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K Yasuda, K Miura
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引用次数: 11

摘要

我们报告了一例罕见的皮质醇应答、地塞米松无应答的周期性库欣病,每日高剂量溴隐肽治疗有效。我们对文献中58例伴有可变激素生成的库欣综合征进行了回顾性分析,并结合我们自己的病例(共59例)。此外,我们还描述了高剂量溴隐亭治疗7例库欣病的结果。该病例为一名57岁女性,经临床和生物化学证实周期长度为3-8天。经每日40mg溴隐亭治疗,周期性高皮质醇血症消失,患者地塞米松对血浆皮质醇的抑制正常,处于缓解期。59例循环库欣综合征中39例为垂体库欣病或库欣综合征合并双侧肾上腺增生。肾上腺腺瘤合并异位ACTH综合征15例(25%)。在34例病例中,22例(62%)观察到血浆皮质醇对地塞米松的矛盾反应。行Hardy手术的16例患者中只有4例(25%)完全痊愈。我们自己的病例显示通过药物治疗可以长期缓解。7例库欣病患者采用高剂量溴隐亭(17.5-55mg/天)治疗。溴隐亭最高剂量为40mg、55mg和35mg/d的3例患者临床和生化长期缓解。这3例患者在治疗初期出现逃逸现象,溴隐亭剂量减少。此后,剂量增加,产生有益的结果。(摘要删节250字)
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Unique type of Cushing's disease in clinical profile: cyclic Cushing's syndrome and Cushing's disease with favorable outcome to a high daily dose of bromocriptine].

A rare case of cortisol-responsive, dexamethasone-non-responsive cyclic Cushing's disease for whom a high daily dose of bromocriptine was effective was presented, and 58 cases of cushing's syndrome with variable hormonogenesis from the literature were reviewed with our own case (a total of 59 cases). In addition, the results of the high daily dose of bromocriptine treatment in our 7 cases of Cushing's disease were described. The presented case, a 57-year-old female, had a clinically and biochemically proven 3-8 day cycle length. With 40mg daily of bromocriptine, periodic hypercortisolemia disappeared and the patient was in remission with normal suppression of plasma cortisol by dexamethasone. Out of 59 cases of cyclic Cushing's syndrome, 39 were pituitary Cushing's disease or Cushing's syndrome with bilateral adrenal hyperplasia. 15 cases (25%) were adrenal adenoma and ectopic ACTH syndrome. In 22 out of 34 cases (62%), paradoxical response of plasma cortisol to dexamethasone was observed. Only 4 out of 16 cases (25%) on whom Hardy's operation was performed remitted completely. Our own presented case alone showed long-term remission with medical treatment. Seven Cushing's disease patients were treated with a high daily dose of bromocriptine (17.5-55mg/day). Three cases, in whom the highest dose of bromocriptine was 40, 55, and 35mg/day, showed clinical and biochemical long-term remission. In these 3 cases, an escape phenomenon was observed during the early treatment period with a decreased dose of bromocriptine. Thereafter the dose was increased, resulting in a beneficial outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

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