متلازمة ACTH خارج الرحم مع الانسداد الرئوي الخثاري أو غيره من المضاعفات المهددة للحياة — عندما يفشل العلاج الطبي المركّب في السيطرة على فرط الكورتيزول

References

DOI: 10.1210/jc.2015-1818

• We recommend urgent treatment (within 24 – 72 h) of hypercortisolism if life-threatening complications of CS such as infection, pulmonary thromboembolism, cardiovascular complications, and acute psychosis are present.
• Many experienced clinicians suggest specific treatments for each condition (eg, anticoagulation prophylaxis and prophylaxis for Pneumocystis jiroveci with trimethoprim-sulfamethoxazole [or dapsone in patients with sulfa allergies]), especially for bedridden or low-mobility patients or those with UFC > 5-fold normal.
• We suggest bilateral adrenalectomy for occult or metastatic EAS or as a life-preserving emergency treatment in patients with very severe ACTH-dependent disease who cannot be promptly controlled by medical therapy.
• Bilateral adrenalectomy provides immediate hypercortisolism control and can be lifesaving.
• If aggressive medical management does not control hypercortisolism, clinicians should consider bilateral adrenalectomy even in high-surgical-risk patients.