Cushing' syndrome

Question 1

Causes

Answer 1

1) #1 = iatrogenic, low ACTH

Endogenous ones

2) Cushing’s disease (70%, ACTH secretion from adenoma)
3) Ectopic ACTH (15%, small cell lung cancer, bronchial carcinoid), high ACTH
4) Adrenal (15%, adenoma, carcinoma, nodular adrenal hyperplasia) low ACTH

Question 2

Finding

Answer 2

HTN,
weight gain,
moon face
truncal obesity
buffalo hump
hyperglycemia
skin changes (thinning striae)
osteoporosis
amenorrhea
immunosuppression

Question 3

Dex test:

Normal

Answer 3

Cortisol level
Low dose: suppressed
High dose: suppressed

Question 4

Dex test:

ACTH pit tumor

Answer 4

Cortisol level
Low dose: remain elevated
High dose: suppressed

Question 5

Dex test:
Ectopic ACTH producing tumor
Cortisol producing tumor

Answer 5

Cortisol level
Low dose: remain elevated
High dose: remain elevated