Cushing Syndrome

Question 1

Incidence of iatrogenic Cushing Syndrome is thought to be higher due to

Answer 1

Therapeutic use of glucocorticoids

Question 2

Differential diagnoses for elevated cortisol when diagnosing Cushing Syndrome

Answer 2

Pregnancy, obesity, excessive activity, alcoholism, severe depression, hypertension, DM, various familial/genetic predispositions

Question 3

Medications that cause elevated cortisol levels

Answer 3

Glucocorticoids, estrogen replacement therapy, oral contraceptives

Question 4

Initial testing for Cushing Syndrome, includes 1 of 4 tests

Answer 4

-urine-free cortisol (at least 2 measurements)
-late-night salivary cortisol (2 measurements)
-1-mg overnight dexamethasone suppression test
-longer low-dose DST (2mg/d for 48 hours)
-additionally: CBC, CMP

Question 5

Initial tests to assess cortisol levels

Answer 5

-serum cortisol levels and urinary cortisol

Question 6

False-positive cortisol levels may occur in patients who are

Answer 6

Obese, depressed, under extreme stress, or taking medications

Question 7

Initial management of Cushing Syndrome

Answer 7

-transsphenoidal pituitary microsurgery = treatment of choice for pituitary
-patients who are not surgical candidates: mitotane or ketoconazole to reduce cortisol production

Question 8

Subsequent management of Cushing Syndrome

Answer 8

-corticotrophins are suppressed and temporary cortisone replacement therapy is indicated for 9-36 months

Question 9

Drugs of choice for replacement therapy in Cushing Syndrome

Answer 9

Hydrocortisone, prednisone, and fludrocortisone