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December 10, 2016 00:03

Hypercortisolism in children |Symptoms and treatment of hypercortisolism in children

hypercortisolism in children - a syndrome caused by the constantly high level of glucocorticoids in the blood as a result of hyperfunction of the adrenal cortex.

code in ICD-10

  • E24 Cushing's syndrome.
  • E24.0 Cushing's disease pituitary origin.
  • E24.1 Nelson's syndrome.
  • Medical E24.2 Cushing's syndrome.
  • E24.3 Ectopic ACTH syndrome.
  • E24.8 Other conditions characterized Kushingoid syndrome.
  • syndrome E24.9 Cushing's unadjusted.

Causes Cushing children

Causes Cushing are very diverse.

  • endogenous hypercortisolism may cause:
    • disease Cushing's - neuroendocrine hypothalamus disease and (or) the pituitary gland;
    • Cushing's syndrome - a disease of the adrenal cortex (corticosteroma benign or malignant, nodular hyperplasia of the adrenal cortex);
    • ectopic ACTH syndrome (bronchial tumors, pancreas, thymus, liver, ovary, or ACTH secreting corticotropin-releasing hormone);
    • hyperaldosteronism (Conn's syndrome).
  • exogenous hypercortisolism due to chronic administration of synthetic glucocorticoids (d
    rug Cushing's syndrome).
  • There are also functional hypercortisolism during puberty and youth dispituitarism, hypothalamic syndrome, obesity, diabetes, liver disease.

Symptoms of Cushing children

characteristic dysplastic obesity, "crescent-shaped" face, excess fat on the chest and stomach with a relatively thin limbs.Develop trophic skin changes (pink and purple striae on the thighs, abdomen, chest, dryness, thinning).Progressing myopathy, hypertension, osteoporosis, systemic encephalopathy, steroid diabetes, secondary immune deficiency, delayed sexual development.In girls after the onset of menstruation sometimes comes amenorrhea.Patients complain of weakness, headaches.

addition to obesity, often the first manifestation of the disease may be stunting.Gradually developing obesity and slowing or stopping the growth of the beginning may not be accompanied by any other symptoms.

On examination, pay attention to the large face, redness of the cheeks, a double chin, fat deposition over the VII cervical vertebra.Due to the excessive production of androgens tumors often show signs of pathological masculinization as hypertrichosis, acne, deepening of voice.Characterized by hypertension.Increased susceptibility to infection, in some cases leading to sepsis.

Diagnosis of Cushing's children

cortisol levels in the blood is usually elevated, but are subject to wide fluctuations in different days.To confirm the diagnosis requires repeated measurements of cortisol in the blood.Most patients with disturbed circadian rhythm of cortisol, the blood must take in 8 and 20 hours, while levels of the hormone may be the same (in healthy children over three years morning cortisol concentration several times higher evening).Often noted polycythemia (increased concentration of hemoglobin and red blood cells), lymphopenia, eosinopenia.It may be impaired glucose tolerance, diabetic by type.Sometimes hypokalemia.Osteoporosis is expressed in the bodies of the vertebrae (spine on radiographs).

using imaging techniques (CT, MRI, ultrasound) for staging nosological diagnosis.Topical diagnosis (micro or macroadenoma pituitary, adrenal gland tumor and other organs) are carried out in patients with previously proven clinical and laboratory syndrome Cushing.

Treatment of hypercortisolism in children

includes surgery, radiotherapy and medical (blockers steroidogenesis - mitotane, dopamine agonists) methods determined by the severity of the disease and lesions size.