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ID:5851942
大小:2.02 MB
页数:49页
时间:2017-12-14
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1、ADRENOCORTICALCANCERIntroduce1per1.7millionpopulationlessthan0.02%ofallcancers0.2%ofallcancerdeaths79%ofadrenaltumorswerefunctionalNonfunctionaltumorsmaybecomefunctionalapeakincidenceatlessthan5yearsandasecondpeakinthefourthandfifthdecadesClinicalFeaturesHormonallyfunctionaltumorsar
2、eslightlymorecommoninwomennonfunctioningtumorsaremorefrequentinmenClinicalSyndromesProducedbyAdrenocorticalCancerandTheirFrequencySYNDROMEFREQUENCY(%)VirilizationandCushing'ssyndrome50Virilization25Cushing'ssyndrome20Feminization<5Precociouspuberty<5Hypokalemiaalkalosis<5Hypoglycemi
3、a<5Cushing'sSyndromeThecharacteristicendocrineabnormalityisanincreaseofplasma11-deoxycortisolanditsurinarymetaboliteparaneoplasticsyndromeassociatedwithectopicadrenocorticotropichormone(ACTH)productionbysolidtumorsVirilizationinassociationwithCushing'ssyndromealmostalwaysindicatesad
4、renalcancerVirilizationVirilizationiscausedbytestosteronetheexcessurinary17-KShelpsdistinguishadrenalcancerfromothervirilizingsyndromeshirsutism(多毛症)istheonlypresentingfeaturewithvirilizingtumorsFeminizationPlasmaandrostenedione(雄烯二酮)maybeconvertedperipherallytoestrogenFeminizationw
5、ithadrenalcancerisunusualThemajorfractionofandrostenedioneismetabolizedtourinary17-KS(17-酮类固醇)Feminizationmeasurementofurinary17-KSwilldistinguishthefeminizationcausedbyadrenalcarcinomafromthegynecomastiaseenwithhumanchorionicgonadotropin(hCG)-producingtumorsofthetestisandwithhCG-pr
6、oducingcancerPrecociousPuberty(性早熟)Inchildren,precociouspubertyorvirilizationmaybeanimportantandpresentingclinicalfindingbecauseandrogensarethepredominantproductsofadrenalcancersecretionIsosexualprecociouspubertyinboysandvirilizationingirlsareusualSodiumRetentionandHypokalemicAlkalo
7、sisRarelypatientswithadrenalcancerwillpresentwiththepictureofprimaryhyperaldosteronismurinary17-KSishigh,andthetumorisgenerallymuchlargerthantheAPA(aldosterone-producingadenoma)HypoglycemiaadrenalcancermaycausehypoglycemiaMeasurementofplasmainsulinlevelswillruleoutinsulin-secretingt
8、umorsasacauseofhypo
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