皮质醇增多症患者的手术治疗方法。
Surgical approach to patients with hypercortisolism.
作者信息
Kiernan Colleen M, Solórzano Carmen C
机构信息
Vanderbilt University Medical Center, Nashville, TN, USA.
出版信息
Gland Surg. 2020 Feb;9(1):59-68. doi: 10.21037/gs.2019.12.13.
Abstract
According to the Endocrine Society Clinical Practice Guidelines, the goal of treating overt Cushing's syndrome is to control cortisol levels or more importantly its actions at its receptor in order to eliminate the end organ effects and treat comorbidities associated with hypercortisolism. This chapter will review the surgical management of hypercortisolism. It will be subdivided into two main sections: the management of: (I) ACTH-dependent; and (II) ACTH-independent (adrenal) hypercortisolism. The perioperative factors that surgeons should consider after the diagnosis has been made will also be discussed. Lastly, the utilization of robotic surgery for adrenalectomy and the perceived benefits and potential pitfalls of this approach when treating patients with hypercortisolism will be reviewed.
摘要
根据内分泌学会临床实践指南，治疗显性库欣综合征的目标是控制皮质醇水平，或更重要的是控制其在受体上的作用，以消除终末器官效应并治疗与皮质醇增多症相关的合并症。本章将回顾皮质醇增多症的外科治疗。它将分为两个主要部分：（I）促肾上腺皮质激素（ACTH）依赖性；和（II）ACTH非依赖性（肾上腺）皮质醇增多症的管理。还将讨论外科医生在做出诊断后应考虑的围手术期因素。最后，将回顾机器人手术在肾上腺切除术中的应用以及这种方法在治疗皮质醇增多症患者时的预期益处和潜在陷阱。
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