皮质醇增多症的靶腺处理

Target gland treatment of Cushing syndrome

皮质醇增多症是机体组织长期暴露于异常增高的糖皮质激素引起的一系列临床症状和体征，分为促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）依赖性和ACTH非依赖性两种类型。不同病因的皮质醇增多症的靶腺处理差别较大，但基本原则是要病因诊断明确。对于ACTH依赖性皮质醇增多症，首先要处理原发病灶，只有原发灶处理不满意或无法确诊时才考虑肾上腺的外科手术治疗。对于诊断明确的库欣综合征或亚临床库欣综合征肾上腺腺瘤，积极推荐保留肾上腺功能的手术。对ACTH非依赖性肾上腺大结节增生和原发性色素结节性肾上腺皮质病靶腺处理的争议较多，个体化治疗方案目前在临床上获得比较多的认可。

Cushing syndrome （CS） is a series of clinical symptoms and signs caused by long-term exposure to abnormally high levels of glucocorticoids. It is divided into two types of adrenocorticotropic hormone（ACTH） dependent and ACTH-independent CS. There are great differences in the target gland treatment of different causes of the disease, but the basic principle is to make a clear diagnosis. It is very important to treat primary lesions for ACTH-dependent CS. The adrenal gland will be resected when the treatment of primary lesions is not satisfied or the diagnosis is not clear. Adrenal sparing surgery is recommended for the definitive diagnosis adenomas of CS or subclinical CS. There is a lot of controversy about the treatment of ACTH-independent adrenal gland hyperplasia and primary pigmented nodular adrenal gland, and the individualized treatment scheme has been recognized.