Cushings syndrome Flashcards
What is it
A collection of signs and symptoms that occur when a patient has long-term exposure to cortisol
Types
Exogenous
Endogenous
Exogenous causes
Iatrogenic e.g. prescription of glucocorticoids for asthma
ACTH dependent endogenous causes
Cushings disease
Ectopic ACTH production (usually from small cell lung cancer)
What is Cushings disease
When ACTH is produced from a pituitary adenoma
Test for Cushings disease
Low-dose dexamethasone test to confirm
ACTH independent endogenous causes
CAS
Cancer - adrenal adenoma
Adrenal nodular hyperplasia
Steroid use
Signs and symptoms
Moon face Central obesity Buffalo hump Acne Hypertension Hyperglycaemia Striae Vertebral collapse Proximal muscle wasting Psychosis
Why should a patient be advised to decrease alcohol intake
Alcohol increases cortisol levels
Diagnostic tests
Urinary free cortisol
Low-dose and high-dose dexamethasone suppression test
Other investigations
Bloods - FBC, U/Es, LFTs, glucose, lipid levels
Radiology - CXR (look for lung cancer and vertebral cancer)
Other - dual energy X-ray (DEXA scan)
Complications
Osteoporosis Diabetes mellitus Hypertension Immunosupression Cataracts Striae formation Ulcers
Conservative treatment
Education about the condition
Lower alcohol consumption
Medical treatment
Ketoconazole
Metyrapone
Mitotane
Treat complications such as hypertension and DM
Surgical treatment of pituitary adenoma
Trans-sphenoidal surgery
