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Medicina & Laboratorio

2013, Número 09-10

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Medicina & Laboratorio 2013; 19 (09-10)


Muestreo de senos petrosos inferiores en el diagnóstico de pacientes con síndrome de Cushing dependiente de hormona adrenocorticotrópica

Montoya EJF, Builes MCE, Gutiérrez RJ, Campuzano MG

Idioma: Español
Referencias bibliográficas: 124
Paginas: 411-450
Archivo PDF: 1907.51 Kb.


RESUMEN

El síndrome de Cushing endógeno es una de las enfermedades más difíciles de estudiar, dado que sus diferentes etiologías requieren una cuidadosa valoración diagnóstica desde el punto de vista clínico, bioquímico y radiológico. Con frecuencia, las características clínicas se solapan con las de enfermedades comunes y algunos pacientes tienen una presentación atípica. Una vez se establece la sospecha clínica, las pruebas bioquímicas de tamizaje permiten definir si existe un estado de hipercortisolismo endógeno; en caso afirmativo, el estudio prosigue con pruebas de laboratorio que ayudan a localizar la causa de la hipercortisolemia. En este punto es fundamental determinar si se trata de un síndrome de Cushing dependiente o no dependiente de hormona adrenocorticotrópica (ACTH) y en caso que sea dependiente, diferenciar entre origen hipofisario y un origen ectópico de la enfermedad. Dicha situación se puede resolver mediante el cateterismo y muestreo de los senos petrosos inferiores, el cual es un procedimiento invasivo y sensible para el diagnóstico diferencial entre el tumor hipofisario y el tumor ectópico secretor de ACTH. En este artículo se revisarán los aspectos generales del diagnóstico del síndrome de Cushing endógeno y luego se presenta una amplia descripción acerca del uso del muestreo venoso central en el subgrupo de pacientes con la forma dependiente de ACTH.


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