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ANKI Endocrine > [18] Cushing's Syndrome > Flashcards

[18] Cushing's Syndrome Flashcards

1
Q

What is Cushing’s syndrome?

A

A clinical state produced by chronic glucocorticoid excess

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2
Q

What are the categories of features of Cushing’s syndrome?

A

Catabolic effects
Glucocorticoid effects
Mineralocorticoid effects

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3
Q

What are the catabolic effects of Cushing’s syndrome?

A

Proximal myopathy
Striae
Bruising
Osteoporosis

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4
Q

What are the glucocorticoid effects of Cushing’s syndrome?

A

DM

Obesity

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5
Q

What are the mineralocorticoid effects of Cushing’s syndrome?

A

HTN

Hypokalameia

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6
Q

Describe the appearance of someone with Cushing’s syndrome

A 
Moon face
Acne and hirsutism
Interscapular and supraclavicular fat pads
Centripetal obesity
Striae
Thin limbs
Bruising
Thin skin
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7
Q

What are the categories of Cushing’s syndrome?

A

ACTH independent

ACTH dependant

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8
Q

What happens to ACTH in ACTH independent Cushing’s syndrome?

A

It is decreased due to negative feedback

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9
Q

What are the causes of ACTH independent Cushing’s syndrome?

A 
Iatrogenic steroids:
Adrenal adenoma / Ca
Adrenal nodular hyperplasia
LAME syndrome 
McCune-Albright
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10
Q

What does a carcinoma causing ACTH independent Cushing’s syndrome often cause?

A

Virilisation

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11
Q

What happens to ACTH in ACTH dependent Cushing’s syndrome?

A

It is increased

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12
Q

What are the causes of ACTH dependent Cushing’s syndrome?

A

Cushing’s disease

Ectopic ACTH production

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13
Q

What is Cushing’s disease?

A

Bilateral adrenal hyperplasia from ACTH-secreting pituitary tumour

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14
Q

Does Cushing’s disease have cortisol suppression with high dose dex?

A

Yes

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15
Q

Does ACTH independent Cushing’s have cortisol suppression with high dose dex?

A

No

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16
Q

What can cause ectopic ACTH production?

A

SCLC

Carcinoid tumour

17
Q

What are the features of ectopic ACTH production?

A

Skin pigmentation
Metabolic alkalosis
Weight loss
Hyperglycaemia

18
Q

Does ectopic ACTH production have cortisol suppression with high dose dex?

A

No

19
Q

What is the first line investigation in Cushing syndrome?

A

24 hour urinary free cortisol

20
Q

What are the other investigations that may be done in Cushings syndrome?

A 
Late night serum or salivary cortisol 
Dexamethosone suppression tests
ACTH testing
Localisation using CT or MRI
DEXA scan
21
Q

When is serum or salivary cortisol highest?

A

In the morning

its lowest at midnight cba to make another card

22
Q

What is the problem with ACTH testing in Cushing’s syndrome?

A

ACTH degrades very quickly after venepuncture

23
Q

How is Cushing’s syndrome managed?

A

Treat the underlying cause

24
Q

How is Cushing’s syndrome treated?

A

Trans-sphenoidal excision

25
Q

How is adrenal adenoma/cancer treated?

A

Adrenelectomy

26
Q

How is ectopic ACTH production treated?

A

Tumour excision

Metyrapone

27
Q

How does metyrapone work?

A

Inhibits cortisol synthesis

ANKI Endocrine (30 decks)

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