Cushingův syndrom

18.3.2012 , Ondřej Volný

cushinguv-syndrom.jpg - kopie
cushinguv-syndrom.jpg - kopie
Kdy myslet na Cushingovův syndrom? Pro tento syndrom jsou nejtypičtější tři příznaky. Velice je charakteristický typ obezity, tedy uložení tuku na břiše. Dále kulatý ,,měsícovitý" obličej, který kontrastuje s tenkými končetinami. Dalším příznakem je únava a řídnutí kostí, které se projevuje bolestmi páteře.

Cushingův syndrom

Příčinou Cushingova syndromu je nadprodukce glukokortikoidů, hormonů produkovaných v kůře nadledviny. Tyto hormony ovlivňují metabolismus cukrů, méně tuků i bílkovin. Nadledvina, jak název napovídá, je párový orgán ležící v těsné blízkosti ledviny, má trojúhelníkovitý tvar a velikost asi 5 x 1,5 x 0,5 cm. Pro anatomickou představu leží nadledvina poblíž páteře, v úrovni 11. žebra. Skládá se ze dvou funkčně odlišných částí a to kůry a dřeně. Kůra i dřeň produkují důležité hormony. Nadledvina je životně důležitým orgánem zapojeným ve složitém systému hormonálního řízení našeho těla. Při poruchách produkce hormonů vznikají různá onemocnění, jedním z nich je právě Cushingův syndrom.

Cushingův syndrom a kortizol

Hormony si můžete představit jako dopisy, kterými mezi sebou komunikují vzdálené orgány. Tyto „dopisy" jsou posílány k orgánům krví. Tímto důmyslným systémem má naše tělo zaručeno, pokud vše funguje tak jak má, že se „dopis", hormon, dostane na správnou adresu a informuje toho správného adresáta. Každý orgán má svou přesnou adresu a odlišnou „poštovní schránku", do které zapadnou jen dopisy „správné" velikosti a tvaru. Tím je zaručeno, že je dopis doručen „do správných rukou", tedy k tomu správnému orgánu.

Jaké jsou funkce kortizolu a co způsobí jeho nadbytek? Jako každý nadbytek vede ke zvýraznění všech účinků tohoto hormonu. Kortizol je nezbytný pro metabolismus cukrů, jeho nadbytek vyvolává zvýšení hladiny krevního cukru (hyperglykemie) a příznaky podobné cukrovce. Dochází až k extrémním objemům moči, až 6 litrů za den. Ztráty tekutin močí jsou pak kompenzovány velkou žízní a chutí na sladké. Kortizol dále zvyšuje odbourávání bílkovin. Základní stavební kameny bílkovin jsou aminokyseliny, ty jsou využívány v játrech k produkci glukózy. Nadbytek kortizolu vede k úbytku svalové hmoty a redistribuci tuku, ztenčení kůže, která je pak tenká, snadno zranitelná a je podobná listu pergamenu. Na kůži břicha se při Cushingově syndromu objevují červenofialové strie. Způsobuje také osteoporózu, což je úbytek kostní hmoty, s následným nebezpečím zlomenin. Vysoké hladiny kortizolu a dalších glukokortikoidů tlumí aktivitu imunitního systému. Typicky se pak objevují kožní infekce, především houbové tzv. mykózy mezi prsty na rukou a na nohou. Dále jeho vysoké hladiny zvyšují krevní tlak, krevní tuky a cholesterol, čímž zvyšují riziko nemocí srdce, cév a mozku. Dále může způsobit vznik žaludečních a dvanáctníkových vředů nebo již existující onemocnění zkomplikovat. Mnohé z těchto příznaků se projevují při tzv. Cushingově syndromu.

Nejčastější otázky u Cushingova syndromu?

Co je příčinou Cushingova syndromu?

Nadbytek kortizolu.

Kdy myslet na Cushingův syndrom?

Pro tuto chorobu jsou nejtypičtější tři příznaky. Prvním je charakteristický typ obezity, tedy uložení tuku na břiše. Dále kulatý ,,měsícovitý" obličej, který kontrastuje s tenkými pavoukovitými končetinami. Dalším příznakem je únava a řídnutí kostí, které se projevuje bolestmi páteře.

Jaké jsou další projevy Cushingova syndromu?

Nově vzniklá cukrovka, zvýšení krevního tlaku, objevují se také mentální změny od zvýšení chuti k jídlu, přes nespavost, euforii až po stavy nevysvětlitelné zmatenosti (psychózy).

Mohou s Cushingovým syndromem souviset poruchy menstruačního cyklu?

Ano.

Diagnostika a léčba Cushingova syndromu

Pokud trpíte výše uvedenými příznaky, neprodleně navštivte svého praktického lékaře nebo specializovaného lékaře endokrinologa (obor interní medicíny zabývající se poruchami žláz s vnitřní sekrecí). Léčbu musí řídit odborník na endokrinologii. Cushingův syndrom lze diagnostikovat z odběrů krve a pomocí ultrazvuku nebo jinými zobrazovacími metodami. Léčba Cushingova syndromu je nezbytná, neléčená choroba je totiž velkým rizikem a může vést ke smrti. Hrozí komplikace srdeční, cévní mozkové příhody, komplikace spojené s diabetem a také je narušeno vyrovnávání se se stresovými situacemi.

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12. března 2016 4:06

Táňa Krátká: Dobrý den, prosím o radu. Je mi 39 let. Od června 2012 do cca ledna 2013 jsem užívala kortikoidy na reaktickou artritidu. V posledních měsících jsem si všimla velkého nárustu břišního tuku, ikdyž jinak mám normální postavu, váha 62kg, výška 166cm). Cítím se velmi unavená cca poslední měsíc, motá se mi hlava, hlavně při změnách poloh, tento měsíc mi vynechala menstruace (15 dní), ikdyž mám cyklus vždy pravidelný 28 dní. Navštívila jsem obvodního lékaře, který mi břicho prohlédl s tím, že se nejeví normálně a jsem odeslána na UTZ břicha. Jiné vyšetření se nedělalo. Obávám se Cushingova syndromu. Jaká vyšetření by byla vhodná? Nebo popsané příznaky nemusí souviset se syndromem? Velice Vám děkuji za radu.

16. prosince 2013 16:21

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