Á¦  ¸ñ :   Pseudo-Cushing syndrome


###Background of PseudoCushing syndrome http://www.goodhormonehealth.com/symptoms/pseudocush.pdf cortisol excess : http://www.virginiahopkinstestkits.com/cortisolzava.html
In 1976, Smalls°ú µ¿·áµé :  Cushing syndromeÀÇ »ýÈ­ÇÐÀû, ½ÅüÀû Ư¼ºÀ» °¡Áø 3¸íÀÇ ¾ËÄÝÀÇÁ¸¼º ȯÀÚ¿¡ ´ëÇØ ±â¼ú, ±×ÈÄ ¿ì¿ïÁõ 2,3,4,5,6 Áõ·Ê¸¦ ¸®ºäÇÔ.
###Recent studies
A study by Dockray et al : 8-13¼¼ »çÀÌÀÇ ³²³à¾Æµ¿¿¡ ´ëÇÑ ¿¬±¸, ¿©¾Æ¿¡ À־ ¾Æµ¿±â ºñ¸¸°ú °ü·ÃµÈ ÄÚƼ¼Ö ¹ÝÀÀ»ó½ÂÀÌ ¿ì¿ïÁõ°ú °ü·ÃµÇ¾î ÀÖÀ½À» ¹àÈû.
###Pathophysiology
¿ÏÀüÈ÷ ¹àÇôÁø °ÍÀº ¾Æ´ÏÁö¸¸ ´ëü·Î hypothalamic or suprahypothalamic level¿¡¼­ ½ÃÀÛµÈ CRHÀÇ ÁßÃßÀÚ±Ø »ó½ÂÀ¸·Î º½.
###Frequency
¹Ì±¹ÀÇ °æ¿ì, ¾ËÄÝÁßµ¶¼¾Å¸¿¡¼­ 56¸íÀÇ ³²¼º ´ë»ó ¿¬±¸
--18% : nonsuppressible serum cortisol levelsÀ» ³ªÅ¸³»¾úÁö¸¸, À̵é Áß ´ëºÎºÐÀº Cushing syndromeÀÇ ½ÅüÀû Ư¡Àº °á¿©µÇ¾î ÀÖ¾úÀ¸¸ç, »ýÈ­ÇÐÀû Ư¡Àº ¼öÀÏ ³»¿¡ ¼Ò½ÇµÇ¾úÀ½,
###Mortality/Morbidity
»ç¸Á·Ê´Â ÇÑ °Çµµ ¾ø¾úÀ½
»ýÈ­ÇÐÀûÀÌ»óÀÌ Áö¼ÓµÇ´Â °æ¿ì¿¡¼­´Â hypertension, glucose intolerance, diabetes mellitus, and osteoporosis°°Àº ÇÕº´ÁõÀÌ À¯¹ßµÇ¾úÀ½.
Sex : ³²³à ¸ðµÎ ºñ½Á
Age : ¾î´À ¿¬·É¿¡¼­³ª ´Ù °¡´É, ƯÈ÷ ¼öÀ¯±â¿¡ ¾ö¸¶°¡ ¾ËÄÝÁßµ¶ÀÎ °æ¿ì ´õ °ü·Ã¼º ÀÖ¾úÀ½.
### Clinical
**History : º´·Â¿¡ À־´Â alcohol abuseÀÇ Á¤µµ¿Í ±â°£ÀÌ °¡Àå Áß¿ä. À¯»çÇÑ ¿ä¼ÒµéÀÌ  depression.2,3,4,5,6 ¿Íµµ °ü°è°¡ ÀÖ¾úÀ½
**Physical : Features of full-blown Cushing syndromeÀÇ ¿¹.
Truncal obesity
Plethoric moon face
Buffalo hump
Supraclavicular fat pads
Hirsutism in women
Thin skin with easy bruising and wide, purplish striae
Hypertension
@ÇÏÁö¸¸ glucocorticoid excessÀÇ Áõ»óÀ̳ª ½ÅüÀû Ư¡ÀÌ ÀüÇô ¾ø´Â °æ¿ìµµ ÀÖ¾ú´Ù..
###Causes
¾ËÄÝ°ú °ü·ÃµÈ °æ¿ìµµ ÀÖÁö¸¸ ±× ¿ÜÀÇ ´Ù¸¥ À¯¹ß¿äÀÎ µéÀº Àß ¸ð¸§.
¾ËÄÝ°ú °ü·ÃµÈ °æ¿ì´Â ±ÝÁÖ ÈÄ ¼öÀÏ ³»¿¡ »ýÈ­ÇÐÀû ÀÌ»óÀÌ ¼Ò½ÇµÉ ¼ö ÀÖ°í, ±× ÈÄ Äí½ÌÁõÈıºÀÇ ¿ÏÀüÇÑ Áõ»óÀÌ ¹ßÇöµÇ´Âµ¥¿¡´Â °ú·®ÀÇ ¾ËÄݼ·Ãë±â°£ÀÌ »ó´çÈ÷ ¿À·¡ Áö³ª¾ß ÇßÀ½.
À¯ÀüÀû ¼ÒÀΰü·Ã¼ºÀº ºÎÁ¤µÇ¾úÀ½
###Differential Diagnoses
Cushing Syndrome
Depression
´Ù¸¥ ±âŸ °í·Á »çÇ× : Stress from severe illness
###Workup
**Laboratory Studies
@24-hour, urinary-free cortisol excretion level  : º¸Åë Á¤»óÄ¡ÀÇ 2-3¹è Á¤µµ À̳»·Î Áõ°¡
@serum cortisolin the morning and evening. : »ó½Â
@low dose overnight DXM suppression test :  morning serum cortisol levelÀÌ 5 µg/dL·Î ¾ïÁ¦µÇÁö ¾ÊÀ½ (by 1 mg dexamethasone administered at midnight.)
@midnight cortisol level of less than 7.5 µg/dL : PCSÁø´Ü¿¡ À־ 96% sensitivity and 100% specificity¸¦ º¸ÀÓ : key value in differentiating pseudo-Cushing from true Cushing syndrome.
@late-night salivary cortisol concentrations :  screening test in suspected Cushing syndrome -- 15.2 ng/mlÀÌ»óÀÏ ¶§ ¹Î°¨µµ 93%, 50ng/mlÀÌ»óÀÏ ¶§ ¹Î°¨µµ 100%
@Serum transaminase levels : º¸Åë »ó½Â, --alcohol-induced hepatitis.
@Blood alcohol level : ÀÔ¿ø ´ç½Ã¿¡¸¸ »ó½Â.
###Treatment
**Medical Care
ȯÀÚ°¡ µµ¿òÀ» ¿øÇÒ ¶§ ½ÃÀÛ.
--alcohol withdrawal syndrome¿¡ ´ëÇØ ¿¹»óÇÏ°í ¿¹¹æÄ¡·á°¡ ÇÊ¿ä. ±ÝÁÖÇÏ¸é ¼ö ÀÏ ¶Ç´Â ¼ö ÁÖ³»¿¡ »ýÈ­ÇÐÀû ÀÌ»óÀÌ Á¤»óÈ­ µÊ
--¿ì¿ïÁõÀ» Ä¡·á..
**Consultations
@Cushing syndromeÀÇ Æ¯Â¡Àû ¸ð½ÀÀ» º¸ÀÏ ¶§´Â ³»ºÐºñÀü¹®ÀÇ¿¡°Ô º¸ÀÏ ÇÊ¿ä ÀÖÀ½.
@Consult psychiatrists for treatment of depression or alcohol abuse.
**Diet
¿µ¾ç½ÇÁ¶¸¦ ÇØ°áÇÒ °Í.
**Medication
alcohol withdrawal or depression Ä¡·á¿ë ¿Ü¿¡´Â ±×´ÙÁö ÇÊ욫 ¾ÊÀ½,
###Follow-up
@overnight dexamethasone suppression test or 24-hour urinary cortisol -- 6-8 weeks ÈÄ¿¡.
**Transfer
in an alcohol detoxification and rehabilitation unit.
###Complications
Hypertension
Glucose intolerance or diabetes mellitus
Osteoporosis
###Prognosis
±ÝÁÖÇϸé Á¤»óÈ­µÇ³ª ¸¸¼º¾ËÄÝÁßµ¶ÀÎ °æ¿ì ÀÚÁÖ Àç¹ßÇÔ.
###Patient Education
°Ç°­»óÅÂ¿Í ¼ö¸í °ü·Ã¼º¿¡ ´ëÇØ È¯ÀÚ¸¦ ±³À°Ç϶ó.
###Miscellaneous
¹ýÀÇÇÐÀû ÇÔÁ¤¿¡ °É¸± ¼ö ÀÖÀ½À» Á¶½ÉÇÒ °Í.
--°©ÀÛ½º·± ±ÝÁÖ´Â chronic alcoholism¿¡¼­ ÁøÀü¼¶¸ÁÀ» ¾ß±âÇÒ ¼ö ÀÖ°í ŸÀο¡°Ô Çظ¦ ÀÔÈú ¼ö ÀÖ°í, ¿ì¿ïÁõÀÌ ÀÖÀ» ¶§¿¡´Â ÀÚ»ì ½ÃµµÇÒ °¡´É¼º ÀÖ´Ù.
###Special Concerns
 alcohol withdrawal syndrome¿¡ ´ëÇØ ÃæºÐÈ÷ ¿¹°ßÇÏ°í ÀÖ¾î¾ß ÇÑ´Ù.

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