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El síndrome de Cushing: una revisión

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El síndrome de Cushing, causado por un alto nivel de cortisol prolongado, afecta a 2-8 por millón al año. El tratamiento implica cirugía, medicamentos o radiación para controlar este trastorno endocrino.

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Área de la Ciencia:

  • Endocrinología
  • Médico interno

Sus antecedentes:

  • El síndrome de Cushing implica un aumento prolongado del cortisol plasmático no debido a razones fisiológicas.
  • Si bien el uso de esteroides exógenos es común, la sobreproducción endógena de cortisol afecta a 2-8 por millón anualmente.
  • Las afecciones asociadas incluyen hiperglucemia, hipertensión, aumento de peso y trastornos del estado de ánimo.

Objetivo del estudio:

  • Para definir el síndrome de Cushing y sus causas.
  • Para delinear los enfoques de diagnóstico para el hipercortisolismo.
  • Para detallar las estrategias de manejo para el síndrome de Cushing.

Principales métodos:

  • El cribado incluye pruebas de cortisol libre urinario de 24 horas, cortisol salival nocturno o de supresión de la dexametasona.
  • Los niveles plasmáticos de corticotropina diferencian las causas suprarrenales frente a las pituitarias.
  • Las imágenes (IRM, muestreo de senos petrosos, escáneres suprarrenales / corporales) identifican las fuentes de tumores.

Principales resultados:

  • La enfermedad de Cushing, una causa de tumor pituitario, representa el 60-70% de los casos endógenos.
  • Los signos característicos incluyen cambios en la piel (plethora, estrías) y problemas metabólicos (hiperglucemia, hipertensión).
  • La evaluación diagnóstica descarta los esteroides exógenos y localiza la sobreproducción de cortisol.

Conclusiones:

  • El tratamiento de primera línea para el síndrome de Cushing endógeno es la extirpación quirúrgica del tumor.
  • Los medicamentos, la radiación o la adrenalectomía bilateral son opciones para los casos que no responden.
  • El manejo efectivo requiere abordar la fuente del exceso de cortisol.