The Physiology Of Hypercortisolism

皮质醇增多症的生理学

• 批准号: 9555644
• 负责人: Lynnette Nieman
• 金额: $ 16.09万
• 依托单位: NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9555644
• 关键词: Adrenal Gland Hyperfunction; Cardiovascular Diseases; Characteristics; Clinical; Cognitive deficits; Comorbidity; Cushing Syndrome; Data; Dexamethasone; Diabetes Mellitus; Diagnosis; Disease; Early Diagnosis; Endocrinologist; Frequencies; General Population; General Practitioners; Glucocorticoids; Hydrocortisone; Hypertension; Infection; Internist; Life Style; Metabolic syndrome; Morbidity - disease rate; Muscle Weakness; Natural History; Obesity; Pathologic; Patients; Performance; Physiological; Physiology; Population; Quality of life; Salivary; Signs and Symptoms; Testing; Urine; Weight Gain; base; diagnostic screening; mortality; screening

Endogenous pathologic hypercortisolism, or Cushing's syndrome, is associated with poor quality of life, morbidity, and increased mortality. Early diagnosis may mitigate against this natural history of the disorder. The clinical presentation of Cushing's syndrome varies, in part related to the extent and duration of cortisol excess. When hypercortisolism is severe, its signs and symptoms are unmistakable. However, most of the signs and symptoms of Cushing's syndrome are common in the general population (e.g., hypertension and weight gain) and not all are present in every patient. In addition to classical features of glucocorticoid excess, such as proximal muscle weakness and wide purple striae, patients may present with the associated comorbidities that are caused by hypercortisolism. These include cardiovascular disease, thromboembolic disease, psychiatric and cognitive deficits, and infections. As a result, internists and generalists must consider Cushing's syndrome as a cause, and endocrinologists should search for and treat these comorbidities. Recommended tests to screen for Cushing's syndrome include 1 mg dexamethasone suppression, urine free cortisol, and late night salivary cortisol. These may be slightly elevated in patients with physiologic hypercortisolism, which should be excluded, along with exogenous glucocorticoid use. Each screening test has caveats and the choice of tests should be individualized based on each patient's characteristics and lifestyle.

内源性病理性高皮层溶质或库欣综合症与生活质量差，发病率和死亡率增加有关。早期诊断可能会减轻这种疾病的自然史。库欣综合征的临床表现与皮质醇过量的程度和持续时间有关。当过度皮质醇严重时，其体征和症状是明确的。但是，库欣综合征的大多数体征和症状在普通人群中很常见（例如，高血压和体重增加），并且并非所有患者都存在。除了糖皮质激素过量的经典特征（例如近端肌肉无力和宽阔的紫色条纹）外，患者还可能出现由高皮质溶液引起的相关合并症。这些包括心血管疾病，血栓栓塞疾病，精神病和认知缺陷以及感染。结果，内科医生和通才必须将库欣综合症视为原因，而内分泌学家应搜索和治疗这些合并症。筛选库欣综合症的建议测试包括1毫克地塞米松抑制，无尿液皮质醇和深夜唾液皮质醇。这些生理高皮层溶质的患者可能会略有升高，应排除外源性糖皮质激素的使用。每个筛查测试都有警告，应根据每个患者的特征和生活方式进行个性化测试。