Bruno Oscar D, Juárez-Allen Lea, Rossi María Alicia, Longobardi Vanesa
División Endocrinología, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Medicina (B Aires). 2009;69(6):674-80.
Despite its low frequency, endogenous Cushing's syndrome is not an exceptional clinical entity. A growing number of cases are currently derived to specialized centers suggesting an increasing knowledge of the clinical features of hypercortisolism by specialists of diverse branches of clinical medicine. Clinical signs derive from an exaggeration of the physiological actions of cortisol inducing protein breakdown, hyperglycemia, fat mobilization, dyslipidemia, hydrosaline retention, immunosuppression and increased susceptibility to infection. Despite its low specificity, symptoms such as unexplained development of central obesity, mood changes, fatigue, weakness, myopathy, easy bruisability, red striae, arterial hypertension, diabetes and hyperlipidemia, are suggestive of the diagnosis. From an epidemiological point of view, Cushing's syndrome is to be suspected and consequently searched for among patients with uncontrolled high blood pressure or diabetes mellitus, metabolic syndrome, polycystic ovarian syndrome, osteoporosis, depression or adrenal incidentaloma. True Cushing's syndrome has to be differentiated from pseudo syndromes. Most sensitive physical signs for discriminating Cushing's syndrome from pseudo-Cushing states are the presence of supraclavicular fat pads, myopathy, thin skin and easy bruising. The recognition of the clinical manifestations of Cushing's syndrome and of the sub-populations at risk of contracting the disease should be improved through medical education at the medical school and at postgraduate levels. Clinical detection of Cushing's syndrome must be performed mainly by non-endocrinologists, yet its etiological diagnosis and therapeutic management is to be carried out in highly experienced and specialized centers, to ensure the best results in the treatment of this really challenging endocrine disturbance.
尽管内源性库欣综合征发病率较低，但它并非罕见的临床病症。目前，越来越多的病例被转诊至专业中心，这表明临床医学各分支的专家对皮质醇增多症临床特征的认识在不断提高。临床症状源于皮质醇生理作用的过度增强，可导致蛋白质分解、高血糖、脂肪动员、血脂异常、水盐潴留、免疫抑制以及感染易感性增加。尽管其特异性较低，但诸如不明原因的向心性肥胖、情绪变化、疲劳、虚弱、肌病、易瘀斑、红色条纹、动脉高血压、糖尿病和高脂血症等症状，提示可能患有该疾病。从流行病学角度来看，在高血压或糖尿病控制不佳的患者、代谢综合征患者、多囊卵巢综合征患者、骨质疏松症患者、抑郁症患者或肾上腺偶发瘤患者中，应怀疑并排查库欣综合征。真正的库欣综合征必须与假性综合征相鉴别。区分库欣综合征与假性库欣状态最敏感的体征是锁骨上脂肪垫、肌病、皮肤变薄和易瘀斑。应通过医学院校教育和研究生阶段的医学教育，提高对库欣综合征临床表现以及患病风险亚人群的认识。库欣综合征的临床检测主要由非内分泌科医生进行，但其病因诊断和治疗管理则需在经验丰富的专业中心开展，以确保在治疗这种极具挑战性的内分泌紊乱疾病时能取得最佳效果。
