Cushing's Syndrome Flashcards
What is Cushing’s syndrome.
The clinical state produced by chronic glucocorticoid excess and loss of the normal feedback mechanisms of the hypothalamo-pituitary-adrenal axis.
There is also loss of circadina rhythm of cortisol secretion.
What are the causes of Cushing’s syndrome. (3)
Exogenous cortisol.
ACTH dependent.
ACTH independent.
What are the exogenous causes of Cushing’s syndrome. (5)
Iatrogenic. Steroids. Pseudo Cushing's. Excess alcohol. Depression.
What are the ACTH dependent causes of Cushing’s syndrome. (5)
Pituitary overproduction of ACTH stimulating adrenal gland to produce cortisol. Cushing's disease. Ectopic ACTH secretion. Small-cell lung cancer. Carcinoid.
What are the ACTH independent causes of Cushing’s syndrome. (2)
Autonomous cortisol secretion.
Adrenal adenoma/carcinoma/hyperplasia.
What are the symptoms of Cushing’s syndrome. (11)
Increased weight gain. Poor wound healing. Recurrent infections. Mood changes (depression, irritability, psychosis, lethargy). Gonadal dysfunction (irregular menses, erectile dysfunction). Proximal weakness. Acne. Recurrent Achilles tendon rupture. Low libido. Hirsutism. Headache.
What are the physical signs of Cushing’s syndrome. (17)
Plethoric moon face. Proximal myopathy. Hirsutism. Thin skin. Easy bruising. Hypertension. Central obesity. Buffalo neck hump. Supraclavicular fat distribution.. Skin and muscle atrophy. Purple abdominal striae. Osteoporosis. Raised BP. Raised glucose. Infection prone. Poor healing. Signs of the cause (eg abdominal mass).
What tests can be done to confirm Cushing’s syndrome. (4)
24hour urine collection for free cortisol.
Random blood cortisol (loss of circadian rhythm).
Low dose dexamethasone suppression test to see if ACTH can indeed be suppressed.
High dose dexamethasone suppression test to differentiate between pituitary and ectopic ACTH secretion.
What are the treatment options for Cushing’s syndrome. (2)
Medical.
Surgery.
What are the medical treatment options for Cushing’s syndrome. (2)
Metyrapone.
Ketoconazole.
What is the treatment for Cushing’s disease.
Trans-sphenoidal surgery.
What is the surgical treatment for Cushing’s syndrome.
Adrenalectomy.
What are the complications post adrenalectomy. (2)
Nelson’s syndrome.
Adrenal insufficiency.
What is the prognosis for patients with Cushing’s syndrome.
Very poor if left untreated.
What are the complications post-transphenoidal surgery.
Hypopituitarism.