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TCD 16 - Obesity > Cushing's Syndrome > Flashcards

Cushing's Syndrome Flashcards

1
Q

What causes Cushing’s?

A

Prolonged elevations of cortisol

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2
Q

What are the glucocorticoid features of Cushing’s Syndrome?

A 
o	Recent rapid weight gain
o	Central obesity
o	Fullness of face or ‘moon face’
o	Buffalo Hump (fat pad on upper back)
o	Abdominal striae
o	Proximal limb muscle wasting
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3
Q

What are the mineralocorticoid effects of Cushing’s Syndrome?

A 
o	HTN
o	Glycosuria and hyperglycaemia (insulin resistance – T2DM)
o	Cardiac hypertrophy
o	Depression
o	Insomnia
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4
Q

What are the extra effects of Cushing’s Syndrome?

A

o Osteoporosis
o Easy bruising and poor skin healing
o Hypokalaemia
o Hirsutism

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5
Q

What are the causes of Cushing’s Syndrome?

A
  • Iatrogenic prescribed corticosteroids = most common
  • Cushing’s Disease: pituitary tumour
  • Small cell lung carcinoma: ectopic ACTH (paraneoplastic)
  • Adrenal adenoma
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6
Q

What electrolyte abnormalities are seen in Cushing’s?

A
  • High sodium
  • Low potassium
  • High bicarbonate
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7
Q

Who do you test for Cushing’s?

A
  • Patients with unusual features for age (osteoporosis, HTN)
  • Patients with multiple progressive features
  • Children with decreasing height percentile and increasing weight
  • Patients with adrenal incidentaloma compatible with adenoma
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8
Q

What tests do you do for Cushing’s?

A
  • Drug Hx
  • Low-dose overnight dexamethasone (1 mg) suppression test
  • Urinary free cortisol
  • 48hr low-dose dexamethasone suppression test
  • Late-night salivary cortisol
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9
Q

What is the dexamethasone suppression test?

A
  • Patient takes a dose of dexamethasone at night and their cortisol and ACTH are measured in the morning.
  • The intention is to find out whether the dexamethasone suppresses their normal morning cortisol spike.
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10
Q

What is the normal response to the dexamethasone suppression test?

A
  • Dexamethasone causes -ve feedback on the hypothalamus and pituitary
  • Hypothalamus reduced CRH output
  • Pituitary reduces ACTH output
  • Results in low cortisol
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11
Q

What do you do if the low-dose dexamethasone suppression test results in cortisol NOT being suppressed?

A

High-dose dexamethasone suppression test

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12
Q

How would you diagnose Cushing’s disease from a high-dose dexamethasone suppression test?

A

Cortisol is suppressed

- Pituitary is suppressed by 8mg dexamethasone

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13
Q

How would you diagnose an adrenal adenoma from a high-dose dexamethasone suppression test?

A

Cortisol stays normal or high

- Cortisol production is independent from the pituitary

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14
Q

How would you diagnose ectopic ACTH from a high-dose dexamethasone suppression test?

A

Cortisol stays normal or high

- ACTH production is independent of the hypothalamus of pituitary

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15
Q

After the high-dose dexamethasone suppression test, what would you look at next and why?

A

ACTH
- To determine whether it is a ACTH-independent (adrenal adenoma) or ACTH-dependent (pituitary adenoma or SCLC) Cushing’s syndrome

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16
Q

Which tests can differentiate between pituitary and adrenal Cushing’s?

A

• Plasma ACTH levels

17
Q

Following a positive initial screening for Cushing’s, what test would be performed if ACTH is raised?

A

• Pituitary imaging

18
Q

Following a positive initial screening for Cushing’s, what test would be performed if ACTH is NOT raised?

A

• Arenal imaging

19
Q

Which test would allow discrimination between a pituitary and ectopic source of excess ACTH?

A

• Inferior petrosal sinus sampling

20
Q

What would be the most useful first line investigation if ectopic ACTH excess was suspected?

A

• CXR

21
Q

What may U+Es show with an adrenal adenoma?

A

Hypokalaemia

- If aldosterone is also secreted from the adenoma

22
Q

What are the options for managing Cushing’s?

A
  • Removal of the tumour
  • Removal of the adrenal glands and steroid replacement for life
  • Hydrocortisone replacement
  • Metyrapone
23
Q

What is metyrapone?

A

o Glucocorticoid synthesis inhibitor

TCD 16 - Obesity (7 decks)

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