Cushing’s disease and Addison’s disease 库欣病和艾迪森氏病

分类:医学文献 38 0

It is sufficient for most gynecologists to be familiar with the presentation and screening of Cushing’s and Addison’s disease in order to make appropriate and timely referrals.


Cushing’s disease is the result of oversecretion of cortisol. It may arise centrally from pituitary over-activity (the eponymous Cushing’s disease), or peripherally from the adrenal gland or elsewhere. Peripheral causes are much less common, and include paraneoplastic secretion of adrenocorticotropic hormone (ACTH) and autonomous secretion of cortisol by the pituitary.


Presentation is variable, but classically includes moon facies and a “buffalo hump” of fat between the shoulders. Patients have truncal obesity with leg muscle atrophy. Women commonly have hirsutism. Other findings include fatigue, irritatility, elevated serum glucose, and depression (1).


Screening is done with serum cortisol. An overnight, 1 mg dexamethasone suppression test can be done, with an 0800 fasting cortisol drawn. Values less than 5mcg/dL exclude Cushing’s Disease of any source. Confirmation of disease is done with 24-hour urinary cortisol testing. Differentiation of peripheral and central disease is done with two- to six-day dexamethasone suppression testing. It is important to remember that although Cushing’s Disease is a common reason for referral to an endocrinologist, it is one of the least common of diagnoses. It is thus important to be familiar not only with its presentation but with the evaluation of hirsutism, to avoid unnecessary tests and referrals.


Addison’s disease is the result of adrenal insufficiency. Cushing’s disease has substantial implications for long-term health, but Addison’s disease can lead to death abruptly from Addisionian crisis unless appropriately diagnosed and treated. Of note, auto-immune disease can be a cause of Addison’s disease as well as of premature ovarian failure and thyroid disease. Consideration should be given to multiple endocrine failures when one such failure is found (2).


Presentation is usually insidious. Common symptoms include orthostatic hypotension, hypoglycemia, fatigue, and muscle weakness. In an Addisonian crisis, patients present acutely ill, with nausea, vomiting, confusion to the point of psychotic symptoms, syncope, and multiple electrolyte disturbances (3).

艾迪森氏病的表现通常是潜伏性的,常见症状包括体位性低血压、低血糖、疲劳和肌肉无力。 在艾迪生病危象中,患者会出现急性病状,伴有恶心、呕吐、精神错乱到精神病症状、晕厥和多种电解质紊乱的症状(3)。

Addison’s disease is not in the purview of any gynecology provider. If the diagnosis is suspected, patients should be sent to an endocrinologist or for emergency care, as appropriate.




1. Newell-Price J, Grossman A. Diagonisis and management of Cushing’s syndrome. Lancet 1999 June 19;353: 2068-2079.

2. Eisenbarth GS, Gottlieb PA. Medical progress-autoimmune polyendocrine syndromes. New Engl J Med 2004; 350(20): 2068-2079.

3. Baker SJ, Wass JA. Addison’s disease. BMJ 2009 July 2; 339: NIL_0007-NIL_0010.

上一篇: 下一篇: