Cushing's syndrome

Question 1

What is Cushing’s syndrome?

What is Cushing’s disease?

Answer 1

Cushing’s syndrome is a group of symptoms and signs caused by prolonged high cortisol

Cushing’s disease refers to the specific condition where a pituitary adenoma releases excess ACTH (which stimulates production of excess cortisol)

Question 2

What are the clinical features of Cushing’s syndrome?

Answer 2

• “Moon” face
• “Buffalo hump”
• Central obesity
• Proximal limb muscle wasting

Question 3

What are the complications of Cushing’s syndrome?

Answer 3

• HYPERtension
• HYPERglycaemia (T2DM)
• Cardiac HYPERtrophy

Question 4

Causes of Cushing’s syndrome

Answer 4

1. Long term steroid use (most common)
2. Tumours:
   - Cushing’s disease (pituitary adenoma releasing excess ACTH)
   - Adrenal adenoma
   - Paraneoplastic Cushing’s (e.g. SCLC releasing ectopic ACTH)

Question 5

Which test is performed to diagnose Cushing’s syndrome?

Answer 5

Dexamethasone suppression test

Question 6

Which test can be used as an alternative to the dexamethasone suppression test to diagnose Cushing’s syndrome?

Answer 6

24 hour urinary free cortisol (however this cannot indicate the underlying cause of Cushing’s syndrome)

Question 7

If you suspect the cause of Cushing’s syndrome is a pituitary adenoma, how would you diagnose this?

Answer 7

MRI brain

Question 8

If you suspect the cause of Cushing’s syndrome is an adrenal adenoma, how would you diagnose this?

Answer 8

Abdominal CT

Question 9

Describe the management of Cushing’s syndrome caused by:

a) Pituitary adenoma
b) Adrenal adenoma

Answer 9

For both, the management is surgical removal of the tumour