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Management of acute hypercortisolism

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Abstract

An occasional patient with Cushing's syndrome may require urgent management primarily because the chronic ravages of hypercortisolism have caused the patient to be in a precarious metabolic condition. The side effects of prolonged excess corticosteroids increase the risk of operations in such patients and must be considered in overall management. Among the many effects of hypercortisolism to be considered are hypertension, diabetes, ocular hypertension, myopathies, dermatologic changes including skin infection, pancreatitis, osteoporosis, pathological fractures, peptic ulcers, renal calculi, coagulopathies, hypokalemia, poor wound healing, and increased susceptibility to infection. The most effective way to avert these complications is by earlier diagnosis and definitive treatment of Cushing's syndrome. The present report includes a review of the etiology and diagnosis of Cushing's syndrome and the management of problems associated with hypercortisolism.

Résumé

Il est possible qu'un malade atteint de maladie de Cushing ait besoin d'être traité sans attente en raisons de troubles métaboliques sévères dus aux effets nocifs de l'hypercortisolisme chronique qui augmentent les risques opératoires et doivent être pris en considération avant tout traitement. Il en est ainsi de l'hypertension, du diabète, de l'hypertension intra-oculaire, des lésions dermiques comprenant l'infection cutanée, la pancréatite, l'ostéoporose, les fractures pathologiques, l'ulcère peptique, les calculs rénaux, les coagulopathies, l'hypokaliémie, la lenteur du processus de cicatrisation et l'augmentation de la suceptibilité à l'infection.

Le meilleur moyen d'éviter ces complications est de porter sans retard le diagnostic de maladic de Cushing et de la traiter radicalement dès que le diagnostic est posé.

Le présent rapport comporte une revue de l'étiologie et du diagnostic de la maladie de Cushing ainsi que du traitement des problèmes qui sont associés à l'hypercortisolisme.

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Authors and Affiliations

  1. Department of Surgery, Section of General Surgery, Division of Endocrine Surgery, The University of Michigan Hospitals, Ann Arbor, Michigan, USA

    Norman W. Thompson M.D. & Maria D. Allo M.D.

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  1. Norman W. Thompson M.D.
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  2. Maria D. Allo M.D.
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Thompson, N.W., Allo, M.D. Management of acute hypercortisolism. World J. Surg. 6, 748–756 (1982). https://doi.org/10.1007/BF01655367

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