After normalisation of level of a hydrocortisone

After normalisation of level of a hydrocortisone by means of a partial adrenalectomy secretion was sharply enlarged because of reduction of brake effect on a feedback mechanism. In due course approximately at 10 of patients were shown AkTg-sekretirujushchie the tumours characterised by a generalised hyperpegmentation [224]. Term between buy zanaflex online an adrenalectomy and tumour occurrence widely varies (from 1 year till 16 years), and in small percent of cases the tumour can sprout surrounding tissues and even to metastasize [237]. Though as a preventive maintenance measure at an adrenalectomy it was offered to irradiate a pituitary body, not numerous data testify to insufficient efficiency of this way [224]. The most rational method now is the transsphenoidal approach with an adenomectomy [177, 225, 238]. Unlike that that observe concerning other hyperfunctioning tumours of a pituitary body, in this case operation is shown at a diagnosis establishment even at patients with the
Turkish saddle not changed on the tomogram. The tumour can have the smallest sizes (2-3 mm) and to settle down in any sites of a forward share of a pituitary body [225], and not just on an average line as it became perceptible earlier [146]. Though one surgeons, considering frequency of the multicentric centres of a hyperplasia, recommend full excision of a forward share of a pituitary body [177], the majority of them consider preferable as the first operation a simple adenomectomy. At this method efficiency of operation, judging by postoperative depression of a hypersecretion of a hydrocortisone, reaches 80-90 [225, 238]. After operation usually there are symptoms of a hypofunction of a cortex of the adrenals, demanding applications of replaceable glucocorticoid therapy; it consider as result of suppression by a tumour gipotalamo-gipofizarnoj axes like that is observed after excision of an adenoma of adrenals. Time necessary for restoration of function of this axis, can reach 2 years, and frequency of relapses remains to the unknown person. Results of operation at patients with a syndrome of Nelson not so ; reduction of a hyperpegmentation and depression of level is observed only in 30 of cases [225]. Radial therapy As the basic method of treatment AkTg-sekretirujushchih of tumours of a pituitary body it is possible to apply and a usual roentgenotherapy. Efficiency of this method, according tegretol level to recently received results of inspection of the big group of children with illness , makes 80 [239]. The irradiation a fascicle of protons leads to depression of secretion of a hydrocortisone at 90 of patients and completely normalises its level approximately at 60 [150, 153]. Applied exposure doses (from 60 to 150 Dzh/kg) above, than at other tumours of a pituitary body. Dynamic reactions gipotalamo-gipofizarnoj axes after an irradiation are studied insufficiently though frequency of relapses, apparently, is low enough. Pharmacotherapy The pharmacological agents operating or on biosynthesis of a hydrocortisone in adrenals are applied to treatment of illness (aminoglutethimide, , about, pr-DdD or an agent used in experiment ), or on a metabolism in . Differences in the mechanism of the action, applied doses, efficiency and by-effects of inhibitors of synthesis of steroids are not described in the given section. In the beginning they were applied as the basic way of the treatment referred on adrenals, then-in quality of an additional agent at a pituitary body irradiation, and now - as an alternative method at contraindications to operation or its unsuccessfulness, and also to normalisation of level of a hydrocortisone before operation. The combination of an irradiation to inhibitors of biosynthesis of steroids allows to achieve faster normalisation of secretion of a hydrocortisone, than application of one irradiation, and provides especially encouraging results at patients with moderately expressed clinical semiology. in the absence of other kinds of treatment possesses fast effect, but sometimes causes a hirsutism [240], and at some patients the phenomenon is observed, i.e. At reduction of action of a hydrocortisone on the mechanism of a negative feedback amplifying secretion overcomes blockade of synthesis of steroids. , prescribed together with aminoglutethimide and dexamethasone, is an effective remedy of suppression of secretion of a hydrocortisone both on short, and for long term [241]. Such combination was recommended for normalisation of secretion of a hydrocortisone before surgical excision AkTg-sekretirujushchej of an adenoma. Though at the majority of patients of it, possibly, it is not required, in some expressed cases of disease preliminary medicamental therapy can reduce danger of operation. On the other hand, about, rp-DdD possesses much slower action and it is applied mainly to long treatment in smaller doses, than it is recommended at a cancer of adrenals [242].