ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket12699ketendo-12699Research ArticleОбзорыReviewsОрбитальные проявления гиперкортицизмаOrbital manifestations of hypercorticismhttps://orcid.org/0000-0002-6954-1126КорчагинаМария ОлеговнаKorchaginaMaria O.

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mary16ko@gmail.comhttps://orcid.org/0000-0001-5592-4727ТрухинАлексей АндреевичTrukhinAlexey A.

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Alexey.trukhin12@gmail.comhttps://orcid.org/0000-0002-8538-5354СвириденкоНаталья ЮрьевнаSviridenkoNatalya Yu.

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natsvir@inbox.ruПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202015062021164413Copyright © Корчагина М.О., Трухин А.А., Свириденко Н.Ю., 20212021Корчагина М.О., Трухин А.А., Свириденко Н.Ю.Korchagina M.O., Trukhin A.A., Sviridenko N.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/12699

В настоящее время синдром Кушинга и его проявления хорошо изучены. При этом основными симптомами гиперкортицизма остаются ожирение, остеопороз, кардиомиопатия, атрофия мышц, истончение кожного покрова и образование багровых полос (стрий) на теле.

На практике самые частые из них — ожирение и остеопороз — встречаются в 90% случаев. Однако есть ряд пациентов с неявной клинической картиной гиперкортицизма. Часть изменений, наблюдаемых у них, затрагивает глаза. В данной обзорной статье рассматривается редкий симптом гиперкортицизма — экзофтальм. Экзофтальм — это патологическое смещение глазного яблока вперед. Этот симптом известен нам в рамках эндокринной орбитопатии, развивающейся при аутоиммунной патологии щитовидной железы. В статье проводится сравнение механизмов развития глазных симптомов при синдроме Кушинга и болезнях щитовидной железы, в особенности при болезни Грейвса. Обсуждаются возможные молекулярные механизмы, приводящие к экзофтальму у пациентов с синдромом Кушинга. Изучаются факторы, влияющие на адипогенез in vitro и in vivo, в частности факторы, приводящие к увеличению жировой клетчатки орбит на фоне повышенного уровня кортизола. Представлены гормональные сигнальные и транскрипционные каскады, отвечающие за дифференцировку адипоцитов в зрелые жировые клетки. Также в статье рассмотрены другие орбитальные проявления гиперкортицизма, встречающиеся на практике относительно редко. К ним относятся глаукома, а также катаракта, узелки Лиша и центральная серозная хориоретинопатия. Рассмотрены клинические случаи синдрома Кушинга с различными глазными проявлениями и сделаны соответствующие выводы.

Nowadays, Cushing's syndrome (hypercortisolism) and its manifestations are well studied. The main symptoms of hyper-cortisolism are obesity, osteoporosis, cardiomyopathy, muscle atrophy, skin thinning and purple stretch marks (striae) on the body. In practice, obesity and osteoporosis are the most frequent symptoms that are found in 90% of cases. However, there are some patients with an implicit clinical picture of hypercorticism. Some cases might concomitant with exophthalmos. This review describes a rare symptom of hypercortisolism — exophthalmos. Exophthalmos is a pathological protruding of eyeballs. This symptom is known in the context of TED that occurs most commonly in patients with Graves' disease. The article compares the mechanisms of development of eye symptoms in Cushing's syndrome and thyroid diseases, especially the Graves' disease. It discusses possible molecular mechanisms leading to exophthalmia in patients with Cushing's syndrome. Factors affecting adipogenesis in vitro and in vivo are studied, in particular factors leading to an increase of orbital fatty tissue against of elevated cortisol levels. Hormonal signaling and transcription cascades responsible for adipocyte differentiation into mature fat cells are presented. Other orbital manifestations of hypercortisolism, which occur relatively rare in practice, are also discussed in the article. These include glaucoma as well as cataract, Lisha nodules and central serous chorioretinopathy. Clinical cases of Cushing's syndrome with different ocular manifestations are considered and appropriate conclusions have been drawn.

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The authors declare that there are no conflicts of interest present.