Wednesday, June 9, 2010

Cushing's Syndrome

DEFINITIONS
In Cushing's syndrome, excessive levels of corticosteroids, usually from excessive production in the adrenal gland.

    * Cushing's syndrome is usually caused by tumors that cause the adrenal glands produce excessive corticosteroid.
    * People with Cushing's syndrome usually results in excessive fat through the torso and has a great face shape.
    * Doctor measure cortisol levels to recognize the Cushing syndrome.
    * Surgery or radiation therapy is often required to remove a tumor.

Adrenal glands can produce excessive kortikosteropid caused problems in the adrenal glands or resulting from too much stimulation from the pituitary gland. Abnormalities in the pituitary gland, such as a tumor, can cause the pituitary to produce large amounts of corticotropin, a hormone that controls the production of corticosteroids from the adrenal glands.

Tumors outside the pituitary gland, such as small cell cancer of lung, may produce corticotropin well (a condition called ectopic corticotropin syndrome). Corticotropin can also be produced by a tumor called a carcinoid, which can occur in almost all parts of the body.

CAUSE
Sometimes tumors are not cancerous (adenomas) occurred in the adrenal glands, which causes the adrenal glands produce excessive corticosteroid. Adrenal adenomas are very common. Half of people experience it at the age of 70. Only a small part in adenomas produce excessive hormones, although such tumors are not cancerous adrenal gland is very rare.

Cushing's syndrome also can occur in people who must use high-dose corticosteroids because of serious medical conditions. They should mengggunakan high doses have the same symptoms with those who produce too much hormone. Symptoms can sometimes occur even if the inhaled corticosteroids, such as for asthma, or used in particular to a skin condition.


SYMPTOMS
Corticosteroids changing the number and distributed to body fat. Body fat is formed through the torso and once on the back of a real possibility. A person with Cushing's syndrome usually have a large face, (front month). Hands and feet are usually lean on the part of a thickened stem. Muscles lose strength and become weak. The skin becomes thin, easily bruised, heal less well when bruises or wounds. Layer of purple that looks like a sign of wrinkles can be formed above the stomach. People with Cushing's syndrome tend to get tired easily.

High corticosteroid levels each time to increase blood pressure, weakened bones (osteoporosis), and reduce perlawana to infection. Risk of renal stone formation and diabetes increases, and mental disorders, including depression and hallucinations, can occur. Women usually have irregular menstrual cycles. Children with Cushing's syndrome grow slowly and remain pandek. In some people, the adrenal glands also produce large amounts of androgens (testosterone and similar hormones), causing an increase in the face and body hair and baldness in women.

DIAGNOSIS
When doctors suspect Cushing's syndrome, they measured levels of cortisol, the major corticosteroid hormones, the blood. Normally, high cortisol levels in the morning and lower at night. In people who have Cushing's syndrome, cortisol levels is very high every day.

If high cortisol levels, your doctor may recommend dexamethasone suppression test. Dexamethasone suppress the pituitary gland and should lead to pressure on the expenditure of cortisol by the adrenal glands. If Cushing syndrome is caused by too much stimulation of the pituitary, cortisol levels will fall to some expansion, although not as much on people who do not have Cushing's syndrome. If you have other causes of Cushing's syndrome, cortisol levels will remain high. High levels of corticotropin further cause excessive stimulation of the adrenal glands.

Possibility of imaging tests needed to confirm the exact cause, including a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the pituitary or adrenal glands and a chest X-ray or CT scan of the lungs. Even so, these tests can sometimes fail to find tumors. When overproduction of corticotropin stated as the cause, the possibility of blood samples taken from vessels that drain the pituitary to see if this is the source.


TREATMENT
Treatment depends on whether the problems in the adrenal gland, pituitary gland, or other areas. The possibility of surgery or radiation therapy is required to lift or destroy the pituitary tumor. Tumors of the adrenal glands (usually adenomas) can often be removed by surgery. The two adrenal glands can be removed if treatment is not effective or if there is no tumor.

People who both adrenaline glands removed, and many people have a part in the adrenaline glands removed, must be using corticosteroids for a living. Tumors outside the pituitary and adrenal glands that secrete excessive hormones are usually removed by surgery. Certain drugs, such as metyrapone or ketoconazole, can reduce levels of cortisol and can be used while awaiting more definitive treatment such as surgery.

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Nasopharyngeal cancer: Recognize, Avoid And Treat!

Is contained in the nasopharing cancer, was among back of the nose and esophagus. Cancer is a malignant tumor of head and neck regions were mostly found in Indonesia. Nearly 60% of head and neck malignant tumor is cancerous nasopharing, followed by malignant tumors nose and paranasal sinuses (18%), larynx (16%), and malignant oral cavity tumors, tonsils, hipofaring in low percentage. In many cases, nasopharing carsinoma numerous in the Mongoloid race countries, especially South China. But did not rule out there in other countries, such as in Greece, Northern Africa like Algeria and Tunisia, Eskimos. In Indonesia, this cancer more attacking China, compared to other ethnic descent. This cancer is more prevalent in men than in women.

What are the signs and symptoms of nasopharyngeal cancer is this?
Nasopharing cancer symptoms can be divided into four groups, namely:
• Symptoms nasopharing itself, in the form of a mild nosebleed (blood out through the nose) or nasal obstruction. This happens if the cancer is still early.

• Symptoms of ear, is an early symptom that arises because the places of origin near the mouth of the fallopian Eustachius tumors (junctions in nose-ear). Symptoms such as ear ringing or buzzing, discomfort in the ear, until the pain.

• Symptoms of the eyes and nerves, can occur as symptoms go because nasopharing closely associated with the passage of the skull cavity of the brain's neurons. Symptoms may include headache, pain in the neck and face (trigeminal neuralgia), blurred vision, vision of two (diplopia).

• Symptoms of metastasis / spread or symptoms in the neck. The form of swelling in the neck due to swollen lymph nodes

What causes this cancer?
In general, cancer is caused by the growth of cancer cells that are not controlled. Cancer can also arise due to heredity (genetic), environmental, and also viruses. Nasopharing cancer due to the growth of cancer cells that are not controlled in part nasopharing. However, in many cases, due carsinoma nasopharing heredity (genetic).

The causes of cancer risk factors nasopharing, among others:
1. Eating salty foods
In many cases in China, nasopharing carsinoma caused from eating salted fish. Also of particular spices and eat food too hot.

2. Virus
Some viruses causing signs and symptoms such as fever. Some viruses have the possibility of cancer nasopharing. EBV-Virus usually causes cancer.

3. Offspring
In families with a history of cancer-especially cancer-nasophariing big nasopharing likely to get cancer than those not having a family history of cancer.

There are more factors that increase the incidence of cancer, such as smoking and consuming alcohol. Both of these possible risk of cancer.

How to make sure sata affected?
As in most cases, your doctor will ask you some questions about the signs and symptoms. After that doctors will start to hit parts of your neck where there is a swollen lymph node. Some of the signs and symptoms of this cancer is not very specific. This examination will probably take several months.

If cancer is suspected, doctors will begin using an endoscope to view the abnormal nasopharing. In its use of local anesthesia is needed. After that, taken biopsy (sample) which was then tested whether the cancer.

Then the doctor will determine the cancer stage manner:
-MRI (help see the cancer that spread around the head)
-CT scan (see the cancer spread to the bone)
-Taking biopsy: This is used to see cancer in lymph nodes.
X-rays (see cancer that spread in the lungs)

The levels of this cancer are:

1. Stage 0: Cancer cells are still in nasopharing limit, usually called the nasopharynx in situ
2. Stage 1: Cancer cells spread in part nasopharing
3. Stage 2: Cancer cells have spread to more than nasopharing into the nasal cavity. Or can also be spread in lymph nodes on one side of the neck.
4. Stage 3: The cancer had invaded the lymph nodes on all sides of the neck
5th. Stage 4: This cancer has spread and bone around the facial nerve.
From these levels of doctor can determine the appropriate type of treatment for sufferers.

How to treat?
Several kinds of treatment for patients nasopharing carsinoma, among others:
1. Radiation Therapy
This therapy can rapidly destroy cancer cells that grow. This therapy is carried out for 5-7 weeks. This therapy is used for cancer at the early levels.
Side effects of this therapy are: dry mouth, loss of hearing and this therapy increase the risk of cancer of the tongue and bone cancer.

2. Chemotherapy
Is a therapy using the help of medication. This therapy works by reducing the cancer cells are there, but sometimes healthy cells (not cancer) were also reduced.
Side effects of this therapy are: hair loss, nausea, weakness (such as loss of energy). Side effects that may arise depending on the type of drug administered.

3. Surgery
The goal of surgery is to take the lymph nodes that had cancer. (Fernando Gazali)

Bibliography
Soepardi, Efiaty Arsyad dkk. Buku Ajar Ilmu Kedokteran Telinga Hidung Tenggorok Kepala & Leher. Edisi keenam. Jakarta: 2007, FKUI.
www.emedicine.com/radio/topic551.htm
www.mayoclinic.com/health/nasopharyngeal-carcinoma
www.utmb.edu/otoref/Grnds/Nasophar-CA-980121/Nasophar-CA-980121.htm
READ MORE - Nasopharyngeal cancer: Recognize, Avoid And Treat!