{"id":11978,"date":"2001-05-07T00:00:00","date_gmt":"2001-05-07T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/analisis-coste-beneficio-y-eficacia-de-las-pruebas-utilizadas-en-el-diagnostico-diferencial-del-sindrome-de-cushing\/"},"modified":"2001-05-07T00:00:00","modified_gmt":"2001-05-07T00:00:00","slug":"analisis-coste-beneficio-y-eficacia-de-las-pruebas-utilizadas-en-el-diagnostico-diferencial-del-sindrome-de-cushing","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/analisis-coste-beneficio-y-eficacia-de-las-pruebas-utilizadas-en-el-diagnostico-diferencial-del-sindrome-de-cushing\/","title":{"rendered":"Analisis coste-beneficio y eficacia de las pruebas utilizadas en el diagnostico diferencial del sindrome de cushing"},"content":{"rendered":"<h2>Tesis doctoral de <strong>  Puig De Dou Jaume <\/strong><\/h2>\n<p>Objetivo: 1)evaluar la eficacia diagnostica y costes de las distintas pruebas bioquimicas y radiologicas utilizadas en el diagnostico etiol\u00f3gico del sindrome de cushing. 2) establecer, seg\u00fan las pruebas evaluadas, el algoritmo diagnostico mas eficaz y eficiente.  material y metodos: noventa pacientes afectos de un sindrome de cushing(80 mujeres diagnosticados entre 1982 y 1999, edad media de 35,7+-13,1 se sometieron a:1) pruebas bioquimicas: acth basal,prueba de frenacion fuerte con dexametosona (pffd), prueba de la metopirona (pm), y cateterismo de los senos petrosos inferiores (cpsi), y 2) pruebas radiologicas: tac abdominal, tac o rm hipofisaria. una vez confirmando el diagnostico anatomo-patologico (56 enfermedades de cushing, 17 adenomas suprarrenales, 3 carcinomas suprarrenales, 4 hiperlasias bilaterales macronodulares, 9 secreciones ectopicas de acth y 1 hiperplasi bilateral micronodular), se calcul\u00f3 la sensibilidad, especificidad, valor predictivo positivo y negativo, cociente de probabilidad asi como el coste de las distintas pruebas utilizada, para posteriormente dise\u00f1ar el algoritmo diagnostico de mayor eficacia y eficiencia.  resultados: todos los pacientes con un sindrome de cushing de origen adrenal presentaron una acth inferior a 2,2 pmol\/l (a excepcion de un pacientecon una hiperplasia macronodular bilateral). La tac abdominal mostr\u00f3 un tumor unilateral en 20 casos y lesiones bilaterales en otros 4. En todos los pacientes con un sindrome de cushing de origen extra-adrenal la acth fue superior a 2,2 pmol\/l. La presencia deuna adenoma hipofisario superior a 7 mm por la rm, o una pffd con una frenacion del cortisol libre urinario superior al 90% o un cociente entre acth central\/acth periferico post-crh superior a 3 en el cspi identifico correctamente a los pacientes con una enfermedad de cushing diferenciandolos de los 9 con una secrecion ectopica de acth. La pffd (con un umbral de frenacion &gt; 50%), la pm y la tac abd<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Analisis coste-beneficio y eficacia de las pruebas utilizadas en el diagnostico diferencial del sindrome de cushing<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Analisis coste-beneficio y eficacia de las pruebas utilizadas en el diagnostico diferencial del sindrome de cushing <\/li>\n<li><strong>Autor:<\/strong>\u00a0  Puig De Dou Jaume <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Aut\u00f3noma de barcelona<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 05\/07\/2001<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Susan Webb Youndale<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: Jos\u00e9 m Pou torell\u00f3 <\/li>\n<li>Manuel Puig domingo (vocal)<\/li>\n<li>Jos\u00e9 Rodriguez espinosa (vocal)<\/li>\n<li>  (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Puig De Dou Jaume Objetivo: 1)evaluar la eficacia diagnostica y costes de las distintas pruebas bioquimicas y [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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