Adrenalcortical excess (inc. Cushings) Flashcards
gluconeogenosis
immunosuppressive
carb, protein, lipid metabolism increased
sodium balance
potassium balance
increased sodium reabsorption
increased secretion of potassium
cortisol
androgens
chronic glucocorticoid secretion (loss of circadian cycle)
circadian (highest on waking)
ACTH secreting pituitary tumour adenoma
hyperplasia
Small cell lung cancers can produce ectopic ACTH
T
increased weight
central obesity
moon face
buffalo hump
osteoporosis
too much variance throughout the day
overnight dexamethasone test
binds to the glucocorticoid receptors in the posterior pituitary suppressing release of ACTH
50
50
48 hour dexamethasone suppression test
confirm the overnight dexamethasone test
distinguish between pituitary and other causes of Cushings
pituitary
ectopic ACTH (usually very high ACTH)
primary adrenal adenoma
CT of the adrenal
posterior pituitary adenoma
ectopic ACTH production (small cell lung cancer)
trans-sphenoidal surgery of post. pit
adrenalectomy
surgery if localised
[cushings]: increased skin pigmentation is only seen in very high levels of ACTH. Which cause is this a ‘unique’ characteristic of
ectopic
produces very high levels of ACTH
steroids (exogenous)
endogenous rare
