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/day2days <50% reduce from basal >50% reduce from basal Cushing’s Synd. NORMAL High dose dexamethasone suppression test 8.0mg/day2days <50% reduce from basal >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