546
PŘEHLEDOVÉ42522001004388130181216258306358404446
ČLÁNKY88722001003973122176223272
Cushingův42533001003976105143158195234272308
syndrom:75033001002865103141165204264279
současný104633001002867105136171200238274
pohled133633001003776114130165204
40218722001004087123
|350220010018
VNITŘNÍ4268040010746106127172220280301
LÉKAŘSTVÍ748804001074185130188236280325378400
/11948040010731
Vnitř1270804001074693112140166
Lék.1456804001074083122140
2026;72(6):402-4111615804001074487129171186227271292334356371414460501527573611645
/23058040010732
www.casopisvnitrnilekarstvi.cz442680400107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
https://doi.org/10.36290/vnl.2026.07442544001003865941331631802022236484400100418310274944001001554791171398904400100287389124167204247293316355396414432470516552594611655686725
Cushingův42598002751122373424695356637919201046
syndrom:1548980027598226354482575701888957
současný2582980027598224351452574679806933
pohled35929800275123249376442561690
Michal4251370013793124174239297327
Kršek7751370013767110158216277
III.42515200133265278101
interní550152001332686121175210271296
klinika–klinika870152001335178103163188239293349401428453513538589643
endokrinologie15361520013355116178238290327352413473499559621646701
a22601520013353
metabolismu,23361520013392147184237299360386410453544603626
1.425167001335673
lékařská522167001332681132186221265316370
fakulta915167001333285136197222258311
Univerzity12501670013371131156208262298346372408462
Karlovy17351670013360114149175235286342
a21001670013353
Všeobecná21761670013362105160221283339389449501
fakultní2701167001333285136197222258318343
nemocnice30671670013361116208268318378403452505
v35961670013353
Praze3672167001335893146193248
Cushingův4252180012158112152209233289346402451
syndrom902218001214089146204237293378
je1306218001212475
vzácné1407218001214894145191247299
endokrinní17322180012150107164220269304328384441465
onemocnění,22232180012155111163247304350406458514538560
které2809218001214784134168219
významně30542180012148100146203252336392443
postihuje35232180012157114154189213270325350401
své3950218001214090140
nositele41162180012156112152176210260285337
a44792180012148
je4553218001212475
spojené4655218001213997153178230286338
s50192180012139
významně50842180012149100146203252336392444
zvýšenou425232001214293143182233288343398
morbiditou8412320012182137170227251307330363417472
a13322320012147
mortalitou,13982320012182137170205254278301334388442464
především1880232001215689139195245293332355438
v23362320012148
důsledku24032320012155109148172222279325380
kardiovaskulárních2802232001214695128183207261308357396442497521568601656680724779
poruch35992320012156112145200245299
a39172320012148
komplikací.39832320012147100183239263286333382426449470
Zvýšená44722320012154100150190240295343
morbidita48332320012183137170227251307330363412
a52642320012147
mortalita53302320012182137170425246001213383107131165215
přetrvávají665246001215791142176210262311359408433457
dokonce11472460012156112161215272318368
řadu1540246001213382140195
let1760246001212475110
po18942460012157114
úspěšné2033246001215595153205245301353
léčbě.2410246001212475122179231251
Včasné2686246001215699149189245296
stanovení3007246001214075125181237285335392416
diagnózy3448246001215680129186242298341392
a38652460012148
časná3938246001214595135191240
léčba4203246001212375121179228
mají44562460012183133157181
proto4662246001215791147180236
velký4922246001214899124171222
význam.51692460012148100146203252336358
Je425260001213789
nezbytné5342600012155107151209257294350402
zdůraznit,9562600012143100156189239283340364398420
že1396260001214394
diagnostika1510260001215781130186243299339374398446496
a20262600012148
diferenciální2095260001215680110162196246303349373422446502527
diagnostika2642260001215680129186242298339374398445495
Cushingova31582600012158112152208232289346402450499
syndromu3678260001213988146203237292377433
patří41312600012157107140174198
mezi43492600012184135179204
nejobtížnější45732600012156107132188246280304348405456481521545
v51382600012148
klinické520626000121477397154178223271321
endokrinologii,4252740012150107164221269304328385441466522580604628649
především1097274001215791141200251300340364448
v15682740012148
důsledku16382740012157112153177228286334391
variabilní2051274001214898131156205262287311367391
etiologie2465274001215084108164189246303327379
a28662740012148
také2937274001213383131181
nedostatečné31402740012156107165221262297346380430477533584
senzitivity3747274001213991148192216250274323348382433
a42032740012148
specificity4273274001214098150196220251278324348382432
používaných47282740012157114170214238288337393440485541
testů.5291274001213384124159215236
Toto425288001215099133188
rovněž636288001213389137194245289
platí949288001215782131164188
pro1160288001215791147
léčbu,1330288001212375121179235257
která1610288001214784134168218
musí18512880012183139179203
být20772880012157105142
často2242288001214595135170225
komplexní24902880012147102186244269320368425449
a29632880012148
musí30342880012183139179203
zahrnovat3261288001214293149183240296344393427
rovněž3711288001213388137194245289
léčbu4023288001212475122179236
komorbidit.42822880012147101186242276334359417441475497
Klíčová425305001235885111155211261312
slova:758305001234268124174225248
Cushingův10273050012158111150206229284340395443
syndrom,1491305001214088144201233288372393
klinický190530500121477295150173218264315
obraz,22413050012155112145193237259
diagnostika,2521305001215679127183238294333367390436486507
léčba.3049305001212374119176224246
Cushing's4253300015061128183252286354423456505
syndrome:9693300015054122190259308375476539574
current15823300015052120169218281350397
view20173300015066100163255
Cushing’s4253500012157110148203225279335355391
syndrome833350001213987142198230283366415
is1266350001212361
a13443500012148
rare1409350001213380112161
endocrine15873500012150105160215259291314368418
disorder2022350001215679117171204259308341
that2380350001213387134166
significantly2563350001213962116171194222248292340394426448495
affects3075350001214876108158203237277
patients33693500012157105136159208263295335
and37213500012148102158
is3896350001212361
associated3975350001214786124178223246293324373429
with4422350001217296128182
significantly4621350001214062117171194223248292340394426449495
increased5134350001212377121153202249288337394
morbidity4253640012183138170227250306329362411
and8543640012148103159
mortality,10303640012183138171206255278301333383399
mainly14463640012183131154208231278
due17423640012156110160
to1920364001213386
cardiovascular2024364001214493125181203258305353392436491514561594
disorders2635364001215679118173205261311343383
and30363640012148103159
complications.3212364001214598181237261284328377409431486541580601
Increased3831364001212378123155204252291341398
morbidity42463640012183138171227251307330362412
and46753640012148103159
mortality48523640012183137170206254277300333382
persist52513640012157108140180203242275
even425378001215097146201
many6443780012183131186231
years893378001214796144176216
after1127378001214877113162194
the1339378001213388138
successful1495378001213993138181230269308338394417
cure.1930378001214499131181200
Therefore,21483780012150106156189238268322355405424
early2590378001215098130154201
diagnosis2808378001215780127183238293331354393
and32193780012148103159
treatment3396378001213365115162195277328383415
are3829378001214880130
of3976378001215584
eminent40783780012150133156211261316348
importance.44443780012123106162218251286335390435483503
It4965378001212457
is5039378001212462
necessary51193780012155106151200239278327359409
to425392001213387
state532392001214073122155204
that756392001213388136169
diagnosis944392001215780128184239294333356395
and13593920012148104160
differential1539392001215680109142192225275330363386434457
diagnosis2016392001215679127183238294333356395
of2431392001215484
Cushing’s25343920012158111151206229284340362398
syndrome2952392001213987144200233287371422
belong33933920012157108132187243299
to3712392001213387
the3819392001213388139
most39773920012184139178212
difficult4209392001215679109141168212267291324
ones45523920012155111161201
in4773392001212378
clinical487139200121456891146169214263286
endocrinology517739200121501061622182632963194254060012155111135190246294
mainly7454060012183131154209233280
for1051406001212984117
variable1193406001214897129153200257281332
aetiology1550406001214898132155210234289346394
and19694060012148103160
also2154406001214872111166
not23454060012156111144
sufficiently2514406001214094124156182227250300356388412459
good29984060012156111167224
performance32484060012156108140173228261344392448493542
of3815406001215584
diagnostic3924406001215780128184239294333367390435
tests.4384406001213383122156197218
That46274060012150106154187
also4839406001214872111166
pays50304060012157106152191
for5246406001213085118
the5389406001213388139
treatment425420001213366115164196279330385418
that864420001213388136169
often1054420001215584120170225
has13004200012156104143
to1464420001213387
be15734200012156107
complex1702420001214498182238263313360
and20834200012148104160
has22654200012155103142
to2428420001213488
include2537420001212378123146201258308
also2866420001214972111166
the3053420001213489139
treatment3213420001213366116164196280330386418
of3652420001215584
comorbidities.3758420001214498182237270327350407430463486537576597
Key4254370012358108158
words:6044370012374130166224266290
Cushing’s9154370012158111150206229284340361397
syndrome,1334437001213987144200233287371422441
clinical179743700121446891146169214262286
presentation,2104437001215790140179230285318366399422477533554
diagnosis,2679437001215679127183238294333356395416
treatment.3116437001213366115164196279330385418439
Definice4254930013872131177211274307357416
a8784930013858
epidemiologie9584930013857121154218277371404466499562626659718
Cushingův565510001075197130178197245294341382
syndrom972510001073374123173199246320
(CS)1317510001072373116139
je1481510001071963
pojmenován1568510001075099118192236284332373414462
podle2055510001074998149167211
amerického22915100010741114158185204244282325374422
neurochirurga2737510001074993140425524001072774116164183210259285334375
Harvey826524001075899125170213253
W.1106524001077486
Cushinga,1219524001075298131180198247297338354
který1599524001073970113139183
ho1808524001074998
poprvé19325240010750100151178222266
komplexně2224524001073986161211231275315364409
popsal26595240010750100151184227246
v4255380010741
roce492538001072775116159
1932677538001074583124166
(1).8695380010724648295
Jedná991538001073175126174215
se1233538001073478
o13385380010748
soubor1412538001073483131181231258
příznaků,169653800107507797134183224262311326
který2049538001073869112139182
vzniká2257538001074180130148186229
následkem2513538001074889123142186236275318392
dlouhodobé425552001074866114161208255304351400444
nadměrné885552001074787135207250276324367
autonomní1267552001074187114160208255328375392
produkce1675552001074975121170216253292333
kortizolu2024552001073784110140158194240259305
a23455520010740
jeho2400552001071962109157
působení2572552001074996128176225269316333
na425566001074887
buňky,528566001074996143180222233
tkáně776566001072865106153196
a9885660010740
orgány1044566001074773120160207245
lidského130456600107193785117154196243290
těla161056600107276987127
a17525660010741
komplexně1808566001073884157205224267306353396
a22205660010740
závažně2276566001073677116156192240283
postihuje2575566001074997129157176222269287330
své425580001073476119
nositele.566580001074897130148176219238282297
Exogenní885579001104693143196243295347371
či1276579001104165
iatrogenní1361579001102470101134185238285337389412
CS17945790011053101
je1916580001071963
způsoben2001580001073687135168216266311359
dlouhodobým2382580001074968116165213261311360410449524
působením4255940010751101136186238285336355432
glukokortikoidů885594001075070120159209249298327359379419468488540589
podávaných15025940010752103155198239282333373414464
systémově1995594001073477113143188264315357402
a24255940010742
podobá24965940010751102154205257300
se2825594001073480
klinicky42560800107396180130149191230275
endogennímu727608001074595146196248294344393413489538
CS.1293608001075297114
Endogenní14356070011048102156209264313367421445
CS19066070011055104
patří2036608001075194122150170
mezi22346080010776122160180
vzácná2442608001074282126168218260
onemocnění.27306080010749991454256220010775125167216261310330346
Jeho798622001073277126176
prevalence1001622001075179123164207226271321362406
a14346220010742
incidence1503622001071968109129179224273315358
se1889622001073479
podle19956220010751101152172217
jednotlivých2239622001072065116165215243263282324368409458
prací2724622001075178121163182
liší.4256360010719377088104
Incidence548636001071967107126175219267308350
se917636001073478
pohybuje1014636001074998147186236284303347
mezi13806360010774118155174
0,7–3,01573636001074459102143184198243
případy183563600107497695145186236276
na2130636001074889
122376360010744
0002293636001074389135
0002439636001074490136
obyvatel2593636001074898138182223250293312
a4256500010741
14916500010744
rok560650001072774112
a6986500010740
prevalence764650001074976119160202220264313353396
mezi11856500010773118155174
22–551384650001074488131174215
případy162465000107507796145187236277
na1926650001074889
120406500010744
0002095650001074490136
0002242650001074489135
obyvatel2402650001074898138182224251293312
(2,274065000107236681
3,2847650001074458
4).42566400107446579
K5256640010745
dalším591664001074990109141160233
stavům,846664001073362104144192265281
které1148664001073869112138181
je1351664001071963
v14356640010741
souvislosti1498664001073381130171190223242290323352371
s18916640010733
CS1946664001075194
potřeba2062664001074998126152195245286
uvést,2370664001074889132166195211
patří2602664001075092119145164
následující:278866400107488942567800107345296146194213231271290304
Cyklický755677001105395142167190231277325
(periodický)1105677001102780127160184235288312353399447473
CS16036770011053100
je1730678001071963
stavem,1819678001073463104144187261276
kdy2121678001073887127
se2274678001073478
střídají237867800107346389108158198217236
období2640678001074898148196246265
aktivity3047496001074179110128170189217260
onemocnění3326496001074897141215263305353397445463
s38094960010734
obdobími3862496001074898149197247266339358
neaktivními,4240496001074892132170201220261310329402421436
ve4696496001074084
kterých4800496001073868111137180220268
někdy5088496001074892130179219
může53274960010773121157200
být3047510001075089120
přítomen318751000107507696124170244289337
i35435100010719
funkční3582510001072473121159198246264
hypokortikalismus.3866510001074887137186225272299330349387429448466499572620653670
Tato4555510001074277104151
forma472651000107237198172213
je4958510001072064
obtížná5041510001074898126145181230271
z53315100010737
hlediska53875100010749681113047524001074968100138180
diagnostiky,3252524001074967108157205254287316335373416427
diferenciální370452400107496791135161204252293312352371419437
diagnostiky4166524001074967108157205254287316335373416
i46065240010719
managementu.46505240010773114162203252296370414462489537553
Může52285240010770117154197
se5449524001073478
vyskytovat3047538001074185119157200231279319361388
u34625380010748
všech3537538001074175119161209
forem377253800107247299143217
(centrální,4015538001072462105154181208250269317336351
periferní4393538001075095122142166210236286304
i47245380010719
ektopické4769538001074483114161211231271310353
–51495380010745
viz522053800107416198
níže).5344538001074968105148170183
Pseudo-Cushingův3047551001105291140194249303335393445485539564618672726774
syndrom3848551001103987142197231284364
je4239552001072066
název4333552001074992131176218
pro4579552001075180129
hypersekreci4736552001074990142189217253299339368413456476
kortizolu52405520010739891171491692082573047566001071968
v31425660010741
důsledku3210566001075098131151195246285334
aktivace3571566001074281112131173216257300
osy3898566001074983125
hypotalamus-hypofýzy-nadledviny.4050566001074988140190218260280321396444478505555594646696721765805849877927968101910381083113411761196124512841297
Tato5374566001074278106153
hypersekrece3047580001074988139184211245290329357400442485
není3559580001074893142160
zcela3746580001073676119139180
autonomní3952580001074189118165214263338386405
a43845800010741
vyskytuje4452580001074184119157200232280299344
se4822580001073479
u49275800010749
různých5002580001072776113162201241290
stavů.5318580001073463105145194209
Patří3047594001074585112139158
sem3228594001073478151
například3402594001074989139166185224245286335
etylismus,3760594001074471114134152185258306339355
depresivní4138594001074993142169212246264305354373
porucha,4534594001074998125174214262303319
obezita,4876594001074898143180199227269284
ale5183594001074160104
i53105940010719
např.5352594001074889138165175
mentální30476080010774118166193234253300319
anorexie.3383608001074088137164206246265309324
Mírná3723607001107498131183229
autonomní3968607001104596128179231282359411434
nadprodukce4418607001105298150203236287341392438478524
kortizolu4958607001104696128162185226277301352
(mild53266070011027101125148201
autonomous3047621001104697129180232283360412464502
cortisol3567621001104091123158181219270294
secretion3880621001103784126158205238261312364
–42636210011045
MACS).4326621001107413318423125845826220010716
Tento4617622001074280129155202
termín483962200107277096171189237
se5096622001073378
nejčastěji5193622001074892111151193226255297316334
používá3047636001074997145181199240280
v33436360010740
souvislosti3399636001073481128169188220238285318347365
s37806360010733
tzv.3829636001072765108120
incidentalomy3965636001071865105123171215262288329347394467505
nadledvin,4486636001074888136155198247287306353368
ve4870636001074183
kterých4969636001073768109135177216264
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