Adrenal Cushing Sendromunda Aitipik Hormon Reseptörlerinin Değerlendirilmesi ve Tanı Testlerinin İncelenmesi

Öz

Son zamanlarda yapılan çalışmalarla atipik hormon reseptörlerinin uyarılmasıyla oluşan adrenal Cushing sendromunun patofizyolojisi yeni anlaşılmaya başlansa da hala net değildir. Bu durum sıklıkla ACTH’dan bağımsız makronodüler adrenal hiperplazide ve daha nadir olarak tek taraflı adrenal adenomlarda karşılaşılan bir patolojidir. Zona fasikülatadaki hücrelerin membranında olan ektopik ve anormal hormon reseptörlerinin uyarılması sonucu oluşan aşırı kortizol salgısı adrenal Cushing sendromuna yol açar. Bu atipik reseptörler gastrik inhibitör peptid (GIP), β-adrenerjik agonistler, LH/hCG, vazopressin, serotonin (5HT4) reseptörlerini içermektedir. Ancak, bu reseptörlerin varlığının gösterilmesi oldukça karmaşık ve zahmetlidir. Bu hastalığın tedavisinde cerrahi dışında seçenekler de mevcuttur. Bu yüzden bu reseptörlerin varlığının tespit edilmesi özellikle bilateral adrenallerinde lezyonları olan hastalarda oldukça büyük önem arz etmektedir. Bu derlemede adrenal Cushing sendromuna yol açan bu reseptörlerin ve ayırıcı tanı testlerinin değerlendirilmesi amaçlanmıştır.

Anahtar Kelimeler

• Adrenal cushing sendromu, atipik hormonal reseptörler

Evaluation And Diagnosis Of Aberrant Hormone Receptors İn Adrenal Cushing’s Syndrome

Abstract

The pathophysiology of adrenal Cushing's syndrome generated by the stimulation of atypical hormone receptors is still unclear though it was started to be understood by the recent studies. This is a case of pathology encountered frequently in macronodular adrenal hyperplasia independent of ACTH and rarely in unilateral macronodular adenomas. The excessive secretion of cortisol, which is generated by the stimulation of ectopic and abnormal hormone receptors in membrane of Zona fasciculata cells, leads to adrenal Cushing's syndrome. These atypical receptors include the receptor of gastric inhibitory peptide (GIP), β-adrenergic agonists, LH / hCG, vasopressin, serotonin (5HT4). However, it is quite complex and cumbersome to indicate the presence of these receptors. There are non-surgical options in the treatment of this disease. Therefore, detecting the presence of these receptors is of very great importance particularly for the patients with bilateral lesions in his/her bilateral adrenal. This study aims to examine these receptors leading to adrenal Cushing's syndrome and differential diagnosis tests.

Keywords

• Adrenal Cushing's syndrome, aberrant hormone receptors

Kaynakça

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