Cushing’s Disease

Question 1

What is Cushing’s Disease?

Answer 1

Cushing’s Disease is a condition in which here is a hypersecretion of cholesterol

Question 2

What is the aetiology of Cushing’s Disease?

Answer 2

The aetiology of Cushing’s Disease is Tumour in adrenal cortex (primary) Tumour in pituitary gland (secondary) Ectopic ACTH secretion (lung carcinoma) Latogenic - overdose of therapeutic corticosteroids

Question 3

What is the pathophysiology of Cushing’s Disease?

Answer 3

The pathophysiology of Cushing’s Disease is Oversecresion of ACTH stimulates oversecresion of cholesterol Bilateral adrenal gland hyperplasia

Question 4

What are the fourteen symptoms of Cushing’s Disease?

Answer 4

The symptoms of Cushing’s Disease are

Thin skin & easy bruising (protein catabolism)

Stretch marks (purple striae)

Red (plethoric) cheeks

Poor wound healing

Hirsutism (male hair patterns)

Headache

Acne

Amenorrhea or impotence

Depression

Oedema (water retention)

Personality changes

Psychosis

Wasting of limb muscles/ proximal myopathy (protein catabolism)

Central fat deposition - Moon face

Question 5

What are the four signs of Cushing’s Disease?

Answer 5

The four signs of Cushing’s Disease are

Hypertension

Growth arrest in children

Osteoporosis

High Na

Question 6

What are the five investigations for suspected Cushing’s Disease?

Answer 6

Overnight Dexamethasone suppression test/ 24 hour urine free cortisol - screening

Low dose dexamethasone test/ 24 hour urine free cortisol - confirm hypercortisolism

Paired morn - midnight ACTH cortisol test - ACTH dependant or not

High dose dexamethasone test - ACTH dependant: pituitary (or ectopic)/ other

MRI sella turcica/ CT adrenals/ CT chest/ BIPSS - localisation