Cushing's Flashcards
What is Cushing’s syndrome?
Syndrome of prolonged elevated cortisol
What is Cushing’s Disease?
A pituitary tumour secreting excess ACTH leading to excessive cortisol production.
Features of Cushing’s Syndrome?
Round (moon) face
Central obesity
Abdominal striae
Buffalo hump
Proximal limb muscle wasting
Hypertension
Cardiac hypertrophy
T2DM
Insomnia
Osteoporosis
Easy bruising/poor skin healing
Causes of Cushing’s syndrome?
Adrenal adenoma
Exogenous steroids
Paraneoplastic Cushing’s
Pituitary adenoma = Cushing’s Disease
What test is used in suspected Cushing’s?
Dexamethasone Suppression Tests (DSTs)
When do you do a high dose dexamethasone suppression test?
If a patient fails a low dose dexamethasone suppression test i.e., 1mg of dexamethasone does not suppress the normal spike of cortisol
With an adrenal adenoma, is cortisol suppressed following the high dose dexamethasone suppression test?
No
With paraneoplastic (ectopic-ACTH), does the high dose dexamethasone suppression test suppress cortisol and ACTH?
No
In Cushing’s Disease, is there suppression of cortisol with the high dose dexamethasone suppression test?
Yes
What gland produces cortisol?
Adrenal gland
What is CRH?
Corticotropin-releasing hormone
Where is corticotropin-releasing hormone (CRH) produced?
Hypothalamus
Where is adrenocorticotropic hormone produced?
Anterior pituitary gland
What is ACTH?
Adrenocorticotropic hormone
Treatment of Cushing’s Disease?
Trans-sphenoidal removal of the pituitary adenoma
