Cushings syndrome

Question 1

Epidemiology of Cushings syndrome

Answer 1

5:1 F:M 25-40

Incidence of Cushing’s syndrome is around of 10 to 15 people per million,

cushings disease itself is rare.

higher incidence in people with diabetes, obesity, hypertension or osteoporosis.

obese patients with type 2 diabetes, especially those with poor blood glucose control and hypertension, the reported prevalence of Cushing’s syndrome is between 2% and 5%.

women adrenal/pituatary cancer more common as cause.

Question 2

Aetiology of Cushings syndrome

Answer 2

caused by prolonged exposure to elevated levels of either

exogenous glucocorticoids (drugs).
endogenous production =
pituatary tumour = Cushings Disease
adrenal gland tumour - -ve feed back on hypo/ pituitary

Question 3

pathogenesis

Answer 3

longterm increased levels of cortisol - anterior pituitary suppression
hippocampus destruction
thyroid problems
immune system suppression

increased oestrogen in men
increased testosterone in women
increase blood pressure
inflammation

Question 4

clincial manifestations

Answer 4

pigmentation (in cushings disease)
atrophic myopathy - loss of muscle mass decrease in fibre size

Hyperglycemia
Na and fluid retention
CNS irritability
fat deposits on back of shoulders/face

Question 5

symptoms

Answer 5

moon face
central obesity

GI distress - increased acid
Amenorrhea
Hirsuitism

Question 6

signs

Answer 6

osteoporosis - fracture risk
thin skin
purple striae
supraclavicular fat bad = buffalo hump.

Question 7

complication

Answer 7

increased chance of infection
perforated viscera and opportunistic fungal infections.
Exposure to excess glucocorticoids results in multiple medical problems, including hypertension, obesity, osteoporosis, fractures, impaired immune function, impaired wound healing, glucose intolerance, and psychosis.
mental function, renal stones

Question 8

prognosis

Answer 8

As a result of the multiple adverse effects of chronic glucocorticoid excess, both endogenous and exogenous Cushing syndrome are associated with significant morbidity.

Question 9

natural history

Answer 9

associated with an increased risk of premature death.