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成人库欣综合征患者合并生长激素(GH)缺乏的临床特征及行3年GH替代治疗的效果
Clinical features of growth hormone (GH) deficiency and effects of 3 years of GH replacement in adults with controlled Cushing's disease
Höybye C, Ragnarsson O, Jönsson PJ  2010/6/30 19:21:00 
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Eur J Endocrinol, 2010,
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Objective:
Patients in remission from Cushing's disease (CD) have many clinical features that are difficult to distinguish from concomitant GHD. In this study, we evaluated the features of GHD in a large cohort of controlled CD and assessed the effect of GH treatment.
 
Design and Methods: 
Data were obtained from KIMS, the Pfizer International Metabolic Database. A retrospective cross-sectional comparison of background characteristics in unmatched cohorts of patients with CD (n=684, 74% women) and non-functioning pituitary adenomas (NFPA) (n=2990, 39% women) was conducted. In addition, a longitudinal evaluation of 3-years of GH replacement in a subset of patients with controlled CD (n=322) and NFPA (n=748) matched for age and gender was performed.
 
Results: 
The cross-sectional study showed a significant delay to GHD diagnosis in the CD group, who had a higher prevalence of hypertension, fractures and diabetes mellitus. In the longitudinal, matched study, the CD group had a better metabolic profile but a poorer quality of life (QoL) at baseline, assessed with the disease specific questionnaire QoL-AGHDA. After 3 years of GH treatment (mean dose at 3 years 0.39mg/day in CD and 0.37mg/day in NFPA), total and LDL-cholesterol decreased, while glucose and HbA1C increased. Improvement in QoL was observed, greater in the CD group (−6 CD group vs. −5 NFPA group, p<0.01).
 
Conclusion: 
In untreated GHD, co-morbidities, including impairment of QoL, were more prevalent in controlled CD. Overall, both groups responded similarly to GH replacement, suggesting that patients with GHD due to CD benefit from GH to the same extent as those with GHD due to NFPA.
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疾病资源中心  疾病资源中心
病例分析 <span class="ModTitle_Intro_Right" id="EPMI_Home_MedicalCases_Intro_div" onclick="javascript:window.location='http://www.elseviermed.cn/tabid/127/Default.aspx'" onmouseover="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.cursor='pointer';document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='underline';" onmouseout="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='none';">[栏目介绍]</span>  病例分析 [栏目介绍]
甲状腺功能亢进合并黄疸

 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
 

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