Cushing's Syndrome Flashcards
What is Cushing’s syndrome?
A clinical state of increased free glucocorticoid.
What is the most common cause of Cushing’s syndrome?
Pituitary disease - usually microadenomas.
remainder split between adrenal tumours and ectopic ACTH secretion from carcinoid tumours
What can produce similar clinical pictures to Cushing’s disease?
Alcohol-induced pseudo-cushing’s
Obesity and depression lead to changes in cortisol metabolism which are almost indistinguishable from cushings.
What are the main abnormal features are seen in cushing’s?
Abnormal facial appearance and body habitus.
95% have triad of hypertension, proximal myopathy and skin changes.
What are the symptoms of cushings?
- Weight gain
- Change of appearance
- Amenorrhoea/Oligomenorrhoea
- Depression
- Poor libido
- Thin skin/easy bruising
- Insomnia
- Hair growth/acne
- Muscular weakness
- Growth arrest in children
- Back pain
- Polyuria/polydipsia
- Psychosis
What signs are seen in cushings?
- Moon face
- Buffalo hump
- Kyphosis
- Depression/psychosis
- Acne
- Central obesity
- Hirsutism
- Frontal balding (female)
- Fractured ribs
- Oedema
- Poor wound healing
- Proximal muscle wasting
- Pigmentation
- Glycosuria
- Skin infection
- Osteoporosis
Signs of most value in distinguishing Cushings from simple obesity + hirsutism:
- Plethora (hypervolaemia)
- Striae
- Thin skin/bruising
- Proximal myopathy
- Pathological fractures
- Hypertension
What is the process for investigation in cushings?
Demostrate increased plasma or urinary cortisol
Dexamethasone suppression test for high cortisol - cortisol remains high despite dexamethasone.
Next step = measure plasma ACTH
If plasma ACTH suppressed = adrenal adenoma
If ACTH raised = pituitary or ectopic cause.
Imaging (CT/MR) of thorax to find cause if ACTH raised.
What are the management options in Cushing’s disease?
Adrenal adenectomy = definitive treatment of adrenal cushing’s.
Likewise, tumours secreting ACTH should be excised.
What is the difference between Cushing’s disease and Cushing’s syndrome?
Cushing’s disease = increased pituitary ACTH secretion
Cushing’s syndrome = adrenal or ectopic for increased cortisol
