General measures Aim to maintain normal weight!Determine BMI (body mass index, body mass index) or body composition using electrical impedance analysis. Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight. … Addison’s Disease: Therapy
In Cushing’s disease (thesaurus synonyms: ACTH [adrenocorticotropic hormone]-pituitary hypersecretion; ACTH [adrenocorticotropic hormone]-pituitary hypersecretion; obesity osteoporotica endocrinica; alcohol-induced pseudo-Cushing’s syndrome; Apert-Cushing’s syndrome; artificial Cushing’s syndrome; drug-induced Cushing’s syndrome; Basophilic hyperpituitarism; Basophilism; Cortico-adrenal basophilism; Crooke-Apert-Gallais syndrome; Cushing’s basophilism; Cushing’s disease; Cushing’s syndrome; Cushing’s syndrome due to ectopic ACTH [adrenocorticotropic hormone]-producing tumor; Dyscorticism; Ectopic ACTH [adrenocorticotropic hormone] syndrome; … Cushing’s Disease: Symptoms, Causes, Treatment
Medical history (history of illness) represents an important component in the diagnosis of Cushing’s disease. Family history Is there a frequent history of metabolic disease in your family? Social anamnesis Current medical history/systemic medical history (somatic and psychological complaints). Have you noticed any changes in your appearance (full moon face (moon face), bull neck or … Cushing’s Disease: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Obesity (obesity). Metabolic syndrome – clinical name for the symptom combination of obesity (overweight), hypertension (high blood pressure), elevated fasting glucose (fasting blood sugar) and fasting insulin serum levels (insulin resistance), and dyslipidemia (elevated VLDL triglycerides, decreased HDL cholesterol). Furthermore, a coagulation disorder (increased tendency to clotting), with an … Cushing’s Disease: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by Cushing’s disease: Eyes and eye appendages (H00-H59). Glaucoma (glaucoma) Cataract (cataract; clouding of the lens) Blood, blood-forming organs – immune system (D50-D90). Erythrocytosis – too many red blood cells (erythrocytes) in the blood. Leukocytosis – too many white blood cells … Cushing’s Disease: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination-including blood pressure, pulse, body weight, height [increased body weight; centrally emphasized obesity]; further: Inspection (viewing). Body proportions, face and skin [full moon face (moon face), bull neck or buffalo neck, truncal obesity; fingernails: thin and brittle, furunculosis – occurrence of … Cushing’s Disease: Examination
1st order laboratory parameters – obligatory laboratory tests. Hormone diagnostics Stage 1 Cortisol diurnal profile: 2-time determination of free cortisol in saliva between 11 pm and midnight or 2-time determination of free cortisol in 24 h collection urine [hypercortisolism: cortisol ↑; abolished diurnal rhythm of cortisol diurnal profile]. Dexamethasone short test/dexamethasone inhibition test (1 mg … Cushing’s Disease: Test and Diagnosis
Therapeutic target Normalization of serum cortisone levels. Therapy recommendations Primary surgical therapy (for indications, see “Surgical therapy” below); in rare cases, radiation therapy of the pituitary gland (e.g., for recurrence/recurrence of Cushing’s disease, in primarily inoperable patients); after surgery, substitution therapy (replacement therapy) with a cortisone drug. In NNR carcinoma treatment with: Cytostatics, adrenostatics In … Cushing’s Disease: Drug Therapy
Pathogenesis (disease development) The causes of primary adrenocortical insufficiency (primary NNR insufficiency) are diverse: Genetic causes (frequency: very rare): Adrenoleukodystrophy (synonyms: X-ALD; Addison-Schilder syndrome) – X-linked recessive disorder leading to a defect in steroid hormone synthesis with accumulation of overlong-chain fatty acids in the NNR and CNS; consequently, neurological deficits and dementia develop with onset … Addison’s Disease: Causes
Obesity – colloquially called overweight – (obesity from Latin adeps “fat”) or obesitas (synonyms: obesity; ICD-10-GM E66.-: obesity) is defined as an excessive increase in body fat. The proportion of fat mass in body weight exceeds 30% in women and 20% in men. Obesity is very widespread in Germany. Only about one third of the … Overweight (Obesity)
Medical history (history of illness) represents an important component in the diagnosis of obesity (overweight). Family history Is there a frequent occurrence of obesity in your family? Social history What is your profession? Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological complaints). … Overweight (Obesity): Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Klinefelter syndrome – genetic disorder with mostly sporadic inheritance: numerical chromosomal aberration (aneuploidy) of the sex chromosomes (gonosomal anomaly) occurring only in boys or Men occurs; in the majority of cases characterized by a supernumerary X chromosome (47, XXY); clinical picture: large stature and testicular hypoplasia (small testis), … Overweight (Obesity): Or something else? Differential Diagnosis