Late evening serum cortisol
Overnight Dexamethasone Test
Normal less than 50 nmol/l (1.8 nmkg/dl)
Specificity of one test 84-90%
Specificity of two tests 96%
Слайд 17Diagnosis
ACTH level in blood
less than 5 pg/ml: ACTH independent (adrenal)
more than
5 pg/ml: ACTH dependent (central or ectopic)
Слайд 20Bilateral inferior petrosal sinus sampling
Differential diagnosis of central and ectopic Cushings
Слайд 21Treatment of Cushing’s disease
Transohenoidal surgery
Cure after the operation 70-80%
10-years cure 60-70%
Medical
treatment
Dopamine-agonist Cabergoline
Somatostatine-analog Pasireotide
Irradiation
Adrenalectomy
Surgery
drugs
Dopamine-agonist Cabergoline
Somatostatine-analog Pasireotide
Irradiation
Adrenalectomy
Surgery
drugs
Слайд 22Treatment of Adrenal Cushing
Adrenalectomy
Medical treatment (Ketoconazole, Metyrapone, Mitotane)
GK supplemental treatment
