{"id":10461,"date":"2007-11-15T14:00:09","date_gmt":"2007-11-15T11:00:09","guid":{"rendered":"https:\/\/www.synevo.ro\/afectiuni\/profil-disfunctie-corticosuprarenala\/"},"modified":"2020-07-10T14:20:52","modified_gmt":"2020-07-10T11:20:52","slug":"profil-disfunctie-corticosuprarenala","status":"publish","type":"synevo_diseases","link":"https:\/\/old.synevo.md\/ru\/afectiuni\/profil-disfunctie-corticosuprarenala\/","title":{"rendered":"Profil disfunc\u0163ie corticosuprarenal\u0103"},"content":{"rendered":"<p><strong>Corticosuprarenala<\/strong> secret\u0103 glucocorticoizi (cel mai important cortizolul) cu efectele principale antiinflamator \u015fi de cre\u015ftere a gluconeogenezei hepatice, mineralocorticoizii (aldosteron) cu efect de re\u0163inere a Na+ \u015fi eliminarea K+ la nivel renal \u015fi androgeni pu\u0163ini activi \u2013 \u201cweak\u201d (dehidroepiandrosteron \u015fi androstendion), care sunt metaboliza\u0163i \u00een testosteron la nivelul ficatului \u015fi altor \u0163esuturi extraglandulare.<\/p><!--more--><p><span style=\"color: #000080;\"><strong>Insuficien\u0163a corticosuprarenal\u0103<\/strong><\/span> poate fi <strong>primar\u0103<\/strong> (afectarea glandei adrenale \u2013 boala Addison) sau <strong>secundar\u0103\/ ter\u0163iar\u0103<\/strong> (prin afectarea secre\u0163iei de ACTH\/ CRH la nivel hipofizar\/ hipotalamic).<\/p><p><strong><em>Insuficien\u0163a primar\u0103 corticosuprarenal\u0103<\/em><\/strong> se datoreaz\u0103 distruc\u0163iei treptate a cortexului glandei suprarenale prin procese inflamatorii, tumorale sau degenerative.<sup>1,2<\/sup><\/p><p>Cea mai frecvent\u0103 cauz\u0103 (70%) este atrofia idiopatic\u0103, probabil printr-un proces autoimun\u00b9. Ea afecteaz\u0103 produc\u0163ia tuturor hormonilor adrenocorticorticali. Pentru c\u0103 gonadele secret\u0103 majoritatea cantit\u0103\u0163ii de androgeni, sc\u0103derea sintezei adrenale de androgeni nu are expresie clinic\u0103. Deficien\u0163a de aldosteron determin\u0103 stimularea maximal\u0103 a sistemului renin-angiotensina. Sc\u0103derea nivelului cortizolului determin\u0103 stimularea maximal\u0103 a secre\u0163iei de ACTH, \u00eenso\u0163it\u0103 de cre\u015fterea simultan\u0103 a produc\u0163iei de hormon melano-stimulator (MSH), din precursorul comun proopiomelanocortin (POMC), cu apari\u0163ia hiperpigment\u0103rii cutanate \u015fi mucoase.<br><strong>Clinic<\/strong> sunt prezente simptome variate, incluz\u00e2nd hipotensiunea \u015fi hiperpigmentarea, cu posibilitatea apari\u0163iei crizei adrenale cu colaps cardiovascular, \u00een condi\u0163ii de stres.<\/p><p><strong><em>Insuficien\u0163a secundar\u0103 sau ter\u0163iar\u0103<\/em> <\/strong>se datoreaz\u0103 afect\u0103rii secre\u0163iei de ACTH sau CRH av\u00e2nd de obicei drept cauz\u0103 tratamentul cu cortizol sau tumorile de hipofiza\/hipotalamus. Hiperpigmenta\u0163ia este absent\u0103 \u00een acest caz.2<\/p><p><span style=\"color: #000080;\"><strong>Hiperfunc\u0163ia corticosuprarenalei<\/strong><\/span> produce sindroame clinice distincte \u00een func\u0163ie de hormonii afecta\u0163i.<\/p><p><em><strong>Sindromul Cushing<\/strong> <\/em>este un grup de manifest\u0103ri clinice cauzate de un nivel cronic crescut de cortizol seric sau de corticosteroizi \u00eenrudi\u0163i.<\/p><p><em>Hiperfunc\u0163ia corticosuprarenalei<\/em> poate fi:<\/p><ul class=\"wp-block-list\"><li style=\"text-align: justify;\">dependen\u0163a de ACTH \u2013 se poate datora hipersecre\u0163iei de ACTH de c\u0103tre glanda hipofiz\u0103; secre\u0163iei de ACTH de c\u0103tre o tumor\u0103 nehipofizar\u0103, ex. carcinomul pulmonar cu celule mici (sindromul de ACTH ectopic); administr\u0103rii de ACTH exogen;<\/li><li style=\"text-align: justify;\">independen\u0163a de reglarea ACTH \u2013 de obicei, \u00een cazul administr\u0103rii terapeutice a unor cantit\u0103\u0163i superioare celor fiziologice de cortizol exogen sau de analogi sintetici \u00eenrudi\u0163i (supreseaz\u0103 func\u0163ia corticosuprarenalei \u015fi mimeaz\u0103 hiperfunc\u0163ia independent\u0103 de ACTH) \u015fi \u00een cazul producerii de cortizol de un adenom sau un carcinom de corticosuprarenal\u0103.<\/li><\/ul><p><strong>Cea mai frecvent\u0103 cauz\u0103 de sindrom Cushing este microadenomul hipofizar secretor de ACTH \u2013 boala Cushing.<\/strong><\/p><p><strong>Simptomele clinice<\/strong> tipice de sindrom Cushing includ faciesul \u00een \u201clun\u0103 plin\u0103\u201d \u015fi obezitatea troncular\u0103 cu extremit\u0103\u0163ile distale \u015fi degetele de obicei sub\u0163iri\u00b9.<\/p><p><strong><em>Hiperplazia adrenal\u0103<\/em><\/strong> congenital\u0103 sau sindromul adrenogenital include un grup de afec\u0163iuni caracterizate fiecare printr-o anomalie ereditar\u0103 \u00een sinteza cortizolului, transmis\u0103 autozomal recesiv, asociat\u0103 de obicei cu o cre\u015ftere a produc\u0163iei de androgeni.<\/p><p><strong>Cea mai frecvent\u0103 cauz\u0103 de sindrom adrenogenital (prezent\u0103 \u00een 95% din cazuri) este deficitul enzimei 21-hidroxilaz\u0103.<\/strong><\/p><p>Datorit\u0103 perturb\u0103rii sintezei cortizolului, metabolismul steroizilor este redirec\u0163ionat c\u0103tre sinteza de androgeni; <strong>clinic<\/strong>, apar semne de virilizare la nou-n\u0103scutul de sex feminin \u015fi pubertate precoce izosexual\u0103 la b\u0103ie\u0163i. Adeseori se asociaz\u0103 \u015fi deficitul de aldosteron.<\/p><p>\u00cen peste 50% din cazuri <strong>debutul formei homozigote a bolii<\/strong> se \u00eenregistreaz\u0103 \u00een primele 3 s\u0103pt\u0103m\u00e2ni de via\u0163\u0103\u00b2. Pe l\u00e2ng\u0103 sindromul adrenogenital clasic, mai exist\u0103 deficitul de 21-hidroxilaz\u0103 cu <strong>debut tardiv<\/strong> \u015fi <strong>forma heterozigot\u0103<\/strong> de hiperplazie adrenal\u0103, care se manifest\u0103 clinic \u00een perioada peripubertar\u0103 sub form\u0103 de tulbur\u0103ri menstruale \u015fi hirsutism sau direct la adult sub form\u0103 de hirsutism.<\/p><div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-1 wp-block-columns-is-layout-flex\"><div class=\"wp-block-column is-vertically-aligned-center is-layout-flow wp-block-column-is-layout-flow\"><p><strong>Teste disponibile \u00een laboratoarele Synevo:<\/strong><\/p><\/div>\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\"><div class=\"synevo-shop-products\">\r\n    <div class=\"sysprod\">\r\n        \r\n        <div class=\"sysprod-products\">\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/acth-hormonul-adrenocorticotrop\/\">ACTH (Hormonul adrenocorticotrop)<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>245 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9115\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9115\"\r\n                                data-product_sku=\"ME02\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/cortizol-seric\/\">Cortizol seric<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>225 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9202\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9202\"\r\n                                data-product_sku=\"ME07\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/cortizol-liber-urinar\/\">Cortizol liber urinar<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>300.00 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9203\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9203\"\r\n                                data-product_sku=\"ME03\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/dehidroepiandrosteron-sulfat-dhea-s\/\">Dehidroepiandrosteron-sulfat (DHEA-S )<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>200 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9219\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9219\"\r\n                                data-product_sku=\"ME08\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/17-cetosteroizi\/\">17-Cetosteroizi<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>600 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9110\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9110\"\r\n                                data-product_sku=\"ME09\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                            <div class=\"sysprod-product\">\r\n                    <a class=\"sysprod-product-title\" href=\"https:\/\/old.synevo.md\/ru\/shop\/17-hidroxiprogesteron\/\">17-hidroxiprogesteron<\/a>\r\n                    <div class=\"sysprod-product-price\">\r\n                        <span>Pre\u021b:<\/span>\r\n                        <span>280.00 lei<\/span>\r\n                    <\/div>\r\n                                            <div class=\"sysprod-product-addcart\">\r\n                            <a\r\n                                href=\"?add-to-cart=9111\"\r\n                                data-quantity=\"1\"\r\n                                class=\"addToCart button product_type_simple add_to_cart_button ajax_add_to_cart \"\r\n                                data-product_id=\"9111\"\r\n                                data-product_sku=\"ME22\"\r\n                                rel=\"nofollow\"\r\n                            ><div><\/div><\/a>\r\n                        <\/div>\r\n                                    <\/div>\r\n                    <\/div>\r\n        \r\n    <\/div>\r\n<\/div>\r\n\r\n<style>\r\n.synevo-shop-products {\r\n    padding: 24px 0;\r\n    margin: 24px 0;\r\n    border-radius: 10px;\r\n    background: #F6F7F9;\r\n}\r\n.synevo-shop-products .sysprod-product {\r\n    position: relative;\r\n    margin: 0 24px;\r\n    margin-bottom: 24px;\r\n    border-radius: 10px;\r\n    background: #fff;\r\n    display: flex;\r\n    flex-direction: row;\r\n    align-items: center;\r\n}\r\n.synevo-shop-products .sysprod-product:last-child {\r\n    margin-bottom: 0;\r\n}\r\n.synevo-shop-products .sysprod-product-title {\r\n    flex-grow: 1;\r\n    padding: 15px;\r\n    margin-left: 14px;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 16px;\r\n    color: #29263F;\r\n}\r\n.synevo-shop-products .sysprod-product-price {\r\n    flex-shrink: 0;\r\n    font-family: Poppins,sans-serif;\r\n    font-weight: 600;\r\n    font-size: 18px;\r\n    color: #FDB813;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart {\r\n    flex-shrink: 0;\r\n    position: relative;\r\n    width: 38px;\r\n    height: 38px;\r\n    margin-left: 24px;\r\n    margin-right: 24px;\r\n}\r\n.synevo-shop-products .sysprod-product-addcart .button {\r\n    top: unset;\r\n    right: unset;\r\n}\r\n<\/style><\/div><\/div><p><strong><small>Bibliografie:<\/small><\/strong><\/p><p><small>1. Adrenal Disorders, The Merck Manual Online Medical Library 2005, Robert S. Porter MD, Justin L. Kaplan MD, www.merck.com.<br>2. Werner Kern, Horst L. Fehm, Hypothalamic-pituitary-adrenal system, \u00een Clinical Laboratory Diagnostics-Use and Assessment of Clinical Laboratory Results. Lothar Thomas. TH-Books Verlagsgesellschaft mbH, Frankfurt \/Main, Germany, 1 Ed., 1998, 1056-1068.<\/small><\/p><hr class=\"wp-block-separator\"\/><p>Teste disponibile \u00een laboratorul Synevo:<\/p><ul class=\"wp-block-list\"><li><a href=\"\/shop\/acth\/\" class=\"rank-math-link\">ACTH<\/a><\/li><li><a href=\"\/shop\/cortizol-seric\/\" class=\"rank-math-link\">Cortizol seric<\/a><\/li><li><a href=\"\/shop\/cortizol-liber-urinar\/\" class=\"rank-math-link\">Cortizol urinar<\/a><\/li><li><a href=\"\/shop\/dehidroepiandrosteron-sulfat-dhea-s\/\" class=\"rank-math-link\">DHEA-S<\/a><\/li><li><a href=\"\/shop\/17-cetosteroizi\/\" class=\"rank-math-link\">17-cetosteroizi urinari<\/a><\/li><li><a href=\"\/shop\/17-hidroxiprogesteron\/\" class=\"rank-math-link\">17-OH progesteron<\/a><\/li><\/ul>","protected":false},"featured_media":0,"template":"","synevo_diseases_category":[894],"class_list":["post-10461","synevo_diseases","type-synevo_diseases","status-publish","hentry","synevo_diseases_category-endocrinologie"],"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases\/10461","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/synevo_diseases"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10461"}],"wp:term":[{"taxonomy":"synevo_diseases_category","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/synevo_diseases_category?post=10461"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}