Lucrari Practice

LUCRARI PRACTICE

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Pacienta M.C, 42 ani, mediu urban

Motivele prezentarii: - ↑ ponderala ~ 12 kg in ultimii 5 ani, - hirsutism accentuat in ultimii 3 ani - seboree de aproximativ un an - amenoree secundara (UM 1 sept 2013)

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APP: Dislipidemie mixta HTA in tratament Gusa micronodulara  AHC: mama – obezitate, HTA, dislipidemica tatal – neoplasm renal bunica paterna – AVC 

EXAMEN CLINIC 

G= 75 kg, H = 160 cm, BMI = 29.9 kg/m2

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Teg. N colorate, discret seboreice

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Tes. adipos cu dispozitie facio-tronculara

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Pulmonar MV prezent bilateral

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TA: 120/60 mmHg, AV: 72/min

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Tranzit intestinal prezent zilnic

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Manevra Giordano negativa

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OTS

EXAMENUL ENDOCRINOLOGIC 

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Hipotalamus: insomnii apetit normal fara sindrom poliuro-polidipsic Hipofiza: G: 75 kg, H: 160 cm Cefalee difuza Fara galactoree Tiroida: gusa mica, omogena, consistenta elastica, clinic pac. Eutiroidiana Paratiroida: semn Chvostek negativ Suprarenale: scaderea fortei musculare, miopatie proximala vergeturi rosii violacee flancuri abd. hirsutism Gonade: N – 1, Av – 1 , amenoree secundara

INVESTIGATII PARACLINICE  HLG

– usoara neutrofilie  TGO, TGP, Uree, Creatinina - N  Colesterol total: 289 mg/dl Colesterol LDL: 194 mg/dl Colesterol HDL: 48 mg/dl  Trigliceride: 232 mg/dl  Glicemie bazala 102 mg/dl  Na: 143 mmol/L,  K: 4.92 mg/dl  Cl: 100.5 mg/dl

DOZARI HORMONALE  ACTH

<1  Cortizol plasmatic: 36 ug/dl  CLU: 520ug/24h  Aldosteron; Renina – in limite normale  MN, NME – in limite normale  DHEAs: 320ug/dl (19 - 231)  Testosteron plasmatic: 0.98 ng/ml  LH: 9.05 mUI/ml ; FSH: 14.96 mUI/ml  TSH: 1.24 uUI/ml, T3: 125 ng/ml  ATPO: 10 (<35 U/L)

TESTE DE SUPRESIE Testul cu DXM 1 mg overnight: Cortizol: Bazal DXM 1 mg 36 ug/dl 17.67ug/dl 

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Testul cu DXM 2 mgx2: Cortizol: Bazal DXM 2 mgx2 32 ug/dl 10 ug/dl

INVESTIGATII PARACLINICE 

Ecografie abdominala: Colecist pereti ingrosati, fin depozit biliar, microlitiaza renala bilaterala, SR stg. 1.63/1.80 cm, Microlitiaza renala bilaterala

CT abdominal: - Nodul tumoral SR stg 29/20/30 mm - Glanda SR dr hipoplazica

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INVESTIGATII PARACLINICE Ecografie tiroidiana: LDT 1.8/2.3/4.10 cm LST 1.6/2.0/4.0 cm, micronodul LST 

Ecografie utero-ovariana: - uter AVF, endometru 10 mm - OD normal ecografic - OS chist 23/25 mm

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DIAGNOSTIC POZITIV Sindrom Cushing prin adenom suprarenalian stang  HTA in tratament  Dislipidemie mixta  Gusa micronodulara  Colecistita cronica alitiazica  Microlitiaza renala  Obezitate gd I 

TRATAMENT 

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Interventie chirurgicala: suprarenalectomie stg (14 nov 2013) Postoperator : tratament de substitutie CSR: initial HHC schimbat treptat la Prednison 10 mg/zi