[Endo] Cushing's syndrome Flashcards

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?

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
what is the medical mx for ectopic ACTH?
one of: - somatostatin analogues - steroidogenesis inhibitors - glucocorticoid receptor antagonists
26
what is the surgical mx for ectopic ACTH?
- surgical resection of the ACTH producing tumour | - bilateral adrenalectomy
27
young female with resistant HTN and hypokalaemia. dx?
Conn's syndrome
28
headache, sweating, tachycardia and HTN. dx?
phaeochromocytoma
29
suppressed cortisol levels following high dose dexamethasone suppression. dx?
Cushing's disease (pituitary adenoma)
30
why should you never suddenly stop / omit long-term steroids?
can precipitate Addisonian crisis