Endo - Cushings Flashcards
How might Cortisol excess present?
Weight gain
Easy bruising
Mood change
Proximal weakness
What are the main features of cortisol excess?
Bruising, striae, hyperpigmentation
Hirsuitism, acne, moon face
Central obesity
Proximal myopathy + leg muscle wasting
DM, HTN
What is the difference between Cushing’s syndrome and Cushing’s Disease?
Cushing’s syndrome describes the physical signs of cortisol excess.
Cushing’s disease is when this cortisol excess is due to a pituitary adenoma secreting ACTH
What are the causes of Cushing’s syndrome?
Cushing’s disease
Excess cortisol use (RA, COPD)
Adrenal adenoma
What is pseudo-Cushing’s?
Similar presentation but caused by alcohol/depression/obesity - all bloods will be normal
How do you investigate Cushing’s syndrome?
- Confirm excess cortisol
- 24h urinary cortisol
- overnight Dex suppression test: morning cortisol should be low (suppressed) - once cortisol excess confirmed:
- if ACTH raised: pituitary cause/ectopic ACTH tumour
- if ACTH low: adrenal - MRI pituitary, CT adrenals, CT whole body to look for tumours
- Inferior petrosal sinus sample: lateralise the source of ACTH from pituitary and exclude ectopic-ACTH source.
What are the treatment options for a pituitary or adrenal adenoma?
- TS surgery of pituitary or adrenalectomy
- Pituitary RT
- Metyrapone
What is the prognosis of untreated Cushing’s syndrome?
50% mortality at 5 years due to accelerated IHD 2’ to DM and HTN.
Differential diagnosis of proximal myopathy?
- Inherited:
- Myotonic dystrophy
- Muscular dystrophy - Endocrine:
- Cushing’s
- Hyperthyroid
- Hyperparathyroidism
- Diabetic amyotrophy - Inflammatory:
- myositis
- PMR
- RA - Metabolic
- Osteomalacia - Malignant - Paraneoplastic
- NMJ
- MG/LEMS - Drugs
- Alcohol, steroid
