たけうち動物病院 竹内和義 - sagami-central-amc.com

1 29 6 17 56 1 53 3 53 54 55 4 32 AAB 1999 3 1 2004 9 2 2006 9 2007 9 CAP 2005 3 2005 3 2005 5 2005 7 2005 9 2005 11 1999 (PDH) (AT) hyperadrenocorticism : HAC cushing syndrome cushing disease 1932 cushing Harvey Williams cushing .

2 1869-1939 (500 1 PDH) 85-90 ACTH ACTH AT 10-15 50% Iatrogenic cushing s SyndromeMiyado Nana PU/PD PU/PD ALKP Tc h o TG CBC TP(g/dl) (g/dl) (g/dl) (U/l)445 AST (U/l)42 ALKP (U/l)479 GGT (U/l)66 TBil (mg/dl) (mg/dl) 358TG(mg/dl) (U/l)2,033 Lipa (U/l)3,455 Glu(mg/dl)686 BUN (mg/dl) (mg/dl) (mmol/l)124K(mmol/l) (mmol/l) ( ALKP) ( (Tcho TG)Takada ChiChemistry CBCRBC(x106/ l) WBC(/ l)28,600 PCV(%) Band-N0 Hb(g/dl) Seg-N24,300 MCV(fl)79 Lym1400 MCHC(%) Mon2,700 Ret(%) <5 Bas0 Plat(104/ l) CBC 3,000-11,5001,000-4,800150-1,350100-1,250 Takada Chi15-406,000-17,000TP(g/dl) (5-8)Alb(g/dl) ( )Glob(g/dl) ALT(U/l)166 (<100)AST(U/l)28 (<80)ALKP(U/l) >3500 (<260)GGT(U/l)35 (<14)TBil(mg/dl))

3 (< )NH3 (mcg/dl) 17 (<100)TCho(mg/dl) >450 (<300)TG(mg/dl) 457 (<140)Glu(mg/dl)115 (75-128)BUN(mg/dl)34 5 (8-28)Cre(mg/dl) ( ) (mmol/l) 141 (140-160)K(mmol/l) ( )Cl(mmol/l) 105 (105-122)T4 (mcg/dl) 2008/01/15 WBC (x102/ l) 153 (60-170)RBC (x104/ l) 774 (550-850)Hb (g/dl) (12-18)PCV (%) 46 (37-55)MCV (fl) (60-80)T4 g/dl > < 20080116 Kitou Pearl Creat mg/dl mg/dl Creat mol/l mol/l UCCR= < 2-210 ACTH 20080117 g/dl 1H Post >50 g/dl 20080120 Pre g/dl 4H 8H 8 <50% PDH 20080115 BUN BUN BUN PU/PD 1/3 BUN ACTH

4 LDDS LDDS ACTH UCCR 3 , mg/dl g/L g/L) mg/dl) :CRX10-5 10-5 10-5 10-5 10-5 > 10-5 10-5 SI (nmol/l) mg/dl g/lUCCR ratio M 3 5 3 6 1 3 3 6 ACTH ACTH PDH AT 50-70 1 PDH AT ACTH preACTH ACTH IM,IV post1 6 800 5.

5 355 1391 ACTH ACTH (Cortrosyn) 5 /kg IV or IM (Max 250 g) 250 mcg IV gel ACTH mcg/kg IM 2 1 Dr Behrend s) PDH 80-85% AT 60% Post Pre Post Pre,Post,Post5,355 7 455 AT ACTH DEX LDDS) DEX DEX PDH 95% AT 100% ACTH 8 PDH AT 7,000 DEX LDDS 1. 2. IV 4hr8hr < < > > >50%> <50%or< > <50%or< > <50% Hac04hr8hrLDDST PDH AT DEX 2.

6 CT MR 3. ACTH 7,455 DEX 8 DEX HDDS PDH DEX FB ACTH AT ACTH DEX PDH 70% 50% PDH AT 100% HDDS DEX IV 4 8 50% PDH 4hr8hr < or <50%> or >50%PDH> or >50%< or <50%PDH< or <50%< or <50%PDH> or >50%> or >50% HSSD ACTH PDH AT PDH or AT 20-100 pg/ml ( pmol/l) PDH:40-500 pg/ml ( pmol/l) AT:<20 pg/ml (< pmol/l) ACTH EDTA 3. 5.

7 ACTH 4 C ACTH PDH > 40 pg/ml AT < 10 pg/ml PDH PDH AT 8cm 3cm 3cm (2) AT PDH PDH PDH 12-33mm 3-7mm 12 6 17 Snapshot DX SnapshotDX IDEXX Lab ACTH LDDST ACTH Lysodren ,o,p'-DDD) (35-40%)- - - (< 5 %) P.

8 25 mg/kg 1 2 7 ACTH 7 ACTH BUN ACTH mg/kg/day 5mg 50 mg/kg 2 ACTH 4 3-4 3-4 o,p -DDD (2) ACTH Post 1 - 3 /dl : 25mg/kg/week div 2-4 3 - 6 /dl : 50mg/kg/week div 2-6 60% (Kintzer&Peterson 1994) Trilostane 3 - - X 2011 1 ( ) 3500 1 117 4500 1 150 6000 1 200 1 1 200 SID HAC 1 1 10mg, 30mg, 60mg kg (mg)

9 SID mg/kg SID 10 10 30 10 20 60 20 40 120 40 60* 180 *60kg 10 14 ACTH ACTHST-post 4 post 4 Post-ACTH g/dL post 22 /dL post 22 /dL 2 4 4 10-25 ACTH ACTH ACTH ACTH 10-14 ACTH ACTH 1/2 EOD 10mg 1 1 SID 1 1 2 BID SID BID 1 1/3 1/2 2 1 30-50% BID SID 2 30 90 3 1.

10 2. 4-6 4. ACTH post ACTH Post g/dL ACTH post g/dL K Na HAC postACTH g/dl BID mg/kg BID 10-14 ACTH post 2-5 g/dl 15-30 post ACTH 3-6 4 HAC post 22 g/dl) HAC AT HAC 15-20 :incidentaloma 3 19 3 30 3 19 3 30 ElinaElinaElina20031 27 2 6 3 20 3 25 3 29 4 5 4 14 ACTH LoveLove ACTH 5 10 50 g/dl<22+ g/dl< + g/dl< + 6 17 4hr8hr < or <50%> or >50%PDH> or >50%< or <50%PD