【正文】 isol by lowdose dexamethasone,第四十六頁，共七十頁。,TreatmentAdrenocortical adenoma and adenocarcinoma,Small adenomas can be removed by laparascopy Large adenomas and carcinomas require an open flank or transabdominal approach The cure with surgical removal of adrenal adenoma is virtually 100%,第五十六頁，共七十頁。)前后均需補充糖皮質(zhì)激素,第六十二頁，共七十頁。li224。Thank you,第七十頁，共七十頁。jiāng)皮質(zhì)醇測定 C 血漿醛固酮測定 D 血兒茶酚胺測定,第六十七頁，共七十頁。ch233。,Treatmentcushing disease,Transsphenoidal microadenomectomy is the most rational current treatment for Cushing disease In patients who are not cured by this treatment, three options remain Reoperate on the pituitary gland Radiate the pituitary gland Perform surgical adrenalectomy and corticoid antagonist,第五十四頁，共七十頁。,皮質(zhì)醇分泌增多(zēnɡ duō)，失去晝夜節(jié)律，不能被小劑量地塞米松抑制,第四十四頁，共七十頁。,臨床表現(xiàn)3,性功能障礙： 月經(jīng)減少、不規(guī)則、停經(jīng)、痤瘡等 明顯(m237。,典型病例(b236。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。nɡ)特征,第十三頁，共七十頁。,第六頁，共七十頁。,Aetiology Clinical presentation laboratory examination Diagnosis and differential diagnosis Treatment ( principle) Prognosis,第七頁，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。,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 virilizing effects may predominate The bulk of tumor is larger,第二十頁，共七十頁。ngl236。ngxiǎn)男性化（警惕腎上腺癌） 代謝障礙： 脂、蛋白、糖代謝 低鉀性堿中毒 ，低鈣 骨質(zhì)疏松，傷口愈合不良，生長發(fā)育延遲,第三十六頁，共七十頁。,Diagnosis and Differential diagnosis 診斷(zhěndu224。,cushing病的治療