cushings syndrome, hypopituitarism and diabetes insipidus Flashcards
What causes Cushing syndrome
Excess cortisol
What are the features of Cushing syndrome?
Myopathy, wasting
Osteoporosis and fractures
Thin skin and bruising
What are the long term effects of Cushing syndrome?
Loss of protein
Altered lipid metabolism
Diabetes Mellitus
Obesity
Altered psyche
Excess mineral corticoid
Excess androgen
What is a rare consequence of Cushing syndrome?
PCOS
What is cushings characterised by?
Thin skin
Proximal myopathy
Frontal balding in women
Conjunctival oedema
Osteoporosis
What are the diagnostic tests for Cushing’s syndrome?
Overnight dexamethasone suppression test (cortisol >130 Nmol/l=abnormal)
Urine free cortisol (24hr urine collection)
Normal is total <250
Diurinal cortisol variation (midnight/8am)
Loss of diurinal variation is suspicious of cushings
What causes Cushing’s syndrome?
Most is due to pituitary tumour=cushings disease
Adenoma of adrenal
Ectopic ACTH production
(Particularly rumours of the thymus, lung and pancreas)
Pseudo
(Alcohol and depression
Steroid medication)
What is the treatment for cushings?
Pituitary
-hypophysectomy
-external radiation
-bilateral adrenalectomy
Adrenal
-adrenalectomy
Ectopic
-remove source
What are the drug treatments for cushings?
Metyrapone
-if other treatments fail
-side effects common
Ketoconazole (hepatotoxic)
Pasireotide LAR
-somatostatin analogue
What can cause pan hypopituitarism?
Pituitary tumours
Other local brain tumours
- meningioma
- glioma
Iatrogenic/surgery
granulomatous disease eg tb
vascular diseases eg polyarteritis
Trauma
Secondary metastases
Hypothalamic disease
Infection
What are the symptoms and signs of anterior hupopituitarism?
Menstrual irregularities
Infertility
Impotence
Gynaecomastia
Abdo obesity
Loss of facial fair
Loss of axillary and pubic hair
Dry skin
Hypothyroid faces
Growth retardation (children)
What are the replacement therapies for hypopituitism
Thyroxine
Hydrocortisone
ADH (desmospray or desmopressin tablets)
GH
sex steroids
How is testosterone given?
IM injection every 3-4 weeks
Skin gel
Prolonged IM injections
What are the risks of testosterone treatments?
Polycythaemia (risk of stroke/MI) ( monitor FBC)
Prostate enlargement (monitor PSA)
Hepatitis in oral tablets (monitor LFTs)
Effects of Growth hormone replacement in adults
Improves wellbeing and quality of life
Decrease abdo fat
Increases muscle mass and strength
Improve cardiac function
Decrease cholesterol and increases LDL
increases bone density
