内科学教学课件：库欣综合征.pptVIP

Yes or No 3.血皮质醇不能被小剂量地塞米松抑制 DXM 小抑制试验: (1) DXM 0.5mg q6h或 0.75mg q8h X 2 days 后24h尿17-羟50% 或游离皮质醇55 nmol/24h对照值 (2)午夜DXM 1mg ,次日晨血皮质醇50%对照值 4. 24h尿游离皮质醇增多 5. 24h尿17-羟皮质类固醇增多 定位 1. DXM 大抑制试验 (1) DXM 2mg, q6h X 2 days后24h尿游离皮质醇或17-羟50%对照值 (2)过夜DXM大抑制:午夜DXM 8mg ,次日晨血皮质醇50%对照值 (3)分析:能抑制提示Cushing病 不能抑制提示肾上腺腺瘤\腺癌\异位ACTH综合症 定位 2.血ACTH 测定: 增高或正常提示ACTH依赖型 明显降低提示非ACTH依赖型 3.选择性静脉分段取血测 ACTH 4.影像学检查 B超 CT MRI Endocrinology Department First Affiliated Hospital Wenzhou Medical College Endocrinology Department First Affiliated Hospital Wenzhou Medical College Endocrinology Department First Affiliated Hospital Wenzhou Medical College Endocrinology Department First Affiliated Hospital Wenzhou Medical College Differentiation of Cushing’s syndrome (1) Cussing’s disease Adrenal adenoma Adrenal carcinoma Entopic ACTH syndrome Urinary 17-OH Moderate raised Moderate raised Severe raised Severe raised Urinary 17-KS Moderate raised Moderate raised Severe raised Severe raised Serum/urine cortisol Mild/moderate raised Mild/moderate raised Severe raised Severe raised Large dose DXM suppression test suppressible insuppressible insuppressible insuppressible ACTH Mild raised low low High level CRH Stimulation test Normal/over normal No response No response No response Differentiation of Cushing’s syndrome (2) Cussing’s disease Adrenal adenoma Adrenal carcinoma Entopic ACTH syndrome Metyrapone test Normal/high response irresponsible irresponsible Partial response Hypokalemic alkolosis no no yes Yes MR/CT scan on pituitary Pituitary adenoma No pituitary adenoma No pituitary adenoma No pituitary adenoma MR/CT scan on adrenal Bilateral adrenal hyperplasic Adrenal adenoma Adrenal carcinoma Bilateral adrenal hyperplasic Adrenal isotope iodine cholesterol scan Bilateral adrenal hyperplasic Adrenal adenoma Adrenal carcinoma Bilateral adrenal hyperplasic 诊断和鉴别诊断 鉴别 1.单纯性肥胖:可有高血压\糖耐量减低\月经少\腹部白色条纹.血正常.