CUSHING'S SYNDROME

Question 1

Cushing’s syndrome vs Cushing’s disease

Answer 1

Cushing’s disease is due to excess ACTH secretion by the pituitary gland
Cushing’s syndrome results from high cortisol levels due to adrenal, pituitary or exogenous causes

Question 1

Causes of cushing’s syndrome

Answer 1

Pituitary tumor
Adrenal tumor
Prolonged and excessive intake or abuse of corticosteroids

Question 2

Symptoms of cushing’s syndrome

Answer 2

Weight gain
Excess body hair and acne (pimples)
Easy bruising of skin
Stretch marks (reddish or purplish)
Menstrual irregularity and sub-fertility
Weakness of the thigh muscles
Lightening of the skin

Question 3

Signs of cushing’s syndrome

Answer 3

Rounded or ‘moon’ face
Prominent supraclavicular fat pads
Truncal obesity
Excess facial and body hair
Acne
Striae (reddish or purplish stretch marks)
Thin skin
Easy bruising and bleeding into the skin after venepuncture
Hypertension
Inability to rise from the squatting position

Question 4

Investigations in cushing’s syndrome

Answer 4

Plasma cortisol
Blood electrolytes (hypokalemia)
Blood glucose (commonly elevated)
Abdominal ultrasound scan
CT scan

Question 5

Difference between plasma cortisol levels in adrenal and pituitary tumors and exogenous corticosteroid use

Answer 5

elevated in pituitary and adrenal tumours, but low in corticosteroid use or abuse

Question 6

Role of CT cushing’s syndrome

Answer 6

may show evidence of a pituitary or adrenal tumour

Question 7

Role of abdominal ultrasound in Cushing’s syndrome

Answer 7

May show adrenal tumor

Question 8

Treatment objectives in Cushing’s syndrome

Answer 8

To normalise plasma level of cortisol
To correct electrolyte imbalance
To correct plasma glucose
To correct blood pressure
To prevent complications of excess plasma cortisol

Question 9

Non0pharmacological treatment of Cushing’s syndrome

Answer 9

Pituitary or adrenal surgery where tumours in the respective glands have been diagnosed

Question 10

Should corticosteroid use be stopped in patients with Cushing’s syndrome and why

Answer 10

Do not withdraw corticosteroids suddenly in patients with Cushing’s syndrome due to corticosteroid abuse or prolonged use

Instead, the dose must be tapered
off slowly over several weeks and months to prevent acute adrenal insufficiency