cushing's syndrome

Question 1

what is cushing’s syndrome

Answer 1

prolonged high levels of glucocorticoids in the body

Question 2

two groups of corticosteroid hormones

Answer 2

glucocorticoids (cortisol)
mineralcorticoids (aldosterone)

Question 3

what is cushing’s disease

Answer 3

pituitary adenoma secreting excessive adrenocorticotorpic hormone (ACTH) which stimulates excessive cortisol release from adrenal glands

Question 4

cushings features

Answer 4

round in the middle with thin limbs
round face
abdominal striae
buffalo hump
hirsutism
easy bruising and poor skin healing
hyperpigmentation of the skin (cushing disease)

Question 5

additional affects seen in cushing syndrome

Answer 5

HTN
cardiac hypertrophy
T2DM
dyslipidaemia
osteoporosis
adverse mental health

Question 6

causes of cushing’s syndrome

Answer 6

CAPE
Cushing’s disease
Adrenal adenoma
Paraneoplastic syndromes (small cell lung cancer)
Exogenous steroids

Question 7

investigations for cushing’s syndrome

Answer 7

dexamethasone (only to identify problems inside the body)
normal response to dexamethasone is suppressed cortisol
lack of cortisol suppression= cushing’s syndrome

Question 8

types of dexamethasone suppression test

Answer 8

low dose overnight test = used in screening to exclude cushings
low dose 48 hour test = used in suspected cushings
high dose 48 hour= determine cause in patients with confirmed cushings

Question 9

how to differentiate between adrenal adenoma and pituitary adenoma

Answer 9

adrenal adenoma not suppressed with high dose test and low ACTH
pituitary adenoma has low cortisol in high dose test and high ACTH

Question 10

treatment of cushing’s syndrome

Answer 10

pituitary adenoma: trans-sphenoidal removal of pituitary adenoma
adrenal tumour: surgical removal
other tumour: surgery