Signs and symptoms Clinical implications

Signs and symptoms Clinical implications AkTg-sekretirujushchih of tumours can be parted on two groups: the cortexes of adrenals bound to a hyperplasia and raised production of a hydrocortisone and caused by extraadrenal effects and related peptides. has the same signs and symptoms irrespective of, it is caused or by secretion , adenomas of a cortex of adrenals or introduction of an exogenous hydrocortisone. The hypertonia, diabetes, hoodia diet an amenorrhea, a hirsutism, eels, an osteoporosis and compression fractures, muscular delicacy concern these signs, violet colour , fragility of capillaries, bad healing of the wounds, the lowered fastness to infections and behavioural disturbances basically Adeps redistribution on a trunk. Rising of secretion and, possibly, b-LPG leads to pigmentation intensifying like that meets at illnesses. The skin darkens on the sites testing pressure (knee, ulnar and interphalanx joints, areas of wearing of a girdle and bra shoulder-straps), and round papillas, in the field of genitals and mucosas, and also in places of formation of fresh cicatrixes. As secretion by a tumour is not completely independent, and partially chokes at , at early stages of illness the hyperpegmentation does not reach appreciable degree and becomes the most expressed after an adrenalectomy when level can sharply raise.
The hyperpegmentation is a leading sign of a syndrome of Nelson and AKTG-PRODUCING tumours. Though fragments and endorphines make the expressed impact on , the behavioural disturbances observed at illness (euphoria, depression of requirement for a dream, and sometimes true psychoses), can, possibly to be caused by the raised level of a hydrocortisone in plasma. Thanks to earlier diagnostics and treatment frequency of common symptoms of growth of the tumour of a pituitary body (the headache, sight disturbance, a hypopituitarism) decreases now. Data of laboratory researches Here results of the researches applied to diagnostics AkTg-sekretirujushchih of tumours, instead of for differential diagnostics of hyperfunction of a cortex of adrenals will be surveyed mainly. At patients with such tumours level and a hydrocortisone busty alli in plasma is raised, the egestion with urine of a hydrocortisone and metabolites of adrenocortical steroids is strengthened, hydrocortisone influence on the mechanism of a negative feedback is broken and neuroendocrinal regulation (basically periodicity) secretions not only , but also a growth and Prolactinum hormone is upset. Maintenance in plasma is raised approximately at 50 of patients with illness [24, 225]. The top border of norm concerning hormone levels fluctuates from 80 to 100 pg/ml, but in different laboratories can receive unequal digits. Reliability of laboratory research plays the major role in such definitions. Daily fluctuations of level are absent, and even at normal its absolute maintenance it appears raised in relation to concentration of a hydrocortisone in blood. At the majority of patients with illness morning indicators of the maintenance of a hydrocortisone in plasma are raised. The top border of fluctuations of these indicators makes 250 mg/l in the morning and 150 mg/l in the evening. Daily allowances , observed at healthy faces, at illness are absent, and consequently rising of level of a hydrocortisone in plasma is more often observed in the evening. From indicators of an egestion with urine the daily egestion of a free hydrocortisone most reliably taps differences between the normal and raised function of a cortex of adrenals [226]. Normal value do not reach 100 mkg/days the Maintenance 17-IT-kortikosteroidov (17-Construction Department) - usually less informative indicator, but it also can be used. The top border of its normal fluctuations makes 10-12 mg/sut depending on a research method. Definition 17-ketosteroidov (17-KS) will be of no use for diagnostics of illness , but matters at differential diagnostics of a syndrome . Though research of daily urine has advantage before research of a single blood sample as allows to estimate hydrocortisone secretion, completeness of the collecting of urine at use of this research as a method of primary inspection at is out-patient observable patients sometimes raises the doubts. To check up it, it is necessary to measure volume of urine and creatinine level in it. The most reliable popular indicator, allowing to differentiate norm, illness and an adrenal tumour, efficiency of a negative feedback serves in system a hypothalamus - a pituitary body - adrenals. A basis of the corresponding test is characteristic depression of sensitivity of secretion tumours to brake action of a hydrocortisone. At use of this assay as a method of primary inspection in a dose of 1 mg enter dexamethasone in 11 evenings, and hydrocortisone level in plasma define in 8 mornings of next day. At the hydrocortisone maintenance in plasma less than 50 mkg/l the diagnosis of a tumour of a pituitary body is excluded, whereas at its higher level the further researches are necessary.