20xx年醫(yī)學專題—cushing綜合癥-wenkub
2024-10-31 17 本頁面
【正文】 二十八頁，共七十頁。,典型病例(b236。,Massive macronodular adrenal disease 大結節(jié)性巨大(j249。,原發(fā)性色素(s232。)腺癌,占cushing綜合癥的5％以下 瘤體積大（直徑56cm)，腫瘤可浸潤(j236。ng)多于女性－ 15%20% 腺瘤呈圓形或橢圓形，直徑約34cm，重40g左右，包膜完整 其病緩慢，病情中等，多毛及雄激素增多少見,第十九頁，共七十頁。,腎上腺皮質(p237。i)ACTH綜合癥,繼發(fā)于垂體以外的惡性腫瘤 小細胞肺癌(f232。ng) 下丘腦功能紊亂,第十五頁，共七十頁。nɡ)特征,第十三頁，共七十頁。 s249。tǐ) （ACTH） adrenal cortex腎上腺皮質 zona glomerulosa zona fasciculata zona reticularis （Aldosterone）（cortisol）（gonadal hormone）,+,+,,,第十頁，共七十頁。n) 治療(原則) 預后,第八頁，共七十頁。,第六頁，共七十頁。,定 義,為各種病因造成腎上腺分泌過多的糖皮質激素（主要是皮質醇）所致病癥(b236。Cushing syndrome Cushing 綜合癥,第一頁，共七十頁。ngzh232。,Aetiology Clinical presentation laboratory examination Diagnosis and differential diagnosis Treatment ( principle) Prognosis,第七頁，共七十頁。,Aetiology 病因(b236。,Aetiology,ACTHdependent Cushing syndrome Cushing disease Ectopic ACTH syndrome ACTH independent Cushing syndrome Adrenocortical adenoma Adrenocortical adenocarcinoma Micronodular adrenal disease Massive macronodular adrenal disease,第十一頁，共七十頁。)結節(jié)性腎上腺病 大結節(jié)性巨大腎上腺病,第十二頁，共七十頁。,Cushing Disease,It is the most common type of Cushing syndrome, and accounts for about 70% of the syndrome Pathogenesis Most patients have ACTHsecreting anterior pituitary corticortrope microadenomas(＜10mm in diameter), but a small number have diffuse corticotrope hyperplasia and pituitary macroadenoma,第十四頁，共七十頁。,Ectopic ACTH syndrome,The majority of patients with ectopic ACTH syndrome have outside pituitary tumor Other sites are pulmonary carcinosis, carcinoid of bronchus, thymic carcinoma pancreatic cancer, chromaffin tumor, medullary carcinoma of thyroid and so on,第十六頁，共七十頁。i 225。zh236。,Adrenocortical adenocarcinoma,It occurs in lower than 5% patients of cushing syndrome Patients with adenocarcinoma tend to have a more acute and progressive course and vir
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