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Endocrine > Cushings syndrome > Flashcards

Cushings syndrome Flashcards

1
Q

What electrolyte imbalance does cushings syndrome cause

A

Hypokalemic metabolic alkalosis

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2
Q

What is cushings syndrome caused by

A

Cortisol excess

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3
Q

Why does cushings cause hypokalemia

A

Cotisol -> stimulates aldosterone, increases Na+ and water retention - increases K+ excretion

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4
Q

Electrolyte imblanaces in cushings

A

High bicarb - pH alkalosis
low potassium

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5
Q

When do you do dynamic testing for hormones

A

Hormone is lacking - stimulate
Hormone being produced in excess - supress

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6
Q

Thyroid horomone cycle

A

Hypothalamus -> TRH ->pituitary -> TSH -> thyroid -> T4 +T3
Somatostatin + dopamine from hypothalamus inhibit TSH release from pituitary

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7
Q

How assess thyroid function

A

measuring TSH, free T4 and free T3

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8
Q

Primary hyperthyroidism on bloods

A

Too much free T4 - supressed TSH

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9
Q

Cushing syndrome vs disease

A

Syndrome = clinical features
Disease = features + piuitary source

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10
Q

Where do aldosterone vs cortisol originate

A

Mineralcorticoid -> aldosterone
Glucocorticoid - cortiosl

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11
Q

Signs of cushings

A

Obesity - central, nuchal or SC fat pads, thin arms and legs
Plethora - red
Moon face
Extensive striae
Decreased libido Menstrual changes
Hirsutism
HPTN
Ecchymoses - extensive skin brusining
Poor healing, skin fragility
Lethargy, depressionn
Abnormal glucose toleranec
Decreased libido
Dorsal kyphosis

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12
Q

Types of cushings syndrome

A

ACTH dependent and independent

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13
Q

What causes cushings disease

A

Pituitary tumours -> ACTH
ACTH dependent

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14
Q

What auses cushings syndrome

A

Adrenal adenoma -> cortisol
ACTH independent

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15
Q

Why do midnigth cortisol in cushings

A

Normlaly lowest at this point - in cushings loss of diurnal variation

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16
Q

Investigations for cushings

A

Elevated 24 hour urinary free cortiosl exretion
Overnight 1mg dex supression test
Plasma cortisol

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17
Q

What test for in 24 hour urine cortiols excretion

A

Cortisol:creatinine ratio

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18
Q

How do dex supresson test + positive results

A

give 1mg dex at 11pm
Test at 9am
Cushings if 9am cortisol not supressed eg >50

19
Q

What investigations do if undetectable ACTH

A

Suggests adrenal pathology -> adrenal imaging - CT scan

20
Q

What investigation do if dectabel ACTH

A

48 hour high dose dex supress test

21
Q

How do 48 hours high dose dex supression test

A

2mg dex every 6 hours - 8am, 2pm, 8pm, 2am
If <50% basal value after 48 hours (50-90% accepted) means supression

22
Q

What does supression on high dose 48 hr dex test but not overnigth suggest

A

Pituitary cushings disease -> pituiatry MRI

23
Q

What does elevation in both overnigth and high dose dex supressiont ests suggest

A

Extopic ACTH production or adrenal tumours

24
Q

Pr op management in cushings

A

Lower cortisol - imporve wound healing and tissue repair
Meyrape
Ketoconazole

25
Q

What can ketoonazole cause

A

Addisons disease

26
Q

What is the deficinitve treatment for cushings disease

A

Surgery - transsphenoidal for pituitary tumours -> radiotherapy if not cured
Adrenal tumours - laparascopic or open adrenalectomy

27
Q

What can low dose overnight dex supression test tell you

A

if there is abnormal cortisol secretion.

28
Q

What can high dose dex supression 48 hour test tell you

A

Excess cortiols due to adrenal glands - syndrome, not supressed
OR ACTH high levels from pituitary - disease, supressed

29
Q

Electrolytes in cushings

A

Low potassium - gluco+mineralcorticoid excess action -> K+ loss
HYPOKALEMIC METABOLIC ALKALOSIS

30
Q

Excess cortisol ->

A

weight gain, muscle weakness, high blood pressure, diabetes, and osteoporosis.

31
Q

What is cuhsings disease

A

Exces cortisol BUT specifically from ACTH secreting pituitary adenoma

32
Q

Musculoskeletal manifestations of cushigns disease

A

Prozima myopathy hip - hide rising from seat
Osteopenia +osteoporosis - increased fracture rsik esp vertebral compression
Avascular necoriss of femoral head

33
Q

Derm features of cushings

A

Hirsutism, acne, seborrheic dermatitis, thin skin, poor wound healing

34
Q

Endocrine symptoms cushings

A

Glucose intolerance or T2DM
Mentrual irregularities - oligo or amenorrhea, decreased libido and ED HPG acis supressed

35
Q

Neuropsych in cushings

A

Depression, anxiety, irritability, emotional lability, and cognitive deficits such as impaired memory or concentration
Sleep disturbances including insomnia or hypersomnia

36
Q

CVS complications from cushgins

A

HPTN - sodium retntion
Increased VTE risk - hypercoagulable

37
Q

Children concerns in scushings

A

n children, growth retardation may occur due to cortisol-mediated suppression of growth hormone secretion
Precocious puberty may be observed in some cases

38
Q

What is ectopic ACTH secretion (eg small cell lung cancer) ass with?

A

Very low K+ levels

39
Q

Will both cortisol and ACTH be supressed in cushings disease in high dose dex supress test

A

Yes

40
Q

Which condition is both cortisol and ACTH not supressed in high dose dex test

A

Ectopic ACTH

41
Q

First line to third line of cushings disease

A

First-line = trans-sphenoidal removal of pituitary tumour (hypophysectomy)
Second-line = repeat trans-sphenoidal surgery, pituitary radiotherapy
Third-line = bilateral adrenalectomy

42
Q

Complications of bilateral adrenalectomy

A

Hypoadrenal crisis - addisons lifelong treat
Nelsons syndrome

43
Q

Nelsons syndrome

A

Bilateral adrenectomy -> pituitary enlargement -> mass effects nad skin hyperpigmenetation
AKAjust get cushings again

Endocrine (17 decks)

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