Cushing's Disease/Syndrome

Question 1

What is the difference between cushing’s disease and cushing’s syndrome?

Answer 1

Cushing’s disease = ACTH dependent

Cushing’s syndrome = ACTH independent

Question 2

What conditions cause Cushing’s disease?

Answer 2

Pituitary tumour

Ectopic lung carcinoma (secreting ACTH)

Question 3

What conditions cause Cushing’s syndrome?

Answer 3

Adrenal cortex tumour

Iatrogenic - steroid use

Question 4

What is Cushing’s syndrome/disease (here on referred to as “Cushing’s”) ?

Answer 4

Increase in serum cortisol from either

Bilateral adrenal hyperplasia (Cushing’s disease - high ACTH)

OR

Adrenal cortex tumour (low ACTH)

Question 5

What are the symptoms of Cushing’s?

Answer 5

Weight gain

Mood change

Extremity weakness

Skin, bone and hair weakness

Hypertension

DIABETES

Question 6

Why do people with cushings get weak extremities?

Answer 6

Fat is redistributed to the trunk

Question 7

What are the signs of Cushing’s?

Answer 7

Moon face

Fat nape

Bruising

Thin skin ulcer - slow wound healing

More susceptible to infection

Question 8

What causes the slow wound healing in Cushing’s?

Answer 8

Anti-inflammatory effects of cortisol

Question 9

What is the 1st line screening test in Cushing’s?

Answer 9

Overnight Dex test

• Normally, dexamethasone will cause negative feedback of ACTH and in the morning cortisol levels will be low
• Test cortisol in urine the morning after

Question 10

Once a diagnosis of Cushing’s disease is obtained, what test allows you to differentiate between a pituitary tumour and an ectopic lung tumour?

Answer 10

High dose dex test

- In high doses, dex can inhibit pituitary ACTH secreting tumours

Question 11

What test allows you to differentiate between Cushing’s disease and Cushing’s syndrome?

Answer 11

Paired morning-midnight ACTH and cortisol levels

- ACTH low in adrenal tumour due to negative feedback

Question 12

What tests allow you to localise the tumour?

Answer 12

MRI sella

CT adrenal

CT Chest

Question 13

Surgical treatment of cushings disease?

Answer 13

Transsphenoidal surgery in pituitary tumour
- Bilateral adrenalectomy if brain surgery contraindicated by LOTS of complications

Ectopic ACTH tumour removal (after stagining)

Question 14

Surgical treatment of cushing’s syndrome?

Answer 14

Unilateral adrenalectomy

Question 15

Pharma management of CushingS?

Answer 15

Ketoconazole can be used to lower ACTH levels pre surgery

Question 16

What are the complications of long term cushings?

Answer 16

OSTEOPOROSIS

DIABETES

Hypertension