Cushings Disease

Question 1

Is Cushing’s Disease the same as Cushing’s

Syndrome?

Answer 1

The term ‘Cushing’s disease’ refers to Cushing’s syndrome that
is cause by the oversecretion of ACTH by a pituitary tumor.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 396.

Question 2

What are the two types of Cushing’s syndrome?

Answer 2

ACTH-dependent and ACTH-independent Cushing’s syndrome
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 396.

Question 3

What are the most common symptoms of Cushing’s

syndrome?

Answer 3

Sudden onset of weight gain, thickening of the facial fat giving a
rounded shape to the face, facial telangiectasias, glucose
intolerance, hypertension, decreased libido in men,
oligomenorrhea, and spontaneous bruising.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 396.

Question 4

What are the three zones of the adrenal gland and

what hormones does each produce?

Answer 4

The three zones of the adrenal gland from outermost to
innermost are the zona glomerulosa (produces
mineralocorticoids such as aldosterone), the zona fasciculata
(produces glucocorticoids such as cortisol), and the zona
reticularis (which produces sex steroids such as androgens).
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 921-922.

Question 5

What is meant by positive and negative feedback

systems?

Answer 5

A positive feedback mechanism is a hormone-regulating system
in which the release of a hormone triggers changes which
amplify the release of the same hormone. A negative feedback
mechanism describes a system in which the release of a
hormone triggers signals that will limit its own release.
Nagelhout JJ, Plaus K. Nurse Anesthesia. 4th ed.
Philadelphia, PA: WB Saunders Company; 2010: 803.

Question 6

What is acute ectopic ACTH syndrome?

Answer 6

This is a form of Cushing’s syndrome associated with small cell
lung cancer.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 396.

Question 7

What is the pathophysiology behind ACTHdependent

Cushing’s syndrome?

Answer 7

Patient’s with ACTH-dependent Cushing’s syndrome exhibit
extremely high plasma ACTH levels which stimulate the adrenal
gland to produce excessive amounts of cortisol.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 396.

Question 8

What is the pathophysiology behind ACTHindependent

Cushing’s syndrome?

Answer 8

The excessive production of cortisol by an abnormal adrenal
gland supresses secretion of corticotropin releasing hormone
and ACTH.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 396.