Cushing's Syndrome

Question 1

Causes of Cushing syndrome

Answer 1

• Iatrogenic, excessive chronic corticosteroid medication

ACTH dependent:

• Pituitary adenoma
• Ectopic ACTH/CRH syndrome, lung scc
• Hypothalamic CRH overproduction

ACTH indpendent:

• Adrenal tumors
  
  • Adenoma
  • Carcinoma
• Bilateral adrenal hyperplasia
• PPNAD
• AIMAH
• McCune Albright Syndrome

Question 2

Symptoms of cushing synd

Answer 2

• Obesity
• Moon face
• Thin, easy bruising skin, purplish, striae, acne, hirsutism
• polyglobulia
• Proximal muscle weakness,
• Proximal muscle weakness, muscle atrophy
• osteoporosis, fractures (growth failure in children)
• Hypokalemia, alkalosis
• hypertension, diabetes mellitus,
• lipid metabolism disorders
• Menstrual irregularities, amenorrhoea, infertility
• Infektion-risk
• depression
• Hirsuitism
• hypercholestrolemia

Question 3

Frequency of ACTH and cortisol secretory tumors by location

Answer 3

Pituitary ACTH tumors: inhibited by high dose dexamethosone 75%

Ectopic, scc. 10-15%

Primary Adrenocortical Cortisol secreting 15-20%

Question 4

What is a potential serious consequence of bilateral Adrenalectomy to treat cushing syndrome?

Answer 4

Nelson’s syndrome.

When the high level of cortisol is dropped to normal, the CRH releasing cells are strongly disinhibited, and release a ton of CRH. Can cause formation of an aggressive corticotropic adenoma in the pituitary.