Sindrom Cushing Yang Disebabkan Pengobatan Dengan Kortikosteroid

8/10/2019 Sindrom Cushing Yang Disebabkan Pengobatan Dengan Kortikosteroid

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Sindrom Cushing yang Disebabkan Pengobatan dengan Kortikosteroid

Tesa Iswa Rahman

102012179

F2

FAKULTAS KEDOKTERANUNIVERSITAS KRISTEN KRIDA WACANA

Koreson!en" #esarahman$%ma&'()om

Pendahuluan

S&s#em en!o*r&n mer+a*an s&s#em ,an% mem+n%*&n*an *om+n&*as& an#ara -a%&an.

-a%&an ,an% #er'e#a* /a+h !a'am #+-+h( T&%a *omonen en#&n% !a'am s&s#em en!o*r&n

a!a'ah *e'en/ar en!o*r&n ,an% mense*res&*an hormon se-a%a& em-awa esan *&m&a

hormon + sen!&r& !an rese#or hormon a!a se'( T&a.#&a hormon mem&'&*& +n%s& ,an%

-er-e!a.-e!a !an a*an #er/a!& %an%%+an &s&o'o%&s /&*a *a!ar hormon men/a!& -er'e-&han

a#a++n *e*+ran%an(

Sa'ah sa#+ hormon en#&n% a!a man+s&a ,a+ *or#&so'( Kor#&so' mer+a*an s+a#+

hormon ,an% !&has&'*an o'eh *or#e*s *e'en/ar a!rena' ,an% -era!a !&a#as %&n/a'( ormon &n&

a*an memen%ar+h& -er-a%a& me#a-o'&sme !a'am #+-+h ,an% a*an !&-ahas *em+!&an( 3&*a

*a!ar *or#&so' -er'e-&h !ar& norma'n,a !an -er'an%s+n% )+*+ 'ama ma*a !aa#men&m-+'*an *ea!aan ,an% !&se-+# s&n!rom )+sh&n%( Nama en,a* &n& !&am-&' !ar& ar4e,

C+sh&n% seoran% ah'& -e!ah ,an% er#ama *a'& men%&!en#&&*as& en,a* &n& a!a #ah+n 1912(

5en!eran,a a*an men%a'am& %an%%+an me#a-o'&sme ro#e&n %'+*osa !an 'ema* ,an% a*an

men,e-a-*an -er-a%a& *e'a&nan seer#& *e'emahan !an a#ro& o#o#o-esas os#eooros&s

ra%&'as em-+'+h !arah s+res& %ona! ser#a -en#+* wa/ah !an -ah+ ,an% *has(

Pembahasan

Anamnesis

5a!a *as+s has&' anamnes&s !&!aa#*an has&' -er&*+#"

I!en#as" La*&.'a*& 66 #ah+n(

Ke'+han +#ama" ser&n% 'emas se/a* 1 -+'an 'a'+

Ke'+han 'a&n" 5as&en a!a ma'am har& #er-an%+n .6 *a'& +n#+* -+an% a&r *e)&'(

R&wa,a# en,a* !ah+'+" 5as&en mem&'&*& r&wa,a# asma

R&wa,a# en,a* *e'+ar%a" as&en me&'&*& *e'+ar%a !en%an !&wa,a# !m #&e 2

R&wa,a# sos&a' 8 o-a#" as&en men%*ons+ms& re!n&son sehar& se*a'& +n#+* asman,a(

1


2/10

Se'a&n + ha'.ha' 'a&n ,an% !aa# !an,a*an a!a'ah a!an,a enam-ahan -era# -a!an

!an o-esas er+-ahan enam&'an h&rs+#&sme amenore &ner#&'as a!an,a s#r&ae 'e-am

#+'an% m+!ah ra*#+r(1

Pemeriksaan Fisik

Ter'e-&h !ah+'+ !&'a*+*an emer&*saan TTV -&sa !&!aa#*an a!an,a h&er#ens&(

Se#e'ah + !&'a*+*an emer&*saan &s&* !an ,an% a'&n% en#&n% a!a'ah &nse*s& -an,a*

%e/a'a *'&n&s a!a s&n!rom )+sh&n% ,an% !aa# !&'&ha# ,a+ O-esas sen#ra' !en%an /ar&n%an

a!&osa men&n%*a# !& me!&as#&n+m !an erone+m en&n%*a#an ra#&o &n%%an%.&n%%+'

,a*n& 1 a!a r&a !an 0: a!a wana #er'&ha# /+%a moon a)e -+a'o h+m( Ke'a&nan

*+' ser#a em-+'+h !arah ,an% #er/a!& men&m-+'*an a)&a' 'e#horas#r&ae e*&mos&s !an

*+' ,an% 'e-&h #&&s( a'.ha' 'a&n ,an% !&erha#&*an a!a'ah a!an,a a#ro& o#o# h&rs+#&sme

e!ema ser#a a!an,a *e'emahan o#o#( Se!an%*an +n#+* emer&*saan a'as& er*+s& !an

a+s*+'#as& #&!a* #er'a'+ -an,a* mem-an#+ +n#+* men!&a%nos&s s&n!rom )+sh&n%(12

Pemeriksaan Penunjang

5emer&*saan !arah a!a as&en !en%an s&n!rom )+sh&n% !aa# men+n/+**an -e-eraa

ha' -er&*+# ,a+ en&n%*a#an hemo%'o-&n !an o'&sem&a *arena *or#&so' meran%san%

errooes&s 'e+*oen&a ne+#ro&'&a '&moen&a eosoen&a *arena *er/a *or#&so' ,an%

mene*an s&s#em &m+n #e#a& !aa# /+%a #er/a!& 'e+*osos&s *arena ser&n% #er/a!& &ne*s&

oor#+n&s#&*( Se'a&n + #er/a!& %an%%+an me#a-o'&sme %'+*osa a*an men,e-a-*an

h&er%'&*em&a !an h&o*a'em& !aa# #&m-+' a*&-a# ee* *or#&so' se-a%a& m&nera'o*or#&*o&!(

Ka!ar *or#&so' -e-as +r&n !an +/& !e*same#ason !os&s ren!ah mer+a*an +/& s*r&n&n%

awa' #er-a&*( Ka!ar *or#&so' -e-as +r&n !&+*+r !en%an men%%+na*an ses&men +r&n 26 /am

!an !&*a#a*an os& s&n!rom )+sh&n% /&*a *a!ar *or#&so' 'e-&h !ar& 1;0 ;


3/10

Se#e'ah !&a%nos&s s&n!rom )+sh&n% !e%a**an en%+*+ran *a!ar ACT !&er'+*an

+n#+* mem-e!a*an e#&o'o%&n,a( 5a!a ATC &n!een!en *arena #er/a!& +man -a'&* a!a

h&o&s&s ma*a *a!ar ACT as&en a*an se!&* *+ran% !ar& ; %=m'( Se!an%*an -er-e!a

!en%an !een!en ACT ,an% *+ran% -ereson a!a !os&s ren!ah !e*same#ason

men%has&'*an ACT a*an !&!aa#*an *a!ar 'e-&h !ar& 10.20 %=m'( U/& s+res& !en%an

!e*same#ason !os&s #&n%%& sema'aman a!a'ah +/& +n#+* mem-e!a*an en,a* )+sh&n% !an

ACT e*#o&*( Se#e'ah ses&men !asar +n#+* emer&*saan *or#&so' a%& har& !&am-&'

!&-er&*an !e*same#ason !os&s #+n%%a' : m% erora' ,an% !&-er&*an a!a /am 11 ma'am !an

*or#&so' 'asma !&+*+r a!a /am : a%& har& -er&*+#n,a( 5a!a en,a* C+sh&n% !os&s #&n%%&

a*an mem-+a# reson a!a h&o&s&s seh&n%%a *a!ar *or#&so' 'asma a*an -er*+ran% sama&

*+ran% !ar& ;0? n&'a& !asar a!a 9;? as&en se!an%*an se*res& s#ero&! a!a as&en.as&en

!en%an s&n!roma ACT e*#o&* a#a+ #+mor #+mor a!rena' ,an% memro!+*s& *or#&so' #&!a*

#ers+res& sama& se/+m'ah + !an -&asan,a #&!a* -er+-ah( U/& !os&s #+n%%a' &n& 'e-&h

#erer)a,a !&-an!&n%*an !en%an +/& !os&s #&n%%& se'ama 2 har& !an !aa# !&er#&m-an%*an

se-a%a& s+a#+ rose!+r #er&'&h(;

5emer&*saan ra!&o'o%& se'an/+#n,a !&'a*+*an se#e'ah emer&*saan -&o*&m&a(

5emer&*saan ,an% !&'a*+*an ses+a& !en%an *e)en!er+n%an e#&'o%& ,an% !+n/+**an

emer&*saan -&o*&m&a( CT san a-!omen !&'a*+*an /&*a #er!aa# *e)+r&%aan a!an,a

neo'asma a!rena' r&mer( @RI h&o&s&s !&'a*+*an a!a en!era #er!+%a s&n!rom )+sh&n%

ser#a CT s)an #hora*s !an a-!omen +n#+* *e)+r&%aan e*#o&* ACT(2

Diagnosis Kerja

Sindrom Cushing

S&n!rom )+sh&n% a!a'ah s&n!rom ,an% !&m-+'*an o'eh *a!ar %'+*o*or#&*o&! ,an%

-er'e-&han a!a #+-+h se)ara *ron&s( S&n!rom &n& mem-+a# *e#&!a*se&m-an%an me#a-o'&sme

ro#e&n 'ema* !an *ar-oh&!ra# seh&n%%a a*an men&m-+'*an -er-a%a& masa'ah *'&n&s(

5en,e-a- *a!ar *or#&so' ,an% -er'e-&h &n& -&sa *arna a*#or e*so%en ,a+ *ons+ms& s#ero&!

a#a++n en!o%en ,a+ #er/a!& ro!+*s& -er'e-&han *or#&so o'eh *e'en/ar a!rena'(

Diagnosis Banding

Penyakit Cushing

5en,a* C+sh&n% a#a+ C+sh&n% !&sease a!a'ah sa'ah sa#+ en,e-a- #&m-+'n,a

s&n!rom )+sh&n%( 5a!a en,a* C+sh&n% #er/a!& se*res& ,an% -er'e-&h ACT o'eh h&o&s&s

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4/10

*ea!aan &n& -&asan,a #er/a!& *arena a!an,a a!enoma h&o&s&s a#a+ h&er'as&a h&o&s&s(

Ka!ar ACT -er'e-&h a*an meran%san% *or#&so' ,an% a*an mem-+a# *a!ar *or#&so' #&n%%& !&

!a'am !arah(

Diabetes Mellitus Tipe 2

D&a-e#es me''+s a!a'ah en,a* me#a-o'&* en!o*r&n *ron&* ,an% !an!a& !en%an

a!an,a h&er%'&*em&a *ron&*( D@ !&-a%& me/a!& -e-eraa #&e ,a+ #&e 1#&e 2 #&e 'a&n !an

!&a-e#es %es#as&ona'( D@ #&e !+a !+'+ !&*ena' se-a%a& #&e !ewasa !an serr&n% -er*aan

!en%an o-esas( D@ #&e 2 !&se-a-*an *e%a%a'an re'a#& se' -e#a an*reas !an res&s#ens&

&ns+'&n ,a+ #+r+nn,a *emam+an &ns+'&n +n#+* meran%san% en%am-&'an %'+*osa o'eh

/ar&n%an er&er( @an&es#as& *'&n&sn,a ,an% *has ,a+ o'&!&s& o'&+r& !an o'&a%&( Se'a&n

+ 'emas *esem+#an /+%a ma#a *a-+r(7

tiologi dan Klasi!ikasi

5en,a* &n& !aa# !&se-a-*an o'eh em-er&an %'+*o*or#&*o&! /an%*a an/an% !a'am

!os&s arma*o'o%&* B&a#ro%en&* a#a+ !&se-a-*an a!an,a h&erse*res& *or#&so' *arna

!&se-a-*an a!an,a %an%%+an a*s&s h&o#a'am+s.h&o&s&s.a!rena' Bson#an(

S&n!rom )+sh&n% &a#ro%en&* ser&n% !em+& a!a en!era ar#r&s rema#o&! asma

'&moma ser#a %an%%+an *+' +m+m ,an% men!aa#*an #era& %'+*o*or#&*o&! s&n#e#&*

se-a%a& an#& &n'amas&( Se!an%*an a!a s&n!rom )+sh&n% son#an #er/a!& h&er+n%s& *or#e*s

a!rena' ,an% men%has&'*an %'+*o*or#&*o&! -&sa *arena s#&m+'as& -er'e-&han o'eh ACT

a#a++n #er/a!& a#o'o%& a!a *e'en/ar a!rena' + sen!&r&( S&n!rom )+sh&n% !aa# !&-a%&

men/a!& !+a /en&s ,a+ !een!en ACT !an &n!een!en ACT(6

5a!a /en&s !een!en ACT h&erse*res& *or#&so' o'eh a!rena' !&se-a-*an *arena

a!an,a s#&m+'as& !ar& *a!ar ACT ,an% -er'e-&h *ea!aan !&se-a-*an o'eh 2 ha' ,a+

en,a* )+sh&n% !an en%has&' ACT e*#o&*( 5en,a* )+sh&n% !&ar#&*an se-a%a& *on!&s&

!&mana #er/a!& h&erse*res& ACT ,an% a-norma' o'eh h&o&s&s( 5a!a :0? as&en !em+*an

a!an,a a!enoma h&o&s&s ,an% men,e*res& ACT !an s&san,a !em+*an h&er'as&a

h&o&s&s a!a emer&*saan h&s#o'o%&s( Is#&'ah en,a* C+sh&n% er'+ !&-e!a*an !en%an

s&n!rom )+sh&n% 5en,a* )+sh&n% mer+a*an e#&o'o%& #erser&n% !ar& s&n!rom )+sh&n%

son#an B se*ar 70?( @e*an&sme *e!+a s&n!rom C+sh&n% !een!en ACT a!a'ah a!an,a

neo'asma.neo'asma ,an% !aa# me-+a# e#&!a m&r& ACT -a&* se)ara *&m&a ma++n

se)ara &s&o'o%&*( 3a!& *a!ar ACT ,an% #&n%%& a!a *ea!aan &n& -erasa' !ar& neo'asma !an

-+*an !ar& h&o&s&s !an sma'' )e' *ars&noma ar+ mer+a*an en,e-a- ;0? *as+s(6

4


5/10

5a!a s&n!rom )+sh&n% &n!een!en ACT -&asan,a !&*arena*an a!an,a neo'asma

r&mer *or#e*s a!rena' #erser&n% a!enoma !an 'e-&h /aran% *ars&noma( T+mor.#+mor &n& #&!a*

!&en%ar+h& h&o&s&s !an men,e*res& *or#&so' se)ara o#onom( 5a!a *as+s ,an% /aran% a!a'ah

h&er'as&a -&'a#era' a!rena'(6

pidemiologi

Kas+s #er-an,a* s&n!rom )+sh&n% &a'ah &a#ro%en&*( Ins&!en s&n!rom )+sh&n% en!o%en

!&er*&ra*an se-an,a* 1 *as+s er sa#+ /+#a oran%( 5en,e-a-n,a a!a'ah )+sh&n% !&sease

70? ACT e*#o&* 1;? !an T+mor a!rena' r&mer 1;?( Kas+s #er-an,a* a!a wana

!&-an!&n% r&a !en%an er-an!&n%an 7"1 !an se-a%&an -esar #er/a!& saa# +s&a !e*a!e *e#&%a

a#a+ *eema#(:

Pato!isiologi

Ke'en/ar a!rena' -an,a* mense*res&*an hormon( 5a!a -a%&an *or#e*s a!rena'

!&has&'*an hormon '+*o*or#&*o&! B*or#&so' @&nera'o*or#&*o&! Ba'!os#eron !an hormon

se*s B#er+#ama DEA=!eh&!roe&an!ros#eron( Ka!ar '+*o*or#&*o&! !&a#+r o'eh h+-+n%an

a!rena'.h&o&s&s.h&o#a'am+s( &o#a'am+s men,e*res&*an hormon CR B)or#o)o#ro&n

re'eas&n% hormon ,an% a*an meran%san% h&o&s&s&s mense*res& ACT Ba!reno )or#&)o#ro&*

hormon( ACT se'an/+#n,a meran%san% *e'en/ar a!rena' +n#+* memro!+*s& *or#&so'(

Ka!ar *or#&so' ,an% #&n%%& a*an men%&r&m*an +man -a'&* ne%a#& a!a h&o#a'am+s !an

h&o&s&s seh&n%%a men&m-+'*an &nh&-&s& CR !an ACT *a!ara *or#&so' !aa#

!&er#ahan*an !a'am ran%e norma'(9

S&n!rom )+sh&n% a!a'ah man&es#as& ,an% !&m-+'*an *arena a!an,a *e'e-&han

hormon %'+*o*or#&*o&! B*or#&so'( Se)ara +m+m *a!ar *or#&so' ,an% -er'e-&h a*an

memen%ar+h& *ea!aan.*ea!aan -er&*+#" @e#a-o'&sme ro#e&n !an *ar-oh&!ra# !&s#r&-+s&

/ar&n%an a!&osa e'e*#ro' s&s#em *e*e-a'an se*res& 'am-+n% +n%s& o#a* erooes&s(

ormon %'+*o*or#&*o&! me*an&sme +#aman,a a!a'ah mereson #erha!a s#ress !an

meran%san% %'+*oneo%enes&s me'a'+& eme)ahan ro#e&n !an 'ema*(

'+*o*or#&*o&! -e*er/a se-a%a& hormon *a#a-o'&* ro#e&n !an a*an men,e-a-*an

eme)ahan ser#a en%ham-a#an s&n#es&s ro#e&n( Se-a%a& a*&-a#n,a #er/a!& *eh&'an%an ro#e&n

a!a /ar&n%an seer#& *+' o#o# #+'an% !an em-+'+h !arah( A*&-a#n,a o#o# men/a!& a#ro&

!an men/a!& 'emah( K+' men/a!& 'e-&h #&&s !an #&!a* mam+ me'awan #ahanan ,an% #er/a!&

a!a a*#&4as norma' seh&n%%a men,e-a-*an #er/a!&n,a s#r&ae( 5en&&san !&n!&n% em-+'+h

!arah ser#a me'emahn,a /ar&n%an er&4as*+'er men,e-a-*an m+!ah #&m-+' '+*a memar(

5


6/10

5em-+'+h !arah men/a!& ra+h seh&n%%a m+!ah #&m-+' e*&mos&s !an e#e*&e( Ke#&*a #er/a!&

re%an%an *+' !& a#as #ema# en&m-+nan 'ema* -ar+ !am-ah h&'an%n,a e'as#&sas *arena

*a#a-o'&sme ro#e&n men%a*&-a#*an r+#+r erm+*aan em-+'+h !arah( Darah merem-es

me'a'+& )e'ah ,an% #er/a!& a*&-a# *a#a-o'&sme *o'a%en a!a /ar&n%an &*a# !&-awah *+'

seh&n%%a !aa# !&'&ha# a!an,a s#r&ae merah *e+n%+an( T+'an% /+%a #eren%ar+h h&'an%n,a

ma#r&*s ro#e&n #+'an% men,e-a-*an *ea!aan os#eooros&s #+'an% men/a!& ra+h !an

#er/a!n,a ra*#+r a#o'o%&s( Os#eooros&s a'&n% ser&n% #er/a!& a!a #+'an% -e'a*an%

men,e-a-*an *o'as 4er#e-ra !&ser#a& n,er& +n%%+n% !an en%+ran%an #&n%%& -a!an(:

@e#a-o'&sme *ar-oh&!ra# /+%a #er%an%%+ %'+*o*or#&*o&! -e*er/a se)ara an#a%on&s

!en%an &ns+'&n %'+*o*or#&*o&! meran%san% %'+*oneo%enes&s !an men%ham-a# +#a*e

%'+*osa er&er( A*&-a#n,a en!eran,a !aa# #er/a!& h&er%'&*em&( 5a!a oran% !en%an

*asas ro!+*s& &ns+'&n norma' ee* &n& a*an !&'awan !en%an en&n%*a#an ro!+*s& &ns+'&n(

Te#a& en!era !en%an *em+an se*res& &ns+'&n ,an% men+r+n #&!a* mam+

men%omensas& *ea!aan &n& !an a*an men&m-+'*an man&es#as& *'&n&s se-a%a& !&a-e#es

me'+s #&e 'a&n(:

Ka!ar %'+*o*or#&*o&! ,an% -er'e-&han /+%a memen%ar+h& !&s#r&-+s& /ar&n%an a!&osa

,an% #er*+m+' !& !aerah sen#ra' #+-+h !an men,e-a-*an o-esas sen#ra' a!a wa/ah Bmoon

a)e mema!a#n,a ossa s+ra*'a4&*+'ar&s !an #on/o'an ser4&*o!orsa'( '+*o*or#&*o&!

mem&'&*& ee* m&n&ma' a!a e'e*#ro' ser+m #e#a& /+*a /+m'ahn,a -er'e-&h ma*a ee*

m&nera'o*or#&*o&!n,a a*an )+*+ menon/o' !an a*an men,e-a-*an re#ens& na#r&+m

em-+an%an *a'&+m e!ema !an a'*a'os&s me#a-o'&*(:

Kor#&so' !an an!ro%en a!rena' BDEA !&-en#+* a!a ona ,an% sama a!a *or#e*s

a!rena'( DEA mer+a*an hormon #es#os#eron ,an% mem&'&*& ee* *+ran% !&-an!&n%*an

#es#os#eron ,an% !&has&'*an #es#&s( Nam+n en&n%*a#an *a!ar DEA a!a wana a*an

mem-+a# #er/a!&n,a h&rs+#&sme en&n%*a#an &n& /+%a a*an men%&nh&-&s& NR

B%ona!o#ro&n re'eas&n% hormon ,an% a*an men&m-+'*an amenore( 5a!a r&a a*an #er/a!&

en+r+nan '&-&!o( Iner#&'as /+%a mer+a*an *e'+han ,an% !&se-a-*an ha' &n&(:

S&s#em &m+n men/a!& *+ran% e&s&en mem+!ah*an #&m-+'n,a &ne*s& -a*#er& ma++n

oor#+n&s#&*( Kee*aan #erha!a &ne*s& se&r&n% !en%an #&n%%&n,a *a!ar *or#&so'( Ee* *or#&so'

#erha!a resons &m+no'o%&s !an &n'amas& an#ara 'a&n men+r+n*an em-en#+*an an#&-o!&

men+r+n*an /+m'ah '&mos eos&no&' !an monos s&r*+'as& men+r+n*an ro!+*s& !an

men%ham-a# *er/a &n#er'e+*&n !an &n#ereron mens#a-&'*an '&sosom men%ham-a# m&%ras&

'e+*os !an men%ham-a# a%osos&s( Sem+a ee* &n& mem-+a# #+-+h #&!a* mam+

me'o*a'&s&r &ne*s& !an men%a*&-a#*an #&n%%&n,a an%*a *ema#&an(:

6


7/10

"ejala Klinis

#besitas

@er+a*an man&es#as& *'&n&s ,an% a'&n% ser&n% !&/+ma& !an enam-ahan -era#

-a!an -&asan,a mer+a*an %e/a'a awa'( Kea!aan &n& se)ara *'as&* -ers&a# sen#ra' #er+#ama

men%ena& wa/ah 'eher -a!an !an a-!omen !an -ers&a# re'a#& !& e*s#remas( A*+m+'as&

'ema* a!a wa/ah men,e-a-*an #er/a!&n,a moon facies ,an% *has ,an% #er!aa# a!a 7;?

*as+s ( A*+m+'as& 'ema* !& se*e'&'&n% 'eher #er+#ama #er!aa# a!a /ar&n%an 'ema*

s+ra*'a4&*+'er !an !orsoser4&*a' *ea!aan ,an% #era*h&r &n& men,e-a-*an +n+* sa&

B-+a'o h+m(6

Perubahan pada Kulit

Ser&n% #er/a!& !an a!an,a *ea!aan &n& har+s !&&*&r*an !&se-a-*an o'eh *or#&so' ,an%

-er'e-&han( A#ro& *+' !an /ar&n%an &*a# !& -awahn,a men,e-a-*an en&&san B%am-aran

*+' ,an% #ransaran( @+!ahn,a #er/a!& memar a*&-a# #ra+ma *e)&' sa/a #er/a!& a!a 60?

*as+s s#r&ae #er/a!& a!a ;0.70?G &n& *has -er+a %am-aran ene*anan *+' -erwarna merah

sama& *e+n%+an ,an% #er/a!& se*+n!er a*&-a# h&'an%n,a /ar&n%an &*a# !& -awah *+' 'eher

B#&!a* /aran% se'e-ar 0;.2 )m !&-an!&n%*an s#r&ae +#&h !a!+ ,an% !aa# #&m-+' a!a

*eham&'an a#a+ en&n%*a#an -era# -a!an ,an% -er'an%s+n% )ea#( S#r&ae.s#r&ae &n& ser&n%

!em+*an !& a-!omen #e#a& !aa# +'a #er/a!& !& se*ar a,+!ara &n%%+' an#a# aha !an

a*s&'a( L+*a.'+*a m&nor !an a-ras& m+n%*&n 'am-a# men,em-+h(6

$irsutisme

Ter/a!& a!a se*ar :0? as&en.as&en -er/en&s *e'am&n erem+an a*&-a#

h&erse*res& an!ro%en.an!ro%en a!rena'( &rs+#&sme as&a' a'&n% ser&n% !&/+ma& #e#a&

en&n%*a#an er#+m-+han ram-+# !aa# +'a #er/a!& !& !aerah a-!omen a,+!ara !a!a !an

aha -a%&an a#as( A*ne !an se-orea -&asan,a #&m-+' men,er#a& h&rs+#&sme( 3aran% #er/a!&

4&r&'&sme *e)+a'& a!a *ars&noma a!rena' ,an% #&m-+' !en%an re*+ens& *+ran% 'e-&h 20?(6

$ipertensi

&er#ens& a!a'ah %am-aran *'as&* !ar& s&n!roma C+sh&n% son#anG #er!aa# a!a

*+ran% 'e-&h 7;? *as+s #e*anan !arah !&as#o'&* 'e-&h !ar& 100 mm% a!a 'e-&h !ar& ;0?

as&en( &er#ens& !an *om'&*as&*om'&*as&n,a men/a!& en,e-a- +#ama !ar& an%*a

mor-&!as !an mor#a'as s&n!roma C+sh&n% son#an(6

7


8/10

Dis!ungsi "onad

Ser&n% !&/+ma& se-a%a& a*&-a# !ar& men&n%*a#n,a an!ro%en Ba!a erem+an !an

*or#&so' Ba!a 'a*&.'a*& !an !a'am /+m'ah ,an% 'e-&h *e)&' a!a erem+an( Amenorea

#er/a!& a!a 7;? wana.wana !& +s&a remenoa+se !an -&asan,a !&ser#a& !en%an a!an,a

&ner#&'as( Ser&n% #er!aa# en+r+nan '&-&!o a!a 'a*&.'a*& !an se-a%&an men%a'am&

en%+ran%an ram-+# #+-+h !an #es#&s me'+na*(6

"angguan%gangguan Psikologi

Ter/a!& a!a se*ar se-a%&an -esar as&en( e/a'a.%e/a'a ,an% r&n%an men)a*+

'a-&'as emos&on&' !an en&n%*a#an &ra-&'as( AnH&e#as !eres& *onsen#ras& ,an% -+r+*

ser#a &n%a#an ,an% -+r+* /+%a !aa# #&m-+'( Ser&n% #er/a!& e+or&a *a!an%.*a!an% #&m-+'

man&es#as& e+or&a a!a as&en( 5a!a se-a%&an -esar as&en #&m-+' %an%%+an #&!+r -er+a

&nsomn&a a#a+ #er-an%+n !& !&n& har&(6

Kelemahan otot

Ter/a!& a!a se*ar 0? *as+s ser&n% #er/a!& !& -a%&an ro*s&ma' !an -&asan,a a'&n%

rom&nen a!a e*s#remas -a%&an -awah(6

#steoporosis

Ter!aa# a!a *e-an,a*an as&enG n,er& !& -a%&an -e'a*an% #+-+h mer+a*an *e'+han

awa' a!a ;:? *as+s( Fra*#+r.ra*#+r a#o'o%&s #er/a!& a!a *as+s.*as+s ,an% -era# #er/a!&

a!a &%a.&%a !an *or+s 4er#e-ra( Fra*#+r *omres& !& #+'an% -e'a*an% #er'&ha# a!a

emer&*saan ra!&o'o%&s a!a 1.22?(6

Batu ginjal

a#+ %&n/a' ,an% #er/a!& a*&-a# h&er*a's&+r&a ,an% !&se-a-*an o'eh %'+*o*or#&*o&!

#er/a!& a!a se*ar 1;? as&en *o'&* %&n/a' *a!an%.*a!an% #&m-+' se-a%a& *e'+han ,an%

men,e-a-*an as&en !a#an% *e !o*#er(6

$aus dan Poliuri

Se*+n!er a*&-a# a!an,a h&er%'&*em&a -era# !an !&a-e#es me'+s #er/a!& a!a se*ar

10? as&en 'e-&h ser&n% !&/+ma& &n#o'erans& %'+*osa ,an% as&m#oma#&*( 6

8


9/10

Ta-e' 1( am-aran *'&n&* s&n!rom C+sh&n%(6

e/a'a K'&n&* 5ersen#ase

O-esas 96

5'e#ora as&a' :6

&er#ens& :2Ke'emahan O#o# 7

N,er& #+-+h -a%&an -e'a*an% ;:

S#r&ae ;2

A*ne 60

e/a'a s&*o'o%&* 60

L+*a memar

a%a' /an#+n% *on%es#& 22

E!ema 1:

a#+ &n/a' 1

Sa* *ea'a 16

5o'&!&s& o'&+r& 10&er&%men#as&

Penatalaksanaan

5ena#a'a*sanaan s&n!rom )+hs&n% #er%an#+n% !ar& e#&o'o%&n,a( 3&*a !&*arena*an

em-er&an reara# %'+*o*or#&*o&! s&n#e#&* ma*a !&+saha*an en%%an#&an s#ero&! !en%an

#era& 'a&n( Un#+* s&n!rom )+sh&n% en!o%en=son#an #era& ,an% a'&n% !&an/+r*an a!a'ah

#&n!a*an -e!ah(

5en,a* )+sh&n% a'&n% -a&* !era& !en%an rese*s& #+mor #ranseno&!a'( Te#a& /&*a

!em+*an h&er+n%s& h&o&s&s #e#a& #+mor #&!a* !em+*an !aa# !&'a*+*an ra!&as& *o-a'#

a!a *e'en/ar h&o&s&s( Se'an/+#n,a !aa# !&%+na*an o-a# o-a#an *&m&a ,an% mam+

men%&nh&-&s& se'.se' en%has&' *or#&so' seer#& *e#o*onao' !an mo#ane( Tera& *e#o*onao'

/an%*a an/an% a!a'ah ,an% a'&n% o+'er !&-an!&n%*an o-a# 'a&nn,a wa'a++n a!a res&*o

ee* sam&n% ,an% har+s !er&ma o'eh as&en( Tera*h&r /&*a rese*s& #+mor #ranseno&!a'

#era& ra!&as& !an o-a#.o-a#an %a%a' en,a* &n& !&*on#ro' !en%an a!rena'e*#om& #o#a'(

5as&en a*an mem-+#+h*an em-er&an !os&s &s&o'o%&* *or#&so' se'ama h&!+n,a( Un#+*#+mor.#+mor en%has&' ACT e*#o&* #era&n,a ham&r sama !&+saha*an +n#+* merese*s&

#+mor.#+mor #erse-+# /&*a #&!a* -erhas&' !&'a*+*an #era& o-a#.o-a#an !an a!rena'e*#om& #o#a'(

5a!a s&n!rom )+sh&n% &n!een!en ACT /+%a har+s !&'a*+*an rese*s& a!a neo'asma ,an%

a!a(

Prognosis

5ro%nos&s as&en -er%an#+n a!a *e-erhas&'an #era& ,an% !&'a*+*an(

9


10/10

Kesimpulan

er!asar*an *e#eran%an *as+s a!a anamnes&s has&' emer&*saan &s&* !an

emer&*saan en+n/an% men+n/+**an -ahwa as&en &n& men!era s&n!rom )+sh&n%(

5en,e-a- #er/a!&n,a s&n!rom )+sh&n% a!a as&en &n& #er/a!& *arena as&en men!aa# #era&

re!n&son se*a'& sehar& +n#+* en,a* asma ,an% !&!eran,a -+*an o'eh en,a* )+sh&n%

a#a++n neo'asma( &o#es&s ,an% !&am-&' !er&ma(

Da!tar Pustaka

1( 'ea!'e 3( A# a %'an)e anamnes&s !an emer&*saan &s&*( 3a*ar#a" 5ener- Er'an%%aG

200;( h(162(

2( S+!o,o AW Se#&,oha!& A'w& I S&ma!&-ra#a @ Se#&a#& S( +*+ A/ar I'm+ 5en,a*

Da'am( E!&s& ;( 3a*ar#a" In#erna 5+-'&sh&n% G 2009(( Se&)her CE Smh 3W( 5em&'&han +/& 'a-ora#or&+m ,an% ee*#&( 3a*ar#a" ECG 200(

6( aH#er 3D T,re'' 3!Endocrinology and Metabolism.E!&s& 2( @)raw.&'' 1997(

;( Sa)her RA( T&n/a+an *'&n&s has&' 'a-ora#or&om( E!&s& 11( 3a*ar#a" ECG 2006(

( 5r&)e SA W&'son L@( 5a#o&s&o'o%& *onse *'&n&s roses.roses en,a*( E!&s& (

3a*ar#a" ECG 200( h(91:.2(

7( @ans/oer A K+s+/& T Sa4r& R( Kaa se'e*#a *e!o*#eran( E!&s& ( 3&'&! 1( 3a*ar#a"

@e!&a Aes)+'a&+sG 200:(

:( Sar'&s N3 Chano)* S3 N&eman LK 2000 Cor#&so'em&) In!&)es 5re!&)# Se4ere Ine)#&ons

&n C+sh&n% S,n!rome !+e #o E)#o&) 5ro!+)#&on o A!reno)or#&)o#ro&n( Journal of

Clinical Endocrinology and Metabolism :;B1G 62.7

9. Sherwoo! L( F&s&o'o%& man+s&a" !ar& se' *e s&s#em( 3a*ar#a" ECG 2001( h( ;2.

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