Академический Документы
Профессиональный Документы
Культура Документы
and
signs
of
(a)
with
serum
or
salivary
(b)
(a)
(b)
Figure 6.8 The effects of glucocorticoid excess in Cushing disease and the benefits of treatment. (a) Florid
signs of excess cortisol in a 15-year-old boy: round face, greasy skin, severe acne, truncal obesity with stretch marks (striae) and
bruising from a venepuncture site on the right arm. (b) Aged 16, 1 year after curative transsphenoidal surgery and an operation to
remove excess abdominal skin.
am
or
of
ACTH.
Although unreliable, serum ACTH levels
tend
to
be
higher from ectopic tumours than
pituitary
tumours.
The
high-dose
dexamethasone
suppression test lacks complete sensitivity and
specificity;
in
experienced
centres,
venous
sampling
from
the
inferior petrosal sinus can be more
effective
for
determining the origin of ACTH
secretion,
albeit
with greater discomfort and risk from
an
invasive
procedure,
e.g.
a
very
small
percentage
risk
of
stroke.
Inferior
petrosal
sinus
sampling
(IPSS)
is
undertaken
by
interventional
radiologists.
The
hormone is measured in left and right
inferior
petrosal sinus following CRH stimulation.
A clear gra-
Treatment