LUCRARI PRACTICE

 Pacienta M.C, 42 ani, mediu urban

 Motivele prezentarii:
- ↑ ponderala ~ 12 kg in ultimii 5 ani,
- hirsutism accentuat in ultimii 3 ani
- seboree de aproximativ un an
- amenoree secundara (UM 1 sept 2013)

 APP: Dislipidemie mixta

HTA in tratament
Gusa micronodulara
 AHC: mama – obezitate, HTA, dislipidemica

tatal – neoplasm renal

bunica paterna – AVC
 EXAMEN CLINIC

 G= 75 kg, H = 160 cm, BMI = 29.9 kg/m2

 Teg. N colorate, discret seboreice

 Tes. adipos cu dispozitie facio-tronculara

 Pulmonar MV prezent bilateral

 TA: 120/60 mmHg, AV: 72/min

 Tranzit intestinal prezent zilnic

 Manevra Giordano negativa

 OTS
 EXAMENUL ENDOCRINOLOGIC
 Hipotalamus: insomnii
apetit normal
fara sindrom poliuro-polidipsic
 Hipofiza: G: 75 kg, H: 160 cm
Cefalee difuza
Fara galactoree
 Tiroida: gusa mica, omogena, consistenta elastica, clinic
pac. Eutiroidiana
 Paratiroida: semn Chvostek negativ
 Suprarenale: scaderea fortei musculare,
miopatie proximala
vergeturi rosii violacee flancuri abd.
hirsutism
 Gonade: N – 1, Av – 1 , amenoree secundara
 INVESTIGATII PARACLINICE
 HLG – usoara neutrofilie
 TGO, TGP, Uree, Creatinina - N

 Colesterol total: 289 mg/dl

Colesterol LDL: 194 mg/dl

Colesterol HDL: 48 mg/dl
 Trigliceride: 232 mg/dl

 Glicemie bazala 102 mg/dl

 Na: 143 mmol/L,

 K: 4.92 mg/dl

 Cl: 100.5 mg/dl

 DOZARI HORMONALE
 ACTH <1
 Cortizol plasmatic: 36 ug/dl

 CLU: 520ug/24h

 Aldosteron; Renina – in limite normale

 MN, NME – in limite normale

 DHEAs: 320ug/dl (19 - 231)

 Testosteron plasmatic: 0.98 ng/ml

 LH: 9.05 mUI/ml ; FSH: 14.96 mUI/ml

 TSH: 1.24 uUI/ml, T3: 125 ng/ml

 ATPO: 10 (<35 U/L)

 TESTE DE SUPRESIE

Testul cu DXM 1 mg overnight:

Cortizol:
Bazal DXM 1 mg
36 ug/dl 17.67ug/dl

 Testul cu DXM 2 mgx2:

Cortizol:
Bazal DXM 2 mgx2
32 ug/dl 10 ug/dl
 INVESTIGATII PARACLINICE

 Ecografie abdominala:
Colecist pereti ingrosati, fin
depozit biliar, microlitiaza
renala bilaterala, SR stg.
1.63/1.80 cm, Microlitiaza
renala bilaterala

 CT abdominal:
- Nodul tumoral SR stg
29/20/30 mm
- Glanda SR dr hipoplazica
 INVESTIGATII PARACLINICE

Ecografie tiroidiana:
LDT 1.8/2.3/4.10 cm
LST 1.6/2.0/4.0 cm, micronodul LST

 Ecografie utero-ovariana:
- uter AVF, endometru 10 mm
- OD normal ecografic
- OS chist 23/25 mm
 DIAGNOSTIC POZITIV

 Sindrom Cushing prin adenom suprarenalian

stang
 HTA in tratament

 Dislipidemie mixta

 Gusa micronodulara

 Colecistita cronica alitiazica

 Microlitiaza renala

 Obezitate gd I
 TRATAMENT

 Interventie chirurgicala: suprarenalectomie stg

(14 nov 2013)

 Postoperator : tratament de substitutie CSR:

initial HHC schimbat treptat la Prednison 10
mg/zi