[Endo] Cushing's syndrome Flashcards

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1
Q

what does Cushing’s syndrome cause?

A

hypercortisolism

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2
Q

what can the causes of Cushing’s syndrome be divided into?

A
  1. ACTH dependent
  2. ACTH independent
  3. exogenous
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3
Q

what does ACTH dependent mean?

A

increased/inappropriately normal ACTH

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4
Q

what are some ACTH dependent causes of Cushing’s syndrome?

A
  • pituitary adenoma (Cushing’s disease)

- ectopic ACTH secretion

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5
Q

what does ACTH independent mean?

A

excessive cortisol despite suppressed ACTH

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6
Q

what are some ACTH independent causes of Cushing’s syndrome?

A
  • adrenal adenoma

- bilateral adrenal hyperplasia

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7
Q

what are exogenous causes of Cushing’s syndrome?

A

exogenous corticosteroids use

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8
Q

what are the differentials for hypercortisolism?

A
  • metabolic syndrome
  • physical stress
  • malnutrition
  • alcoholism
  • depression
  • pregnancy
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9
Q

you suspect a pt has Cushing’s syndrome. what do you do first?

A

exclude exogenous glucocorticoid exposure

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10
Q

once you have excluded exogenous glucocorticoid exposure, what test would you perform?

A

one of:

  • 24 h urinary cortisol
  • overnight (low-dose) 1mg dexamethasone suppression test
  • salivary cortisol
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11
Q

the test you performed for Cushing’s syndrome came back with an abnormal result. what do you do next?

A
  • exclude physiological causes

- perform other tests that have not been initially completed. if abnormal result → Cushing’s syndrome diagnosed

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12
Q

you have confirmed a dx of Cushing’s syndrome. what test do you order now?

A

serum midnight ACTH measurement

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13
Q

serum midnight ACTH measurement showed an inappropriately normal/raised ACTH. what does this mean?

A

ACTH dependent cause

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14
Q

how do you further investigate an ACTH dependent cause of Cushing’s syndrome?

A

high-dose dexamethasone suppression test

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15
Q

high-dose dexamethasone suppression test shows cortisol being suppressed. what is the cause of Cushing’s syndrome?

A

Cushing’s disease (pituitary adenoma)

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16
Q

how do you confirm a dx of Cushing’s disease?

A

pituitary MRI

17
Q

high-dose dexamethasone suppression test does not suppress cortisol. what is the cause of Cushing’s syndrome?

A

ectopic ACTH

18
Q

how do you confirm a dx of Cushing’s syndrome 2˚ to ectopic ACTH?

A

CT TAP

19
Q

serum midnight ACTH measurement showed a low ACTH. what does this mean?

A

ACTH independent cause

20
Q

how do you further investigate an ACTH independent cause of Cushing’s syndrome?

A

CT TAP for ? adrenal adenoma

21
Q

what may be needed to differentiate between pituitary and ectopic ACTH secretion?

A

petrosal sinus sampling of ACTH

22
Q

what is the medical mx for Cushing’s disease?

A

one of:

  • somatostatin analogues
  • steroidogenesis inhibitors
  • glucocorticoid receptor antagonists
23
Q

what is the surgical mx for Cushing’s disease?

A

transsphenoidal resection of pituitary adenoma

24
Q

what is the mx for ACTH independent Cushing’s syndrome?

A

surgical: laparoscopic adrenalectomy

25
Q

what is the medical mx for ectopic ACTH?

A

one of:

  • somatostatin analogues
  • steroidogenesis inhibitors
  • glucocorticoid receptor antagonists
26
Q

what is the surgical mx for ectopic ACTH?

A
  • surgical resection of the ACTH producing tumour

- bilateral adrenalectomy

27
Q

young female with resistant HTN and hypokalaemia. dx?

A

Conn’s syndrome

28
Q

headache, sweating, tachycardia and HTN. dx?

A

phaeochromocytoma

29
Q

suppressed cortisol levels following high dose dexamethasone suppression. dx?

A

Cushing’s disease (pituitary adenoma)

30
Q

why should you never suddenly stop / omit long-term steroids?

A

can precipitate Addisonian crisis