2961756
1
533
5354 554 32
AAB
19993 1 20049
2 20069
20079
CAP 20053 20053 20055 20057 20059 200511
1999
(PDH)(AT)
Hyperadrenocorticism: HAC
Cushing syndrome
Cushing disease
1932Cushing
Harvey Williams Cushing:1869-1939
(5001
PDH)85-90ACTH
ACTH
AT10-15
50%
Iatrogenic Cushings Syndrome Miyado Nana
PU/PD
PU/PD
ALKP
TchoTG
CBC
1.020
TP (g/dl) 6.8Alb (g/dl) 3.06Glob (g/dl) 3.74A/G 0.81ALT (U/l) 445AST (U/l) 42ALKP (U/l) 479GGT (U/l) 66TBil (mg/dl) 0.56TCho (mg/dl) 358TG (mg/dl) 94.7
Amy (U/l) 2,033 Lipa (U/l) 3,455Glu (mg/dl) 686BUN (mg/dl) 95.6Cre (mg/dl) 1.28UN/Cr 74.6Na (mmol/l) 124K (mmol/l) 3.16Cl (mmol/l) 93.3
(ALKP) ( (TchoTG)
Takada Chi
Chemistry
CBC
RBC (x106/l) 5.36 WBC (/l) 28,600
PCV (%) 42.2 Band-N 0
Hb (g/dl) 13.2 Seg-N 24,300
MCV (fl) 79 Lym 1400
MCHC (%) 31.3 Mon 2,700
Ret (%) 0.9 Eos 280
II
TP (g/dl) 6.1 (5-8)Alb (g/dl) 3.5 (2.6-4)Glob (g/dl) 2.6 ALT (U/l) 166 (
20080116 Kitou Pearl
Creat 50.8 mg/dl 50.1 mg/dl Creat :50.8x88.4=4464.2 mol/l :50.1x276=13827.6mol/l UCCR=3.09
UCCR
ACTH20080117 Pre 5.7 g/dl 1H Post >50 g/dl
20080120 Pre 6.7 g/dl 4H 3.9 8H 6.8
HDDS8
20080115
BUN
BUN
BUN
PU/PD
1/3 BUN
1. UCCR2. ACTHACTH3. LDDST
LDDS
LDDSACTH
UCCR
3 , 3.0 mg/dl
2.0ml g/L
g/L) 2.76
mg/dl) 88.4=UC:CR
X10-5
10-5
10-5
10-5
3.5 10-5
>3.610-5
1.3-3.6 10-5
SI(nmol/l)
mg/dl
g/l UCCRratio
117.1 3460.0 92.25
M 54.4 675.0 38.74
369.2 8.7 0.0736
149.2 7.6 0.1590
94.7 209.0 6.9
35 36 1336
ACTH
ACTH PDHAT50-70
1
PDHAT
ACTH
preACTH ACTH
0.25mg IM,IV
post1
68005,3551391
ACTHACTH (Cortrosyn)
5 /kg IV or IM (Max 250g) 250 mcg IV
gelACTH 2.2 mcg/kg IM 21Dr Behrends)
PDH80-85% AT60%
Post
PrePost
Pre,Post,Post
5,355 7455
ATACTH
DEXLDDS)
DEX
DEX
PDH95%AT100% ACTH
8 PDHAT
7,000DEX
LDDS1.
2. 0.01mg/kg IV 0.1mg/kg
3. 4
4. 8
4hr 8hr < 1.0 < 1.0
1.0 1.5 1.0 1.5 ?> 1.5 > 1.5 >50% > 1.5
3.0
6.0
9.0
PDH?/ADH
PDH
Normal
Hac
0 4hr 8hr
LDDST
PDHAT
1. HDDSDEX2.
CTMR
3. ACTH
7,455DEX8
DEX HDDS
PDHDEXFB ACTH
AT ACTH DEX
PDH70% 50%PDH
AT100%
HDDS
DEX 0.1mg IV 4 8
50% PDH
4hr 8hr 50% PDH
>1.5 or >50%
ACTH
PDHAT PDHor AT
20-100 pg/ml (4.4-22 pmol/l) PDH:40-500 pg/ml (8.8-110 pmol/l) AT:
ACTH1. 122. 4-5ml
EDTA3.
4. 3-5
5.
ACTH 4 ACTH
PDH > 40 pg/ml AT < 10 pg/ml
PDH 0.75cmPDH
AT 1.58cm 3cm 3cm
(2)
0.3cm
AT
PDH
PDH
PDH
12-33mm3-7mm
12617
Snapshot DX
SnapshotDX IDEXX Lab
ACTH 6.0/9.1 5.3/9.6
LDDST
5.5/1.4/5.04.0/2.1/5.8
ACTH 9.1/9.6 5.7/10.3
Lysodren ,o,p'-DDD)
(35-40%)- - - (< 5 %)
P
:
25 mg/kg 12
7
ACTH
7 ACTH
BUNACTH
0.25 mg/kg/day
5mg
50 mg/kg2
ACTH4 3-4 3-4
o,p-DDD
(2)
ACTHPost 1 - 3 /dl : 25mg/kg/week div 2-4 3 - 6 /dl : 50mg/kg/week div 2-6
60%(Kintzer&Peterson 1994)
Trilostane
3--
X
20111
35001117
45001150
60001200
1 698.41200
SID HAC
2.2-6.7mg/kg 11
10mg, 30mg, 60mg
kg (mg) SID mg/kg SID
1.7 4.5 10 2.25.9 4.5 10 30 3.06.7 10 20 60 3.06.0 20 40 120 3.06.0 40 60* 180 3.04.5
*60kg
1014 ACTH
ACTHST-post 4post
4
Post-ACTHg/dL
1.45post22/dL
1.459.1
9.1
1.45post22/dL
1.4-5.4
9.1
24
4
5.49.1
10-25
ACTH
ACTH
ACTH ACTH
10-14ACTH
ACTH 1/2 EOD
10mg
11SID 1
12BID SIDBID 11/31/22
130-50% BIDSID2
30903
1. 2. 3. ACTH4-64.
ACTHpost
ACTHPost1.49.1g/dL ACTHpost1.4g/dLKNa
HACpostACTH5.0-
9.0g/dl
BID
0.25-2.5 mg/kg BID
10-14 ACTH post2-5 g/dl
15-30 post
ACTH
3-6
4
HAC
post 22g/dl)
HAC
ATHAC15-20
:incidentaloma
319 330
319 330
Elina
Elina
Elina
2003 127
26 320
325
329 45 414
ACTH 6.4 6.2 0.3 0.4 0.6 0.2 1.1
ACTH 50 0.1 0.4 0.8 1.6 3.9
HDDS4H 2.6
HDDS8H 2.4
PDH
Murakami Love
Love ACTH 510
Pre 12.2 g/dl 2.0-7.5
Post 50 g/dl
4hr 8hr 50% PDH
>1.5 or >50% 50%8H 6.4 g/dl >1.5 or >50%
6291/230mgSID PO
715ACTH
6/17 7/15
Pre 12.2 17.0
Post 50 36.7
17.8X5.5mm
12-33mm3-7mm
18.7X6.5mm
12-33mm3-7.5mm
>7.5mmPDH
PDH
5/10 7/15 9/14 12/18 12/21 12/25 12/31 1/12 1/25 3/8 4/22
pre 12.2 17 8.5 25.2 7.9 5.9 1.8 3.5 4.6 4.5 50 36.7 25.9 38.0 22.0 11.6 2.6 4.0 8.1 8.4
0.01-0.02mg/kg(1.5-2tab/10kg) PO SID-BID 1-2NaK 0.05-0.1mg/day 1-21 6-12
Na/K
2022242628303234
2006
/4/2
120
06/5
/21
2006
/6/2
120
06/7
/21
2006
/8/2
120
06/9
/21
2006
/10/
2120
06/1
1/21
Murakami Love
0.012mg/kg/day
0.0180.03mg
32.4!
DOCP2.2mg/kg
/IM
DOCP
DOCP 1 mg/lb every 25 days Prednisone 0.2 - 0.4 mg/kg/day
Pu/Pd DOCP DOCP
KNa DOCP 2-3
