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Endocrinoloy > Cushing Syndrome > Flashcards

Cushing Syndrome Flashcards

1
Q
  1. Signs and symptoms that develop after prolonged abnormal elevation of cortisol.
A
  1. Cushing syndrome
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2
Q

A condition where a pituitary adenoma secretes excessive ACTH?

A
  1. Cushing’s disease
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3
Q

Cushing’s disease causes Cushing’s syndrome, but Cushing syndrome is not always?

A
  1. Cushing disease
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4
Q

What are features of Cushing syndrome?

A
  1. Round moon face
  2. central obesity
  3. abdominal striae
  4. buffalo hump
  5. proximal limb wasting
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5
Q

What do high levels of the stress hormone cause what symptoms?

A
  1. HTN
  2. Cardiac hypertrophy
  3. Type 2 DM
  4. Depression
  5. Insomnia
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6
Q

As a result of Cushing Syndrome what are some of the side effects patients may experience?

A
  1. Osteoporosis

2. Easily bruising and poor skin healing

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7
Q

What are causes of Cushing’s Syndrome?

A
  1. Exogenous steroids
  2. Pituitary adenoma
  3. Adrenal adenoma a hormones’ stimulating tumor of the adrenal glands
  4. Paraneoplastic Cushing cause by a cancer
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8
Q

Excess in release of ACTH from a cancer not of the pituitary and stimulates excessive cortisol release. ATCH from somewhere other than the pituitary is called?

A
  1. Ectopic ATCH
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9
Q
  1. What type of cancer causes excessive secretion of ACTH
A
  1. Most common cause of ACTH secreting cancer is Small cell lung cancer
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10
Q

What is the test of choice for diagnosing Cushing’s Syndrome?

A
  1. Dexamethasone suppression test
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11
Q

What is the purpose of the low Dexamethasone Suppression test?

A
  1. The patient is given a low dose of dexamethasone, if the test is normal Cushing’s is excluded.
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12
Q

What is the purpose of giving low dose Dexamethasone to diagnose Cushing’s disease

A
  1. The patient is given a low dexamethasone, a normal response is for the Dexamethasone to suppress the release of cortisol by effective negative feedback on the hypothalamus and pituitary.
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13
Q

How does the pituitary and hypothalamus gland respond to Dexamethasone?

A
  1. The hypothalamus responds by reducing CRH output. The Pituitary responds by reducing ACTH output. The lower the CRH and ACTH levels result in a low cortisol level
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14
Q

If during a dexamethasone test if the cortisol is not suppressed is the test normal

A
  1. Abnormal
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15
Q

When is the high dose Dexamethasone test performed?

A
  1. After an abnormal low dose test
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16
Q
  1. The pituitary still shows some response to negative feedback and 8 mg of dexamethasone is enough to suppress cortisol
A
  1. Cushing’s Disease
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17
Q

When would cortisol production be independent from the pituitary?

A
  1. Adrenal adenoma
18
Q

If ACTH production is not suppressed during the dexamethasone suppression test what does this mean?

A
  1. ACTH is ectopic from either a small cell lung cancer
19
Q

If the patient has a pituitary adenoma what happens with Cortisol and ACTH

A
  1. Suppressed
20
Q
  1. If the patient has an adrenal adenoma, what happens with Cortisol and ACTH during the suppression test?
A
  1. Cortisol is not suppressed

2. ACTH is suppressed

21
Q

If the patient has ectopic production of ATCH what happens with the cortisol and ACTH levels during the suppression test?

A
  1. Neither cortisol or ACTH is suppressed
22
Q

What is an alternative to a Dexamethasone suppression test?

A
  1. 24 hour urinary free cortisol.
23
Q

A condition in which the adrenal glands do not produce enough Cortisol and Aldoesterone?

A
  1. Addison’s disease
24
Q

This specific condition, occurs when the adrenal glands have been damaged resulting in the reduction of the secretion of cortisol and aldosterone.

A
  1. Primary adrenal insufficiency.
25
Q

Inadequate production of ACTH stimulating the adrenal glands resulting in low cortisol release, this is a result of loss or damage to the pituitary gland. Either due to surgery, loss of blood flow or radiotherapy and Sheehan’s syndrome.

A
  1. Secondary adrenal insufficiency
26
Q

This can result from patients being on long term oral steroids, inadequate release of CRH by the hypothalamus, when the exogenous steroids are suddenly withdrawn the hypothalamus does not wake up fast enough and the endogenous steroids are not adequately produced.

A
  1. Tertiary adrenal insufficiency
27
Q

What are symptoms of adrenal insufficiency?

A
  1. Fatigue
  2. Nausea
  3. Cramps
  4. Abdominal pain
  5. Reduced libido
28
Q

What are some signs of adrenal insufficiency?

A
  1. Bronze hyperpigmentation to the skin

2. postural hypotension

29
Q

What is the test of choice for diagnosing adrenal insufficiency?

A
  1. Short synacthen test
30
Q

With this type of adrenal insufficiency, the ATCH level is high as the pituitary gland is trying hard to stimulate the adrenal gland without any negative feedback in the absence of cortisol

A
  1. Primary adrenal failure
31
Q

The ACTFCH level is low because the adrenal glands are not producing cortisol as they are not being stimulated by ACTH

A
  1. Secondary adrenal failiure
32
Q

This test is performed in the am when the adrenal glands are fresh. The patient is given synacthen, blood cortisol levels are measured at 30 and 60 minutes after administration, the ATCH will stimulate health adrenal glands to produce cortisol and the cortisol level should double. A failure of the cortisol to rise indicates what? And what is the test called.

A
  1. Primary adrenal insufficiency (Addison’s Disease)

2. Short Synacthen test.

33
Q

What happens with adrenal atrophy?

A
  1. The prolonged ACTh eventually gets the adrenals going again and cortisol rises
34
Q

What is hydrocortisone?

A
  1. Glucocorticoid hormone used to replace cortisol.
35
Q

What is Fludrocortisone?

A
  1. Minercorticoid hormone used to replace aldosterone if aldosterone is also insufficient
36
Q

When are doses of steroids’ double for patients with adrenal insufficiency?

A
  1. During an illness
37
Q 
What is the condition called when an absence of steroid hormones leads to a life threatening presentation with:
Reduced consciousness
hypotension
hypoglycemia
hyponatremia
hyperkalemia
A
  1. Addisonian crisis
38
Q

How is Addisonian crisis managed?

A
  1. Intensive monitoring
  2. parenteral steroids
  3. IV fluid resuscitation
  4. Correct hypoglycemia
  5. careful monitoring of fluid and electrolyte balance
39
Q

This is a key biochemical clue of adrenal insufficiency and sometimes the only presenting feature?

A
  1. Hyponatremia
40
Q

Elevation of this electrolyte is possible with adrenal insufficiency?

A
  1. Hyperkalemia

Endocrinoloy (6 decks)

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