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.

　　對(duì)于大多數(shù)婦科醫(yī)生來說，只要熟悉庫欣病和艾迪森氏病的表現(xiàn)和檢測(cè)方法就足夠他們及時(shí)且恰當(dāng)?shù)亟o病人轉(zhuǎn)診。

　　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.

　　庫欣病是皮質(zhì)醇分泌過多導(dǎo)致的疾病，皮質(zhì)醇有可能來自垂體過度活動(dòng)(同名庫欣病)的核心，或腎上腺及其他地方的外周。外周激素包括副腫瘤分泌的促腎上腺皮質(zhì)激素(ACTH)和垂體自主分泌的皮質(zhì)醇。

　　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).

　　庫欣病的癥狀有多種表現(xiàn)，典型癥狀包括滿月臉和肩部脂肪堆積成的“水牛駝峰”。患者有軀干肥胖伴腿部肌肉萎縮。女性通?；加卸嗝Y。其他表現(xiàn)包括疲勞、煩躁、血清葡萄糖升高和抑郁(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.

　　庫欣病通過血清皮質(zhì)醇檢測(cè)進(jìn)行篩查?？梢栽谠缟?點(diǎn)空腹抽血用1mg地塞米松進(jìn)行隔夜控制試驗(yàn)。結(jié)果小于5mcg/dL可以排除庫欣病。確診試驗(yàn)需要通過尿液檢測(cè)24小時(shí)皮質(zhì)醇水平。區(qū)分外周疾病和核心疾病，則需要2至6天地塞米松控制試驗(yàn)來完成。不過，雖然庫欣病是需要轉(zhuǎn)給內(nèi)分泌學(xué)家的常見疾病，但它確診率很低。因此，醫(yī)生不僅需要熟悉多毛癥的表現(xiàn)，還要熟悉多毛癥的評(píng)估方法，以避免不必要的檢查和轉(zhuǎn)診，這點(diǎn)非常重要。

　　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).

　　艾迪森氏病是腎上腺皮質(zhì)功能減退癥。庫欣病對(duì)長(zhǎng)期健康有重大影響，但艾迪森氏病如果沒有及時(shí)診斷和適當(dāng)治療，可能會(huì)因急性腎上腺皮質(zhì)危象而導(dǎo)致猝死。需要關(guān)注的是，自身免疫性疾病可能是艾迪森氏病以及卵巢早衰和甲狀腺疾病的病因。當(dāng)出現(xiàn)這類疾病時(shí)，應(yīng)當(dāng)考慮是否存在多種內(nèi)分泌失調(diào)(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).

　　艾迪森氏病的表現(xiàn)通常是潛伏性的，常見癥狀包括體位性低血壓、低血糖、疲勞和肌肉無力。 在艾迪生病危象中，患者會(huì)出現(xiàn)急疾病 狀，伴有惡心、嘔吐、精神錯(cuò)亂到精神病癥狀、暈厥和多種電解質(zhì)紊亂的癥狀(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.

　　艾迪森氏病不屬于婦科范圍。如有疑似案例，應(yīng)酌情將患者送往內(nèi)分泌科或接受緊急護(hù)理。

　　References

　　參考文獻(xiàn)

　　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.

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