Cushing's

Question 1

What is Cushing’s?

Answer 1

Hypersecretion of cortisol and aldosterone

Question 2

What are the causes of Cushing’s?

Answer 2

ACTH dependent- Cushing disease, ectopic ACTH secretion

ACTH independent- adrenal tumour

Question 3

What causes Cushing disease?

Answer 3

Pituitary tumour

Question 4

What is an example of ectopic ACTH secretion?

Answer 4

ACTH secreting lung carcinma

Question 5

What are the features of Cushing?

Answer 5

Weight gain- central adiposity, supraclavicular fullness, dorsicervical fat pads
Hypertension
Glucose intolerance
Plethoric facies
Oedema
Acne, Hirsutism, Menstrual irregularities, Impotence
Easy bruising, for wound healing

Question 6

What investigations are done for Cushing?

Answer 6

24 hour urinary free cortisol
Low dose dexamethasone suppression test
High dose dexamethasone suppression test
Imaging

Question 7

What are the cortisol levels in a 24 hour urinary free cortisol?

Answer 7

> 50

Question 8

What results would indicate an adrenal pathology?

Answer 8

Suppressed by low dose dexamethasone

Question 9

What results would indicate Cushing’s disease?

Answer 9

Not suppressed by lw dose but suppressed by high dose

Question 10

What results would indicate ectopic ACTH secretion?

Answer 10

Not suppressed by low or high dose

Question 11

What is the management of Cushing’s?

Answer 11

Tumour/adrenal resection +/- chemo/radio
Ketoconazole
Mifepristone