How to treat Cushing's disease

summary

Many people don't understand why Cushing's disease is so bad? In fact, Cushing's syndrome (Cushing's syndrome) is caused by various causes of adrenal gland secretion of excessive glucocorticoids, mainly manifested as full moon face, multi blood appearance, centripetal obesity, acne, purple lines, hypertension, secondary diabetes and osteoporosis. The etiological classification: 1. Cushing's syndrome dependent on ACTH: Cushing's disease; ectopic ACTH syndrome. 2. Cushing's syndrome independent of ACTH: adrenocortical adenoma; adrenocortical adenocarcinoma; bilateral adrenal small nodular hyperplasia independent of ACTH; bilateral adrenal large nodular hyperplasia independent of ACTH. So how to treat Cushing's disease. Let's study together.

How to treat Cushing's disease

First, the diagnosis of the disease should be confirmed: mainly based on the typical clinical manifestations and laboratory examination, the urine 17 hydroxycorticosteroid is 55 μ mol / 24h, and the urine free cortisol is more than 304nmol / 24h, which can not be inhibited by low-dose dexamethasone test. Then we need to find out the cause: that is, the difference is cortical hyperplasia caused by adrenal cortical adenoma, adenocarcinoma, pituitary tumor, non pituitary tumor or heterologous ACTH secreting tumor. According to the clinical manifestations, combined with imaging and laboratory examination, it can be distinguished.

1. Cushing's syndrome dependent on ACTH: ①. Cushing's disease: the first choice is transsphenoidal resection of pituitary microadenoma; if transsphenoidal damage can not be found and removed pituitary microadenoma or pituitary damage can not be done, and serious cases can be one side of total adrenalectomy, the other side of partial or total adrenalectomy, postoperative hormone replacement. For patients with macroadenoma, craniotomy and postoperative radiotherapy can be performed. ② Ectopic ACTH syndrome, depending on the situation of surgery, radiotherapy and chemotherapy.

3. Cushing's syndrome independent of ACTH: 1. Adrenal adenoma and adrenal carcinoma should be removed. Hormone replacement was given according to the situation after operation. ② Bilateral adrenal small nodular hyperplasia or bilateral adrenal large nodular hyperplasia independent of ACTH were treated with bilateral adrenalectomy and hormone replacement after operation.

matters needing attention

Cushing's syndrome is caused by various causes of adrenal gland secretion of excessive glucocorticoids caused by the disease, so we need to find its cause, in order to better treatment. After effective treatment, the condition can gradually improve after a few months, but if the course of disease is long, the blood pressure is not easy to return to normal after irreversible renal vascular damage. In addition, the curative effect of Cushing's disease after treatment is different, so it is necessary to regularly observe whether there is recurrence and adrenocortical insufficiency.