Cushing's Syndrome

Question 1

What is Cushing’s syndrome?

Answer 1

Cushing’s syndrome is a condition caused by prolonged exposure to excessive cortisol levels, either endogenous or exogenous.

Question 2

What are the main symptoms of Cushing’s syndrome?

Answer 2

Symptoms include weight gain, central obesity, moon face, buffalo hump, skin thinning, easy bruising, muscle weakness, and hypertension.

Question 3

What is the most common cause of Cushing’s syndrome?

Answer 3

Exogenous steroid use is the most common cause.

Question 4

What is the difference between Cushing’s syndrome and Cushing’s disease?

Answer 4

Cushing’s disease refers to Cushing’s syndrome specifically caused by a pituitary adenoma secreting excess ACTH.

Question 5

What are the endogenous causes of Cushing’s syndrome?

Answer 5

Endogenous causes include pituitary adenomas (Cushing’s disease), adrenal tumours, and ectopic ACTH secretion.

Question 6

What is the pathophysiology of Cushing’s syndrome?

Answer 6

Excess cortisol disrupts normal metabolic, immune, and inflammatory responses, leading to symptoms like hyperglycaemia, hypertension, and immunosuppression.

Question 7

What are the classic facial features of Cushing’s syndrome?

Answer 7

Moon face (round, full face) and facial plethora (redness).

Question 8

What are the skin changes associated with Cushing’s syndrome?

Answer 8

Thin skin, easy bruising, purple striae, and poor wound healing.

Question 9

What are the common metabolic complications of Cushing’s syndrome?

Answer 9

Hyperglycaemia, insulin resistance, dyslipidaemia, and osteoporosis.

Question 10

How does Cushing’s syndrome affect blood pressure?

Answer 10

It often causes hypertension due to cortisol’s mineralocorticoid effects.

Question 11

What are the main risk factors for developing Cushing’s syndrome?

Answer 11

Long-term steroid use, adrenal tumours, pituitary adenomas, and ectopic ACTH-producing tumours.

Question 12

What is the gold standard test for diagnosing Cushing’s syndrome?

Answer 12

The 24-hour urinary free cortisol test is considered the gold standard for diagnosing hypercortisolism.

Question 13

What is the role of the dexamethasone suppression test in Cushing’s syndrome?

Answer 13

It assesses the ability of dexamethasone to suppress cortisol production. Lack of suppression indicates Cushing’s syndrome.

Question 14

What are the typical cortisol levels in Cushing’s syndrome?

Answer 14

Elevated cortisol levels that do not follow the normal diurnal variation.

Question 15

How can the cause of Cushing’s syndrome be differentiated?

Answer 15

ACTH levels help differentiate ACTH-dependent (pituitary/ectopic) from ACTH-independent (adrenal) causes. Imaging studies further localise the cause.

Question 16

What are the common differential diagnoses for Cushing’s syndrome?

Answer 16

Obesity, metabolic syndrome, chronic stress, and pseudo-Cushing’s syndrome (e.g., alcohol misuse or depression).

Question 17

What imaging studies are used to investigate Cushing’s syndrome?

Answer 17

MRI for pituitary adenomas, CT or MRI for adrenal tumours, and CT for ectopic ACTH-producing tumours.

Question 18

How is exogenous Cushing’s syndrome managed?

Answer 18

Gradual tapering of corticosteroids under medical supervision to allow recovery of the hypothalamic-pituitary-adrenal axis.

Question 19

What is the management for Cushing’s disease?

Answer 19

Surgical resection of the pituitary adenoma (transsphenoidal surgery) is the first-line treatment.

Question 20

How are adrenal tumours causing Cushing’s syndrome managed?

Answer 20

Adrenalectomy is the treatment of choice for adrenal tumours.

Question 21

What are the complications of untreated Cushing’s syndrome?

Answer 21

Cardiovascular disease, diabetes, osteoporosis, infections, and psychiatric disorders such as depression or anxiety.

Question 22

How does Cushing’s syndrome affect bone health?

Answer 22

Cortisol excess leads to reduced bone formation and increased bone resorption, causing osteoporosis and an increased risk of fractures.

Question 23

What lifestyle advice should be given to patients with Cushing’s syndrome?

Answer 23

Maintain a healthy diet, engage in weight-bearing exercises, monitor for infections, and manage cardiovascular risk factors.

Question 24

What medications are used for medical management of Cushing’s syndrome?

Answer 24

Medications include metyrapone, ketoconazole, and mitotane, which reduce cortisol production, often used when surgery is not an option.

Question 25

What is pseudo-Cushing’s syndrome?

Answer 25

A condition mimicking Cushing’s syndrome, often caused by alcohol misuse, depression, or chronic stress, with reversible hypercortisolism.