Cushing's disease/syndrome

Question 1

What drugs are used to treat ectopic ACTH production?

Answer 1

1. Metyrapone
2. Ketoconazole
3. Fluconazole

All prevent/suppress cortisol production

Question 2

What drugs are used to treat ACTH induced psychosis?

Answer 2

1. Mifepristone (ACTH receptor antagonist)

2. Etomidate (block cortisol synthesis)

Question 3

What is a complication of bilateral adrenalectomy?

Answer 3

Nelson’s syndrome (hyperplasia of corticotrophs in ant pit gland –> excessive ACTH production)

Question 4

What are some signs and symptoms of ectopic ACTH production?

Answer 4

1. Hypokalaemic metabolic alkalosis (due to excessive mineralocorticoid production)
2. Skin pigmentation
3. Hyperglycaemia

Question 5

What are some classical signs of Cushing’s syndrome?

Answer 5

1. BUFFALO HUMP
2. Central obesity
3. Moon face
4. Purple abdominal stretch marks