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Difference Between Addison Disease and Cushing Syndrome

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关键区别 - 艾迪生疾病与库欣综合症

艾迪生病和库欣综合症都是endocrinedisorders. The key difference between Addison disease and Cushing syndrome is thatthere is a hormonal insufficiency ofcortisol和aldosteronein Addison disease whereas there is an excess of cortisol in Cushing syndrome.重要的是要了解艾迪生疾病和库欣综合症之间的区别，以便诊断和治疗它们。

内容

1.Overview and Key Difference
2.What is Cushing Syndrome
3.What is Addison Disease
4.艾迪生病和库欣综合症之间的相似之处
5.Side by Side Comparison – Addison Disease vs Cushing Syndrome in Tabular Form
6.Summary

What is Cushing Syndrome?

A set of clinical features that appear consistently together because of the excessive stimulation of the glucocorticoid receptors is called the Cushing syndrome.

Causes

  • Iatrogenic causes such as the long term administration of glucocorticoids
  • Pituitaryadenomas- 当临床特征是由于垂体腺瘤引起的，疾病被称为库欣疾病
  • 恶性肿瘤，例如支气管癌，肾上腺癌和小细胞肺癌
  • Adrenal adenomas
  • ACTH independent macronodular增生
  • 酒精过量
  • Depressive ailments
  • 基本的肥胖

Clinical Features

The presence of few related clinical symptoms, however, is not a conclusive enough evidence to make a diagnosis of Cushing syndrome. There can be alterations in the glucocorticoid level of the body because of other illnesses such as obesity anddepression。因此，应通过进一步研究来确认库欣综合征的任何临床怀疑。患者的药物病史对于排除任何医源性原因非常重要。如果库欣综合症是由于恶性肿瘤引起的，则临床特征的外观通常会迅速发生，并且存在同存的恶病质。

调查

Because of the limitations in the specificity and the sensitivity of the techniques, several test results are combined together when arriving at a diagnosis in order to increase the accuracy of the process. The investigations aim at,

  • 确定患者是否患有库欣综合症
  • Identifying the underlying pathology

建立库欣综合症的存在

如果下面提到的三个测试中的两项给出了阳性结果，则证实了库欣综合征的存在。

  • Increase in the 24-hour urine free cortisol level
  • Inability to suppress the serum cortisol level by the administration of oral dexamethasone
  • Change in the circadian rhythm of cortisol secretion

Determining the Underlying Pathology

ACTH level is measured for the purpose of establishing the underlying pathology. If the level is undetectably low, this points towards an adrenal cause. On the other hand, abnormally high levels of ACTH suggest a pituitary cause.

可以进行MRI和CT扫描以识别任何tumorsin the brain to cement the diagnosis.

Management

In the management of the Cushing syndrome, priority is given to the surgical interventions. Various drugs are administered to keep the cortisol level at bay until the surgery is done. The management varies depending on the underlying pathology.

Cushing Disease

  • 跨性蝶手术
  • 腹腔镜双侧肾上腺切除术

肾上腺肿瘤

  • Laparoscopic adrenal surgery
  • Radiotherapy

What is Addison Disease?

The adrenocortical insufficiency occurring as a result of the destruction or dysfunction of the adrenal cortex is called the Addison disease. By the time the clinical features appear, about 90% of both adrenal cortices have been destroyed.

Causes

Clinical Features

Since the entire adrenal cortex is affected, the production of both cortisols and aldosterone is drastically reduced. This hormonal imbalance gives rise to a variety of clinical manifestations.

Symptoms due to Cortisol Deficiency

  • 嗜睡和软弱

The reduction in the cortisol levels increases the insulin sensitivity of the body tissues, resulting in低血糖。Glycogen stored in the liver is used to compensate this hypoglycemic state, and with their depletion, the compensatory mechanism also fails, making the patient weak and lethargic.

  • Immune suppression
  • 肌肉无力
  • 易怒
  • Mood changes
  • Hypotension
  • Weight loss

Symptoms due to Aldosterone Deficiency

  • 心律不齐- 由于导致的低钠血症和高钾血症
  • CNS干扰
  • Nausea
  • 腹泻
  • 呕吐
  • Metabolic acidosis
  • 血容量低
  • Hypotension

Addison疾病的另一个独特的临床特征是由于ACTH水平升高，具有MSH类似于活动的活性。

关键区别 - 艾迪生疾病与库欣综合症

图02：糖皮质激素的生理负反馈回路

Adrenal Crisis

肾上腺危机是医疗紧急情况，患者患有发烧，呕吐，腹泻和血压显着降低。如果没有立即治疗，患者可能会死于低血容量休克。即使在没有肾上腺疾病史的个体中，这种情况也可能发生。肾上腺危机的最常见原因是双侧肾上腺出血，在新生儿和服用抗凝药（如华法林）的成年人中经常出现。该疾病用糖皮质激素和盐水处理。

Treatment

The Addison disease is treated by the administration of synthetic hormones to restore the normal levels of aldosterone and cortisol.

What are the Similarities Between Addison Disease and Cushing Syndrome?

  • 两种情况下由于结构或functional changes in the adrenal gland.

What is the Difference Between Addison Disease and Cushing Syndrome?

艾迪生病与库欣综合症
艾迪生病是由于肾上腺皮质的破坏或功能障碍而导致的肾上腺皮质不足。 库欣综合征是一组临床特征，由于糖皮质激素受体的过度激活而始终如一地出现。
Cortisol and Aldosterone Levels
In Addison disease, both cortisol and aldosterone levels are affected. 在库欣综合征中，仅皮质醇水平受到影响。
Effect on Cortisol Level
艾迪生疾病中皮质醇水平降低。 库欣综合征的特征是皮质醇水平的升高。
Symptoms
Hypotension and hypoglycemia are clinical features of this endocrine disorder. 在库欣综合征、高血压和hyperglycemia are observed as symptoms.

摘要 - 艾迪生病与库欣综合症

这些内分泌疾病的早期诊断很重要，因为它们可能是严重潜在原因（例如恶性肿瘤）的表现。艾迪生疾病和库欣综合征之间的主要区别在于，艾迪生疾病的特征是皮质醇和醛固酮的激素不足，而库欣综合征的特征是皮质醇过量。在开处方抗炎皮质类固醇时，应跟踪患者，以防止出现不必要和可避免的并发症，例如库欣综合症。

Download PDF Version of Addison Disease vs Cushing Syndrome

You can download PDF version of this article and use it for offline purposes as per citation notes. Please download PDF version here艾迪生疾病和库欣综合症之间的差异。

参考：

1. Hayes，P。C.，K。J. Sympson和O. J. Garden。“戴维森的医学原理和实践。”（2002）。

Image Courtesy:

1.MikaelHäggström的“库欣综合症” - 自己的作品（CC0）Commons Wikimedia
2. Drosenbach的“ ACTH负面反馈” -(CC BY 3.0)viaCommons Wikimedia

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