柯兴综合症Cushing Syndrome

柯兴综合症Cushing Syndrome 柯 兴 综 合 症 *什么是柯兴综合症, 柯兴综合症是一种由于身体组织长期暴露于高水平的皮质醇荷尔蒙下而导致的激素紊乱。有时被称作皮质醇增多症。柯兴综合症相对少见并通常发病于20至50岁成人间。那些有?型糖尿病的肥胖者～并伴有高血糖、高血压者患病的概率增大。 *柯兴综合症的症状是什么, 柯兴综合症的症状很多～但大多数激素紊乱者都有:上部躯干肥胖～圆脸～脖子周围脂肪堆积～以及相对纤细的四肢。孩子则伴有生长缓慢的肥胖倾向。 还有一些症状表现于皮肤:皮肤薄而易碰伤～并且难以愈合。在腹部、大腿、股臀、胳膊和乳房会出现紫色或粉色的拉升印记,紫纹,。 骨骼会变得脆弱～弯腰、提物或从椅子上起身等日常活动都可能导致背痛～甚至肋骨或脊柱骨折。 女性患者常常在脸部、颈部、胸部、腹部及腿部有多毛症状～她们的经期会不正常或者闭经。男性患者会有性欲减退或消失～有的则有勃起功能障碍。 其它常见的症状包括:严重乏力、疲劳,肌肉无力,高血压,高血糖,多渴多尿,易躁易怒～焦虑或抑郁,肩间背部脂肪堆积,水牛背,。 有时其它情况也会引起柯兴病的症状～而此时患者并没有非正常的皮质醇激素水平升高情况。例如,多囊卵巢综合症会引起月经紊乱、青春期体重增加及多毛、糖尿病。代谢综合症会引起一系列症状～包括腰围增大、高血压、血糖不正常及胰岛素紊乱。但这些都是柯兴综合症的假性症状。 urban traffic structure in the urban public transport system, rail traffic with a fast, large capacity, low pollution and high efficiency, become an indispensable part of urban traffic structure, is the contradiction between supply and demand of the growing metropolis, cities, effective means to meet the needs of urban traffic. The following table is a rail transport and other modes of urban passenger transport capacity, transportation speed and resource consumption, and so on. Comparison of urban passenger traffic characteristics table 5.1-2 traffic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 10-15 3,000 short car 20-50 10-20 wide bus 6,000-9,000 1-2 40-60 0.25-0.5 from the Metro light rail of 10,000-30,000 in long-distance line 3 More than 0,000 40-60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource consumption and environmental pollution, rail transport is undoubtedly an effective means to solve the problem of traffic congestion in cities. Especially in urban population strength enormous traffic demand on the route to ease traffic pressure, rail transportation has incomparable advantages. Washington, DC, area of 177km2, and a population of 600,000, is a United States political center. For the Washington Metro system United States second-busiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, net annual passenger volume reached 223 million people. According to statistics, from 2000 to 2009 vehicle trip down 12.7%, bus travel has increased by 12%. Objectives of the Washington Metro system boils down to the following three points: by driving onto the tracks at the station transfer mode in order to alleviate traffic congestion; For those who will not or cannot drive the person with a better option than conventional public transit; Block highway *是什么导致了柯兴综合症, 当身体组织长期暴露于高水平的皮质醇激素下～即会产生柯兴综合症。许多患者是由于服用了糖皮质激素药物,一种化学性质与皮质醇相近的人工激素,～它可用于治疗气喘病、风湿性关节炎及肺炎等。糖皮质激素也常被用于器官或组织移植后遏制器官组织的排异反应。 另一部分患者患病则是因为其自身产生了太多皮质醇。正常的皮质醇激素产生遵循以下过程链:首先～大脑中有如方糖大小的组织下丘脑传输CRH激素给脑垂体～CRH激素由此分泌ACTH激素并刺激肾上腺～于是位于肾脏上部的肾上腺接收到ACTH激素后～即释放皮质醇激素到血液中作为回应。 皮质醇在人体中执行的生命任务包括:帮助保持血压～减少肺部免疫系统的反应,平衡用于分解糖元的胰岛素,调节蛋白质、碳水化合物及脂肪的新陈代谢。 皮质醇另有一项重要功能是:帮助机体进行应激反应。因此～怀孕后三个月的妇女～以及进行高强度竞技运动训练的人往往会呈现高水平的皮质醇状态。此外～那些受抑郁、酗酒、营养不良、惊恐症之苦的人也会使血液内的皮质醇水平增高。 当血液内的皮质醇水平适当～下丘脑和脑垂体会释放少量适当的CRH和ACTH激素～以保证肾上腺分泌能满足身体日常需求量的皮质醇～但是～当肾上腺或脑垂体、下丘脑这些调节阀中的某一部分出了问题～皮质醇的生产过程就会出岔子。 #脑垂体肿瘤,腺样增殖体, 包括因使用了糖皮质激素药物的人为因素在内～有70%的柯兴综合症由脑垂体肿瘤引起—即由这些良性的脑垂体肿块分泌了过多的ACTH激素引起。大多数患者只有单个肿瘤。患上此种柯兴病的女性是男性的五倍。 #异位ACTH综合症 30,000 in long-ro light rail of 10,0000.5 from the Met-60 0.25-2 40-9,000 1-20 wide bus 6,000-50 10-15 3,000 short car 20-2 traffic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 10-n. Comparison of urban passenger traffic characteristics table 5.1so o is a rail transport and other modes of urban passenger transport capacity, transportation speed and resource consumption, and supply and demand of the growing metropolis, cities, effective means to meet the needs of urban traffic. The following tableh efficiency, become an indispensable part of urban traffic structure, is the contradiction between urban traffic structure in the urban public transport system, rail traffic with a fast, large capacity, low pollution and higperson with a better option than conventional public transit; Block highwaythe tracks at the station transfer mode in order to alleviate traffic congestion; For those who will not or cannot drive the onto s travel has increased by 12%. Objectives of the Washington Metro system boils down to the following three points: by drivinget annual passenger volume reached 223 million people. According to statistics, from 2000 to 2009 vehicle trip down 12.7%, bubusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, n-s secondrea of 177km2, and a population of 600,000, is a United States political center. For the Washington Metro system United StateDC, a h enormous traffic demand on the route to ease traffic pressure, rail transportation has incomparable advantages. Washington,s undoubtedly an effective means to solve the problem of traffic congestion in cities. Especially in urban population strengtconsumption and environmental pollution, rail transport i60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource -distance line 3 More than 0,000 40-2 有时为良性～更多时候为脑垂体外的恶性肿瘤会产生ACTH激素～此类情况被称为异位ACTH综合症。超过半数的病例由肺部肿块引起～且男性患者是女性的三倍。最常见的异位ACTH分泌者为微型肺癌细胞～约占所有肺癌病例的13%～其次为身体其它各部位的激素分泌细胞所产生的微腺瘤～还有一些较少见类型的肿瘤诸如胰腺瘤、甲状腺瘤也能分泌ACHT激素。 #肾上腺肿瘤 在极少的病例中～肾上腺肿块也会引起柯兴综合症。女性发病要高于男性4-5倍～平均的起病年龄约为40岁。其中的大多数病例是由于良性的肾上腺体瘤释放过度的皮质醇激素至血液中引起的。 肾上腺癌是柯兴病起因中最罕见的情况。在这种情况下～癌细胞会分泌多种过量的肾上腺皮质激素～包括皮质醇和雄酮激素。肾上腺癌往往会导致极高的激素水平～并且症状发展非常迅猛。 #家族柯兴综合症,遗传性, 大多数的柯兴综合症是不遗传的。但是～少数情况下～具有遗传倾向的内分泌激素肿瘤会导致柯兴综合症。在肾上腺微腺瘤病例中～后代可能会有肾上腺微腺肿块。在混合微腺瘤病例中～甲状腺瘤、胰腺瘤及垂体瘤等这些激素分泌瘤都可能遗传。而这些垂体、异位或肾上腺肿块都可能导致柯兴综合症。 *如何诊断柯兴综合症, 诊断是建立在回顾病人病史～进行物理检查及化学试验等基础上的。对肾上腺及脑垂体照射X光影～以此对肿瘤进行定位也是有所帮助的。 #确诊柯兴综合症的 没有一种单一的试验检测是完美的～确诊往往需要多项检测。最常用的三种方法是:24小时尿皮质醇检测～午夜血皮质醇或唾液皮质 30,000 in long-0.5 from the Metro light rail of 10,000-60 0.25-2 40-9,000 1-20 wide bus 6,000-50 10-15 3,000 short car 20-fic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 102 traf-y, transportation speed and resource consumption, and so on. Comparison of urban passenger traffic characteristics table 5.1eet the needs of urban traffic. The following table is a rail transport and other modes of urban passenger transport capacitto m of urban traffic structure, is the contradiction between supply and demand of the growing metropolis, cities, effective means c transport system, rail traffic with a fast, large capacity, low pollution and high efficiency, become an indispensable parturban traffic structure in the urban publihwaygestion; For those who will not or cannot drive the person with a better option than conventional public transit; Block higic conboils down to the following three points: by driving onto the tracks at the station transfer mode in order to alleviate traffstics, from 2000 to 2009 vehicle trip down 12.7%, bus travel has increased by 12%. Objectives of the Washington Metro system annual passenger volume reached 223 million people. According to statibusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, net -center. For the Washington Metro system United States secondtical nsportation has incomparable advantages. Washington, DC, area of 177km2, and a population of 600,000, is a United States polion in cities. Especially in urban population strength enormous traffic demand on the route to ease traffic pressure, rail tragesticonsumption and environmental pollution, rail transport is undoubtedly an effective means to solve the problem of traffic con60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource -distance line 3 More than 0,000 40-3 醇水平测量～以及小剂量地塞米松抑制试验检测。还有一种检测:地塞米松-促肾上腺皮质释放激素试验～是用来区别柯兴综合症和其他原因引起的皮质醇增多的。 24小时尿游离皮质醇水平。在此项检测中～病员须收集24小时区间内的尿液以用来检测皮质醇～对于成人而言高于50-100微克/日则提示柯兴综合症。检测的不同上限要依据所使用的不同测量技术。 午夜血皮质醇或唾液皮质醇检测。午夜血皮质醇测量的是血液中的皮质醇浓度。在晚上～皮质醇的生产通常都是被抑制的～但在柯兴综合症的病例中则不被抑制。如果血皮质醇水平超过50nmol/L～则被疑似柯兴综合症。这项检测需要病员留院48小时～以防皮质醇水平因压力等原因假性上升。不过～晚间的唾液样本可以在家中取得～再由医院测定皮质醇～其诊断值的范围也应依据测量所用的技术手段。 小剂量地塞米松抑制试验,LDDST,检测。在此项检测中～病员在两天中每6小时需口服小剂量的地塞米松,一种人造激素,～尿液则须在服药前和服药的每一天被收集。,PS:修正型LDDST检测会使用一次性的整夜剂量。,在小剂量地塞米松抑制试验中～伴有抑郁、酗酒、高雄激素水平、急症或压力过大的人都可能会显示皮质醇水平未下降的结果～以致提示错误的柯兴综合症信息。另一方面～苯妥英及苯巴比妥等药物则会导致皮质醇水平下降～以致患有柯兴综合症的病人被误诊。因此～医师们常会建议他们的病人在检测前停止服用这些药物至少一周。 地塞米松-促肾上腺皮质释放激素试验,CRH,检测。有些人虽皮质醇水平高～但却没有渐进的柯兴综合症的症状发展～诸如肌肉乏力、骨折～及皮肤变薄等。这些人也许患上了假性的柯兴综合症～这种情况往往在抑郁、焦虑症、酗酒、未控制好的糖尿病～或极度肥胖的人群中被发现。假性柯兴综合症并不会像柯兴综合症那样对健康有长期的影响～因而不需对内分泌腺进行直接的治疗。 30,000 in long-ro light rail of 10,0000.5 from the Met-60 0.25-2 40-9,000 1-20 wide bus 6,000-50 10-15 3,000 short car 20-2 traffic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 10-n. Comparison of urban passenger traffic characteristics table 5.1so o is a rail transport and other modes of urban passenger transport capacity, transportation speed and resource consumption, and supply and demand of the growing metropolis, cities, effective means to meet the needs of urban traffic. The following tableh efficiency, become an indispensable part of urban traffic structure, is the contradiction between urban traffic structure in the urban public transport system, rail traffic with a fast, large capacity, low pollution and higperson with a better option than conventional public transit; Block highwaythe tracks at the station transfer mode in order to alleviate traffic congestion; For those who will not or cannot drive the onto s travel has increased by 12%. Objectives of the Washington Metro system boils down to the following three points: by drivinget annual passenger volume reached 223 million people. According to statistics, from 2000 to 2009 vehicle trip down 12.7%, bubusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, n-s secondrea of 177km2, and a population of 600,000, is a United States political center. For the Washington Metro system United StateDC, a h enormous traffic demand on the route to ease traffic pressure, rail transportation has incomparable advantages. Washington,s undoubtedly an effective means to solve the problem of traffic congestion in cities. Especially in urban population strengtconsumption and environmental pollution, rail transport i60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource -distance line 3 More than 0,000 40-4 地塞米松-CRH试验能快速地鉴别出假性柯兴综合症与轻度的柯兴综合症病例。此项检测结合了小剂量地塞米松抑制试验与促肾上腺皮质激素刺激试验。在CRH刺激试验中～注射促肾上腺皮质素CRH会引起脑垂体分泌ACTH～因为预先服用了地塞米松～假性柯兴综合症者皮质醇水平能被抑制～柯兴综合症病人的皮质醇水平在检测中则会升高。 #找到柯兴综合症成因的检测 一旦柯兴综合症被确诊～即需要做一些其他检测～用来找到导致过量皮质醇产生异常所在的精确位臵。对于检测种类的选择～部分是基于内分泌专家的选择或检测中心所能提供的种类。 促肾上腺皮质释放激素,CRH,刺激试验。CRH试验～是在未预先进行过地塞米松治疗的情况下～以帮助区别垂体瘤患者、异位ACTH患者与肾上腺瘤患者。在注射了促肾上腺皮质激素,CRH,后～垂体瘤患者的血ACTH及皮质醇水平会升高～因为CRH直接作用于脑垂体。但这种升高反应极少见于异位ACTH患者～也几乎未见于肾上腺瘤患者。 大剂量地塞米松抑制试验,HDDST,。大剂量地塞米松抑制试验和小剂量地塞米松抑制试验方法一样～只是使用了大剂量的地塞米松进行。这项检测能帮助区别ACTH的过量分泌是由于垂体瘤还是异位ACTH肿瘤引起的。大剂量的地塞米松能抑制垂体瘤患者的皮质醇水平～但不能抑制异位ACTH肿瘤患者的皮质醇水平。 放射显像:直接显现内分泌腺。影像学检测能揭示闹吹及肾上腺的大小和形状～以确诊是否存在肿瘤。最常用的影像学检查市CT扫描及MRI核磁共振。CT扫描所产生的X光片能提供身体组织的代表性显像。MRI核磁共振也能提供体内脏器的显像～并使患者免于暴露在电离辐射下。影像学检测应用于柯兴病确诊之后～而非确诊的诊断过程之中～因为脑垂体和肾上腺常被发现有良性肿瘤。这些肿瘤～有 -distance line 3 More than 0,000 40-30,000 in long-0.5 from the Metro light rail of 10,000-60 0.25-2 40-9,000 1-20 wide bus 6,000-50 10-15 3,000 short car 20-fic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 102 traf-y, transportation speed and resource consumption, and so on. Comparison of urban passenger traffic characteristics table 5.1eet the needs of urban traffic. The following table is a rail transport and other modes of urban passenger transport capacitto m of urban traffic structure, is the contradiction between supply and demand of the growing metropolis, cities, effective means c transport system, rail traffic with a fast, large capacity, low pollution and high efficiency, become an indispensable parturban traffic structure in the urban publihwaygestion; For those who will not or cannot drive the person with a better option than conventional public transit; Block higic conboils down to the following three points: by driving onto the tracks at the station transfer mode in order to alleviate traffstics, from 2000 to 2009 vehicle trip down 12.7%, bus travel has increased by 12%. Objectives of the Washington Metro system annual passenger volume reached 223 million people. According to statibusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, net -center. For the Washington Metro system United States secondtical nsportation has incomparable advantages. Washington, DC, area of 177km2, and a population of 600,000, is a United States polion in cities. Especially in urban population strength enormous traffic demand on the route to ease traffic pressure, rail tragesticonsumption and environmental pollution, rail transport is undoubtedly an effective means to solve the problem of traffic con60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource 5 时被称为附瘤～并不产生有害的过量激素。它们不需要被摘除～除非血液检测显示它们引起了症状或它们非正常的长大。相反地～近半数的垂体瘤患者通过影像学可能无法检测到瘤体～而他们最终仍需通过垂体手术治疗柯兴病。 岩下窦采样。此项检测并非必须～但在许多病例中～这是区别垂体或异位原因所导致的柯兴综合症之最佳方法。血样从岩下窦被引采出,岩下窦是自脑垂体流出的静脉血管,。岩下窦采样是通过自大腿上部或腿间的静脉血管中插入极小的真空管来实现的。检测过程中需施以麻醉及轻微镇静剂～X射线则被用于确认真空管的正确位臵。刺激ACTH分泌的CRH激素～在检测中也被应用到以提高诊断的准确性。岩下窦的ACTH水平被检测后与前臂的ACTH水平相比较～岩下窦ACTH水平高则显示脑垂体瘤～水平相近则提示异位ACTH综合症。 *如何治疗柯兴综合症, 依据过量产生皮质醇的具体原因～治疗手段包括:手术～放射疗法～化学疗法～或皮质醇抑制药物。如果是由于长期服用人工激素用以治疗其它疾病～医生会逐步减少剂量直至能控制原来疾病的最低需求量。一旦柯兴病的症状被控制～人工激素的日用剂量可能加倍并隔天服用用以减少其副作用。在一些病例中～可处方非皮质醇类药物用以替代原先的人工激素。 #脑垂体瘤 ACTH垂体瘤所引起的柯兴病可选多种疗法～其中应用最广泛的是外科手术摘除肿瘤～即经蝶窦腺瘤切除手术。通过专用显微镜及先进仪器～外科医生经鼻孔或上嘴唇做切口进入脑垂体。由于此项手术及其精微～病人常被转至专门从事此类手术的专科中心治疗。在大量已完成的外科手术病例中～有超过80%的治愈率。如果手术失败或仅产生了临时疗效～此项手术可以重复～并往往也能有好的效果。 0.5 from the Met-60 0.25-2 40-9,000 1-20 wide bus 6,000-50 10-15 3,000 short car 20-2 traffic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 10-n. Comparison of urban passenger traffic characteristics table 5.1so o is a rail transport and other modes of urban passenger transport capacity, transportation speed and resource consumption, and supply and demand of the growing metropolis, cities, effective means to meet the needs of urban traffic. The following tableh efficiency, become an indispensable part of urban traffic structure, is the contradiction between urban traffic structure in the urban public transport system, rail traffic with a fast, large capacity, low pollution and higperson with a better option than conventional public transit; Block highwaythe tracks at the station transfer mode in order to alleviate traffic congestion; For those who will not or cannot drive the onto s travel has increased by 12%. Objectives of the Washington Metro system boils down to the following three points: by drivinget annual passenger volume reached 223 million people. According to statistics, from 2000 to 2009 vehicle trip down 12.7%, bubusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, n-s secondrea of 177km2, and a population of 600,000, is a United States political center. For the Washington Metro system United StateDC, a h enormous traffic demand on the route to ease traffic pressure, rail transportation has incomparable advantages. Washington,s undoubtedly an effective means to solve the problem of traffic congestion in cities. Especially in urban population strengtconsumption and environmental pollution, rail transport i60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource -distance line 3 More than 0,000 40-30,000 in long-ro light rail of 10,0006 在垂体瘤治疗手术后～ACTH的产量会比正常值下降两成。这种下降是正常且临时的～病人会被补充人工合成的皮质醇例如氢化可的松或强的松。大多数人可在1-2年中停止这种替代疗法～但有些人则须持续终身。 如果经蝶窦手术失败或病人不适于外科手术～放射疗法则是另一种选择。放疗6周为一疗程～对40%-50%的成人及85%的儿童病例有改善疗效。另一种被称为立体定位放疗手术或伽马刀技术～是一种单次的大剂量放射线治疗手段～它可能要在治疗的几个月后或几年后才会显现疗效。此外～把放射疗法与皮质醇抑制药物相结合可以帮助产生疗效的速度。 单独或结合应用于治疗皮质醇增多的药物有:酮康唑、米托坦、氨鲁米特和美替拉酮。每一种药物都有其自身的副作用～因而医生会根据不同的病人开具处方。 #异位ACTH综合症 要治疗异位ACTH症状引起的皮质醇增多～所有会分泌ACTH的癌组织可能都必须被排除。对癌症的治疗:外科手术、放射疗法、化学疗法、免疫疗法～或将这些疗法相结合～这要依据癌症的类型以及它的扩散程度。由于分泌ACTH的肿瘤可能很小并广泛分布～导致其很难被定位及直接治疗～因此皮质醇抑制药物是治疗的重要手段。在一些病例中～如果其它治疗方法都失败了～用外科手术切除肾上腺,即双侧肾上腺切除手术,可用来替代药物疗法。 #肾上腺瘤 外科手术是肾上腺良性肿瘤及恶性肿瘤的唯一治疗手段。先天性的心脏肿瘤会导致内分泌过度活跃及柯兴综合症～需手术切除肾上腺。 *需要记住的要点 0.5 from the Metro light rail of 10,000-60 0.25-2 40-9,000 1-20 wide bus 6,000-50 10-15 3,000 short car 20-fic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 102 traf-y, transportation speed and resource consumption, and so on. Comparison of urban passenger traffic characteristics table 5.1eet the needs of urban traffic. The following table is a rail transport and other modes of urban passenger transport capacitto m of urban traffic structure, is the contradiction between supply and demand of the growing metropolis, cities, effective means c transport system, rail traffic with a fast, large capacity, low pollution and high efficiency, become an indispensable parturban traffic structure in the urban publihwaygestion; For those who will not or cannot drive the person with a better option than conventional public transit; Block higic conboils down to the following three points: by driving onto the tracks at the station transfer mode in order to alleviate traffstics, from 2000 to 2009 vehicle trip down 12.7%, bus travel has increased by 12%. Objectives of the Washington Metro system annual passenger volume reached 223 million people. According to statibusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, net -center. For the Washington Metro system United States secondtical nsportation has incomparable advantages. Washington, DC, area of 177km2, and a population of 600,000, is a United States polion in cities. Especially in urban population strength enormous traffic demand on the route to ease traffic pressure, rail tragesticonsumption and environmental pollution, rail transport is undoubtedly an effective means to solve the problem of traffic con60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource -distance line 3 More than 0,000 40-30,000 in long-7 #柯兴综合症是由于身体组织长期处于高水平的皮质醇水平下所引起的紊乱。 #典型柯兴综合症的标志与症状包括:上半身肥胖、满月脸、皮肤易损伤且难以愈合、骨质脆弱、毛发过度生长～女性月经不规律以及男性性欲下降。 #引起柯兴综合症的原因有:服用用于治疗炎症的人工皮质激素～或由于自身产生过量的皮质醇～大多是由脑垂体、肾上腺或肺部肿瘤引起的。 #确诊柯兴综合症通常需要多项检测～包括:尿液、血液和唾液的检测。其它检测则能帮助找到发病的原因。 #基于皮质醇过量分泌的具体原因～治疗手段包括:外科手术、放射疗法、化学疗法～或服用皮质醇抑制药物。 *研究展望 美国国家健康研究所,NIH,下属多个组成机构已带领并致力于柯兴综合症及其他内分泌系统紊乱的研究～其中包括:国家糖尿病、消化道病及肾病研究组织,国家儿童健康及人类发展组织,NICHD,,国家神经紊乱及安抚科研组织,国家癌症科研组织,以及国家策略研究中心。 NIH资助的科学家们正致力于对主要的内分泌腺正常及非正常的运作～内分泌系统分泌的多种激素进行深入地研究。专家们将持续研究皮质醇的作用影响～包括对脑部结构及其运作的影响。为了精简诊断过程～研究也正着手对现行的筛查测试的准确性进行评估～以及对新用于异位ACTH病患的显像技术其有效性进行评估。专家们还在研究颈静脉的真空管采样技术～相对于岩下窦采样具较小的侵入性伤害。针对治疗方法的研究则包括:对由异位ACTH分泌引起的柯兴综合症其症状的治疗药物。 0.5 from the Met-60 0.25-2 40-9,000 1-20 wide bus 6,000-50 10-15 3,000 short car 20-2 traffic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 10-n. Comparison of urban passenger traffic characteristics table 5.1so o is a rail transport and other modes of urban passenger transport capacity, transportation speed and resource consumption, and supply and demand of the growing metropolis, cities, effective means to meet the needs of urban traffic. The following tableh efficiency, become an indispensable part of urban traffic structure, is the contradiction between urban traffic structure in the urban public transport system, rail traffic with a fast, large capacity, low pollution and higperson with a better option than conventional public transit; Block highwaythe tracks at the station transfer mode in order to alleviate traffic congestion; For those who will not or cannot drive the onto s travel has increased by 12%. Objectives of the Washington Metro system boils down to the following three points: by drivinget annual passenger volume reached 223 million people. According to statistics, from 2000 to 2009 vehicle trip down 12.7%, bubusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, n-s secondrea of 177km2, and a population of 600,000, is a United States political center. For the Washington Metro system United StateDC, a h enormous traffic demand on the route to ease traffic pressure, rail transportation has incomparable advantages. Washington,s undoubtedly an effective means to solve the problem of traffic congestion in cities. Especially in urban population strengtconsumption and environmental pollution, rail transport i60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource -distance line 3 More than 0,000 40-30,000 in long-ro light rail of 10,0008 研究正着力于获知良性内分泌肿瘤的形成原因～例如那些导致了大多柯兴病的肿瘤。在许多垂体瘤病例中～已证实存在特殊基因缺陷～这也许能对获知肿瘤的成因提供重要的线索。此外～内分泌因素也可能在此间发挥作用。越来越多的证据显示～肿瘤的成因是一个渐进多的进程。对柯兴综合症的基础研究将会研发新的治疗方法。 NIH所支持的与柯兴综合症相关的研究医疗中心遍及全美国。专家们也会在Bethesda, MD (贝塞斯达:美国马里兰州中西部城市～是华盛顿特区的居住郊区～是美国国家健康研究所所在地)的美国国家健康研究所临床中心治疗柯兴综合症病人。有兴趣请教成人病例的医生～可以联络Lynnette Nieman, M.D., at NICHD, 10 Center Drive, Room 1-3140, Bethesda MD 20892-1109。有兴趣请教幼儿或青少年病例的～可联络Constantine Stratakis, M.D., D.Sc., at NICHD, 10 Center Drive, Room 1-3330, Bethesda MD 20892-1103。. -20 wide bus 6,000-50 10-15 3,000 short car 20-fic volume (human/h) transport speed (km/people) Road area occupied (M2/people) scope bike 2,000 102 traf-y, transportation speed and resource consumption, and so on. Comparison of urban passenger traffic characteristics table 5.1eet the needs of urban traffic. The following table is a rail transport and other modes of urban passenger transport capacitto m of urban traffic structure, is the contradiction between supply and demand of the growing metropolis, cities, effective means c transport system, rail traffic with a fast, large capacity, low pollution and high efficiency, become an indispensable parturban traffic structure in the urban publihwaygestion; For those who will not or cannot drive the person with a better option than conventional public transit; Block higic conboils down to the following three points: by driving onto the tracks at the station transfer mode in order to alleviate traffstics, from 2000 to 2009 vehicle trip down 12.7%, bus travel has increased by 12%. Objectives of the Washington Metro system annual passenger volume reached 223 million people. According to statibusiest subway, second only to the New York subway, opened in 1976. Current rail sizes for 5, station 86, total 171.6km, net -center. For the Washington Metro system United States secondtical nsportation has incomparable advantages. Washington, DC, area of 177km2, and a population of 600,000, is a United States polion in cities. Especially in urban population strength enormous traffic demand on the route to ease traffic pressure, rail tragesticonsumption and environmental pollution, rail transport is undoubtedly an effective means to solve the problem of traffic con60 do not occupy an area both in terms of transport over long distances, transport efficiency, or from the level of resource -distance line 3 More than 0,000 40-30,000 in long-0.5 from the Metro light rail of 10,000-60 0.25-2 40-9,000 19