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Disease and Cushing's syndrome


ItsekkoDefinition
This is the hypothalamic-pituitary
disease characterized by
excessive secretion of corticotropin
(ACTH) and subsequent
* bilateral adrenal hyperplasia and
hyperfunction
(Cushing).
Cushing's syndrome - a hormonally
active tumor
adrenal cortex (glyukosteroma) with the
development of gilerkortitsizma.
Classification
a) in the form of the disease: mild,
moderate and severe. b) the flow
disease: progressive (within several
months) and torpid
(Within a few years).
Etiology
Not completely known. Possible
etiofaktorami are:
cranial, trauma, infectious diseases
(Neural: encephalitis, meningitis,
arahnoentsefalit)
intoxication, pituitary tumor, receiving
glucocorticoids,
pregnancy, childbirth, hormonal
changes during menopause.
Pathogenesis
The pathogenesis of Cushing's disease is
associated with a violation
regulatory mechanisms that control the
function of the hypothalamicpituitary-adrenal axis. Violations occur
in the CNS
at the level of serotonin and dopamine
receptors, as well as reducing
inhibitory effect of dopamine
neurotransmitters. As a result,
the primary pathology of the limbic

brain structures and


breach of control mediator secretion
CRH (corticotropin
releasing hormone), there is an excess
secretion of ACTH, which
major pathogenetic factor of the
disease. Hyperproduction
ACTH increases are mainly a function of
the beam, and reticular zones of the
cortex
adrenal glands. This reduces the
sensitivity of the hypothalamicpituitary system to corticosteroids,
resulting in
there is a simultaneous increase in the
secretion of both ACTH and
cortisol.
Clinic
Menstrual disorders, decreased libido
and potency,
purplish-red color of the face, obesity,
somnolence, lethargy, hair growth
women in male-type, selective
localization of fat on the face
(Moon, and purplish-red face), chest,
abdomen, neck, and VII of the
cervical vertebra ("climacteric hump"),
acne, boils and
stretch marks on the skin.
Hypertension, gastric ulcers and 12 sc
Osteoporosis of spine, skull, ribs, bones,
feet and hands, sometimes with
development of spontaneous bone
fractures.
Laboratory and instrumental data
Blood tests: increase in ACTH, cortisol
and 17-ACS
hyperglycemia and
hypercholesterolemia Urine: increased
17 ACS. X-ray diagnosis' on kraniogramme
- osteoporosis, bone

skull marked osteoporosis of the


vertebral bodies ("fish" vertebrae).
Computed tomography: hyperplasia of
both adrenal adenoma
pituitary gland. Pharmacological test:
positive samples with
metapyron and dexamethasone
Treatment
A. Radiotherapy. Carried out at a mild
to moderate
, Gravity. Spend exposure
mezhutochno-pituitary region with
total dose of 1600-2500 rad to the
course. Two. Surgical treatment (2
sided adrenalectomy total), followed by
substitution
therapy with corticosteroids. Three. ,
Medical treatment for
central forms of Cushing disease. 3.1.
Drugs
suppress the secretion of CRH and
corticotropin: Peritol
(Suppresses the secretion of CRH) at a
dose of 80-100 mg / day for 3-4 weeks
and parladel (inhibits the secretion of
corticotropin), 5.0 mg / day for a long
time-610 months. 3.2. Drugs that inhibit the
biosynthesis of glucocorticoids
in the adrenal cortex (hloditan,
mammolit litoperon and a daily dose of
5.0 mg per day). 3.3. Correction of
protein metabolism (anabolic
hormones: nerabolil retabolil or 1.0 / m
2 twice a month). 3.4.
Correction of osteoporosis: vitamin Dz,
calcium salts. -