中国医科大学附属第一医院：《内科学》课程教学资源（PPT课件讲稿，双语版）Cushing's syndrome

Cushings syndrome Zhaoxiaojuan

Cushing’s syndrome Zhaoxiaojuan

Effects of glucocorticoid Effects on meta bolism Effects on immunologic function and inflammatory Effects on musculo keletal and connective tissues Effects on fluid and electrolyte homeostasis Neuropsychiatric and behavioral effects Gastrointestinal effects Developmental effects

Effects of glucocorticoid Effects on metabolism Effects on immunologic function and inflammatory Effects on musculoskeletal and connective tissues Effects on fluid and electrolyte homeostasis Neuropsychiatric and behavioral effects Gastrointestinal effects Developmental effects

Clinical features Obesity (the increased fat distribution is not generalized) Moon-shaped face and plethoric Purple striae Hypertension GT Osteoporosis Hypokalemic alkalosis

Clinical features Obesity (The increased fat distribution is not generalized) Moon-shaped face and plethoric Purple striae Hypertension IGT Osteoporosis Hypokalemic alkalosis

Suspected Cushings synd. Plasma cortisol.个 Urinary free cortisol Urinary17-OHCS个 Low dose dexamethasone suppression test 20mg/day×2day 50% reduce from basal >50% reduce from basal Cushing's Synd NORMAL High dose dexamethasone suppression test 80mg/day×2days 50% reduce from basal >50% reduce from basal Plasma acth个 Adrenal disease Probable Ectopic ACTH Synd. Cushing’ s Disease

Suspected Cushing’s synd. Plasma cortisol Urinary free cortisol Urinary 17-OHCS  Low dose dexamethasone suppression test 2.0mg/day2days 50% reduce from basal Cushing’s Synd. NORMAL High dose dexamethasone suppression test 8.0mg/day2days 50% reduce from basal Probable Cushing’s Disease Adrenal Disease Ectopic ACTH Synd. Suspected Cushing’s synd. Plasma ACTH 

Adrenal disease Ectopic ACTH Synd Plasma acth Increased Low Probable Ectopic ACTH Synd Probable Adrenal Disease TTumor Search CT/MRI Scan of Adrenals positive negative normal adrenal mass urinary 17-Ks ECTOPIC Consider Plasma dhea ACTH SYNDROME Adrenonodular DHEA→ Hyperplasia, 17-KS个 DHEA个 17-KS→ Other disorders ADRENAL ADRENAL ADENOMA CARCINOMA

Adrenal Disease Ectopic ACTH Synd 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

Hypothalamus Nyctohemeral CRH Neural stimuli rhythm Anterior pituitary eclac ACTH Adrenal cortex Cortisol t Cortisol Plasma Physiological and (CBG bound)(free) Metabolic effects Inactivation by reduction and conjugation Liver Urine Tetrahydrocortisol Unchanged cortisol Tetrahydrocortisone (measured as urinary Contols,Cort tolones free cortisol) (measurd as urinary 17-OHCS The hypothalamic-pituitary-adrenal axis

Nyctohemeral rhythm CRH Neural stimuli 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 urinary free cortisol) Tetrahydrocortisol Tetrahydrocortisone Cortols,Cortolones (measurd as urinary 17-OHCS) Urine The hypothalamic-pituitary-adrenal axis

gery Drugs: Radiation hypothalamus Cyproheptadine energ Bromocryptine CRH Surg Transsphenoidal microsurgery Radiation: 60 linear accelerator ACTH D O,p DDD(mitotane) Adrenalectomy adrenal Metyrapone Aminoglutethimide ketokonazole TREATMENT

hypothalamus pituitary adrenal Drugs: Cyproheptadine Metergoline Bromocryptine Adrenalectomy Surgery: Transsphenoidal microsurgery Radiation: 60Co linear accelerator Drug: o,p’DDD(mitotane) Metyrapone Aninoglutethmide ketokonazole CRH ACTH CS Surgery Radiation TREATMENT