Cushing's syndrome

Question 1

define

Answer 1

excess cortisol secretion

Question 2

who is this most commonly seen in?

Answer 2

women 20-40

Question 3

role of cortisol

Answer 3

it increases sensitivity to adrenaline allowing the body to cope with stress

Question 4

three types of ACTH dependent Cushing’s

Answer 4

ACTH dependent e.g. pituitary adenoma (Cushing’s disease)
ectopic ACTH
ectopic CRH

Question 5

why is there a high level of androgens in Cushing’s?

Answer 5

the zona reticularis which secretes androgens is also controlled by ACTH

Question 6

three types of ACTH-independent

Answer 6

adrenal adenoma
carcinoma
nodular hyperplasia
do not have high androgens

Question 7

presentation

Answer 7

easy bruising
facial plethora
moon face
proximal weakness
stretch marks/striae
buffalo hump
abdomen fat

Question 8

diagnosis

Answer 8

ACTH is low in adrenal due to negative feedback from cortisol, if pituitary then both will be high
suppression test
24hr urinary free cortisol
late-night salivary cortisol
DEXA scan for osteoporosis

Question 9

define iatrogenic Cushing’s

Answer 9

prolonged high dose steroid therapy (usually oral)

Question 10

what does iatrogenic Cushing’s lead to?

Answer 10

chronic suppression of pituitary ACTH and adrenal atrophy

Question 11

implications in iatrogenic Cuhsing’s

Answer 11

inability to respond to stress (illness/surgery)

Question 12

management of iatrogenic Cushing’s

Answer 12

gradual withdrawal of steroid therapy