Cushings

Question 1

what is Cushing’s syndrome who does it affect

Answer 1

the state of increased free circulating glucocorticoid. occurs most commonly following the therapeutic administration of synthetic steroids or ACTH causing increased cortisol levels

10-15 people per million per year
- women (20 to 50)

Question 2

what is cushings patho/ causes

Answer 2

1. increased circulating ACTH from the pituitary or from an ‘ectopic’, non-pituitary, ACTH-producing tumour elsewhere in the body (10%) with consequent glucocorticoid excess (ACTH dependent cushing’s)
2. a primary excess of endogenous cortisol secretion (25%) by an adrenal tumour or nodular hyperplasia with subsequent suppression of ACTH

the increased ACTH stimulates the production of cortisol. this affects various organs and tissues in the body, leading to metabolic abnormalities etc.

Question 3

clinical features of cushings

Answer 3

• pigmentation (only with ACTH-dependent causes)
• a cushingoid appearance - can be caused by excess alcohol consumption
• impaired glucose tolerance
• hypokalaemia
• hypertension

Question 4

common signs and symptoms of cushing’s

Answer 4

• weight gain and fatty tissue deposits (midsection and upper back)
• moon face and buffalo hump
• pink and purple stretch marks on the skin of the abdomen, thighs, breasts and arms
• thinning, fragile skin that bruises easily
• slow healing of cuts, buts and infections
• acne
• muscle weakness and wasting
• irregular menstrual periods in women

Question 5

treatment of cushings

Answer 5

• whatever the underlying cause, cortisol hypersecretion should be controlled prior to surgery or radiotherapy
• the usual drug is metyrapone, an 11β-hydroxylase blocker.
• for pituitary-dependent hyperadrenalism - trans-sphenoidal removal of the tumor is the treatment of choice.