Cushings Syndrome Flashcards
define cushings syndrome
any cortisol excess state
define cushings disease
cortisol excess state due to ACTH producing pituitary adenoma
name the four ways to get cushings syndrome
cushings disease (pituitary ACTH secretion)
ectopic ACTH
ectopic CRH
adrenal/cortical adenoma
what are the features of cortisol excess?
muscle wasting/weakness easy bruising/poor wound healing osteoporosis central obesity glucose intolerance hyperglycemia/diabetes psych disturbances
what is seen on skin with cortisol excess?
easy bruising and poor wound healing
what is seen in MSK with cortisol excess?
osteoporosis
what three tests are used for cushings syndrome diagnosis
24 hour free urine cortisol
low dose dexamethasone suppression test
salivary free cortisol
if tests for cortisol are abnormally high, what is next step in management of cushings
figure out where ACTH is coming from
how do you find out where ACTH is coming from?
just measure it..if high then issue is outside of the adrenal gland
if ACTH is low and cortisol is high, where is issue?
adrenal cushing
what is most common cause of adrenal cushings?
adrenocortical adenomas
if you have high ACTH and high cortisol, what test do you run and why
high dose dexamethasone suppression test…to figure out where ACTH is coming from
in HDDST explain the two possible outcomes
if ACTH is from pituitary then pituitary will slow ACTH prdxn and it will decrease in response to high dose, but if ectopic ACTH prdxn then prdxn will continue
what are rx options for ACTH secreting tumor pituitary?
surgical removal
drug therapy to block ACTH
bilateral adrenalectomy
what are rx options for primary adrenal cortisol secreting tumor?
surgical resection
drug therapy to block steroid biosynthesis
