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CUSHING SYNDROME

Identifikasi fakta
Pria 35 tahun keluhan wajah bengkak sejak minum tablet hijau 6 tablet/hari selama 6 bulan u/ mengurangi nyeri sendi Nyeri timbul jika tidak minum obat BB naik 10 kg selama 6 bulan BB=70 kg; TB = 160 cm ; IMT = 27,4 Terdapat garis bekas guratan di paha dan perut

PF
KU : sakit sedang, compos mentis Tanda Vital
TD= 160/90 mmHg RR= 20 x/menit Nadi=80 x/menit Suhu=36,8 c

Wajah: tampak tebal Lengan: kedua lengan tampak urus dibanding tubuhnya Abdomen: membesar , tampak striae. Hepato/splenomegali= (-). Bising usus= N Edema pretibial

PP
GDS= 235 GDP= TGA= 210 HDL= 45 LDL= 150 Kolesterol total = 240 Albumin= 3 () Kortisol serum pagi= 45() Kortisol plasma= 15()

gluconeogenic enzymes : 1. phosphoenolpyruvate kinase 2. glucose-6-phosphatase, 3.fructose-2,6bisphosphatase

I konsumsi
KORIKOSTEROID JANGKA PANJANG

Suppression of the HPA axis may occur with doses of prednisone greater than 5 mg/d
who have received glucocorticoids equivalent to 1020 mg of prednisone per day for 3 weeks or more should be assumed to have clinically significant HPA axis suppression.

1.Increased contractility 2.Increased vascular reactivity to vasoconstrictors (catecholamines, angiotensin II)


GLUKONEOGENESIS glycogen synthesis blood glucose

KADAR KORTISOL MENINGKAT


HIPERKORTISOLISME Antiproliferative for fibroblasts and keratinocytes
MENGGANGGU KERJA INSULIN DI SEL PERIFER

Pemberhentian langsung

Steroid Withdrawal
Makanya di tapering off biar ga Steroid Withdrawal

1.decreased glucose uptake and metabolism 2.decreased protein synthesis, and increased release of amino acids

redistribution of body fat

Wajah

HIPERGLIKEMI (GDS=235mg/dL)

Easy bruisability due to dermal atrophy cos elastisitas kulit

Muscle wasting ekstrmitas terlihat megecil abdomen

moonface

striae
VISKOSITAS DARAH

Obes central TD (160/90 mmHg) Retensi Na

ekskresi kalium
Penampilan Cushingoid

udem

hipokalemi

embriologi
2 bulan janin = z.fetal & z.definitif 3 after melahirkan = z.fetal menghilang , z.definitif berdiferensiasi menjadi 3 zona yg kita kenal di korteks

anatomi
arterial supply from branches of the inferior phrenic artery, the renal arteries, and the aorta.

histo
Lebih dominan @z.glomerolusa

Tanamkan ini dalam pikiran kalian

mineralokortikoid
adrenocortical glukokotikoid

aldosteron

cortisol

Sintesis Steroid
Perangsangan ACTH DLM MERANGSANG CORTISOL

Synthesis and Binding to Plasma Proteins

There are three mechanisms of neuroendocrine control:


(1) episodic secretion and the circadian rhythm of ACTH, (2) stress responsiveness of the hypothalamicpituitary-adrenal (HPA) axis, and (3) feedback inhibition by cortisol of ACTH secretion.

(1) episodic secretion and the circadian rhythm of ACTH,

(2) stress responsiveness of the hypothalamic-pituitaryadrenal (HPA) axis

(3) feedback inhibition by cortisol of ACTH secretion.


This feedback inhibition occurs at both the pituitary and the hypothalamus

TRANSPORT CORTISOL
2: KORTISOL BEBAS & TERIKAT TERIKAT OLEH 3 : 1. Corticosteroid-Binding Globulin (CBG) 75% 2. Albumin 3. Androgen Binding

EFFECT OF CORTISOL

tambahin
Cara taapering off Hipernatremi & hipokalemi Beda cushing syndrome karena penggunaan steroid ..cushing disesase disebabkan adenoma Cara diagnosis cushing syndrome @ IPDBAB HIPERKORTISOL

Cara tepering off *based on dr.hadiyanti spPd


Misal dosis harian prednison 30 mg, nanti akan dilakukan
Dalam sehari pagi Dari dosis harian Minggu Minggu pertama kedua 15 mg 15 mg Minggu ketiga 10 mg Minggu keempat 5 mg

siang
malam

2/3
1/3

10 mg (dari 15)
5mg (dari 15)

10 mg
-

5 mg
-

Dimaintenence selama 6 minggu dengan dosis 5 10 mg

Daftar pustaka
Guyton Greenspand (*yg disuruh baca khatam ma dr.kekmana) Patofis yg di jual ABS (*ituloh yg diterangin depan kelas e-book nya sama zul) Patofis lange 2006

Thx to
Allah SWT Dr.devi as my fasil Klmpok 5(Adi yg mirip suneo, obin sang pengorbit artis dangdut, atingul yg jadi gaul, neneng yg sudah gu temukan kembarannya, dian f yg bawa spidol banyak banget*entah tuh spidol betak dimana, ayes yg suka nyengir ga jelas, kharis yg makin deket sama blue tiger, kijut yg kontroversi, seil yg jalannya aneh.) Semua dosen yg ada di temu pakar. Semua orang yg bikin pemicu ini