Hypercortisolism皮质醇增多症PPT课件下载推荐.pptx

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？

@#@,