Cushings (High cortisol)

Question 1

What is Cushings syndome

Answer 1

Excessive glucocorticoid produced by the Adrenal gland (Zona Fasciculata)

Question 2

What are the two types of of causes for Cushing’s

Answer 2

ACTH dependant

Non ACTH dependant

Question 3

What are some ACTH dependant causes of Cushing’s

Answer 3

Pituitary tumour
Ectopic ACTH releasing tumours
Bilateral Adrenal hyperplasia

Question 4

What are non ACTH dependant causes of Cushing’s

Answer 4

Adrenal adenoma
Adrenal Carcinoma
Prednisolone (Corticosteroids) (mc)

Question 5

What are some presentations of Cushing’s

Answer 5

Buffalo hump
Abdo striae
Moon face
Gastric ulcer
Central obesity
Bruising

Question 6

How to identify cortisol excess

Answer 6

• 24hr urinary free cortisol

- Low dose dexamethasone suppression test

Question 7

How to localise Cortisol cause

Answer 7

Plasma ACTH
High dose Dexamethasone suppression
Pituitary MRI
CT chest and abdomen

Question 8

What does the high dose dexamethasone suppression test show

Answer 8

Undetected ACTH - adrenal tumour

Detected ACTH - Pituitary/ectopic cause

Question 9

What us the medical management of Cushing’s

Answer 9

Metyrapone

Question 10

What should Cushing’s patients carry with them

Answer 10

Steroid card

medic alert bracelet

Question 11

What are the surgical interventions for cushing’s

Answer 11

Pituitary tumour resection

Adrenalectomy

Question 12

What is pseudocushing’s

Answer 12

Excessive alcohol intake which resolves in a few weeks

Question 13

What are the complications of Cushing’s

Answer 13

CVD
HTN
DM
Osteoporosis

Question 14

Risk factors for Cushing’s

Answer 14

Adrenal and Pituitary tumours
long term corticosteroids
female

Question 15

What is Cushing’s disease

Answer 15

Pituitary adenoma secreting ACTH

Question 16

What is Cushing’s Syndrome

Answer 16

All causes of increased Cortisol

Question 17

What is the difference between cushing’s syndrome and disease

Answer 17

Syndrome = Increase cortisol
Disease = Pit Adenoma secreting ACTH

Question 18

What are the steps to diagnosing Cushing’s

Answer 18

STOP oral steroids
Serum cortisol levels
Dexamethosone suppression test
Plasma ACTH

Question 19

How is the Dexamethesone test conducted

Answer 19

Measure at 12am
(In heathy patient - Cortisol decrease at HPA axis)
1-Give dexamethasone and measure cortisol
2-measure cortisol at 8am

Question 20

What are the results of Dexamethasone suppression test

Answer 20

Non Cushing = Suppression

Cushing = no Supression

Question 21

When and why is Serum ACTH measured

Answer 21

If positive DMT to deduce cause ACTH vs Non ACTH cause
ACTH cause = Pituitary adenoma so do MRI
Non ACTH cause = consider adrenal adenoma

Question 22

How do you treat Cushing disease/Pituitary adenoma

Answer 22

Transphenoidal resection

Question 23

What is a complication of Bilateral Adenectomy

Answer 23

Nelson Syndrome

Question 24

What is NELSON SYNDROME

Answer 24

Complication of Bilateral adrenelectomy

• Continuous enlargement of pituitary tumour.
• Nonegative feedback from adrenals
• Increase ACTH and skin pigmentation

Question 25

How do you treat an adrenal adenoma

Answer 25

Unilateral adrenalectomy

Question 26

How can you prevent ectopic ACTH release

Answer 26

Surgical removal

Question 27

What are the two main complications of Cushing’s

Answer 27

T2DM

Osteoporosis