《内科学》ppt课件温医大库欣综合征2017.ppt

First Affiliated Hospital Wenzhou Medical College Endocrinology Department First Affiliated Hospital Wenzhou Medical College Endocrinology Department First Affiliated Hospital Wenzhou Medical College Endocrinology Department First Affiliated Hospital Wenzhou Medical College First Affilated Hospital Wenzhou Medical College Sign or symptom Report incidence (%) Centripetal obesity 79-97 Facial plethora 50-94 Glucose intolerance 39-90 Weakness, proximal myopathy 29-90 Hypertension 74-87 Psychological changes 31-86 Easy bruisability 23-84 Hisutism 64-81 Oligomenorrhea / amenorrhea 55-80 Impotence 55-80 Acne, oily skin 26-80 Abdominal striae 51-71 Ankle edema 28-60 Backache,vertebral collapse,fracture 40-50 Polydipsia, polyuria 25-44 Renal calculi 15-19 Hyperpigmentation 4-16 Headache 0-47 Exophthalmas 0-33 Tinea versicolor infection 0-30 Abdomina pain 0-21 诊断和鉴别诊断 诊断步骤: 第一步：Yes or No 第二步： 找病因 第三步: 定位 诊断和鉴别诊断 第一步： 1)血皮质醇水平与节律 8am(N165~441 nmol/L) 4pm(N55~248 nmol/L ) 12pm (N55~138 nmol/L) 2） 24h尿游离皮质醇 normal ：130~304nmol/24hrs 3) DXM 小抑制试验 1 mg过夜小抑制 经典小抑制0.5mg q6h X 2 days 24h尿游离皮质醇55 nmol/24hrs Diurnal rhythm of plasma cortisol levels Diurnal rhythm of plasma cortisol ACTH 诊断和鉴别诊断 第二步： 1) DXM 大抑制试验 2mg,