Cushing’s Flashcards
What hormone is affected in Cushing’s and in what way?
Cortisol, high levels
What 4 things can cause Cushing’s?
1) Long term glucocorticoid meds
2) Pituitary tumour (Cushing’s disease)
3) Adrenal tumour
4) Ectopic ACTH-producing tumour
What are 7 symptoms of Cushing’s?
1) Moon face
2) Purple striae
3) Buffalo hump
4) Muscle wasting and thin extremities
5) Weight gain and obesity
6) Skin and bone thinning
7) Easy bruising
Suspicion of Cushing’s: What’s the first thing to check in a patient?
If they take glucocorticoids. Stop medication before continuing investigation
Suspicion of Cushing’s: What are the 3 screening tests?
Late-night salivary cortisol (x2)
24h UFC (x2)
Overnight 1mg DST
Suspicion of Cushing’s: How many times does a patient have to repeat the screening tests if they were abnormal?
1-2 times
Suspicion of Cushing’s: After repeating the screening tests, what do you need to exclude and why?
Non-neoplasticism hypercortisolism/Pseudocushing’s
CKD, alcoholism, neuropsychiatric disease, and DM can increase cortisol lvls
Confirmation of Cushing’s: After repeating screening tests and obtaining abnormal results, Cushing’s confirmed. What do you do next?
Measure ACTH
Confirmation of Cushing’s: After measuring ACTH, what would a normal and abnormal result mean and prompt?
Low: Adrenal Source. Adrenal CT scan or MRI
Normal or High: Pituitary or Ectopic source. Pituitary MRI
Confirmation of Cushing’s: After doing a pituitary MRI, what happens if you do or don’t encounter an adenoma?
Adenoma: larger than 10 mm = confirmed pituitary Cushing’s
No adenoma (or smaller than 6-9 mm): Ectopic or pituitary. Do:
1. CRH and Desmopressin test + whole body CT
2. If above is inconclusive, do a IPSS
Confirmation of Cushing’s: What result would you expect in IPSS if the cortisol source is ectopic?
No pituitary gradient —> Ectopic Source
