adrenocortical cancer课件

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1、ADRENOCORTICALCANCERIntroduce1per1.7millionpopulationlessthan0.02%ofallcancers0.2%ofallcancerdeaths79%ofadrenaltumorswerefunctionalNonfunctionaltumorsmaybecomefunctionalapeakincidenceatlessthan5yearsandasecondpeakinthefourthandfifthdecadesClinicalFeaturesHormonallyfunctionaltumorsar

2、eslightlymorecommoninwomennonfunctioningtumorsaremorefrequentinmenClinicalSyndromesProducedbyAdrenocorticalCancerandTheirFrequencySYNDROMEFREQUENCY(%)VirilizationandCushing'ssyndrome50Virilization25Cushing'ssyndrome20Feminization<5Precociouspuberty<5Hypokalemiaalkalosis<5Hypoglycemi

3、a<5Cushing'sSyndromeThecharacteristicendocrineabnormalityisanincreaseofplasma11-deoxycortisolanditsurinarymetaboliteparaneoplasticsyndromeassociatedwithectopicadrenocorticotropichormone(ACTH)productionbysolidtumorsVirilizationinassociationwithCushing'ssyndromealmostalwaysindicatesad

4、renalcancerVirilizationVirilizationiscausedbytestosteronetheexcessurinary17-KShelpsdistinguishadrenalcancerfromothervirilizingsyndromeshirsutism(多毛症)istheonlypresentingfeaturewithvirilizingtumorsFeminizationPlasmaandrostenedione（雄烯二酮）maybeconvertedperipherallytoestrogenFeminizationw

5、ithadrenalcancerisunusualThemajorfractionofandrostenedioneismetabolizedtourinary17-KS（17-酮类固醇）Feminizationmeasurementofurinary17-KSwilldistinguishthefeminizationcausedbyadrenalcarcinomafromthegynecomastiaseenwithhumanchorionicgonadotropin(hCG)-producingtumorsofthetestisandwithhCG-pr

6、oducingcancerPrecociousPuberty（性早熟）Inchildren,precociouspubertyorvirilizationmaybeanimportantandpresentingclinicalfindingbecauseandrogensarethepredominantproductsofadrenalcancersecretionIsosexualprecociouspubertyinboysandvirilizationingirlsareusualSodiumRetentionandHypokalemicAlkalo

7、sisRarelypatientswithadrenalcancerwillpresentwiththepictureofprimaryhyperaldosteronismurinary17-KSishigh,andthetumorisgenerallymuchlargerthantheAPA（aldosterone-producingadenoma）HypoglycemiaadrenalcancermaycausehypoglycemiaMeasurementofplasmainsulinlevelswillruleoutinsulin-secretingt

8、umorsasacauseofhypo