Excessive secretion of glucocorticoids
Introduction
Introduction If a normal person has excessive secretion of glucocorticoids or long-term use of cortisone hormones, it can cause centripetal obesity, face like full moon, muscle atrophy, high blood sugar, high blood pressure, purple streaks on the abdomen and thigh skin, called Cushing. Syndrome. It refers to clinical syndromes caused by excessive cortisol in the body. A group of syndromes caused by long-term secretion of excess cortisol from the adrenal cortex due to various causes, mainly characterized by full moon face, multiple blood appearance, central obesity, hemorrhoids, purple streaks, hypertension, secondary diabetes and osteoporosis Wait.
Cause
Cause
A group of syndromes caused by long-term secretion of excess cortisol from the adrenal cortex due to various causes, mainly characterized by full moon face, multiple blood appearance, central obesity, hemorrhoids, purple streaks, hypertension, secondary diabetes and osteoporosis Wait.
Long-term use of glucocorticoids in the treatment of certain diseases can lead to clinical manifestations of cortisol, which is very common in the clinic. This is caused by exogenous hormones and can be gradually restored after stopping the drug. However, long-term use of glucocorticoids can feedback the secretion of ACTH in the pituitary gland, causing atrophy of the adrenal cortex. Once the drug is stopped, it may lead to a series of manifestations of cortical dysfunction and even crisis, so it should be noted.
Tumor growth and secretion of adrenocortical hormone are autonomous and not controlled by ACTH. Since the tumor secretes a large amount of corticosteroids, the feedback inhibits the secretion function of the pituitary, which lowers the plasma ACTH concentration, so that the normal adrenal cortex of the non-tumor part is obviously atrophied. In patients with this type of ACTH-induced or high-dose dexamethasone, the amount of cortisol secreted does not change.
Examine
an examination
Related inspection
Blood examination, whole body soft tissue MRI examination
Diagnosis: Cushing's syndrome (Cushing's syndrome) is a general term for diseases caused by the secretion of polyglucocorticoids (mainly cortisol) by the adrenal gland. The most common cause is the secretion of pituitary adrenocorticotropic hormone (ACTH). The clinical type is called Cushing's disease. This disease is more common in adults and women. The ratio of male to female is 1:2.5. The age of onset is mostly 20-40 years old.
Glucocorticoids increase, and the secretion rhythm of day and night disappears. 1. Increased free cortisol (F) in the urine, exceeding 110g/24h. Since the urine F reflects the cortisol level of 24h, it is less affected by other factors than the cortisol in the blood, so the diagnostic value is higher. 2. ACTH assay in plasma can identify ACTH-dependent Cushing's disease and non-ACTH-dependent Cushing's disease. ACTH also has a diurnal secretion rhythm, which is the highest at 8 o'clock in the morning (fasting basis value 10 ~ 100pg / ml), the lowest in the evening; the circadian rhythm of ACTH in patients with Cushing's disease disappears. 3. Low-dose dexamethasone inhibition test. 4. High-dose dexamethasone inhibition test (DST). 5. CRH Excitatory Test For patients who cannot be identified with a large dose of 8 mg DST, a CRH stimulation test can be performed.
Diagnosis
Differential diagnosis
Excessive secretion of salt corticosteroids: mineralocorticoid: mainly acts on sodium, potassium, chloride and water metabolism, so it is called mineralocorticoid. Among these hormones are aldosterone and deoxycorticosterone, among which aldosterone is the strongest. Mineralocorticoids have the effect of preserving sodium and potassium, promoting the reabsorption of sodium by the renal tubules and the effect of potassium release, thereby maintaining the proper concentration of sodium and potassium in the plasma. When the adrenal cortex hyperfunction (such as Cushing's syndrome), 11-deoxycorticosterone secretion, due to retention of sodium and water in the body beyond the limits of edema, increased blood volume, elevated blood pressure, high blood sugar, hypokalemia Wait. Conversely, if the adrenal cortical function is insufficient, the metabolism of sugar and minerals is disordered, causing a bronze disease, or "Addison's disease", which shows muscle weakness, decreased blood pressure, skin pigmentation and hypoglycemia, blood. Symptoms such as decreased sodium and increased potassium, while blood loses water and concentrates, and are life-threatening in severe cases.
Corticosteroid dependence: Glucocorticoid dermatitis refers to dermatitis caused by long-term topical glucocorticoids, which is characterized by dependence on hormones. This is a side effect caused by inappropriate topical glucocorticoids. The glucocorticoid-dependent dermatitis is characterized by skin flushing, papules, skin atrophy, telangiectasia, acne-like and rosacea-like rash, with burning sensation, pain, itching. Dry, tight feeling, after the topical glucocorticoids are stopped, the skin disease recurs and there is a rebound phenomenon. The disease is extremely common, and more than 500 cases have been reported in various parts of China.
Elevated corticosteroids: a class of steroidal compounds synthesized and secreted by the adrenal cortex whose primary function is to regulate water-salt metabolism and glucose metabolism in animals. Corticosteroids have too many serious adverse reactions. The adverse reactions of corticosteroids include: cortical hyperfunction, steroid diabetes, muscle atrophy and osteoporosis, induce and aggravate infection, induce and aggravate ulcers, induce mental symptoms, and develop eye diseases. Teratogenicity, inappropriate withdrawal of the drug may also have symptoms such as insufficient cortical function, hormone withdrawal syndrome and symptom rebound.
