Subclinical Cushing's Syndrome: Resection Ntawm Adrenal Incidentaloma

Xav paub ntau ntxiv plz hu raudavid.wan@wecistanche.com

Kev piav qhia

Ib tus poj niam muaj hnub nyoog 41- xyoo raug xa mus rau kev phais dav dav vim yog ib qhoadrenal qogpom qhov xwm txheej ntawm lub plab ultrasound. Nws muaj mob qaug dab peg tswj los ntawmlevetiracetam tshuajthiabphenobarbital tshuaj. Tus neeg mob tau asymptomatic qhia me me, ntuav taub hau thiab palpitations. Ntawm kev kuaj lub cev, tsis muaj cov tsos mob ntawm tus kab mob adrenal, ntshav siab, lossis rog (lub cev qhov ntsuas ntawm 19kg / m ~).

Nyem qhov no kom paub ntau ntxiv txog Cistanche

Nws lub plab ultrasound qhia tau tias ahypoechoicnodule localized superiorly nyob rau hauv relation mus rau sab sauv ncej ntawm lub raum sab laug ntsuas 33 × 27mm. Ua ntej adrenalxwm txheej, qhov mob no yuav tsum tau soj ntsuam rau malignancy thiab hormonal secretion. Kev tshawb nrhiav pom tau pom cov khoom muaj txiaj ntsig zoo, txhais tau hais tias sab laug adrenal loj nrog qhov tsis zoo ntawm CT attenuation qhov tseem ceeb (<10 hounsfield="" units="" (hu)),="" without="" calcifications="" or="" invasion="" of="" adjacent="" organs,="" measuring="" 30×40="" mm="" (figure="">

Daim duab 1 CT scan: Khoom, zoo-txhais sab laug adrenal loj nrog qis CT attenuation qhov tseem ceeb (<10hounsfield units),="" without="" calcifications="" or="" invasion="" of="" adjacent="" organs,="" measuring="" 30×40="">

Nws lub raum ua haujlwm thiab cov qib electrolyte cov ntshav tau zoo li qub, nrog rau cov ntshav plasma/24-teevcov zis fractionated metanephrines, catecholamines, renin, thiab aldosterone serum qib. Pob txha ceev los ntawm DEXA scan (Dual-zog X-ray absorptiometry) thiab cov piam thaj kam rau siab los ntawm 75g qhov ncauj qhov ncauj qabzib ntsuas nyob rau hauv ib txwm muaj. Ob qhov kev ntsuam xyuas nocturn suppression tom qab 1 mg ntawm dexamethasone tau ua thiab qhia txog qib siab cortisol (13.8ug / dL thiab 17.1ug / dL, raws li: qib ib txwm muaj.<1.8ug l)raising="" the="" suspicion="" of="" excessive="" and="" abnormal="" cortisol="">

Cov 24-teev cov zis cortisol tsis pub dhau ib teev yog ciam teb (85.9ug / dL: ib txwm theem ntawm 20 ug / dL thiab 90 ug / dL) uas tuaj yeem piav qhia los ntawm kev tswj hwm ntawm phenobarbital uas induces CYP3A4 metabolism thiab accelerates urinary cortisolmetabolism. Serum adrenocorticotropic hormone (ACTH) qib tau ntsuas nyob rau hauv cov lus teb rau corticotrophin-tso tshuaj hormone (CRH) kev tswj hwm thiab tau pom tias yog<0.005ug l="" (two="" measurements),="" setting="" aside="" acth-dependent="" causes="" for="" high="" levels="" of="" cortisol.="" after="" excluding="" the="" physiological="" causes="" of="" hypercortisolism,="" she="" was="" diagnosed="" with="" subclinical="" autonomous="" hypercortisolism.="" the="" decision="" to="" operate="" on="" cortisol-secreting="" tumors="" without="" clinical="" stigmata="" is="" still="" under="" debate.="" despite="" the="" absence="" of="" external="" signs,="" patients="" may="" have="" underlying="" clinical="" features="" (hypertension,="" diabetes,="" obesity)="" and="" this="" condition="" can="" progress="" to="" overt="" cushing's="" syndrome="" in="" a="" substantial="" percentage(12.5%).="" surgical="" resection="" must="" be="" considered="" in="" young="" patients="" with="" well-documented="" autonomous="" cortisol="" secretion="" and="" symptomatic="" patients="" due="" to="" a="" functional="" adrenal="" mass.2="" therefore,="" our="" patient="" was="" a="" surgical="" candidate="" and="" laparoscopic="" transabdominal="" unilateral="" left="" adrenalectomy="" was="" performed="" without="" intraoperative="" complications="" (video="">

Kev soj ntsuam ua ntej ntawm kev pheej hmoo txog kev hloov kho glucocorticoid yog qhov tseem ceeb kom tsis txhob ua haujlwm tom qab.adrenalinsufficiency, hemodynamic instability thiab, txawm, tuag. Glucocorticoids yuav tsum tau pib ua haujlwm hauv kev ua haujlwm thiab txuas ntxiv mus rau lub sijhawm tom qab phais kom txog thaum cov qib cortisol ruaj khov. Kev sib koom ua ke ntau yam xws li tshuaj loog, endocrinology, thiab kev phais endocrine yog tsim nyog los xyuas kom meej qhov ua tau zoo. Tom qab kev ua haujlwm, tus neeg mob tau pom qhov kev txwv ib ntus ntawm cortisol secretion, nrog rau thaum sawv ntxov cortisol ntawm 0.6ug/dL. Tus neeg mob raug tso tawm tom qab 4 hnub thiab lub sijhawm postoperative cia siab rau kev hloov glucocorticoid thiab kev saib xyuas hypothalamic-pituitary-adrenal axis. Anatomopathological tsom xam ntawm cov qauv retrieved tau nthuav tawm lub cortex adenoma nrog glomerular thiab trabecular hlwb sib xws nrog ACTH-ywj siab Cushing's syndrome. Txawm hais tias muaj kev cuam tshuam ntawm phenobarbital, nws tsis tsim nyog los ua kom ntau npaum li cas thiab nws muaj peev xwm nrog-kho tshuaj tom qab 6 lub hlis nrog cov theem ntawm nocturnal cortisol tom qab kev tawm tsam ntawm 1 mg ntawm dexamethasone (0.8ug / dL) .

Cov ntsiab lus kawm

Subclinical Cushing's Syndromelos yog autonomous cortisol secretion tej zaum yuav muaj qhov cuam tshuam tseem ceeb hauv kev kho mob thiab tuaj yeem nce mus rau Cushing's syndrome hauv 12.5 feem pua ​​​​ntawm cov neeg mob.

Kev txiav txim siab phais yuav tsum tau coj los ntawm cov neeg mob lub hnub nyoog, hormonal ua haujlwm ntawm adrenal loj, kev pheej hmoo ntawm malignancy, thiab cov tsos mob tshwm sim.

Kev sib koom tes ua haujlwm ntau yam (anaesthesiology, endocrinology, thiab kev phais endocrine) yog qhov tseem ceeb heev kom tsis txhob muaj teeb meem hauv kev ua haujlwm thiab tom qab phais hauv cov qog cortisol-secreting thiab ua rau muaj txiaj ntsig zoo.