Hypercortisolism皮质醇增多症PPT课件下载推荐.pptx
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Hypercortisolism皮质醇增多症PPT课件下载推荐.pptx
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Effectsofglucocorticoid糖皮质激素作用,对代谢的影响,EffectsonmetabolismEffectsonimmunologicfunctionandinflammatory免疫与炎症Effectsonmusculoskeletalandconnectivetissues肌肉骨骼与结缔组织Effectsonfluidandelectrolytehomeostasis水电解质平衡Neuropsychiatricandbehavioraleffects神经心理与行为效应Gastrointestinaleffects胃肠道效应Developmentaleffects对发育的影响,Thehypothalamic-pituitary-adrenalaxis下丘脑-垂体-肾上腺轴,Nyctohemeralrhythm,Neuralstimuli,CRH,ACTH,CortisolCortisol(CBGbound)(free),PhysiologicalandMetaboliceffects,Negativefeedback,Plasma,Hypothalamus,Anteriorpituitary,Adrenalcortex,Inactivationbyreductionandconjugation,Liver,Unchangedcortisol(measuredasUFC),TetrahydrocortisolTetrahydrocortisoneCortols,Cortolones(measurdasurinary17-OHCS),Urine,Sometimesanoncanceroustumor(adenoma)developsintheadrenalglands,whichcausesthemtooverproducecorticosteroids.Adrenaladenomasareextremelycommon;@#@halfofallpeoplehavethembytheageof70.Onlyasmallfractionofadenomasproduceexcesshormone,however.Canceroustumorsoftheadrenalglandsareveryrare.Cushingssyndromecanalsodevelopinpeoplewhomusttakelargedosesofcorticosteroidsbecauseofaseriousmedicalcondition.Thosewhomusttakelargedoseshavethesamesymptomsasthosewhoproducetoomuchofthehormone.Thesymptomscanoccasionallyoccurevenifthecorticosteroidsareinhaled,asforasthma,orareusedtopicallyforaskincondition.,syndrome,ACTH依赖性Cushingdisease库欣病垂体多有微腺瘤少数为大腺瘤Ectopiccorticotropin异位ACTH综合征非ACTH依赖性Adrenalneoplasia肾上腺皮质腺瘤肾上腺皮质癌;@#@,不依赖ACTH的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,Clinicalfeatures临床特征,Obesity(Theincreasedfatdistributionisnotgeneralized)向心性肥胖Moon-shapedfaceandplethoric满月脸Purplestriae紫纹Hypertension高血压IGT/Diabetes糖耐量异常/糖尿病Osteoporosis骨质疏松Hypokalemicalkalosis低钾性碱中毒,Obesity,Moon-shapedface,7个月,8450g,114/52mmHg,Purplestriae,Purplestriae,痤疮,满月脸,面部/身体体毛增多体重增加紫纹,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,DiagnosisandDifferentialDiagnosis诊断与鉴别,SuspectedCushingssynd.PlasmacortisolUrinaryfreecortisolUrinary17-OHCS,Lowdosedexamethasonesuppressiontest1.0mg/day2days,50%reducefrombasal,NORMAL,50%reducefrombasalCushingsSynd.,Highdosedexamethasonesuppressiontest8.0mg/day2days,50%reducefrombasal,ProbableCushingsDisease,AdrenalDiseaseEctopicACTHSynd.,SuspectedCushingssynd.,50%reducefrombasalPlasmaACTH,AdrenalDiseaseEctopicACTHSyndrome,PlasmaACTH,IncreasedProbableEctopicACTHSynd.,LowProbableAdrenalDisease,TumorSearch,CT/MRIScanofAdrenals,positive,negative,ECTOPICACTHSYNDROME,normal,ConsiderAdrenonodularHyperplasia,OtherDisorders,adrenalmassurinary17-KSPlasmaDHEA,17-KSDHEA,ADRENALCARCINOMA,DHEA17-KS,ADRENALADENOMA,诊断流程,TREATMENT治疗,2)肾上腺肿瘤肾上腺腺瘤摘除后可治愈,术后补充糖皮质激素以治疗暂时性肾上腺皮质功能低减;@#@对肾上腺皮质癌应尽早作手术治疗。
@#@(3)不依赖ACTH小结节性或大结节性双侧肾上腺增生作双侧肾上腺切除术,术后作激素替代治疗。
@#@(4)异位ACTH综合征手术切除分泌ACTH的肿瘤是根治性治疗,综合征可以缓解;@#@如不能根治,则需要用肾上腺皮质激素合成阻滞药。
@#@赛更定Cyproheptadine(血清素抑制剂)麦角苄脂Metergoline双氯苯二氯乙烷(米托坦)o,pDDD(mitotane)(束、网状带萎缩)美替拉酮Metyrapone(抑制CS合成)氨基导眠能Aninoglutethmide(抑制CS合成)酮康唑ketokonazole(减少CS合成),CS,hypothalamus,pituitary,adrenal,Drugs:
@#@CyproheptadineMetergolineBromocryptine,Adrenalectomy,Surgery:
@#@TranssphenoidalmicrosurgeryRadiation:
@#@60Colinearaccelerator,Drug:
@#@o,pDDD(mitotane)MetyraponeAninoglutethmideketokonazole,CRH,ACTH,SurgeryRadiation,病例分析,一40岁女性,自述近两年体重增加,尤其腹部,但体力却明显下降。
@#@到当地医院就诊时发现血压高、血糖高、血脂高、血钾低,对症治疗不见好转来诊。
@#@考虑哪些疾病可导致上述表现?
@#@线索?
@#@如何鉴别?
@#@,
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- Hypercortisolism 皮质醇 增多