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Endocrinology

Syndrome of Kushinga

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Syndrome of Kushinga
Treatment and forecast
Syndrome of Kushinga — the group of diseases, the general for which is the raised products of cortisol bark of adrenal glands. Usually the bilateral hyperplasia of bark of adrenal glands resulting from the increased development of AKTG against adenoma of a hypophysis or pituitary and hypothalamic dysfunction is the cornerstone. Sometimes hyperproduction of cortisol is caused by tumors of bark of adrenal glands (adenoma, a carcinoma) or is observed at a nodal hyperplasia of bark of adrenal glands that takes place at children more often. In some cases AKTG is produced by cells of malignant tumors, for example, at lung cancer. All listed options belong to an endogenous syndrome of Kushinga. However this syndrome quite often happens iatrogenic, i.e. is connected with long therapy by glucocorticoids or AKTG — an exogenous syndrome of Kushinga.

It is considered that the increased maintenance of glucocorticoids in blood and fabrics leads to a sodium delay that promotes developing of arterial hypertension. At some patients with a syndrome of Kushinga level and mineralokortikoid is increased. It is possible that glucocorticoids stimulate also a renin-angiotenzinovuyu system and increase reactivity of a vascular wall in relation to pressor influences.

Clinical manifestations of a syndrome of Kushinga

Most of patients has a typical appearance — an excess adiposity in a face, necks, trunks, a crescent-shaped face, skin dry, thinned, on a face and in a breast of crimson and cyanochroic color. Striya on skin of a stomach, hips, an internal surface plechy. A hypertrichosis on face skin, spins. Easy emergence of bruises on skin, osteoporosis, a polycythemia, a hyperglycemia, a hypopotassemia, mental disturbances (a depression or euphoria) are noted. Muscular weakness is expressed, working capacity is lowered.

Arterial hypertension is expressed at most of patients with a syndrome of Kushinga and can reach very high level. The disease outcome quite often is defined by defeat of cardiovascular system against arterial hypertension.

Recognition of a syndrome of Kushinga and treatment of arterial hypertension at this syndrome.

The diagnosis is based on characteristic clinical manifestations. The exogenous nature of a disease becomes clear when collecting the anamnesis when there are data on prolonged use of glucocorticoids, for example, at a system lupus erythematosus, a pseudorheumatism, bronchial asthma, a nephrotic syndrome and other diseases.

At suspicion on an endogenous syndrome of Kushinga define cortisol in daily urine (content more than 250 mkg confirms the diagnosis). After identification of a giperkortizolemiya carry out differential diagnosis of options of a syndrome, and at the final stage — establish localization of pathological process.
Treatment of arterial hypertension at a syndrome of Kushinga does not differ from treatment of other forms of hypertensia (except for a pheochromocytoma).



 
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