cushing's syndrome

Question 1

difference between cushing syndrome and disease?

Answer 1

syndorme is define as high cortisone due to any cause and in disease high corticosteroids due to increase acth due to pituitary adenoma, disease is 4th time more in female than male

Question 2

etiology?

Answer 2

iatrogenic due to steriod therapy(most common)
spontaneous either ACTH dependent or not dependent
*acth dependent: 
pituitary tumor
acth secreting tumor
iatrogenic
*acth independent
adrenal adenoma
adrenal carcinoma

Question 3

what is pseudo cushing syndrome?

Answer 3

alchol excess
depressive disorder
phenotyoin phenobarbital
primary obesity

Question 4

symptoms?

Answer 4

weight gain
menstraul irregularity
hirustism
pyschiatric
bachache
muscle weakness

Question 5

signs?

Answer 5

obesity
plethora
moon face
hypertension
bruising
striae
muscles weakness

Question 6

why muscle weakness occur?

Answer 6

due to protein catabolism affect quadriceps and proximal muscles

Question 7

in pseudo and actual cushing syndrome which signs favour cushing syndrome?

Answer 7

bruising, hypertension, myopathy

Question 8

how to differentiate pituitary secreting acth and ectopic secretion?

Answer 8

in ectopic there is no negative feedback sensitivity to cortisol

Question 9

which thing aggravated myopathy?

Answer 9

hypokalemia due to sodium retension and potassium excretion hypokalemia aggravated myopathy

Question 10

which pituitary tumor is most common in cushing?

Answer 10

microadenoma of pituitary

Question 11

investigation?

Answer 11

1. overnight LDDS test( in cushing there is abnormality in negative feedback mechanism so there is no decrease is cortison secretion)
2. 24 hour urinary free cortisol measurement( in cushing there is 300-1000ug/24hr
3. 48 hour LDDS test if not conclude by overnight method
4. circadian rhythm ( not low during night like normal remain same throughout the day)

Question 12

other test to confirm the cause?

Answer 12

after diagnosed the hypercortison condition then diagnose the cause by CT/MRI of pituitary and adrenal glands

Question 13

what is nelson syndrome?

Answer 13

in bilateral adrenalectomy in pituitary dependent cushing syndome there is high level of ACTH which causes pigmentation which is called nelson syndrome

Question 14

treatment?

Answer 14

trans-sphenoidal surgery to remove pituitary tumor
adrenal gland remove through loin incision
ketoconazole, mitotane and metyrapone decrease synthesis of steroids
octreotide supress acth secretion