Cushing's

Question 1

Presentation

Answer 1

Cushingoid facies
Centripetal obesity
Interscapular and supraclavicular fat pads
Acne vulgaris
Purpuric and petechial rashes
Bruising and thin skin
Violaceous striae
Proximal myopathy

Question 2

Complications

Answer 2

Diabetes
Hypertension
Cataracts
Osteoporosis - avascular necrosis of the femoral head

Question 3

Cushing’s syndrome

Answer 3

Symptoms and signs caused by cortisol excess

Question 4

Cushing’s disease

Answer 4

hypersecretion of ACTH by a pituitary adenoma

Question 5

ACTH-dependent causes of Cushing’s syndrome

Answer 5

• ACTH hypersecretion by a pituitary adenoma - Cushing’s disease
• Ectopic secretion of ACTH by a non-pituitary tumour - SCLC, carcinoid

Question 6

ACTH independent causes of Cushing’s

Answer 6

• Exogenous steroid administration
  -Adrenocorticol adenomas and carcinomas

Question 7

Investigations

Answer 7

• 24 hour urinary free cortisol
• Dexamethosone suppression tests - overnight, low dose, high dose
• CRH levels
• Inferior petrosal sinus sampling

Question 8

Management

Answer 8

• surgical - resection of tumour
• medical - ketoconazole

Question 9

High calcium in Cushing’sq

Answer 9

?MEN1 - autosomal dominant - hyperparathyroidism, pituitary adenomas, pancreatic islet cell tumours