Cushing's Syndrome

Question 1

What are the three layers of the adrenal gland and which hormone does each produce?

Answer 1

Glomerulosa - Aldosterone

Fasiculata - cortisol

Reticularis - adrogens

Question 2

What disease is caused by an over production of glucocorticoids?

Answer 2

Cushing’s

Question 3

What disease is caused by an over production of aldosterone?

Answer 3

Conn’s

Question 4

What disease is caused by an overproduction of androgens?

Answer 4

Virilisation syndromes

Question 5

What are the categories of cause of glucocorticoid excess?

Answer 5

Exogenous - steroid
Endogenous - pituitary adenoma
adrenal tumor
Ectopic secretion

Question 6

What are the Physical features of Cushing’s syndrome?

Answer 6

Moon Face
Thin Skin
Easy bruising
Central obesity
Striae
Buffalo Hump

Question 7

What abnormalities will show on blood tests in Cushing’s syndrome?

Answer 7

Hypokalaemia
High ACTH
Hypernatraemia

Question 8

How would you diagnose a patient with Cushing’s syndrome?

Answer 8

Midnight plasma cortisol
Low dose dexamethasone test
Silivary cortisol
Urinary free cortisol

Question 9

What investigations would you use work out the cause of Cushing’s?

Answer 9

Head MRI

Plasma ACTH

Question 10

In Cushing’s if ACTH is high then what is the cause?

Answer 10

Pituitary adenoma

ACTH secreting ectopic tumour

Question 11

In Cushing’s if ACTH is low then what is the cause?

Answer 11

Iatrogenic cause

Adrenal cortical excess like a tumor

Question 12

How is a high dose DEXA test carried out and what is its purpose?

Answer 12

2mg 6-hourly for 48 hours

If pituitary cause then cortisol will be low
if ectopic cause then cortisol will still be high

Question 13

What are the features of a patient with Conn’s disease?

Answer 13

hypertension
hypokalaemia
No oedema