Cushing’s Disease Vs Addison’s Disease

Question 1

Cushing’s Causes/Etiology

Answer 1

Adrenalcorticotropic hormone (ACTH) hypersecretion by the pituitary
Adrenal tumors
Chronic administration of glucosteroids

Question 2

Addison’s Causes/Etiology

Answer 2

Deficient cortisol, androgens and aldosterone
Autoimmune destruction of adrenal gland
Metastatic cancer
Bilateral adrenal hemorrhage
Pituitary failure resulting in decreased ACTH

Question 3

Cushing’s Signs/Symptoms

Answer 3

Central obesity
Moon face and buffalo hump
Acne
Poor wound healing
Purple striae
Hirsutism
Hypertension
Weakness
Amenorrhea
Impotent
HA
Polyuria
Labile mood
Frequent infections

Question 4

Addison’s Signs/Symptoms

Answer 4

Hyper pigmentation in buccal mucosa in skin creases
Diffuse tanning and freckles
Orthostasis and hypotension
Scant auxiliary and pubic hair
Rapid worsening of chronic signs and symptoms
Fever
Changes in LOC

Question 5

Cushing’s Lab/Diagnostics

Answer 5

**Hyperglycemia
**Hypernatremia
**Hypokalemia
Glycosuria
Leukocytosis
Elevated plasm cortisol in the AM
Defame that’s one suppression test to differentiate cause
Serum ACTH

Question 6

Addison’s Lab/Diagnostics

Answer 6

**Hypoglycemia
**Hyponatremia
** Hyperkalemia
Elevated ESR
Lymphocytes is
Plasma cortisol <5 at 800
** Cosyntropin stimulation test R/O

Question 7

Cushing’s Management

Answer 7

Depends on the cause:

• Discontinue medication’s inducing symptoms
• Transphenoidal resection of Pituitary adenoma through the nose
• Surgical removal of adrenal tumors
• Resection of ACTH secreting tumors

Manage electrolyte imbalance

Question 8

Addison’s Management

Answer 8

Outpatient
Specialist referral
Glucocorticoid and mineral corticoid replacement
- Hydrocortisone and fludrocortisone acetate

Inpatient
Hydro Cortizone: 100–300 mg IV initially with normal saline; Replace volume with D5NS at 500 ML – HR times four hours and then taper per condition
Vasopressin’s usually ineffective
Treat underlying cause; often infection