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Síndrome de Cushing

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  • Обзор
  • Теория
  • Диагноз
  • Лечение
  • Последующее наблюдение
  • Источники
Последний просмотренный: 13 Apr 2026
Last updated: 20 Mar 2026

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • presencia de factores de riesgo
  • plétora facial
  • plenitud supraclavicular
  • estrías violáceas
  • ausencia de embarazo
  • irregularidades menstruales
  • ausencia de desnutrición
  • ausencia de alcoholismo
  • ausencia de estrés fisiológico
  • desaceleración del crecimiento lineal en niños
Полная информация

Другие диагностические факторы

  • sexo femenino
  • hipertensión
  • intolerancia a la glucosa o diabetes mellitus
  • osteoporosis prematura o fracturas inexplicables
  • aumento de peso y obesidad central
  • acné
  • síntomas psiquiátricos
  • libido disminuida
  • tendencia a la formación de hematomas
  • debilidad
  • redondez facial
  • almohadillas de grasa dorsocervicales
  • nefrolitiasis inexplicable
  • evento venotrombólico
  • virilización
Полная информация

Факторы риска

  • uso exógeno de corticosteroides
  • adenoma hipofisario
  • adenoma suprarrenal
  • carcinoma suprarrenal
  • tumores neuroendocrinos
  • carcinoma torácico o broncogénico
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • prueba de embarazo en orina
  • glucosa sérica
  • cortisol salival nocturno
  • prueba de supresión con dexametasona de 1 mg durante la noche
  • cortisol libre urinario de 24 horas
  • prueba de supresión con dexametasona de 2 mg (baja dosis) durante 48 horas
Полная информация

Исследования, проведение которых нужно рассмотреть

  • cortisol sérico matutino y la hormona adrenocorticotropa (ACTH)
  • nivel plasmático de sulfato de deshidroepiandrosterona (DHEAS)
  • resonancia magnética (IRM) hipofisaria
  • estudios por imágenes suprarrenales
  • prueba de supresión con dexametasona a dosis alta
  • cateterismo de senos petrosos inferiores (CSPI)
  • tomografía computarizada (TC) de tórax, abdomen y pelvis
  • Resonancia magnética de tórax, abdomen y pelvis
  • tomografía por emisión de positrones con fluorodesoxiglucosa (FDG-PET) o FDG-PET/TC
  • exploración con octreotida
  • TEP/TC de galio-68 DOTATATE
Полная информация

Алгоритм лечения

ПРОДОЛЖЕНИЕ

Enfermedad de Cushing (adenoma hipofisario secretor de hormona adrenocorticotropa [ACTH])

síndrome de hormona adrenocorticotrópica (ACTH) u hormona liberadora de corticotropina (CRH) ectópicas

independiente de la hormona adrenocorticotrópica (ACTH) provocado por carcinoma o adenoma suprarrenal unilateral

independiente de la hormona adrenocorticotrópica (ACTH) provocado por enfermedad suprarrenal bilateral (hiperplasia o adenoma)

secreción autónoma leve de cortisol (anteriormente conocida como síndrome de Cushing subclínico)

Составители

Авторы

Maria Fleseriu, MD, FACE

Professor of Medicine (Endocrinology) and Neurological Surgery

Director

Pituitary Center

Oregon Health & Science University

Portland

OR

Раскрытие информации

MF is on the Endocrine Society's Board of Directors. She holds a research grant to the university for clinical studies as principal investigator for Crinetics and Sparrow Pharmaceuticals, and is an occasional scientific consultant for Crinetics, Recordati, Sparrow Pharmaceuticals, and Xeris Pharmaceuticals. MF is an author of several references cited in this topic.

Выражение благодарностей

Dr Maria Fleseriu would like to gratefully acknowledge Dr Ty Carroll and Dr James Findling, contributors to a previous version of this topic.

Раскрытие информации

TC is an author of a number of references cited in this topic. He is an investigator in clinical trials sponsored by Corcept. JF is an author of a number of references cited in this topic. He is a consultant for, and investigator in, clinical trials sponsored by Corcept and Novartis.

Рецензенты

Paul M. Stewart, FRCP FMedSci

Professor of Medicine

Director of Research

College of Medical and Dental Sciences

University of Birmingham

Honorary Consultant Physician

Queen Elizabeth Hospital

Birmingham

UK

Раскрытие информации

PMS declares that he has no competing interests.

Antoine Tabarin, MD

Head

Department of Endocrinology

University Hospital of Bordeaux

Pessac

France

Раскрытие информации

AT declares that he has no competing interests.

Liliana Contrersas, MD

Chief

Endocrine Research Department

Instituto de Investigaciones Médicas A. Lanari

University of Buenos Aires and IDIM-CONICET

Buenos Aires

Argentina

Раскрытие информации

LC declares that she has no competing interests.

Philip R. Orlander, MD

Professor of Medicine

Director

Division of Endocrinology, Diabetes & Metabolism

University of Texas Medical School

Houston

TX

Раскрытие информации

PRO declares that he has no competing interests.

Mouhammed Amir Habra, MD, FACP, FACE

Assistant Professor

Department of Endocrine Neoplasia and Hormonal Disorders

Division of Internal Medicine

University of Texas MD Anderson Cancer Center

Houston

TX

Раскрытие информации

MAH declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Fleseriu M, Auchus R, Bancos I, et al. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol. 2021 Dec;9(12):847-75.Полный текст  Аннотация

Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Aug;100(8):2807-31.Полный текст  Аннотация

Feelders RA, Newell-Price J, Pivonello R, et al. Advances in the medical treatment of Cushing's syndrome. Lancet Diabetes Endocrinol. 2019 Apr;7(4):300-12. Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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