ACTH-dependent Cushing's syndrome

ACTH-independent Cushing's syndrome

Other types of Cushing's syndrome

Central obesity, moon face, sanguine appearance

Skin manifestations: Common patients may have purple-red stripes on both sides of the lower abdomen, outer thighs, buttocks, etc.

Metabolic disorders: Abnormal glucose metabolism

Cardiovascular manifestations: symptoms of hypertension, increased blood pressure and mild edema. At the same time, the patient was accompanied by arteriosclerosis

Weakened resistance to infection: patients are prone to various infections, among which pulmonary infections are more common

Sexual dysfunction: Men may have impotence, loss of sexual desire, penis shrinkage, testicle softening, etc.

Whole body and nervous system: The muscles of the limbs may atrophy, often manifesting as muscle weakness and difficulty in standing up after squatting.

Cortisol measurement: increased plasma cortisol levels and loss of circadian rhythm

Dexamethasone suppression test: a qualitative diagnostic test for Cushing's syndrome

Act h stimulation test: patients with pituitary Cull disease and ectopic act h syndrome often respond, while most patients with primary adrenocortical tumors do not respond.

Imaging examination: Adrenal B-ultrasound examination can detect adrenal hyperplasia or tumors. CT examination of adrenal gland lesions is more sensitive, and MRI examination of pituitary gland lesions is the best.

Cushing's disease

adrenal adenoma

Buenos cth micronodular or macronodular bilateral adrenal hyperplasia

ectopic act h syndrome

Embodiment disorders: associated with changes in body appearance caused by Cushing's syndrome

Excessive body fluids: related to water and sodium retention caused by increased cortisol

Risk of infection: related to increased cortisol leading to decreased immunity

Potential complications: fracture

Decreased activity tolerance: related to muscle atrophy caused by protein metabolism disorder

Risk of compromised skin integrity: associated with dry, thin skin and edema

Potential complications: heart failure, stroke, steroid-induced diabetes

Disease knowledge guidance: Instruct patients to pay attention to preventing infections in daily life, keeping skin clean, preventing trauma and fractures and other factors that may aggravate the condition or induce complications. Regular outpatient review

Medication guidance and disease monitoring: Inform patients of basic knowledge about the disease and treatment methods, guide patients to use medications correctly, and master the observation of drug efficacy and adverse reactions. Understand the precautions associated with post-operative hormone replacement therapy, especially identifying signs and symptoms of hormone excess or deficiency

Infection: Adrenal tuberculosis is a common cause, accounting for about 20% of men than women.

Autoimmune adrenalitis, more common in women

Other causes: Adrenal gland metastases

Pigmentation: Pigmentation of skin and mucous membranes is the most characteristic clinical manifestation. Pigmentation is characterized by deepening of skin pigmentation all over the body, which is tan and shiny, and is easily exposed when it is not above the skin surface. It is more noticeable in areas that are prone to friction, such as the face, palms, insteps, and belt areas.

Hyponatremia: Dilutional hyponatremia can occur after drinking large amounts of water due to a reduced ability of the kidneys to excrete the water load.

Digestive system: loss of appetite, reduced gastric acid, indigestion

Neuropsychiatric symptoms: fatigue, apathy, drowsiness and confusion in those with severe fatigue, and mental disorders may occur

Cardiovascular system: low blood pressure and orthostatic hypotension, dull heart sounds, dizziness and orthostatic syncope may occur

Reproductive system: Sparse loss of pubic hair and armpit hair in women, menstrual irregularity or amenorrhea, decreased sexual desire in men and impotence, etc.

Metabolic disorders: weakened gluconeogenesis, depletion of liver glycogen, and hypoglycemia may occur

Others: People caused by tuberculosis often have symptoms such as low fever, night sweats, weak constitution, and more severe weight loss.

Adrenal crisis: Crisis can be induced when the patient is under stress conditions such as infection, trauma surgery, overworked childbirth, excessive sweating, vomiting, diarrhea, etc., or when adrenocortical hormone replacement therapy is suddenly interrupted. Symptoms include high fever, nausea, vomiting, abdominal pain or diarrhea, dehydration, low blood pressure, tachycardia, collapse, extreme weakness, inability to react, apathy or lethargy, and may also manifest as irritability and mental disorder.

Routine blood examination: normocytic normochromic anemia is common, and a few are combined with pernicious anemia. Differential white blood cell count showed neutropenia, relative increase in lymphocytes, and significant increase in eosinophils.

Blood biochemistry tests: decreased blood sodium, increased blood potassium, decreased fasting blood sugar, a few patients had mild or moderate symptoms, and increased blood calcium.

Adrenocortical function test: plasma cortisol, Act h stimulation test, plasma act h determination

Imaging examination: X-rays of the adrenal gland area of ​​tuberculosis patients, CT or MRI examination can show adrenal gland enlargement and calcification shadows

The patient has skin and mucous membrane pigmentation, fatigue and weakness, loss of appetite, weight loss, and low blood sugar and blood pressure. The diagnosis can be confirmed by combining cortisol measurement or act h stimulation test.

Basic treatment: Glucocorticoid replacement therapy should be given as early as possible and generally requires lifelong supplementation. Salt, corticosteroids, and salt intake should be sufficient at least 8 to 10 grams per day. If there are diarrhea, heavy sweating, etc., the amount should be increased as appropriate.

Treatment of the cause: Patients with active conjunctivitis should be actively given anti-tuberculosis treatment while undergoing alternative treatment.

Adrenal crisis treatment: This crisis is a medical emergency and should be actively rescued

Treatment during surgery or other stress: When patients experience severe stress, the total daily dose of cortisone should not be less than 300 mg

Insufficient body fluids: reduced aldosterone secretion causes water and sodium excretion, increases gastrointestinal dysfunction, and causes nausea, vomiting, and diarrhea.

Potential complications, adrenal crisis

Nutritional imbalance is lower than the body's requirements, which is related to the lack of glucocorticoids leading to food fear and poor digestive function.

Decreased activity tolerance is associated with cortisol deficiency leading to muscle weakness and fatigue

Body image disorder is related to increased pituitary acthmsh secretion, leading to skin pigmentation

Disease knowledge guidance: Instruct patients to avoid infection, trauma, overexertion and other factors that aggravate the condition. Inform patients to avoid direct sunlight when going out to avoid aggravating pigmentation of skin and mucous membranes.

Medication guidance and disease detection: Educate patients and their families to understand that this disease requires lifelong treatment, and they should actively cooperate in guiding patients to take medications, emphasizing that they should be taken on time and in a quantitative manner. Do not increase or decrease the dose or stop medication on your own to avoid danger. Understand the adverse reactions of drugs and instruct patients to take the drugs with food or antacids and avoid taking them alone or on an empty stomach to avoid damaging the gastric mucosa. Go to the hospital for regular check-ups and adjust drug dosage

Community family support: Community nurses should establish a complete follow-up system to understand the patient's medication status, psychological state, etc., and provide targeted health guidance. Patients undergoing lifelong hormone replacement therapy in Yinxu are under great psychological pressure. Their families should be encouraged to provide spiritual comfort and support so that the patients can maintain emotional stability and increase their confidence to cooperate with the treatment.