Dijagnostički pristup bolesniku sa sumnjom na Cushingov sindrom

master's thesis

• Title (english): Diagnostic approach to a patient with suspected Cushing's syndrome
• Author: Leon Čukman
• Mentor: Velimir Altabas (mentor)
• Committee member: Maja Baretić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Velimir Altabas (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Relativno rijedak endokrini poremećaj poznat pod nazivom Cushingov sindrom pojavljuje se zbog
dugotrajno povišene količine glukokortikoida u krvi. Praćen je nizom nespecifičnih kliničkih
manifestacija nalik onima u metaboličkom sindromu. Zbog toga ova bolest često može ostati dulje
vrijeme neprepoznata. Veću dijagnostičku vrijednost imaju simptomi poput “vrata bivola” ili “lica
poput mjeseca”. Kada se pojavi sumnja na Cushingov sindrom, treba provesti dijagnostički
postupak. On uključuje anamenzu i status te laboratorijske pretrage čiji je cilj potvrditi
hiperkortizolizam. Za inicijalnu potvrdu dijagnoze koriste se barem dva od tri sljedeća testa:
mjerenje slobodnog kortizola u 24-satnom urinu, mjerenje kortizola iz sline kasno navečer i
prekonoćni deksametazonski test. Za daljnu diferencijaciju etiologije Cushingovog sindroma,
potrebno je odrediti je li Cushingov sindrom ACTH ovisan ili neovisan. Za konačnu potvrdu
dijagnoze i etiologije, koriste se razne invazivne i neinvazivne radiološke metode, kojima je cilj
vizualizirati tumor ili neku drugu netumorsku tvorbu koja je uzrok istraživane bolesti. Nakon
postavljanja dijagnoze, provodi se liječenje, koje najčešće uključuje radikalan kirurški zahvat,
osim pri jasnoj vizualizaciji tvorbe, kada se može eventualno pokušati rješiti bolest s poštednijim
zahvatom. Medikamentozna terapija se koristi uglavnom samo kao privremeno rješenje, najčešće
pri odgađanju operacijskog zahvata. Često je nakon operacijskih zahvata potrebno, pa čak u
nekim slučajevima i kroz duže vrijeme, koristiti nadomjesnu terapiju glukokortikoidima. Za razliku
od endogenog Cushinogov sindroma, na jatrogeni Cushingov sindrom često već ukazuje
anamneza uzimanja glukokortikoida, kao terapijska mjera najznačajnija je postepeno smanjivanje
doze i eventualni prestanak uzimanja kortikosteroida.

Abstract (english)

A relatively rare endocrine disorder known as Cushing's syndrome occurs due to long-term
elevated levels of glucocorticoids in the blood. It is accompanied by a series of nonspecific clinical
manifestations similar to those in metabolic syndrome. As a result, this disease often goes
unnoticed for a long time. Symptoms such as a "buffalo hump" or "moon face" have greater
diagnostic value. When CS is suspected, a diagnostic procedure should be performed. It includes
medical history and physical examination, and laboratory tests aimed at confirming
hypercortisolism. At least two of the following three tests are used to initially confirm the diagnosis:
measurement of free cortisol in 24-hour urine, measurement of late-evening salivary cortisol, and
overnight dexamethasone test. To further differentiate the etiology of Cushing’s syndrome, it is
necessary to determine whether Cushing’s syndrome is ACTH dependent or independent. For
the final confirmation of the diagnosis and etiology, various invasive and non-invasive radiological
methods are used, which aim to visualize the tumor or some other non-tumor formation that is the
cause of the inspected disease. After the diagnosis is made, treatment is carried out. It usually
involves radical surgery, except with a clear visualization of the formation, when a more sparing
procedure is eventually tried. Drug therapy is used mostly only as a temporary solution, most
often in order to delay the surgery. It is often necessary to use glucocorticoid replacement therapy
after surgery, in some cases even for a long time. In the case of iatrogenic Cushing’s syndrome,
a positive medical history of taking glucocorticoid drugs will be indicative in the diagnostic process,
and gradual therapy cessation and, if possible termination will result in patients’ improvement.

• Keywords: Cushingov sindrom; dijagnostika; hiperkortizolizam
• Keywords (english): Cushing’s syndrome; diagnostics; hypercortisolism
• Language: croatian
• URN:NBN: urn:nbn:hr:105:932928
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-05 08:33:10