20100413 sindrome de cushing pagina

8/17/2019 20100413 Sindrome de Cushing Pagina

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SINDROME DE CUSHING

(HIPERCORTISOLISMO)

ALUMNO:

JUAN DAVIO QUISPE FERNÁNDEZ


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Harvey W. Cushing(1869-1939)

Science Mueu!" Hi#$%& $' Meicine e*i#e


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CORTEZA

M+DULA

RETI

CULADA

FASCICULADA

GLOMERULAR

CATECOLAMINAS

MINERALOCORTICOIDEALDOSTERONA

GLUCOCORTICOIDES:CORTISOL

ANDR,GENOS


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ETIOLOG-

AAu!en#$ en ./ 0%$ucci1n c$%#i$. 0$% ./u0%/%%en/.2

C/u/ !/&$%3/: 4i0e%0./i/ u0%/%%en/.*i./#e%/. (ACTH: 4i015i6 ec#10ic/6#u!$%)27 898 / ; ? e0enien#e #u!$% 4i0$5i/%i$

De'ec#$ 0%i!/%i$: e/%%$..$ e novo e/en$!/

H/%%i$n" On.ine > Chapter 336. Disorders of the A


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En'e%!e/ e Cu4in@: #u!$%4i0$5i/%i$ 0%$uc#$% e ACTH

S3n%$!e e Cu4in@: #$/ ./c/u/ e e9ce$ e c$%#i$.:

2Tu!$% ACTH e91@en$

B2Tu!$% u0%/%%en/.82Tu!$% 4i0$5i/%i$ ec%e#$% ACTH

;2T%/#/!ien#$ c$n e9ce$ e @.uc$c$%#ic$ie


ETIOLOG-

A


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2 TUMOR ACTH ECT,PICO:

• Tu!$%e n$ 4i0$5i/%i$•

Hi0e%0./i/ u0%/%%en/. *i./#e%/.• Si@n$ & 3n#$!/ 0%een#e $ n$2• A.c/.$i 4i0$0$#/

C/%cin$!/ *%$nc1@en$ ce.2 0eue/6c/%cin$ie: #i!$6 0nc%e/6 $/%i$6!eu./% #i%$ie$ /en$!/*%$nui/.e2


ETIOLOG-

A


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B2 TUMOR SUPRARRENAL• B>B? en S9 Cu4in@•

Uni./#e%/.e• >? !/.i@n$

Puee: 4i0e%ec%eci1n 4i0$5i/%i/ 4i0e%0./i/ n$u./%u0%/%%en/.e


ETIOLOG-

A


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82 TUMOR HIPOFISIARIOSECRETOR ACTH

Mic%$ $ !/c%$/en$!/>? 6 !!

;2 KATROGENIAC/u/ ! '%ecuen#e


ETIOLOG-

A


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Evaluation of health-related quality of life in patients with Cushing's syndrome with a new questionnaire". Webb, S! adia, #! arahotrasburge, C$! &abarin, %! van %en, (! )ivonello, *! Stalla, +! amberts, SW$! +lusman, $E. E*()E% $(*% (/ E0(C*1((+2,


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SIGNOS K S-NTOMAS

• G.uc$c$%#ic$ie: c/#/*$.i!$ – De*i.i/ !ucu./% – F/#i@/ – O#e$0$%ii – E#%i/ – Eui!$i

• G.uc$ne$@


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12/28


13/28H/%%i$n" On.ine > Chapter 336. Disorders of the A


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DIAGN,STICO

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e9/!e#/$n/2

N$ 4/& 0%ue*/ ue u0e%e =?e0eci5ci/2

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2SUPRESI,N NOCTURNA:@%2 e9/ / ./ >>:>> 4%C$%#i$. :>> 4% @>>!.



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B2 OESOS O DEPRIMIDOSC$%#i$. u%in/%i$ en B; 4$%/> @3/$0ec4/

82 De5ni#i$:De9/ 2!@ c4% 0$% ; 4%

c$%#i$. u%in n$ *// e >@6 $ ic$%#i$. 0./! n$ *// e @>>!.


DIAGN,STICO


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#$!/n$ en cuen#/ / ACTH6 i%e 0/%/i#in@ui% ./ ie%/ c/u/( e0enien#e $ ine0enien#e eACTH)2

Tu!$%e u0%/%%en/.e: nie.e ACTH*/$ $ ine#ec#/*.e ( !en$ >0@!.)

ACTH ec#10ic/: !/ >> 0@!.

Mic%$/en$!/ $ i'unci1n HH6 ACTH 8>> 0@!. (n$%!/. > 0@!.)


DIAGN,STICO


17/28

Di#inci1n e !ic%$/en$!/ ec%e#$% ACTH2 Di'unci1n HH6 $#%/:

Re/cci1n c$%#i$. /n#e e9/ B!@ c4 0$% ;4%

$ !@ e9/ u%/n#e ./ n$c4e

P%ue*/ u0%ei1n c$n $i e.e//:E0eci5ci/ ce%c/n/ >>?6 i ./ u0%ei1n

en !/ =>? e c$%#i$. .i*%e en $%in/2


DIAGN,STICO


18/28

O#%/ 0%ue*/:

Me#i%/0$n/ & G$#e$ CRHWi 4/& 4i0e%ec%eci1n e

e#e%$ie 0$% #u!$%

u0%/%%en/.6 $ 0%$ucci1nec#10ic/ e ACTH6 e*e c/u/%u0%ei1n e. ee HH


DIAGN,STICO


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E. i.e!/ e. i/@n$#ic$

0%inci0/.:

C$ni#e en i#in@ui% en#%e .$

c/$ 0$% !ic%$/en$!/ e4i015i6 'uen#e ec#10ic/ / .$ue 0%$ucen CRH6 ACTH $

/!*/2 H/%%i$n" On.ine > Chapter 336. Disorders of the A

DIAGN,STICO


20/28

Si estudios de imagen son negativos

Determina!i"n de AC#H en sangre deseno petroso$ midiendo!on!entra!i"n %asal$ a los &.' y ()minutos despu*s de administrar C+H

,(-g/g 012Si perif*ri!a mayor de 3$ !onrma

tumor hiposiario.


DIAGN,STICO


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Aen$!/ u0%/%%en/. 0%$uc#$% ec$%#i$.:

ACTH *//

C$%#i$. .i*%e en $%in/

C/%cin$!/ u0%/%%en/.M// /*$!in/. 0/.0/*.eXce#$e#e%$ie u%in/%i$


DIAGN,STICO


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DIAGN,STICO

DIFERENCIALSINDROME SEUDO CUSHING

O*ei/6 /.c$4$.i!$6 e0%ei1n2E.e/ci1n !$e%// e c$%#i$. en$%in/

Rei#enci/ 0%ue*/ u0%ei1n



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Sin%$!e Cu4in@ .ee e%u Seu$Cu4in@

De9/ $i *// en B i/6 /.#/eni*i.i/ & e0eci5ci/2

K/#%1@en$6 !e@e#%$.: c.3nic/!en#eini#in@ui*.e e 4i0e%'unci1nu0%/%%en/.2


DIAGN,STICO

DIFERENCIAL


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4rue%a de !ortisol en saliva , no!turna2

DIAGN,STICO

DIFERENCIAL

#he 5ournal of Clini!al ndo!rinology 7 8eta%olism 9(,()23:;6


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L/ in#eni/ e S9 Cu4in@ &/#%1@en$e0ene e :

2D$i #$#/.

B2Vi/ !ei/ *i$.1@ic/

82Du%/ci1n #%/#/!ien#$

M//n/ & #/%e:

M//n/:

T$!$@%/'3/6 !e$% #


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TRATAMIENTO

eoplasia suprarrenal xtirpa!i"n tumor

4revia prepara!i"n , insu!ien!ia 2

Diario &)mg@()mg@).(

( da antes !x &)@()@).(

Da !iruga () mghra

Dia (@: '@:.'$&.'@'$&.'@' B ;)@&)@).($&.'@' B ;)@&)@).($ ;)@&)@).($ &)@&)@).($ &)@()@).(.


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C/%cin$!/ u0%/%%en/.: !ue%en 8 /$e0u


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20100413 sindrome de cushing pagina

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