Cushings (High cortisol) Flashcards
What is Cushings syndome
Excessive glucocorticoid produced by the Adrenal gland (Zona Fasciculata)
What are the two types of of causes for Cushing’s
ACTH dependant
Non ACTH dependant
What are some ACTH dependant causes of Cushing’s
Pituitary tumour
Ectopic ACTH releasing tumours
Bilateral Adrenal hyperplasia
What are non ACTH dependant causes of Cushing’s
Adrenal adenoma
Adrenal Carcinoma
Prednisolone (Corticosteroids) (mc)
What are some presentations of Cushing’s
Buffalo hump Abdo striae Moon face Gastric ulcer Central obesity Bruising
How to identify cortisol excess
- 24hr urinary free cortisol
- Low dose dexamethasone suppression test
How to localise Cortisol cause
Plasma ACTH
High dose Dexamethasone suppression
Pituitary MRI
CT chest and abdomen
What does the high dose dexamethasone suppression test show
Undetected ACTH - adrenal tumour
Detected ACTH - Pituitary/ectopic cause
What us the medical management of Cushing’s
Metyrapone
What should Cushing’s patients carry with them
Steroid card
medic alert bracelet
What are the surgical interventions for cushing’s
Pituitary tumour resection
Adrenalectomy
What is pseudocushing’s
Excessive alcohol intake which resolves in a few weeks
What are the complications of Cushing’s
CVD
HTN
DM
Osteoporosis
Risk factors for Cushing’s
Adrenal and Pituitary tumours
long term corticosteroids
female
What is Cushing’s disease
Pituitary adenoma secreting ACTH
What is Cushing’s Syndrome
All causes of increased Cortisol
What is the difference between cushing’s syndrome and disease
Syndrome = Increase cortisol Disease = Pit Adenoma secreting ACTH
What are the steps to diagnosing Cushing’s
STOP oral steroids
Serum cortisol levels
Dexamethosone suppression test
Plasma ACTH
How is the Dexamethesone test conducted
Measure at 12am
(In heathy patient - Cortisol decrease at HPA axis)
1-Give dexamethasone and measure cortisol
2-measure cortisol at 8am
What are the results of Dexamethasone suppression test
Non Cushing = Suppression
Cushing = no Supression
When and why is Serum ACTH measured
If positive DMT to deduce cause ACTH vs Non ACTH cause
ACTH cause = Pituitary adenoma so do MRI
Non ACTH cause = consider adrenal adenoma
How do you treat Cushing disease/Pituitary adenoma
Transphenoidal resection
What is a complication of Bilateral Adenectomy
Nelson Syndrome
What is NELSON SYNDROME
Complication of Bilateral adrenelectomy
- Continuous enlargement of pituitary tumour.
- Nonegative feedback from adrenals
- Increase ACTH and skin pigmentation
How do you treat an adrenal adenoma
Unilateral adrenalectomy
How can you prevent ectopic ACTH release
Surgical removal
What are the two main complications of Cushing’s
T2DM
Osteoporosis
