Cushing's disease is a disease of the endocrinesystem, resulting from the defeat of the hypothalamic-pituitary system and increased production of the hormone ACTH by the adrenal cortex. This pathology is characterized by multisymptomaticity. Most often, the disease develops in women. Patients suffering from Itsenko-Cushing's disease are diagnosed with obesity, hypertension, diabetes and many other specific manifestations.
To confirm the assumption of thisdisease, the patient will have to undergo a series of biochemical blood tests, hormone tests, X-rays of the spinal column and chest, CT of the pituitary and adrenal glands. The pathology is treated with drugs, radiation and surgery.
In medicine, there are two concepts:Cushing's disease and syndrome. In the second case, we are talking about the primary manifestations of hypercortisolism. Both the disease and the Itsenko-Cushing syndrome have the same symptom complex, but at the same time have a different origin nature.
The basis of the development of the syndrome is increasedproduction of the human hormone glucocorticosteroid, caused by hyperplastic tumors of the adrenal cortex. Basically, such a malfunction of the endocrine system occurs due to the increasing in size of corticosteromas, gluco-steromas, adenocarcinomas. Hypercorticism, triggered by long-term use of synthetic steroids, can also be a cause of Cushing's syndrome. In rare cases, the prerequisites for the development of this pathology are cancers of the ovary, lung, pancreas, intestine, thyroid gland. Against the background of these malignant processes, ectopic ACTH syndrome with similar clinical manifestations develops.
Unlike syndrome, Cushing's diseaseoriginates at the level of the hypothalamic-pituitary system, and the adrenal glands and other glands of the endocrine system are involved in the pathological process in the later stages. The disease occurs among the representatives of the weaker sex several times more often than among men, and most often the disease affects women of fertile age. The course of the disease is characterized by serious neuroendocrine disorders, including metabolic disorders, neurological symptoms, malfunctioning of the cardiovascular, digestive and excretory systems.
Причины болезни Кушинга кроются в наличии аденомы pituitary, producing an excessive amount of adrenocorticotropic hormone. In the case of tumor lesions of this brain gland, adenocarcinoma, micro- or macroadenoma is detected in patients. Often the occurrence of these tumors is associated with the consequences of infections and damage to the central nervous system (encephalitis, arachnoiditis, meningitis), traumatic brain injury, intoxication. In medical practice, there have been cases when Cushing's disease in women developed on the background of hormonal disorders caused by pregnancy, childbirth, and menopause.
Механизм развития патологии Иценко – Кушинга is a violation of the hypothalamic-pituitary-adrenal nexus, as a result of which too much hormone ACT is produced. In turn, the increased synthesis of this substance explains the whole chain of adrenal and extra-adrenal reactions in the body:
There are several forms of the clinical course of Itsenko-Cushing disease. The disease has three severity:
Also distinguish the course of the disease by speedgrowth of pathological changes - allocate the progressive and torpid form of the disease. In the first case, the illness develops over 6-12 months. Changes to the patient do not go unnoticed by others. With torpid course, the symptoms of the disease are formed in stages, within 3-10 years.
Распознать симптомы болезни Иценко – Кушинга не make it a lot of work, even those who are far from medicine. To do this, you need to know what kind of disorders arise in this disease and how the face of a person who has this ailment changes with them.
Patients suffering from the disease differ in the so-called cushingoid appearance, which is characterized by:
In women with Itsenko-Cushing's syndrome occursfailure in the menstrual cycle, in some cases, menstruation completely disappear. In addition, it is impossible not to note the excess atypical male type hair growth - this phenomenon in medicine is called "hirsutism." We are talking about vegetation on the face, neck, chin, temples, abdomen, chest and intense hair loss on the head.
In men suffering from Cushing's disease,on the contrary, body hair falls out, the growth of stubble on the face stops. Over time, patients, regardless of gender, decrease libido, sexual desire is lost. If the disease affects in childhood, it is likely that delayed sexual development and growth due to a decrease in the secretion of gonadotropic hormone.
Due to calcium reabsorption and developmentosteoporosis bone deformation occurs, possible fractures, pain in the joints. Over time, tachycardia, cardiopathy, and chronic heart failure increase with hypertension. Patients in this category often suffer from bronchitis, pneumonia and tuberculosis.
Нельзя оставить вне внимания поражения digestive system in the development of Itsenko - Cushing syndrome. Patients often complain of frequent heartburn, pain in the epigastric region, caused by "steroid" peptic ulcer disease and bleeding within the gastrointestinal tract. Probable violations in the work of the kidneys, lesions of the urinary tract, up to uremia, are not excluded.
The progression of the pathology Itsenko - Cushingthreatens the patient with the development of pain, amyotrophic, stem-cerebellar and pyramidal syndromes. But if the pain and amyotrophic syndromes are amenable to drug control, then the changes caused by stem-cerebellar and pyramidal syndromes cannot be contained, they are irreversible. Patients may experience ataxia, nystagmus, pathological reflexes, in which the facial and hypoglossal nerves are involved.
When Itsenko - Cushing's disease often occurpsycho-emotional disorders on the basis of neurasthenic, depressive, astheno-dynamic and epileptiform syndromes. A completely natural phenomenon becomes the deterioration of memory and intelligence, lethargy, reduction of the amplitude of emotional fluctuations. Some patients have obsessive suicidal thoughts.
Interestingly, for quadrupeds this diseasediagnosed as often as in humans. The cause of the incidence is a similar effect of cortisol on the work of the whole organism. In an animal with Itsenko-Cushing's syndrome, immunity is affected, the nervous and urogenital systems, the heart suffers, the condition of the connective tissue and internal organs deteriorates. The disease almost never develops rapidly, so the pet owners have enough time and good chances to help the animal and prolong its life. Should alert these symptoms:
Other symptoms of the disease can also be observed.Cushing In dogs, with frequent urination, incontinence appears. Pet gaining excess weight, and fat deposits are localized mainly in the neck, abdomen and chest. Over time, the weakened muscles become unable to hold the enlarged abdomen, making it droop. The dog becomes inactive, lethargic, drowsy, possibly unbalanced behavior. If the cause of the disease was pituitary adenoma, there is a lack of coordination.
To begin treatment, it is not enough just patient complaints and examination by a doctor. The diagnosis will require consultation of an endocrinologist, a neuropathologist, a gastroenterologist, a cardiologist, and a gynecologist.
Experts in their arguments rely onresults of biochemical blood tests - a number of indicators undergo typical changes in Cushing's disease. Diagnosis allows us to conclude that the high content of cholesterol, chlorine and sodium in the blood. In patients with this disease, the level of sugar in the blood and urine significantly exceeds the norm, which indicates the development of the characteristic "steroid" diabetes mellitus.
A blood test for hormones, which allows to detect the concentration of cortisol, adrenocorticotropic hormone, renin, is obligatory. Cortisol is also counted in the patient's urine.
In addition to laboratory research methods, the patient must undergo:
Since Itsenko – Cushing’s disease develops onagainst the background of violations of the secretion of ACTH, treatment involves the elimination of endocrine disorders and the restoration of metabolic processes. The therapeutic program involves the use of drugs, radiotherapy of the hypothalamic-pituitary region. In severe cases, the most effective treatment option will be surgery or a combination of several therapeutic methods.
Medicines are prescribed to patients only at earlystages of the disease. The blockade of pituitary functions is an intermediate goal of drug exposure. To achieve it, drugs such as Reserpine and Bromocriptine are prescribed - they actively suppress the secretion of ACTH. In addition to centrally acting hormones, adrenal steroid synthesis blockers can be used in the treatment of Itsenko-Cushing's disease. Symptomatic therapy, corrective protein, mineral, carbohydrate, and electrolyte metabolism are necessarily carried out.
Лучевая терапия зачастую проводится пациентам, у which there are no x-ray data on pituitary tumors. One of the methods of treatment is the implantation of radioactive isotopes into the pituitary gland. A few months after the therapy, a period of remission begins, which is accompanied by a decrease in body weight, blood pressure, stabilization of the menstrual cycle, inhibition of the pathological process, and damage to the bone and muscle tissues. Irradiation of the pituitary gland is often combined with unilateral removal of the adrenal gland (adrenalectomy).
При тяжелой форме болезни Кушинга лечение is the removal of the adrenal glands from two sides (bilateral adrenalectomy), which further requires lifelong replacement therapy with glucocorticosteroids and mineralocorticoids.
If the disease has become benignpituitary tumor, carry out endoscopic transnasal or transcranial removal of adenoma. In some cases, surgery to excise the affected part of the pituitary gland is performed by transsphenoidal way. After removal of the adenoma, remission occurs in a predominant number of cases, but approximately every fifth patient develops a relapse.
Determine the chances of recovery of a person withCushing's disease is not easy. The outcome of the disease depends on its severity, the age of the patient. With timely initiated treatment of pathology at an early stage in young patients, complete recovery is not excluded. While the prolonged course of Cushing's disease leads to persistent changes in the bone tissue, cardiovascular and urogenital systems, it affects the ability to work and aggravates the prognosis, even if the underlying cause is subsequently removed. Launched forms of this disease end lethal due to the addition of infections, septic complications, the development of renal failure.
Patients with pathology Itsenko - Cushing shouldregularly observed by an endocrinologist, cardiologist, neurologist, gynecologist. In order to prevent the progression of the disease, it is important to avoid exorbitant physical and psycho-emotional stress, time to treat infectious diseases, intoxication, to prevent complications. With such a diagnosis, night work shift is completely excluded.
