cushings syndrome Flashcards

1
Q

symptoms of cushings?

A

weight gain, change of appearance, depression, insomnia, amenorrhoea, poor libido, thin skin, hair growth, acne, slow growth in children, back pain, polyuria, dyspepsia

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2
Q

signs?

A

moonface, frontal balding in females, pigmentation, skin infections, hypertension, osteoperosis, pathological fractures, buffalo hump, kyphosis, straie, oedema, proximal myopathy, glycosuria

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3
Q

what is the important distinction to make in cushings?

A

those that are ACTH dependant and independent

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4
Q

what happens in cushings disease

A

there is an increase in pituitary ACTH production

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5
Q

why does an adrenal tumour cause suppressed ACTH?

A

negative feedback from cortisol

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6
Q

diagnose cushings?

A

24-hour urinary free cortisol measurements

48-hour low does dexamethasone test

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7
Q

cortisol high and ACTH is very low or even undetectable, what does this suggest?

A

adrenal tumour

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8
Q

how to you investigate adrenal adenomas and carcinomas?

A

CT

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9
Q

imaging method to identify pituitary tumour?

A

pituitary MRI

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10
Q

in the high dose dexamethasone test, failure to suppress suggests?

A

adrenal tumour or ectopic production of ACTH

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11
Q

what do you die with in cushings?

A

MI, hypertension, infection or heart failure

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12
Q

two main options for treatment ?

A

surgery and radiotherapy

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13
Q

the hypersecretion of cortisol should be controlled before the ‘proper’ treatment begins. what drug should be given?

A

metyrapone

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14
Q

treatment of adrenal adenoma?

A

Should be resected after remission with drug treatment has been achieved

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15
Q

treatment of adrenal carcinoma?

A

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.

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16
Q

treatment of Ectopic ACTH tumours?

A

These should be removed wherever possible, and if not, then chemo and radiotherapy can be beneficial

17
Q

phaeochromocytoma is a neuroendocrine tumour of which part of the adrenal gland?

A

the medulla

18
Q

large quantities of which catecholamines are released?

A

lots of noradrenaline, adrenaline to a lesser extent

19
Q

phaeochromocytoma (NAH)

A

presents with severe headaches and hypertension

20
Q

why would you get cardiac tachycardias?

A

NA and adrenaline

21
Q

what 3 things are phaeochromocytomas associated with?

A

associated with MEN type II, neurofibromatosis and von Hippel-Lindau syndrome

22
Q

how do you confirm pahaeocromocytoma?

A

Confirmed by 3x 24-hour collection of urine catecholamines

23
Q

what is the initial best test to rule out phaechr…?

A

met adrenaline blood test

24
Q

what other symptoms would you expect ?

think adrenaline

A

A plethora of other symptoms, including flushing+unwell+wt loss (like in hyperthyroid), panic/anxiety, sweating, pallor, hyperglycaemia, pyrexia, abdominal pain …

25
Q

treatment of pheochromocytoma?

A

Stabilise patient: ALPHA-blockers (phenoxybenzamine) BEFORE beta-blockers, to prevent hypertensive crisis from unopposed alpha-stimulation.

26
Q

definitive surgical treatment ?

A

surgical resection of adrenal gland