Cushings disease

Modul IV
Gangguan endokrin IV

Definisi
kelainan hormonal endokrin yang
disebabkan oleh kortisol dalam darah.
Disebut juga hypercortisolism/
hyperadrenocortism.

Etiologi
Pituitary Cushings syndrome
Tumor pd pituitary anterior ACTH hiperplasia adrenal
(bilateral, nodular) kortisol

Adrenal Cushings syndrome

Tumor korteks adrenal kortisol ; ACTH krn penekanan kortisol

Paraneoplastik Cushings syndrome

kanker paru-paru ACTH hyperplasia adrenal
bilateral kortisol
Iatrogenik Cushings syndrome
pemakaian kortikoid yg lama
- gejala klinik Cushings syndrom
- atrofi adrenal bilateral

Manifestasi klinik

BB cepat
Central obesity dada & muka ; tungkai & lengan kurus
Moon face
Telangiectasia dilatasi kapiler plethoric facies
Penipisan kulit (mnybabkan mudah memar) & membran
mukus
Striae lividae krn penipisan kulit
Lemah otot proximal
Hirsutism pd
Buffalo hump
Fatique
Osteoporosis

Manifestasi klinik

Gangguan mental
TD
Resistensi insulin hyperglikemia DM
Hyperpigmentasi
fertilitas, libido
: oligomenorrhoea, amenorrhoea

Palmar erythema
Palmar erythema is reddening of the palms at
the thenar and hypothenar eminences. It is
associated with various physiological as well as
pathological changes, the principal one of which
is portal hypertension. It is also seen in patients
with liver dysfunction. Palmar erythema may
also be the result of dermatoses such as
eczema or psoriasis. It may also be a normal
finding. It has been attributed to high estrogen
levels.

hirsutism

Hirsutism
(from Latin hirsutus = shaggy, hairy) is defined
as excessive and increased hair growth in
women in locations where the occurrence of
terminal hair normally is minimal or absent. It
refers to a male pattern of body hair (
androgenic hair) and it is therefore primarily of
cosmetic and psychological concern. Hirsutism
is a symptom rather than a disease and may be
a sign of a more serious medical indication,
especially if it develops well after puberty.

Causes

The cause of hirsutism can be either an increased level of androgens (male hormones) or an
oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair
growth, increase size and intensify the pigmentation of hair. Other symptoms associated with a
high level of male hormones include acne, irregular menstrual periods, deepening of the voice
and increased muscle mass.
Growing evidence implicates high circulating levels of insulin in women to the development of
hirsutism. This theory is consistent with the observation that obese (and thus presumably insulin
resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that
lower insulin levels will lead to a reduction in hirsutism.
It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to
produce androgens. There may also be an effect of high levels of insulin to activate the insulinlike growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen
production.
One study suggests clothing may also affects the amount of hair but it may not cause hirsutism.
The following may be some of the conditions that may increase a woman's normally low level of
male hormones:
o
o
o
o
o

Polycystic ovary syndrome

Cushing's disease
Tumors in the ovaries or adrenal gland (cancer)
Certain medications
Congenital adrenal hyperplasia

Appearance and evaluation

Hirsutism only affects women, since the rising of
androgens causes a male pattern of body hair,
particularly in locations where women normally
do not develop terminal hair within their puberty (
chest, abdomen, back and face). The medical
term for excessive hair growth that affect both
men and women is hypertrichosis.
One method of evaluating hirsutism is the
Ferriman-Gallwey score which gives a score
based on the amount and location of hair growth
on a woman.

Treatment

Many women with unwanted hair seek methods of hair removal to

control the appearance of hirsutism. But the actual causes should
be evaluated by physicians, who can conduct blood tests, pinpoint
the specific origin of the abnormal hair growth, and advise on the
best course of treatment.
Recent studies indicate that drinking two cups of spearmint tea a
day for five days can reduce androgen levels in women with
hirsutism, which may be a good natural alternative for women who
have mild symptoms.
The tea is made by pouring boiling water on 1 or 2 teaspoons of
dried mint (the sort used for making mint sauce and is found in the
herb department of any supermarket) and leaving it for 5-10 minutes
before straining it and drinking the strained liquid.
The five days are the follicular period of the menstrual cycle.
It is best to take one cup in the morning and one at night to even out
the effect throughout the day.

Central obesity

Central obesity
(or "apple-shaped" or "masculine" obesity) occurs when
the main deposits of body fat are localised around the
abdomen and the upper body. Central obesity is
correlated with visceral fat.
Central obesity is common in polycystic ovary syndrome
(PCOS) and metabolic syndrome, and it is associated
with a statistically higher risk of heart disease,
hypertension, insulin resistance, and diabetes mellitus
type 2.
Central obesity can also be a feature of lipodystrophies,
a group of diseases which is either inherited, or due to
secondary causes (often protease inhibitors, a group of
medications against AIDS). Central obesityone of
primary symptom Cushings

Central obesity(cont.)
Diagnosis
Central obesity is diagnosed by measuring the
waist-hip ratio. When this exceeds 1.0 in men or 0.9 in
women, central obesity can be diagnosed.
Therapy
Weight loss is the main intervention against central
obesity when this is considered disfiguring or when it
puts one at a risk for the above mentioned diseases.
Adjunctive therapies are the use of orlistat or sibutramine
. In the presence of diabetes mellitus type 2, the
physician might prefer to prescribe metformin and
thiazolidinediones (rosiglitazone or pioglitazone) as antidiabetic drugs rather than sulfonylurea derivatives.

Cushings syndrome

After treatment

Buffalo hump

Moon face

striae