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W jaki sposób zespół Cushinga wpływa na gojenie ran?

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Zespół Cushinga, czyli grupa objawów klinicznych związanych z podwyższonym stężeniem kortyzolu we krwi, może wywoływać różnorodne reakcje skórne, a w następstwie wpływać na powstawanie ran i utrudniać ich gojenie.

Patofizjologia zmian skórnych w zespole Cushinga

W wyniku zaburzeń w wydzielaniu glikokortykosteroidów w organizmie dochodzi do zróżnicowanych reakcji fizjologicznych. Uważa się, że podwyższony poziom glikokortykosteroidów wpływa na zmniejszenie proliferacji keratynocytów i fibroblastów w tkance skóry. Zmiany te prowadzą do ograniczenia produkcji kolagenu i innych składników macierzy zewnątrzkomórkowej, co w następstwie wywołuje atrofię i łamliwość skóry. Kataboliczne działanie glikokortykosteroidów obejmuje także podskórną tkankę łączną.

Objawy skórne zespołu Cushinga

Pacjenci pediatryczni z zespołem Cushinga w większości przypadków cierpią na otyłość i zaburzenia wzrostu. Otyłość występująca w przebiegu zespołu Cushinga charakteryzuje się gromadzeniem tkanki tłuszczowej w specyficznych obszarach ciała – na twarzy, tułowiu (zwłaszcza w okolicy karku) i brzuchu.

Zespół Cushinga objawia się ponadto licznymi specyficznymi zmianami skórnymi. Skóra staje się cienka, delikatna i wrażliwa na uszkodzenia i siniaki. Pojawia się skłonność do obrzęków i wylewów podskórnych. W wyniku znacznego zwiększenia masy ciała na brzuchu, udach i pośladkach występują rozstępy o intensywnie czerwonym lub fioletowym zabarwieniu. Nadmiar glikokortykosteroidów może także spowodować wystąpienie trądziku, objawiającego się w postaci rumieniowatych krost w obrębie tułowia, kończyn górnych, szyi i twarzy. Może on także predysponować do zwiększonej podatności na zakażenia (szczególnie grzybicze).

Zespół Cushinga a gojenie ran

Nadmierny poziom kortyzolu może prowadzić do upośledzenia i spowolnienia procesu gojenia ran m.in. ze względu na supresję odpowiedzi immunologicznej i zapalnej.

W 80-90 proc. przypadków zachorowań na zespół Cushinga występuje nadciśnienie tętnicze. W części przypadków objawem tej jednostki chorobowej może być także cukrzyca (20-50 proc. chorych) lub upośledzona tolerancja glukozy (70 proc. chorych). Czynniki te dodatkowo predysponują pacjentów cierpiących na zespół Cushinga do częstszego powstawania i utrudnionego gojenia ran.

Należy także zauważyć, że hiperkortyzolemia zwiększa ryzyko wystąpienia zespołu zakrzepowo-zatorowego. Z tego względu urazy i zabiegi operacyjne u pacjentów z zespołem Cushinga obarczone są większym ryzykiem powikłań.

Źródła:

Lause M., Kamboj A., Fernandez Faith E., “Dermatologic Manifestations of Endocrine Disorders”, “Translational Pediatrics” 2017, 6(4): 300-312.

Shibli-Rahhal A., Van Beek M., Schelchte J.A., “Cushing’s Syndrome”, “Clinical Dermatology” 2006, 24(4): 260.

Stratakis C., „Skin Manifestations of Cushing’s Syndrome”, “Reviews in Endocrine and Metabolic Disorders” 2016, 17(3): 283-286.

 

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