Cushings and pheo

Question 1

what is cushing syndrome and cushing disease

Answer 1

syndrome - excessive levels of glucocorticoids

disease - results from pit. cushing syndrome

Question 2

4 causes of cushings

Answer 2

1. iatrogenic - prednisone
2. ACTH secreting tumor of pit
3. adrenal adenoma and carcinoma
4. ectopic ACTH production
   - most often small cell of lung

Question 3

8 Sx of cushing

Answer 3

1. appearance changes
   - obesity, moon face, striae
2. HTN
3. decreased glucose tolerance - diabetes
4. hypogonadism
5. masculinization in females
6. MSK muscle wasting and weakness
7. psych disturbances
8. impaired immune

Question 4

initial screen for cushing

Answer 4

dexa supression test
- give and night and measure cort in AM
if 5 has - order high dose test
can also use 24hr free cort test

Question 5

next Dx steps

Answer 5

1. measure ACTH to see where from
   - if low - adrenal
2. high dose dexamethasone
   - cushing disease will have reduced cort
   - if ACTH levels still high - ectopic ACTH
3. CRH
   - if ACTH response then cushing disease
   - if no response, then ectopic or adrenal
4. image appropriate area

Question 6

Tx of cushing

Answer 6

1. iatrogenic - taper off
2. pituitary - surg
3. adrenal - surg

Question 7

what is pheo

Answer 7

rare tumors that produce catecholamines

Question 8

features of pheo

Answer 8

1. HTN
2. severe pounding HA
3. severe sweating
4. palp
5. anxiety
6. feeling doom

Question 9

Dx of pheo

Answer 9

1. urine screen for breakdown porducts
   - metanephrine
2. urine/serum epi and norepi
3. imaging

Question 10

Tx for pheo

Answer 10

1. surgery

2. BB in meantime