Cushings Syndrome

Question 1

What is Cushings Syndrome?

Answer 1

The clinical manifestation of increased levels of glucocorticoids (cortisol) from any cause

Question 2

Epidemiology and Cushing’s

Answer 2

Relatively uncommon
Affects those with HTN, adrenal Ca, osteoporosis more
More likely in women
Usually diagnosed between 20-50

Question 3

Aetiology of Cushing’s

Answer 3

Most common cause is EXOGENOUS corticosteroids exposure

Most common ENDOGENOUS cause is :

• ACTH secreting pit. adenoma
• Adrenal adenoma
• Adrenal carcinoma

Question 4

Classification of Cushing’s

Answer 4

ATCH increased
-pituitary adenomas

ACTH decreased
-adrenal adenoma/carcinoma

Exogenous
-drugs

Question 5

Risk factors for cushings

Answer 5

Adrenal Ca
ACTH Pit. adenoma
Corticosteroid use

Question 6

DDx Cushings

Answer 6

Metabolic syndrome

Obesity

Question 7

Clinical presentation of Cushings

Answer 7

CUSHINGOID

Cataracts
Ulcers
Skin: striae, thinning, bruising
HTN/Hypergly./Hirtuism
Infections
Necrosis
Glycosuria
Osteoporosis/obesity
Immunosuppression
Diabetes

Question 8

Investigations to consider in Cushings

Answer 8

Overnight dexamethasone suppression test: >50nanomol
24hr urine cortisol: >50micrograms/24hr
Late night serum cortisol: increased
Serum glucose: increased
Imaging may show Ca

Question 9

Management

Answer 9

Surgery if mass present

Pharmaceutical with steroidogenesis inhibitors