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Rakeem's Endocrinology > cushings syndrome > Flashcards

cushings syndrome Flashcards

1
Q

define Cushing syndrome

A

Increased levels of cortisol in the body which leads to adverse symptoms

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2
Q

what are the two ways that the cortisol levels in your blood can increase?

A
  1. ACTH-dependent
    2.ACTH-independent
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3
Q

what do ACTH- dependant causes revolve around?

A

increased ACTH release which stimulates the adrenal glands to release cortisol

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4
Q

what can ACTH dependant Cushings be due to?

A

a pituitary adenoma which releases excess ACTH (Cushing’s Disease), ACTH therapyor due to ectopic ACTH release.

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5
Q

what are two examples of ACTH independent cushings syndrome?

A

-taking too many exogenous steroids
-an adrenal adenoma that releases too much cortisol.

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6
Q

describe pesudo cushings

A
  • has similar features to cushings
  • has increased cortisol
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7
Q

what are the complications of Cushing syndrome?

A

-Osteoporosis
-T2DM
-Hypertension
-ischaemic Heart Disease (Angina

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8
Q

what can pseudo cushings be due to?

A

can be due to alcohol excess, depression, obesity and pregnancy

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9
Q

what can pseudo cushings result in during diagnosis? how do you differentiate this?

A

It can result in a false positive in diagnosis, but it can be differentiated with an insulin stress test.

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10
Q

what are the signs of cushings syndrome?

A

-Central Obesity
-Moon Face
-Abdominal Striae
-Buffalo Hump
-Ecchymoses and Fragile skin
-Hypertension

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11
Q

what are the symptoms of Cushing syndrome?

A

-Weight gain
-Mood change
-Menstrual irregularity
-Reduced libido
-Hyperglycaemia
-Increased susceptibility to infection

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12
Q

how is Cushing syndrome diagnosed?

A
  • the DEXAMETHASONE SUPRESSION TEST**
  • a PLasma ACTH test
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13
Q

what does the dexamethasone suppression test tell you when diagnosing cushings syndrome?

A

Normally it should be suppressed but in Cushing’s it is not.

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14
Q

what are the three types of dexamethasone suppression tests when diagnosing cushings syndrome?

A
  • low dose overnight
  • low dose 48 hrs
  • high dose 48 hrs
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15
Q

what is the low dose overnight test done for when diagnosing cushings syndrome?

A

screening test to exclude cushings

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16
Q

when is the low dose 48hrs test done when diagnosing cushings syndrome?

A

used when cushings is suspected

17
Q

when is the high dose 48 hrs test done when diagnosing cushings syndrome?

A

Used to confirm the cause of Cushing’s

18
Q

what does a plasma ACTH test tell you when diagnosing cushings syndrome?

A

tell you the levels of ACTH:
-If it is high, the cause is ACTH-dependent
- if it is low, it is independent.

19
Q

what is the treatment for Cushings syndrome when cushings disease is the cause?

A

Transsphenoidal Tumour or Bilateral Adrenalectomy

20
Q

what is the treatment for Cushings syndrome when adrenal adenomas are the cause?

A

Tumour Resection or Unilateral Adrenalectomy

21
Q

what is the treatment for Cushings syndrome when a tumour releasing ACTH ( SCLC) is the cause?

A

Surgical removal of the tumour

22
Q

what is a complication of the treatment for Cushings syndrome?

A

Nelson’s syndrome

23
Q

what is nelsons syndrome?

A

where an ACTH pituitary tumour develops due to negative feedback and lack of cortisol

24
Q

what does nelsons syndrome results is?

A

in skin pigmentation and bitemporal hemianopia.

25
Q

when can nelsons syndrome occur?

A

due to bilateral adrenalectomy

26
Q

what should the dexmaethasone suppression test look like in a normal person?

A

low dose 48hrs - low
high dose 48hrs- low
ACTH- normal

27
Q

what should the dexmaethasone suppression test look like with a pituitary adenoma?

A

low dose 48hrs - not suppressed
high dose 48hrs- low
ACTH- high

28
Q

what should the dexmaethasone suppression test look like with a adrenal adenoma?

A

low dose 48hrs - not suppressed
high dose 48hrs- not surpassed
ACTH- low

29
Q

what should the dexmaethasone suppression test look like with ectopic ACTH?

A

low dose 48hrs - not suppressed
high dose 48hrs- not surpassed
ACTH- high

30
Q

what drug is used to treat Cushings?

A

metyrapone- reduces cortisol

31
Q

when is a low dose dexamethasone and a high dose dexamethasone test done?

A

LOW DOSE- to confirm your diagnosis of cushings

HIGH dose- to see whether its pituitary or ectopic ACTH release

Rakeem's Endocrinology (23 decks)

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