Cushing's syndrome

Question 1

what is Cushing’s syndrome

Answer 1

collection of signs and symptoms

caused by prolonged abnormal elevation of cortisol

i.e. opposite of addisons disease

Question 2

what is the difference between Cushing’s syndrome and Cushing’s disease

Answer 2

Cushing’s disease occurs when a pituitary adenoma (tumour) secretes too much ACTH

Cushing’s syndrome is the following collection of signs and symptoms

cushings disease is one of many causes of Cushing’s syndrome

Question 3

what causes Cushing’s syndrome

Answer 3

Exogenous:
- iatrogenic e.g. glucocorticoid asthma inhalers

Endogenous:

• ACTH dependant (e.g. ACTH produced from pituitary adenoma, ectopic ACTH from small cell lung cancer)
• Adrenal adenoma
• Adrenal hyperplasia
• McCune-Albright Syndrome

TLDR either lots of steroid use or tumours

Question 4

who gets Cushing’s syndrome

Answer 4

mostly adults 30-50

women 3:1 men

Question 5

how does Cushing’s syndrome present

Answer 5

Moon face
buffalo hump (back of neck)
central obesity
weight gain

abdominal striae (stretch marks)
proximal limb muscle wasting
osteoporosis
hypertension
easy bruising and poor skin healing

Question 6

how do you investigate Cushing’s syndrome

Answer 6

24 hour urine test to measure free cortisol

first morning sample 2 days

Question 7

how do you manage Cushing’s syndrome

Answer 7

Trans-sphenoidal (through the nose) removal of a pituitary adenoma

can remove both adrenal glands and then give patient replacement steroids

reduce alcohol consumption (alcohol contains cortisol)