[
    {
        "page": 1,
        "title": "S\u00edndrome de Cushing",
        "body": "<div><span style=\"font-size:23pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">S\u00edndrome de Cushing<\/span>\n<ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Mutaciones en <\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">USP8<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> (adenomas hipofisarios) \u2192 aumento de se\u00f1alizaci\u00f3n EGF y POMC.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">PRKACA<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> en adenomas suprarrenales.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">ARMC5<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> en hiperplasia macronodular bilateral.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">PDE11A\/PDE8B<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> en PPNAD.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">GNAS1<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> en McCune-Albright.<\/span><\/p><\/li><\/ul><h2 dir=\"ltr\" style=\"line-height:1.38;margin-top:18pt;margin-bottom:4pt\"><span style=\"font-size:17pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Fisiopatolog\u00eda<\/span><\/h2><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt;margin-bottom:12pt\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">El exceso de glucocorticoides:<\/span><\/p><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Interrumpe el ritmo circadiano de secreci\u00f3n de cortisol (concentraciones altas a medianoche).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Satura la enzima 11\u03b2-HSD2 renal \u2192 acci\u00f3n mineralocorticoide con hipertensi\u00f3n diast\u00f3lica, hipopotasemia y edema <\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-style:italic;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">(preguntado previamente en CONAREM, aclarando que NO produce hiperkalemia)<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Afecta ejes endocrinos: supresi\u00f3n de gonadotropinas (hipogonadismo, amenorrea) y del eje tirotropo (disminuci\u00f3n de TSH).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Efectos en receptores GR: activaci\u00f3n de genes proglucocorticoides y represi\u00f3n de genes proinflamatorios, con consecuencias metab\u00f3licas, inmunol\u00f3gicas y cardiovasculares.<\/span><\/p><\/li><\/ul><h2 dir=\"ltr\" style=\"line-height:1.38;margin-top:18pt;margin-bottom:4pt\"><span style=\"font-size:17pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Manifestaciones cl\u00ednicas<\/span><\/h2><h3 dir=\"ltr\" style=\"line-height:1.38;margin-top:14pt;margin-bottom:4pt\"><span style=\"font-size:13pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">S\u00edntomas generales<\/span><\/h3><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Aumento de peso con distribuci\u00f3n centr\u00edpeta, obesidad troncal, cara en \u201cluna llena\u201d, giba dorsocervical.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Hipertensi\u00f3n, intolerancia a la glucosa, dislipidemia.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Alteraciones psiqui\u00e1tricas: depresi\u00f3n, ansiedad, psicosis <\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-style:italic;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">(preguntado previamente en CONAREM)<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">.<\/span><\/p><\/li><\/ul><h3 dir=\"ltr\" style=\"line-height:1.38;margin-top:14pt;margin-bottom:4pt\"><span style=\"font-size:13pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Signos espec\u00edficos<\/span><\/h3><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Piel fina, fragilidad cut\u00e1nea, hematomas amplios &gt;1 cm.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Estr\u00edas viol\u00e1ceas anchas en abdomen y muslos.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Miopat\u00eda proximal (dificultad para levantarse de una silla o subir escaleras) <\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-style:italic;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">(preguntado previamente en CONAREM: lo caracter\u00edstico es proximal, no distal)<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Osteoporosis con fracturas vertebrales, retraso del crecimiento en ni\u00f1os.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Hirsutismo y acn\u00e9.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Amenorrea e infertilidad en mujeres <\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-style:italic;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">(preguntado previamente en CONAREM, hipermenorrea no es caracter\u00edstica)<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Hipopotasemia y alcalosis metab\u00f3lica por exceso mineralocorticoide.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><\/ul><h3 dir=\"ltr\" style=\"line-height:1.38;margin-top:14pt;margin-bottom:4pt\"><span style=\"font-size:13pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Complicaciones<\/span><\/h3><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Estado de hipercoagulabilidad con riesgo de trombosis venosa profunda y embolia pulmonar.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Mayor susceptibilidad a infecciones.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Aumento de riesgo cardiovascular y osteoporosis incluso tras curaci\u00f3n.<\/span><\/p><\/li><\/ul><h2 dir=\"ltr\" style=\"line-height:1.38;margin-top:18pt;margin-bottom:4pt\"><span style=\"font-size:17pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Diagn\u00f3stico<\/span><\/h2><ol style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:decimal;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Cribado inicial<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"> (se requieren al menos dos pruebas positivas):<\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Excreci\u00f3n urinaria de cortisol libre en 24 h (&gt;3\u00d7 l\u00edmite normal).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Prueba de supresi\u00f3n con dexametasona nocturna (1 mg a las 23 h, cortisol &gt;50 nmol\/L a las 8 h).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Cortisol en saliva o plasma a medianoche &gt;130 nmol\/L.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><\/ul><li dir=\"ltr\" style=\"list-style-type:decimal;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Diferenciaci\u00f3n<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">:<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">ACTH plasm\u00e1tica suprimida (&lt;5 pg\/mL): Cushing independiente de ACTH (suprarrenal).<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">ACTH normal\/alta (&gt;15 pg\/mL): Cushing dependiente de ACTH.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><\/ul><li dir=\"ltr\" style=\"list-style-type:decimal;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Im\u00e1genes<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">:<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">RM de hip\u00f3fisis: puede no detectar hasta 40% de microadenomas.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">CT suprarrenal: \u00fatil en formas independientes de ACTH.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><\/ul><li dir=\"ltr\" style=\"list-style-type:decimal;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Pruebas din\u00e1micas<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">:<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Prueba con CRH: aumento de ACTH &gt;40% y cortisol &gt;20% sugiere adenoma hipofisario.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Supresi\u00f3n con dexametasona en dosis altas: \u00fatil para diferenciar enfermedad hipofisaria vs ect\u00f3pica.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Muestreo de seno petroso inferior: gold standard cuando hay dudas (ACTH central\/perif\u00e9rica &gt;2 basal, &gt;3 post-CRH = enfermedad de Cushing).<\/span><\/p><\/li><\/ul><\/ol><h2 dir=\"ltr\" style=\"line-height:1.38;margin-top:18pt;margin-bottom:4pt\"><span style=\"font-size:17pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Tratamiento<\/span><\/h2><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Enfermedad de Cushing (adenoma hipofisario ACTH-dependiente)<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: cirug\u00eda transesfenoidal selectiva, con tasas de curaci\u00f3n 70\u201380% en centros especializados.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Cushing suprarrenal<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: suprarrenalectom\u00eda laparosc\u00f3pica en adenomas; abierta en tumores grandes o sospechosos de carcinoma.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">S\u00edndrome de ACTH ect\u00f3pico<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: localizar y resecar el tumor primario; si no es posible, considerar suprarrenalectom\u00eda bilateral.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Tratamiento m\u00e9dico<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">:<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Metirapona<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: inhibe 11\u03b2-hidroxilasa.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Ketoconazol<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: bloquea pasos iniciales de esteroidog\u00e9nesis.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Mitotano<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: suprarrenol\u00edtico, \u00fatil en carcinoma corticosuprarrenal.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:circle;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"2\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Etomidato IV<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: en casos graves, inhibe r\u00e1pidamente la 11\u03b2-hidroxilasa.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><\/ul><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Manejo postoperatorio<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: hidrocortisona de sustituci\u00f3n inmediata tras resecci\u00f3n; recuperaci\u00f3n del eje HPA puede tardar meses-a\u00f1os.<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Otras opciones<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">: radioterapia, radiocirug\u00eda estereot\u00e1ctica, suprarrenalectom\u00eda bilateral en casos resistentes.<\/span><\/p><\/li><\/ul><h2 dir=\"ltr\" style=\"line-height:1.38;margin-top:18pt;margin-bottom:4pt\"><span style=\"font-size:17pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-weight:700;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Informaci\u00f3n clave para examen<\/span><\/h2><ul style=\"margin-top:0;margin-bottom:0;padding-inline-start:48px\"><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-top:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Mal pron\u00f3stico si no se trata.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Manifestaciones espec\u00edficas: estr\u00edas viol\u00e1ceas, hematomas amplios, miopat\u00eda proximal.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Amenorrea, no hipermenorrea.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Hipopotasemia frecuente; hiperkalemia no es t\u00edpica.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Diagn\u00f3stico: pruebas bioqu\u00edmicas + diferenciaci\u00f3n con ACTH.<\/span><\/p><\/li><li dir=\"ltr\" style=\"list-style-type:disc;font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre\" aria-level=\"1\"><p dir=\"ltr\" style=\"line-height:1.38;margin-bottom:12pt\" role=\"presentation\"><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\">Tratamiento de elecci\u00f3n: cirug\u00eda seg\u00fan etiolog\u00eda (hipofisaria vs suprarrenal vs ect\u00f3pica).<\/span><span style=\"font-size:11pt;font-family:Arial,sans-serif;color:#000000;background-color:transparent;font-variant:normal;text-decoration:none;vertical-align:baseline;white-space:pre;white-space:pre-wrap\"><br \/><br \/><\/span><\/p><\/li><\/ul><br \/><br \/>\n<br \/><\/div>",
        "footer": "P\u00e1gina 1"
    }
]