西安交通大学医学院内分泌系统疾病课件 CUSHING’S SYNDROME.pptVIP

CUSHING’S SYNDROME(Hypercortisolism) By. Guo Hui Cushing’s Syndrome(Hypercortisolism) Cushing’s syndrome also named hypercortisolism. It was first described by Harvey Cushing in 1912. It’s a disease caused by excessive production or use of cortisol presenting with clinical features of excessive cortisol. Cushing’s Syndrome(Hypercortisolism) Background knowledge 1.The two adrenal glands located either on the top of each kidney,Each gland weigh 6-8g 2. Adrenal gland consists of outer cortex and inner medulla. outer cortex:steroid inner medulla:catecholamines Cushing’s Syndrome(Hypercortisolism) 3.The cortex is composed of three histologic zones in the adult. Zona glomerulosa----aldosterone ----mineralcorticoid Zona fasciculata----cortisol ----glucocorticoid Zona reticularis ----androgen and estrogen Cushing’s Syndrome(Hypercortisolism) Cushing’s Syndrome(Hypercortisolism) Cushing’s Syndrome(Hypercortisolism) Etiology According to plasma ACTH levels, Cushing′ Syndrome can be divided into two main groups ACTH-Dependent Causes -ACTH-secreting pituitary tumor(Cushing′ s disease) -Ectopic ACTH Syndrome Cushing’s Syndrome(Hypercortisolism) ACTH-independent Causes (Cushings Syndrome) -Adrenal adenoma 15% -Adrenal carcinoma 5% -Adrenal hyperplasia -Iatrogenic Cushing′ s Syndrome(due to receiving long-term therapy with glucocorticoid in high dosage) Pseudo Cushings -Alcohol excess -Obesity -Depression Clinical features Clinical features 2.Protein metabolic disturbance Striae,muscle weakness,osteopenia,arrest of growth in children etc. 3.Glucose metabolic disturbance:impaired glucose tolerance (IGT), steroid diabetes mellitus. Clinical features 4. Electrolyte disturbance: hypokalemia, alkalosis, edema, 5. Cardiovascular disease: hypertension, Ventricular hypertrophy, Heart failure, stroke,Thrombosis. 6. Susceptible infection: 7. Blood: