Cushing's Syndrome Flashcards
What is Cushing’s syndrome?
clinical manifestation of pathological hypercortisolism from any cause
What steroids do the adrenal cortex produce?
- Glucocorticoids
- Mineral corticoids
- Androgens
What is an example of a glucocorticoid?
cortisol
What do glucocorticoids do?
affect carbohydrate, lipid and protein metabolites
What is an example of a mineralcorticoid?
aldosterone
What do mineral corticoids do?
control sodium and potassium balance
What are androgens?
sex hormones converted to testosterone and dihydrotestosterone
What is the process by which cortisol is released?
- CRF from hypothalamus stimulates ACTH secretion from pituitary
- in turn stimulated cortisol and androgen production by adrenal cortex
What are causes of Cushing’s syndrome
- Pituitary or adrenal adenoma
- Ectopic ACTH production
- Adrenal carcinoma
- Exogenous corticosteroid use
What is cushing’s disease?
- pituitary or adrenal adenoma (Cushings disease) – bilateral adrenal hyperplasia
- peak age 30-50yrs
When might there be ectopic ACTH production?
- small cell lung cancer
- carcinoid tumour
What is most common cause of Cushing’s syndrome?
exogenous corticosteroid exposure
What is the majority of endogenous Cushing syndrome caused by?
ACTH secreting pituitary adenomas
What are the symptoms of Cushing’s syndrome?
- Increased weight
- Mood change
- Proximal weakness
- Gonadal dysfunction
What are signs of Cushing’s syndrome?
- Central obesity
- Plethoric moon faces
- Buffalo hump
- Supraclavicular fullness
- High glucose
- High BP
- Violaceous stria
What are some differential diagnosis of Cushing’s syndrome?
- obesity
2. metabolic syndrome
What are some complications of Cushing’s syndrome?
- Adrenal insufficiency secondary to adrenal suppression
- cardiovascular disease
- hypertension (pseudohyperaldosteronim)
- diabetes mellitus
- osteoporosis
- nephrolithiasis
What investigations may you do for Cushing’s syndrome?
- Urine pregnancy test
- Serum glucose
- Late-night salivary cortisol
- 1mg overnight suppression test
- 24hr urinary free cortisol
- 48h 2mg dexamethasone suppression test