Cushing's (Hypercortisolism)

Question 1

Causes of hypercortisolism

Answer 1

• Cushing’s syndrome/disease
• Iatrogenic
• Stress
• Alcohol
• Caffeine
• Lack of sleep

Question 2

Cushing’s syndrome

Answer 2

Hypersecretion of cortisol due to adrenal pathology

Question 3

Cushing’s disease (more common)

Answer 3

Hypersecretion of cortisol due to ACTH-secreting pituitary adenoma

Question 4

Cushing’s syndrome causes

Answer 4

ACTH-independent

• Tumour (adenoma, carcinoma) of adrenal cortex
• Corticosteriod therapy
• Bilateral adrenal hyperplasia

Question 5

Cushing’s disease causes

Answer 5

ACTH-dependent

• Tumour (adenoma, carcinoma) of pituitary gland
• Ectopic ACTH secretion e.g. lung carcinoid

Question 6

Hypercortisolism symptoms

Answer 6

• Proximal muscle wasting
• Skin thinning
• Facial mooning
• Central obesity (stretch marks)
• Supraclavicular fat pads
• Easy bruising

Question 7

Hypercortisolism complications

Answer 7

• Infection
• Osteoporosis
• Depression
• Hypertension
• Diabetes mellitus (insulin antagonism)

Question 8

Hypercortisolism investigations

Answer 8

1. Confirm
   - 24-hour urinary free cortisol
   - Dexamethasone suppression testing
2. ACTH testing
   - Raised: pituitary cause
   - Suppressed: adenoma cause
3. Localisation (imaging)
   - MRI
   - CT

Question 9

Hypercortisolism management

Answer 9

• Surgical resection of adenoma
• Somatostatins
• Radiotherapy