Cushings Syndrome Flashcards
Cushings syndrome relates to prolonged high levels glucocorticoids in the body and is estimated to affect up to 40 million people. Is this typically more common in men or women?
- women
What age does cushings syndrome typically peak?
1 - 10-20
2 - 25-40
3 - 30-50
4 - 40-80
2 - 25-40
Which 2 of the following are glucocorticoids that cause cushings syndrome?
1 - cortisol
2 - aldosterone
3 - androstenedione
4 - adrenaline
1 - cortisol
2 - aldosterone
Cortisol is the primary natural glucocorticoid produced by the adrenal gland
Cushings disease refers to excessive release of cortisol from the adrenal glands due to excessive adrenocorticotropic hormone (ACTH). What is the cause of cushings disease?
1 - hypothalamus calcium toxicity
2 - pituitary adenoma
3 - adrenal adenoma
4 - all of the above
2 - pituitary adenoma
This is NOT the only cause of cushing syndrome though
Which of the following does NOT typically lead to cushings syndrome?
1 - prednisolone
2 - salbutamol
3 - dexamethasone
4 - methylprednisolone
2 - salbutamol
All others are exogenous corticosteroids that are NOT produced by the body
Which of the following is NOT a feature of cushings syndrome?
1 - Round face/moon face
2 - Central anorexia
3 - Abdominal striae
4 - Fat pad on the upper back/buffalo hump
5 - Proximal limb muscle wasting/weakness
6 - Male pattern facial hair in women (hirsutism)
7 - Easy bruising and poor skin healing
8 - Hyperpigmentation of the skin
2 - Central anorexia
Leads to central obesity
In addition to clinical features in cushings syndrome, which of the following metabolic effects does cushings syndrome also cause?
1 - Hypertension
2 - Cardiac hypertrophy
3 - Type 2 diabetes
4 - Dyslipidaemia (cholesterol/triglycerides)
5 - Osteoporosis
6 - all of the above
6 - all of the above
In addition to clinical features in cushings syndrome, which of the following mental health effects does cushings syndrome NOT cause?
1 - Anxiety
2 - Depression
3 - Insomnia
4 - Psychosis (rarely)
6 - Autism
6 - Autism
The mnemonic CAPE can be used to remember the causes of cushings syndrome. What does the C refer to?
1 - Calcium
2 - Cushing disease and pituitary adenoma
3 - Cortisol levels due to adrenal adenoma
2 - Cushing disease and pituitary adenoma
Pituitary adenoma causes elevated ACTH that subsequently causes increased cortisol
The mnemonic CAPE can be used to remember the causes of cushings syndrome. What does the A refer to?
1 - Adrenal adenoma increasing cortisol
2 - Alopecia causing thin and weak skin
3 - ACTH increased due to hypothalamus tumour
1 - Adrenal adenoma increasing cortisol
The mnemonic CAPE can be used to remember the causes of cushings syndrome. What does the P refer to?
1 - Pituitary atrophy
2 - Paraneoplastic syndrome
3 - Parathyroid hormone
2 - Paraneoplastic syndrome
Tumours that secrete Adrenocorticotropic hormone (ACTH), referred to as ectopic ACTH
Small cell lung cancer is the most common cause
The mnemonic CAPE can be used to remember the causes of cushings syndrome. What does the E refer to?
1 - Elevated parathyroid hormone
2 - Enlarged thyroid/goitre
3 - Endogenous steroids
3 - Endogenous steroids
Which of the following causes of cushings syndrome is most likely to cause hyperpigmentation of the skin?
1 - cushings disease due to pituitary adenoma and raised ACTH
2 - adrenal adenoma increasing cortisol
3 - paraneoplastic syndrome
4 - endogenous steroids
1 - cushings disease due to pituitary adenoma and raised ACTH
ACTH stimulates melanocytes to produce melanin
Hyperpigmentation does NOT occur due to exogenous steroids or adrenal adenoma
Which of the following is the gold standard for diagnosing cushings syndrome?
1 - 24h urine cortisol levels
2 - head MRI
3 - U&Es
4 - dexamethasone suppression test
4 - dexamethasone suppression test
The dexamethasone suppression test is the gold standard for diagnosing cushing syndrome. Which of the following causes of cushings syndrome is this test NOT effective for diagnosing as a possible cause of cusging syndrome?
1 - cushings disease due to pituitary adenoma and raised ACTH
2 - adrenal adenoma increasing cortisol
3 - paraneoplastic syndrome
4 - endogenous steroids
4 - endogenous steroids
The dexamethasone suppression test is the gold standard for diagnosing cushing syndrome. The initial test is a low dose of dexamethasone test. What would a normal response to dexamethasone look like?
1 - increased cortisol
2 - cortisol levels remain constant
3 - reduced cortisol levels
3 - reduced cortisol levels
Negative feedback causes by dexamethasone would lead to reduction in:
- corticotropin-releasing hormone (CRH) output
- Adrenocorticotropic hormone (ACTH) output
- low CRH and ACTH = lower cortisol release by adrenal gland
The dexamethasone suppression test (DST) is the gold standard for diagnosing cushing syndrome. There are 3 types of DST, which of these is used if you suspect cushing syndrome?
1 - Low-dose overnight test
2 - Low-dose 48-hour test
3 - High-dose 48-hour test
4 - any of the above
2 - Low-dose 48-hour test
- begin at 9am with cortisol measured
- 0.5mg/6h for total of 8 doses
- cortisol measured at 9am on day 3
- Normal response = suppressed cortisol
- Abnormal response = unsuppressed cortisol
Abnormal could be due to cushing syndrome
The dexamethasone suppression test (DST) is the gold standard for diagnosing cushing syndrome. There are 3 types of DST, which of these is used to exclude cushing syndrome?
1 - Low-dose overnight test
2 - Low-dose 48-hour test
3 - High-dose 48-hour test
4 - any of the above
1 - Low-dose overnight test
- Dexamethasone given 10-11pm
- Cortisol checked at 9am
- Normal response = suppressed cortisol
- Abnormal response = unsuppressed cortisol
Abnormal could be due to cushing syndrome
The dexamethasone suppression test (DST) is the gold standard for diagnosing cushing syndrome. There are 3 types of DST, which of these is used if you have a confirmed diagnosis of cushing syndrome?
1 - Low-dose overnight test
2 - Low-dose 48-hour test
3 - High-dose 48-hour test
4 - any of the above
3 - High-dose 48-hour test
- begin at 9am with cortisol measured
- 2mg/6h for total of 8 doses
- cortisol measured at 9am on day 3
- Normal response = suppressed cortisol
- Abnormal response = unsuppressed cortisol
High dose dexamethasone can suppress cushings disease due to pituitary adenoma.
DOES NOT suppress cause of adrenal adenoma or ectopic ACTH.
Of the following options, which would we expect to see in a patient with a ectopic adrenocorticotropic hormone (ACTH) due to a paraneoplastic syndrome such as a small cell lung cancer?
Dexamethasone unable to suppress cortisol or ACTH as no negative feedback loop involved in ectopic ACTH production
Of the following options, which would we expect to see in a patient with a pituitary adenoma causing adrenocorticotropic hormone (ACTH) elevated ACTH and cortisol?
Dexamethasone able to suppress cortisol due to negative feedback loop involved, but ACTH continues due to adenoma
Of the following options, which would we expect to see in a patient with a adrenal adenoma causing elevated cortisol?
Dexamethasone reduced ACTH due to negative feedback, BUT cortisol remains high due to adenoma
The dexamethasone suppression test is the gold standard for diagnosing cushings syndrome. All of the following are methods for diagnosing cushing syndrome, but which of the following is the most common 2nd line test to perform?
1 - 24h urine cortisol levels
2 - head MRI
3 - U&Es
4 - full blood count (high WBC count)
5 - U&Es (hypokalaemia)
6 - MRI brain for a pituitary adenoma
7 - CT chest for small cell lung cancer
8 CT abdomen for adrenal tumours
1 - 24h urine cortisol levels
All others can be used once there is a more accurate identification of the cause of cushing syndrome
Treatment for cushing syndrome is based on the cause. Which of the following is the 1st line for treating a pituitary adenoma?
1 - Bore holes
2 - Radiotherapy
3 - Trans-sphenoidal
4 - Chemotherapy
3 - Trans-sphenoidal
In ectopic and adrenal adenomas, surgery to remove the cause would be used
If surgery is not possible in a patient with cushings disease due to a pituitary adenoma, what can also be offered?
1 - Bore holes
2 - Radiotherapy
3 - Long term strong dose of dexamethasone to suppress adrenal glands
4 - Removal of both adrenal glands and lifelong steroids
4 - Removal of both adrenal glands and lifelong steroids
If both the adrenal glands are removed as surgery on the pituitary tumour is not possible, this can lead to what?
1 - thyrotoxicosis
2 - nelsons syndrome
3 - psychosis
4 - anorexia
2 - nelsons syndrome
No negative feedback from exogenous cortisol means the pituitary adenoma growth goes into over drive
