1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.
2 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX.
AJR Am J Roentgenol. 2017 Jul;209(1):19-32. doi: 10.2214/AJR.16.17290.
Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids. Endogenous CS is subdivided into two types: adrenocorticotropic hormone (ACTH) dependent and ACTH independent.
Cushing disease, which is caused by a pituitary adenoma, is the most common cause of ACTH-dependent CS for which pituitary MRI can be diagnostic, with bilateral inferior petrosal sinus sampling useful in equivocal cases. In ectopic ACTH production, which is usually caused by a tumor in the thorax (e.g., small cell lung carcinoma, bronchial and thymic carcinoids, or medullary thyroid carcinoma) or abdomen (e.g., gastroenteropancreatic neuroendocrine tumors or pheochromocytoma), CT, MRI, and nuclear medicine tests are used for localizing the source of ACTH. In ACTH-independent CS, which is caused by various adrenal abnormalities, adrenal protocol CT or MRI is usually diagnostic.
库欣综合征（CS）是一组由慢性暴露于过量皮质醇引起的临床体征和症状，无论是外源性还是内源性的。外源性 CS 最常见于糖皮质激素的应用。内源性 CS 分为两种类型：促肾上腺皮质激素（ACTH）依赖性和 ACTH 非依赖性。
由垂体腺瘤引起的库欣病是最常见的 ACTH 依赖性 CS 病因，垂体 MRI 可用于诊断，在模棱两可的情况下，双侧岩下窦取样有用。异位 ACTH 产生，通常由胸部（例如小细胞肺癌、支气管和胸腺类癌，或甲状腺髓样癌）或腹部（例如胃肠胰神经内分泌肿瘤或嗜铬细胞瘤）的肿瘤引起，使用 CT、MRI 和核医学检查来定位 ACTH 的来源。在 ACTH 非依赖性 CS 中，由各种肾上腺异常引起，肾上腺方案 CT 或 MRI 通常具有诊断价值。
