cushings syndrome Flashcards
symptoms of cushings?
weight gain, change of appearance, depression, insomnia, amenorrhoea, poor libido, thin skin, hair growth, acne, slow growth in children, back pain, polyuria, dyspepsia
signs?
moonface, frontal balding in females, pigmentation, skin infections, hypertension, osteoperosis, pathological fractures, buffalo hump, kyphosis, straie, oedema, proximal myopathy, glycosuria
what is the important distinction to make in cushings?
those that are ACTH dependant and independent
what happens in cushings disease
there is an increase in pituitary ACTH production
why does an adrenal tumour cause suppressed ACTH?
negative feedback from cortisol
diagnose cushings?
24-hour urinary free cortisol measurements
48-hour low does dexamethasone test
cortisol high and ACTH is very low or even undetectable, what does this suggest?
adrenal tumour
how to you investigate adrenal adenomas and carcinomas?
CT
imaging method to identify pituitary tumour?
pituitary MRI
in the high dose dexamethasone test, failure to suppress suggests?
adrenal tumour or ectopic production of ACTH
what do you die with in cushings?
MI, hypertension, infection or heart failure
two main options for treatment ?
surgery and radiotherapy
the hypersecretion of cortisol should be controlled before the ‘proper’ treatment begins. what drug should be given?
metyrapone
treatment of adrenal adenoma?
Should be resected after remission with drug treatment has been achieved
treatment of adrenal carcinoma?
These are very aggressive and the prognosis is poor. Generally, if there are not widespread metastasis, then you should treat the primary tumour surgically. Radiotherapy may be beneficial to some patients.
treatment of Ectopic ACTH tumours?
These should be removed wherever possible, and if not, then chemo and radiotherapy can be beneficial
phaeochromocytoma is a neuroendocrine tumour of which part of the adrenal gland?
the medulla
large quantities of which catecholamines are released?
lots of noradrenaline, adrenaline to a lesser extent
phaeochromocytoma (NAH)
presents with severe headaches and hypertension
why would you get cardiac tachycardias?
NA and adrenaline
what 3 things are phaeochromocytomas associated with?
associated with MEN type II, neurofibromatosis and von Hippel-Lindau syndrome
how do you confirm pahaeocromocytoma?
Confirmed by 3x 24-hour collection of urine catecholamines
what is the initial best test to rule out phaechr…?
met adrenaline blood test
what other symptoms would you expect ?
think adrenaline
A plethora of other symptoms, including flushing+unwell+wt loss (like in hyperthyroid), panic/anxiety, sweating, pallor, hyperglycaemia, pyrexia, abdominal pain …
