Illness of isenko-cushing: symptoms and treatment

Disease of Itenko-Cushing

Endocrinology distinguishes between the disease and the Itenko-Cushing syndrome (primary hypercorticism). Both diseases manifest themselves as a common symptom complex, but they have different etiologies.

At the heart of the Itenko-Cushing syndrome lies the hyperproduction of glucocorticoids by hyperplastic tumors of the adrenal cortex (corticosteroma, glucosteroma, adenocarcinoma) or hypercorticism caused by prolonged administration of exogenous glucocorticoid hormones. In some cases, with ectopic corticotropinomas emanating from the cells of the APUD system (a lipid-cell tumor of the ovary, lung cancer, cancer pancreas, intestines, thymus, thyroid, etc.), the so-called ectopic ACTH syndrome with similar clinical manifestations.

With Isenko-Cushing's disease, the primary lesion is localized at the level of the hypothalamic-pituitary system, and the peripheral endocrine glands are involved in the pathogenesis of the disease again.

Itenko-Cushing's disease develops in women 3-8 times more often than in men; mostly women of childbearing age (25-40 years old) are ill.

The course of the Itenko-Cushing's disease is characterized by severe neuroendocrinal disorders: a disorder of carbohydrate and mineral metabolism, symptomatic complex of neurological, cardiovascular, digestive, renal disorders.

Causes of Itenko-Cushing's disease

The development of the Itenko-Cushing disease in most cases is associated with the presence of a basophilic or chromophobic adenoma of the pituitary gland secreting adrenocorticotropic hormone. In case of tumor lesion of the pituitary gland, microadenoma, macroadenoma, adenocarcinoma are detected in patients.

In some cases, the connection of the onset of the disease with the previous infectious lesions of the central nervous system (encephalitis, arachnoiditis, meningitis), craniocerebral trauma, intoxication is noted.

In women, Itenko-Cushing's disease can develop on the background of hormonal adjustment, due to pregnancy, childbirth, menopause.

Increased synthesis of ACTH causes a cascade of adrenal and adrenal glandular effects. In the adrenal glands, the synthesis of glucocorticoids, androgens, and, to a lesser extent, mineralocorticoids, is increased.

An increase in the level of glucocorticoids has a catabolic effect on protein-carbohydrate metabolism, which is accompanied by atrophy of the muscular and connective tissue, hyperglycemia, insulin insufficiency and insulin resistance, followed by the development of a steroid diabetes mellitus. Violation of fat metabolism causes the development of obesity.

The intensification of mineralocorticoid activity in the Itenko-Cushing disease activates the renin-angiotensin-aldosterone system, thereby promoting the development of hypokalemia and arterial hypertension.

The catabolic effect on bone tissue is accompanied by the elution and reduction of calcium reabsorption in the gastrointestinal tract and the development of osteoporosis.

The androgenic properties of steroids cause abnormal ovarian function.

The severity of the course of the Itenko-Cushing's disease can be mild, moderate or severe. An easy degree of the disease is accompanied by mildly expressed symptoms: menstrual function can be preserved, osteoporosis sometimes absent.

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With an average severity of Isenko-Cushing's disease, the symptoms are pronounced, but complications do not develop.

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The severe form of the disease is characterized by the development of complications: muscle atrophy, hypokalemia, hypertonic kidney, severe mental disorders, etc.

The rate of development of pathological changes distinguishes the progressing and torpid course of the Itenko-Cushing's disease.

The progressive course is characterized by rapid (within 6-12 months) increase in symptoms and complications of the disease; at torpid current, pathological changes are formed gradually, during 3-10 years.

Symptoms of Itenko-Cushing's disease

With the disease of Itenko-Cushing, violations of fat metabolism, changes in the bone, neuromuscular, cardiovascular, respiratory, sexual, digestive system, psyche develop.

Patients with Isenko-Cushing's disease differ in their cousingoid appearance due to the deposition of adipose tissue in typical places: on the face, neck, shoulders, mammary glands, back, abdomen.

The face has a lunate shape, a fatty "climacteric hump" is formed in the region of the VII cervical vertebra, the volume of the thorax and abdomen increases; while the limbs remain relatively thin. The skin becomes dry, scaly, with a pronounced purple-marble pattern, striae in the area of ​​the mammary glands, shoulders, abdomen, intradermal hemorrhage. Acne or furuncles are often noted.

In men, there is a decrease and loss of hair on the face and on the body; decreased sexual desire, impotence.

The onset of Ithenko-Cushing's disease in childhood can lead to a delay in sexual development due to a decrease in the secretion of gonadotropic hormones.

Changes in the osseous system that result from osteoporosis are manifested by pain, deformity and fractures of the bones, in children - delayed growth and differentiation of the skeleton.

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Cardiovascular disorders in the Itenko-Cushing disease may include arterial hypertension, tachycardia, electrolyte-steroid cardiopathy, and the development of chronic heart failure.

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Patients with Isenko-Cushing's disease are prone to frequent incidence of bronchitis, pneumonia, and tuberculosis.

The defeat of the digestive system is accompanied by the appearance of heartburn, epigastric pain, the development of chronic hyperacid gastritis, steroid diabetes, steroid ulcers of the stomach and duodenum, gastrointestinal bleeding. Due to damage to the kidneys and urinary tract can occur chronic pyelonephritis, urolithiasis, nephrosclerosis, renal failure, up to uremia.

Neurological disorders in the Itenko-Cushing disease can be expressed in the development of pain, amyotrophic, stem-cerebellar and pyramidal syndromes.

If pain and amyotrophic syndromes are potentially reversible under the influence of adequate therapy of Itenko-Cushing's disease, then the stem-cerebellar and pyramidal syndromes are irreversible. At a stem-cerebellar syndrome develop ataxia, nystagmus, pathological reflexes.

With Isenko-Cushing's disease, mental disorders can occur as a neurasthenic, astheno-dynamic, epileptiform, depressive, hypochondriac syndrome. Characteristic decrease in memory and intelligence, lethargy, a decrease in the magnitude of emotional fluctuations; patients may attend obsessive suicidal thoughts.

Development of diagnostic and therapeutic tactics in the case of Isenko-Cushing's disease requires close cooperation of the endocrinologist, neurologist, cardiologist, gastroenterologist, urologist, gynecologist.

With the Itenko-Cushing disease, there are typical changes in the biochemical parameters of the blood: hypercholesterolemia, hyperglobulinemia, hyperchloremia, hypernatremia, hypokalemia, hypophosphatemia, hypoalbuminemia, decreased activity alkaline phosphatase.

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With the development of steroid diabetes mellitus, glucosuria and hyperglycemia are recorded.

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The study of blood hormones reveals an increase in the level of cortisol, ACTH, renin; in the urine erythrocytes, protein, granular and hyaline cylinders are detected, the allocation of 17-CS, 17-ACS, cortisol.

For the purpose of differential diagnosis of the disease and Isenko-Cushing syndrome, diagnostic tests with dexamethasone and methopyron (Liddle test) are performed.

Increase in excretion of 17-ACS in urine after taking metopyrone or decrease in excretion of 17-ACS by more than 50% after administration dexamethasone indicates the Itzenko-Cushing's disease, whereas the absence of changes in the excretion of 17-ACS indicates a syndrome Itenko-Cushing.

Study of the adrenal glands (ultrasound of the adrenal glands, adrenal gland MRI, CT, scintigraphy) with Isenko-Cushing's disease reveals bilateral adrenal hyperplasia.

At the same time, an asymmetric unilateral enlargement of the adrenal gland indicates a glucosteroma.

Differential diagnosis of the Itenko-Cushing's disease is performed with a similar syndrome, a hypothalamic syndrome of the pubertal period, and obesity.

Treatment of Itenko-Cushing's disease

With the Itenko-Cushing's disease, it is required to eliminate hypothalamic changes, normalize the secretion of ACTH and corticosteroids, and restore the disturbed metabolism.

To treat the disease, pharmacotherapy, gamma-ray therapy, proton therapy of the hypothalamic-pituitary region, surgical treatment, and a combination of different methods can be used.

Medical therapy is used in the initial stages of the Itenko-Cushing's disease. In order to block the function of the pituitary gland, reserpine, bromocriptine, is prescribed.

In addition to central-action drugs that suppress the secretion of ACTH, blockers for the synthesis of steroid hormones in the adrenal glands can be used to treat the Itenko-Cushing disease.

Symptomatic therapy aimed at correction of protein, mineral, carbohydrate, electrolyte metabolism is carried out.

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Gamma X-ray and proton therapy is usually carried out in patients who do not have radiological data for a tumor of the pituitary gland.

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One of the methods of radiation therapy is the stereotaxic implantation of radioactive isotopes into the pituitary gland.

Usually, a few months after radiation therapy, a clinical remission occurs, accompanied by a decrease in body weight, blood pressure, normalization of the menstrual cycle, a decrease in the damage to the bone and muscle systems. Irradiation of the pituitary gland can be combined with unilateral adrenalectomy or directed destruction of the hyperplastic substance of the adrenal gland.

With a severe form of Itenko-Cushing's disease, bilateral adrenal removal can be shown (bilateral adrenalectomy), requiring further lifelong ST-glucocorticoids and mineralocorticoids.

After adenomectomy, remission occurs in 70-80% of cases, approximately 20% may experience a relapse of the pituitary tumor.

Prognosis and prevention of Itenko-Cushing's disease

The prognosis of the Itenko-Cushing disease is determined by the duration, severity of the disease, the age of the patient. With early treatment and mild disease, complete recovery is possible in young patients.

The prolonged course of the Itenko-Cushing's disease, even with the elimination of the underlying cause, leads to persistent changes in bone, cardiovascular, urinary systems, which disrupts the ability to work and burdens the forecast.

The started forms of the Itenko-Cushing's disease result in a fatal outcome due to the seizure of septic complications, renal failure.

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Patients with Isenko-Cushing's disease should be observed by an endocrinologist, cardiologist, neurologist, gynecologist-endocrinologist; avoid excessive physical and psycho-emotional stress, work in the night shift. Prevention of the development of the Itenko-Cushing disease is reduced to general preventive measures - prevention of TBI, intoxications, neuroinfections, etc.

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A source: http://www.krasotaimedicina.ru/diseases/zabolevanija_endocrinology/itsenko-cushing

Cushing's Syndrome: Symptoms and Treatment

Category: Endocrine system 24254

Syndrome Itenko-Cushing - a pathological process, the formation of which is affected by high levels of hormones glucocorticoids. The main one is cortisol. Therapy of the disease must be complex and directed at arresting the cause that contributes to the development of the disease.

What causes the disease?

Cushing's syndrome can occur for a variety of reasons. The disease is divided into three types: exogenous, endogenous and pseudosyndrome. Each of them has its own reasons for education:

1. Exogenous. The reasons for its development include an overdose or a prolonged use of steroids during the therapy of another ailment. As a rule, steroids are used when it is necessary to cure asthma, rheumatoid arthritis.
2. Endogenous. Its formation causes an internal malfunction in the functioning of the body.
3. Pseudosyndrome. There are times when a person is visited by symptoms similar to those of Cushing's syndrome, but in fact it is not. There is such a condition due to excess weight, alcohol intoxication in chronic form, pregnancy, stress, depression.

How does the disease manifest itself?

Symptoms of Itenko-Cushing syndrome

Cushing's syndrome in each patient manifests itself in its own way. The reason is that the organism of a certain person reacts in its own way to this pathological process. There are the following most common symptoms:

• gain in weight;
• weakness, fatigue;
• excess hair;
• osteoporosis.

Weight gain

Very often the symptoms of Cushing's disease manifest themselves in a rapid increase in weight. This forecast is observed in 90% of patients. At the same fatty layers are deposited on the abdomen, face, neck. Hands and feet, on the contrary, become thin.

Atrophy of muscle mass is noticeable on the shoulders and legs. Such a process causes the patient symptoms associated with general weakness and rapid fatigue.

In combination with obesity, such a manifestation of the disease causes considerable difficulties for the patient during physical exertion.

In certain situations, a person can be hurt if he gets up or squats.

Thinning of the skin

A similar symptom in Cushing's syndrome occurs quite often. Skin covers acquire a marble shade, excess dryness and have areas of local hyperhidrosis. The patient has cyanosis, and cuts and wounds heal very long.

Excessive hair formation

Such symptoms are often visited by a woman who is diagnosed with Isenko-Cushing's disease. Hairs begin to form on the chest, upper lip and chin.

The reason for this condition is the accelerated production of adrenal glands by male hormones - androgens.

In addition to this symptom, a woman has a menstrual disorder, while in men impotence and a decrease in libido.

Osteoporosis

Osteoporosis

This pathology is diagnosed in 90% of cases in patients with Cushing's syndrome. Osteoporosis is manifested with a pain syndrome that affects the bones and joints.

It is not excluded the formation of spontaneous fractures of the ribs and extremities.

If the Itenko-Cushing's disease affects the child's body, then there is a noticeable lag in the development of the child's growth.

Cardiomyopathy

With Cushing's syndrome, this condition affects the patient very often. There is a cardiomyopathy, as a rule, of a mixed type. Affects its formation of arterial hypertension, electrolyte disruptions or catabolic effects of steroids. In humans, these symptoms are noted:

In addition to the presented symptoms Cushing's syndrome can cause a pathology such as diabetes mellitus. It is determined in 10-20% of cases. Regulation of blood sugar can be done with the help of special medicines.

Relative to the nervous system, the following manifestations occur:

• retardation;
• depression;
• euphoria;
• poor sleep;
• steroid psychosis.

Development of the disease in children

Itenko-Cushing's disease is diagnosed very rarely in young patients. But the severity of the course takes the leading position among endocrine pathologies. Most often affects the ailment of children at an older age. But it is impossible to exclude the formation of the process in preschool children.

The pathological process so quickly covers many types of exchange, so timely diagnosis and therapy should be carried out as soon as possible.

In 90% of patients, a delay in growth is diagnosed. In combination with being overweight, this leads to dehydration of the body. The lag in growth is characterized by the closure of epiphyseal growth zones.

In children, as in adults, hair begins to grow, although true puberty is delayed.

In boys, such symptoms are associated with a delay in the development of testicles and the penis, and in girls - in violation of the function of the ovaries, uterine hypoplasia, swelling of the mammary glands and menstruation.

The hair covering starts to hit such areas of the body as the back, spine, limbs.

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A characteristic manifestation of Cushing's syndrome is a violation of the trophism of the skin. Such a symptom is expressed in the formation of stretch bands.

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They are concentrated, as a rule, on the lower abdomen, sides, buttocks, inner thighs. These strips can be represented both in the singular and in the plural. Their color is pink and purple.

The skin with this process becomes dry, thin, it is very easy to injure. Often the child's body is affected by abscesses, fungi, furunculosis. The area of ​​the chest, face and back has an acne.

On the skin of the trunk and limbs, lichen-like rashes are formed. There is acrocyanosis. Skin covers on the site of the buttocks are accompanied by dryness, and to the touch they are cold.

Syndrome Itenko-Cushing in children

The defeat is applied to the flat bone and tubular. In the event of a fracture, clinical features are noted: absence or sharp reduction of the pain syndrome at the site of the fracture.

During healing, large enough sizes can be formed and a long-lasting corn.

The Itenko-Cushing syndrome causes pathological changes in the cardiovascular system in children. It manifests itself in the form of hypertension, electrolyte metabolism and hormonal failure.

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Increased blood pressure in this case are mandatory. This is the persistent and early symptom of the disease. The pressure indicators depend on the age of the patient. The younger he is, the higher his blood pressure will be.

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Tachycardia is diagnosed in almost all patients.

In small patients, neurological and mental disorders occur. For these symptoms, the following features are inherent:

• multi-point;
• wipeiness;
• different severity;
• dynamism.

Often there is a violation of the psyche. This condition manifests itself in a depressed mood, arousal, often patients visit suicidal thoughts. When Cushing's syndrome reached a stable remission, all these manifestations quickly disappear.

Children are often diagnosed with signs of steroid diabetes, the course of which occurs without acidosis.

Therapeutic events

Treatment of the disease first of all involves activities whose purpose is to eliminate the cause of pathology and balance the hormonal background. The Itenko-Cushing syndrome can suggest three methods of treatment:

• medicamentous;
• ray;
• surgical.

Methods of treatment of Itenko-Cushing's disease

It is very important to start treatment in time, because according to statistics, if therapy is not started in the first 5 years from the beginning, then the fatal outcome occurs in 30-50% of cases.

Medication Therapy

This treatment focuses on a complex of drugs, whose action is aimed at reducing the production of hormones in the adrenal cortex.

Often, the doctor appoints a doctor in conjunction with other methods of treatment.

For the therapy of Isenko-Cushing syndrome, the patient may be prescribed such drugs:

• Mitotane;
• Metirapan;
• Trilostane;
• Aminoglutethimide.

As a rule, these medicines should be used when the surgical method of treatment does not give a positive result, or it is simply impossible to perform the operation.

Radiation therapy

Radiation therapy

Use this method of treatment is appropriate in the case when the disease was caused by the adenoma of the pituitary gland. Radiation therapy due to the influence on the pituitary gland allows to reduce the production of adrenocorticotropic hormone.

As a rule, this method of therapy is carried out in conjunction with medical or surgical treatment.

Often it is thanks to a combination with medications that there is an increased effect of radiation therapy on the treatment of Cushing's syndrome.

Surgical intervention

To treat the disease is often prescribed surgery. It involves the removal of adenoma with the help of microsurgical techniques. The patient becomes better very quickly, and the effectiveness of such therapy is 70-80%.

If Cushing's syndrome was caused by a tumor of the adrenal cortex, the operation includes measures to remove this neoplasm.

If the disease is very difficult, then the doctors remove the two adrenals, resulting in the patient will have to apply glucocorticoids throughout his life as a substitute therapy.

The main manifestations of the disease are obesity and high blood pressure.

Treatment gives positive results only if all the therapeutic procedures have been performed in a timely manner.

Diseases with similar symptoms:

Hyperandrogenism (concurrent symptoms: 6 of 20)

Hyperandrogenism is a pathological condition that occurs in girls and women, and is characterized by an elevated level of androgens in the body.

Androgen is considered a male hormone - in the female body it is also present, but in a small amount, so when its level increases, the woman has characteristic symptoms, including stopping menstruation and infertility, male-type hair and some others. Changing the hormonal background requires an urgent correction, as this can lead to the development of many pathologies in the woman's body.

... Obesity (coinciding symptoms: 5 of 20)

Obesity is a condition of the body in which fatty deposits begin to accumulate in excess in its fiber, tissues and organs.

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Obesity, whose symptoms consist in increasing the weight from 20% or more when compared with the mean values, is not only the cause of general discomfort.

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It also leads to the appearance of psycho-physical problems on this background, problems with joints and spine, problems associated with with sexual life, as well as problems associated with the development of other conditions associated with this kind of changes in organism.

... Myocarditis (coinciding symptoms: 5 of 20)

Myocarditis is a common name for inflammatory processes in the heart muscle, or myocardium. The disease can appear against a background of various infections and autoimmune lesions, exposure to toxins or allergens.

There are primary inflammation of the myocardium, which develops as an independent ailment, and secondary, when cardiac pathology is one of the main manifestations of a systemic disease.

... Premenopause (coinciding symptoms: 5 of 20)

Premenopause is a special period in the life of a woman, whose term for each female representative is individual. This is a kind of gap between the weakened and fuzzy menstrual cycle and the last menstrual period that comes with menopause.

... Myotonia (coinciding symptoms: 5 of 20)

Myotonia is a genetically determined pathology that belongs to the category of neuromuscular ailments. It is noteworthy that, depending on its variety, it can manifest at different ages, and not from the moment when the baby is born.

The main reason for the development of the disease is to transfer the child mutating gene from one or both parents, and they can be perfectly healthy. Other prerequisites affecting the development of such a rare disease remain unknown.

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• In contact with

A source: http://SimptoMer.ru/bolezni/endokrinnaya-sistema/561-sindrom-kushinga-simptomy

Icenko-Cushing syndrome - causes and symptoms, diagnosis and treatment of the disease in children and adults

If, according to the results of the performed tests, there is an excess of glucocorticoid hormones in the adrenal glands, this is a sign of a dangerous disease.

Cushing's disease often prevails in women, can be treated with conservative and operative methods.

The patient experiences a pronounced symptomatology, needs timely diagnostics.

Causes of Itenko-Cushing syndrome

For a number of patients, the diagnosis becomes an unpleasant surprise. In such cases, the hormonal imbalance is preceded by the pharmacological introduction of synthetic hormones for the successful treatment of autoimmune conditions of the body.

It is a question of various medicinal preparations, for example, Prednisolone, Solu-Medrol, Dexamethasone for subcutaneous injection into the systemic bloodstream.

However, other causes of the Itenko-Cushing syndrome are known, having in practice the acquired character, are already considered pathological.

These were exogenous reasons why Cushing's syndrome appears, but the characteristic ailment has another classification according to the etiology of the pathological process. So:

1. Pseudosyndrome. This abnormal condition is only similar to the Itzenko-Cushing disease, but in reality, hormonal imbalance and ACTH concentrations precede overweight, congenital or acquired diabetes mellitus, chronic alcoholism, progressive pregnancy, a state of deep depression, impaired metabolism substances.
2. Endogenous factor. In this case, there are real health problems, and significant ones. This tumor of the pituitary gland, neoplasm of the female reproductive system, lung cancer, tumor processes of the adrenal cortex, for example, adenoma. Itenko-Cushing's disease badly needs an integrated approach, surgical intervention is not ruled out.

Dysfunction of the pituitary and hypothalamus for the first time remains unnoticed by clinical patients. People learn about the diagnosis of a biochemical blood test, and, quite by accident.

Symptoms of the Itenko-Cushing syndrome appear later, cause a certain concern for one's own health. For example, the patient is concerned about the growth of vegetation on the body, the appearance of a hump on the neck.

In addition, the clinical picture of the syndrome is characterized by the following changes in general well-being:

• increased fatigue;
• muscle weakness in the Itenko-Cushing disease;
• relaxation and reduction of smooth muscle tone;
• Rapid weight gain;
• moon face (matronism);
• osteoporosis in hypercortisolism;
• Marble shade of the dermis with a vascular pattern;
• a decrease in the activity of the nervous system: obvious inhibition, passivity, absent-mindedness;
• Increased signs of hypertension (sudden pressure jumps);
• frog stomach with the appearance of stretch marks;
• fat deposition in the cervical vertebrae;
• Sweating disorder (increased production of sebum);
• functional disturbance of systemic digestion.

Isenko-Cushing syndrome - diagnosis

In order to timely identify the syndrome of hypercorticism, it is required to undergo a number of laboratory tests. Among them, a blood test is necessary to determine the cortisol index for several days.

In addition, with the same analysis, 17-oxycorticosteroids are evaluated, and the level of ACTH is studied. The second mandatory condition for the Itenko-Cushing disease is the study of the composition of urine. This is a general analysis.

In this way, it is possible to identify the Itenko-Cushing syndrome, the diagnosis also includes other measures:

• MRI of the pituitary gland, adrenal glands;
• fluoroscopy;
• CT of sternum;
• radioisotope study;
• performance of a number of Itenko-Cushing tests.

Syndrome Itenko-Cushing in children

Hyperfunction of the adrenal gland can develop in childhood. Electrolyte disorders have a genetic predisposition, but in practice they are extremely rare.

The pathogenesis of this syndrome is studied individually, and the main symptoms are hypertension and dysplastic obesity.

It is possible that in the child's body develops diabetes.

To finally cure the Itenko-Cushing syndrome in children, it is important to normalize the hormonal background, to eliminate dysfunction of the adrenal cortex of the patient.

To get rid of pathology and suppress her development, the attending physician strongly recommends using conservative and surgical methods strictly for medical reasons.

The features of intensive care are as follows:

1. Admission of steroid hormones in combination with gamma-therapy.
2. Transsphenoidal adenomectomy or adrenalectomy.

Isenko-Cushing syndrome - treatment

Hyperadrenocorticosis needs to be properly diagnosed, with timely prescription of therapy with predominantly conservative methods. When cushingoid, changes in nutrition, mandatory medication, and the involvement of physiotherapy procedures are necessary.

Treatment of the Itenko-Cushing syndrome involves the intake of synthetic hormones, in order to correct the cushingoid (luniform) face with time.

Additionally, antidepressants, hypertensive drugs and other pharmacological groups are required depending on the symptomatology.

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A complicated operation with hypercorticism involves the removal of a tumor or other focus of pathology.

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Before the surgical intervention, medication is necessary.

This is necessarily insulin in diabetes, calcium and potassium preparations, anabolic steroids. After surgery, a patient with a lunar shape of the face is performed.

Disease and Itenko-Cushing syndrome

With hypercorticism, there is an increase in the value of cortisol in the blood. However, the disease and the syndrome have a different etiology of the pathological process.

For example, in case of illness, these are obvious pathologies of the hypothalamic-pituitary system, and in the syndrome it is a question of external external and internal stimuli. The main task of specialists is to correctly differentiate the progressing disease.

Only in this case, the syndrome or Icenko-Cushing's disease can be quickly cured, stabilize the hormonal background, and prevent dangerous complications for health.

: Itzenko-Cushing's disease

A source: http://sovets.net/8642-sindrom-itsenko-kushinga.html

Disease Itenko - Cushing - diagnosis, symptoms, treatment

Disease Itenko-Cushinga is a neuroendocrinal disorder characterized by increased production of hormones in the adrenal cortex.

It develops mainly in women of childbearing age (25-40 years), it occurs 3-8 times more often than in men.

The endocrinologist, gastroenterologist, neurologist, gynecologist, urologist and cardiologist are engaged in diagnostics and treatment.

Causes

The development of the Itenko-Cushing's disease is often due to the presence of a chromophobic or basophilic adenoma of the pituitary gland, which produces adrenocorticotropic hormone. In case of tumor lesion of the pituitary gland, the patient is diagnosed with adenocarcinoma, macro- or microadenoma.

In some cases, the relationship of the onset of pathology with previous intoxications, infectious lesions of the central nervous system, craniocerebral trauma is established.

In women, Itenko-Cushing's disease occurs against the background of hormonal fluctuations caused by puberty, menopause, pregnancy, childbirth.

Each of these factors triggers the following mechanism: corticoliberin (a hormone of the hypothalamus) is produced in large volumes, which leads to an enhanced synthesis of ACTH (a pituitary hormone).

The latter causes a cascade of adrenal and adrenal effects. In the adrenal gland secretion of androgens, glucocorticoids, to a lesser extent - mineralocorticoids.

Increase in glucocorticoid content has a catabolic effect on protein-carbohydrate metabolism, which provokes hyperglycemia, atrophy connective and muscular tissues, insulin insufficiency and insulin resistance, followed by the appearance of a steroidal sugar diabetes. The violation of fat metabolism is accompanied by the development of obesity.

Classification

The degree of development of the Itenko-Cushing's disease is mild, moderate and severe. The mild degree is characterized by mild symptoms.

With an average form, the symptomatology is bright, but there are no negative consequences.

The severe form is characterized by the development of various complications that hamper the patient's performance and lead to disability and death.

By the speed of development, the torpid and progressive course of the disease is distinguished. With torpid current, pathological processes are formed gradually, within 3-10 years. The progressive course is characterized by a rapid (during 6-12 months) increase in symptoms and complications.

Symptoms

People suffering from this disease have a peculiar appearance due to the accumulation of adipose tissue in typical places.

The face has a lunate shape, in the region of the VII cervical vertebra, the so-called fat climacteric hump is formed, the volume of the abdomen and thorax increases. At the same time, the legs and arms remain relatively thin.

Skin, with a pronounced purple-marble pattern, intradermal hemorrhages and stretch marks in the abdomen, shoulders and mammary glands, is scaly and dry. Quite often there is a development of furuncles or acne.

In men, impotence, decreased sexual desire, decrease and loss of hair on the body and face.

In childhood, the disease of Itenko-Cushing leads to a delay in sexual development due to a decrease in the production of gonadotropic hormones.

Due to the development of osteoporosis, changes occur on the part of the bone system. They are manifested by fractures, deformities and pains in the bones, in children - delayed growth and the formation of the skeleton.

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Cardiovascular disorders include electrolyte-steroid cardiopathy, tachycardia, arterial hypertension, chronic heart failure.

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People with this pathology are more susceptible to the development of pneumonia, bronchitis, tuberculosis.

The defeat of the digestive system is manifested by heartburn, chronic hyperacid gastritis, epigastric pain, gastrointestinal bleeding, steroid ulcers of the duodenum and stomach, steroid sugar diabetes. As a result of functional disorders of the urinary tract and kidneys, kidney failure occurs up to uremia, chronic pyelonephritis, nephrosclerosis, urolithiasis.

Neurological disorders are expressed in the development of stem-cerebellar, pain, pyramidal and amyotrophic syndromes. Amiotrophic and pain syndromes are potentially reversible under the influence of adequate treatment of the Itenko-Cushing's disease.

Pyramidal and stem-cerebellar syndromes are irreversible. Pyramidal syndrome is characterized by a central lesion of the sublingual and facial nerves, a tendon hyperreflexia with the corresponding symptomatology.

With this disease, mental disorders such as epileptiform, neurasthenic, hypochondriacal, depressive, astheno-dynamic syndromes are possible. Characteristic emotional inhibition, lethargy, decreased intelligence and memory. The patient may be troubled by compulsive suicidal thoughts.

Diagnostics

For the diagnosis is assessed the presence of the above symptoms of the disease Itenko - Cushing. Then the urine and blood are examined.

Usually, the results obtained confirm the decrease in activity of alkaline phosphatase and the presence of hypercholesterolemia, hypophosphatemia, hyperglobulinemia, hypokalemia, hyperchloremia, hypoalbuminemia, Hypernatremia.

With the development of steroid diabetes, hyperglycemia and glucosuria are recorded. A blood test for hormones reveals an increase in the level of cortisol, renin, ACTH.

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In the urine, hyaline and granular cylinders, protein, erythrocytes are found, the release of cortisol, 17-ACS, 17-CS increases.

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More information is provided by instrumental methods of diagnosing the Itenko-Cushing disease-radiography of the spine, bones of the skull and limbs, CT and MRI of the brain.

They show tumors of the pituitary gland and destruction of the bone system.

Ultrasound, radioisotope imaging and angiography of the adrenal glands will allow us to estimate their size and the degree of functioning of each layer.

Pathology is important to distinguish from the syndrome of hypercorticism (corticoblastoma or corticosteroma), hypercortisolemia, adolescent dyspituitism and hypothalamic syndrome, adrenogenital syndrome and exogenous obesity.

Treatment

Treatment of the Itenko-Cushing's disease is aimed at eliminating the hypothalamic changes, restoring the disturbed metabolism, normalizing the secretion of corticosteroids and ACTH.

For this purpose, drug therapy, surgical treatment, proton therapy of the hypothalamic-pituitary region, gamma-ray therapy, diet therapy, and a combination of different methods are prescribed.

Medical therapy is performed at the initial stages of the disease. For blockade of the pituitary gland, bromocriptine and reserpine are indicated.

In addition to central-action drugs that inhibit the production of ACTH, in the treatment of pathology, the blockers of the synthesis of steroid hormones in the adrenal glands are effective.

Simultaneously, symptomatic treatment aimed at correction of mineral, protein, electrolyte and carbohydrate metabolism is carried out.

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X-ray gamma and proton therapy are indicated for patients who do not have any radiographic data confirming the presence of a pituitary tumor.

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From the methods of radiation therapy stereotactic implantation of radioactive isotopes in the pituitary gland is used.

After a few months, a clinical remission comes in which the menstrual cycle normalizes, blood pressure and body weight decreases, and the damage to the muscular and bone systems decreases.

With severe disease, bilateral adrenal removal is required. When an adenoma of the pituitary gland is found, endoscopic transcranial (by trepanation of the skull) or transnasal (through the nose) removal of the tumor is performed.

A common method of symptomatic treatment of Isenko-Cushing's disease is dietotherapy. It regulates metabolism and fights complications of pathology.

With stones in the kidneys and osteoporosis, the level of calcium in the body needs to be normalized. Experts recommend increasing the number of products containing vitamin D. It's eggs, cheese, sour milk.

Abstain from saturated fatty acids, which are contained in mayonnaise, butter, margarine.

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With obesity, the patient's condition will facilitate the minimum intake of animal fats and sodium (especially salt), and in severe cases - and fluids (up to -2 liters per day).

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Diet with a peptic ulcer provoked by this pathology, implies frequent fractional meals. When choosing products, you need to focus on table 1, 1A and 1B for Pevzner.

He excludes baking, sour, fatty, smoked and salty dishes that stimulate the secretion of gastric juice and aggravate the course of the pathology. Also it is forbidden to drink strong alcoholic beverages, coffee and black tea.

During the exacerbation, it is desirable to eat low-fat soups, cereals, boiled meat and other light foods.

With heart failure, the goal of the diet is to normalize the volume of circulating blood. The patient is recommended to follow the treatment table number 10 according to Pevzner, limit the consumption of water (up to 1, l per day) and salt (up to -2 g per day).

Possible complications

The most serious complications of the disease are:

• kidney kidney disease;
• stomach ulcer;
• steroid diabetes mellitus;
• heart failure;
• weakening of the immune system.

Urolithiasis of the kidneys is explained by the elution of calcium compounds from the bones. They are not absorbed by the bone tissue, get into the blood and accumulate in large quantities in the renal pelvis.

Gradually, they form solid concretions that disrupt the outflow of urine into the ureters, injure the epithelium of the organ and cause renal colic.

Also, education data predispose to the development of infections (pyelonephritis).

Metabolic disorders affect the mucous membrane of the stomach. First of all, the production of mucus decreases, which normally envelops the walls of the organ.

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It becomes less protected before the aggressive action of acidic, spicy and solid foods.

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Also, the rate of recovery of mucosal cells slows down, which increases the risk of ulceration of the stomach or duodenum.

Steroid diabetes mellitus against the background of the Itenko-Cushing's disease develops in 10-20% of patients. Pathology proceeds much more easily than classical diabetes mellitus.

The glucose level is regulated by a properly selected diet, without taking medications.

In neglected cases, steroid diabetes mellitus provokes serious disorders.

Even if the Itzenko-Cushing's disease has been cured, changes in the myocardium are irreversible. The patient quickly gets tired of daily work, can not cope with heavy physical exertion.

Increased release of corticosteroids depresses the immune system. As a consequence, the body becomes more susceptible to different infections. Patients often suffer from ARVI, pustular skin diseases.

Prophylaxis and prognosis

People with symptoms of Itenko-Cushing's disease should be observed in different specialists and avoid excessive psycho-emotional and physical exertion. Also, general preventive measures include the fight against neuroinfection, intoxication, prevention of craniocerebral trauma, etc.

The prognosis of the disease depends on the patient's age, severity and duration of the pathological process. With early diagnosis, mild course and age 30 years, the outcome is favorable.

In moderate cases, after normalization of the function of the adrenal cortex, the arterial hypertension, osteoporosis, diabetes mellitus, irreversible impairment of kidney function and cardiovascular system.

With complete regression of signs of ailment, a person remains able-bodied.

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Bilateral adrenalectomy leads to the appearance of chronic adrenal insufficiency. This requires lifelong replacement therapy with mineralocorticoids and glucocorticoids. Otherwise, the risk of Nelson's syndrome increases. Also completely inefficient.

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A source: http://dolgojit.net/bolezn-itcenko-kushinga.php