Endocrine: Cushings syndrome

Question 1

Most types of Cushings syndrome are treated surgically. What drug has been found to be helpful in controlling symptoms of the disease and to prepare a patient for surgery?

Answer 1

Metyrapone.

Question 2

How does metyrapone work?

Answer 2

Metyrapone is a competitive inhibitor of 11B-hydroxylation in the adrenal cortex, the resulting inhibition of cortisol (and to a lesser extent aldosterone) production leads to an increase in ACTH production which in turn leads to increased synthesis and release of cortisol precursors.

Avoid in acute porphyrias.

Question 3

What antifungal can be used under specialist supervision for treatment of endogenous Cushing’s syndrome?

Answer 3

Ketoconazole. It may have a direct effect on corticotropic tumour cells in patients with Cushings disease.

Question 4

What is the most common cause of Cushing disease?

Answer 4

A type of pituitary tumour called an adenoma - benign.

With Cushings disease, the pituitary gland releases too much ACTH.

ACTH stimulates the production and release of cortisol, a stress hormone because ACTH causes the adrenal glands to make too much.

Question 5

What is the most common cause of Cushing disease?

Answer 5

A type of pituitary tumour called an adenoma - benign.

With Cushings disease, the pituitary gland releases too much ACTH.

ACTH stimulates the production and release of cortisol, a stress hormone because ACTH causes the adrenal glands to make too much.

Question 6

Women with Cushings may notice what?

Answer 6

Extra facial hair and body hair, absent or irregular menstruation.

Question 7

Men with Cushings may notice what?

Answer 7

ED
Loss of sexual interest
Decreased fertility

Question 8

What are the most characteristic features of Cushings disease?

Answer 8

1. Weight gain/obesity.
2. Fatty deposits, especially in the midsection, the face (causing a round, moon-shaped face) and between the shoulders and the upper back: Buffalo hump.
3. Purple stretch marks on the breasts, arms, abdomen and thighs.
4. Thinning skin that bruises easily.

Also:
Acne, fatigue, muscle weakness, glucose intolerance, increased thirst, increased urination.

Question 9

What is the most common medicine which causes cushings?

Answer 9

Corticosteroid medications like prednisolone.

Question 10

What tests can be used for Cushings? (3)

Answer 10

1. A 24-hour urinary free cortisol test.
2. Midnight plasma cortisol and late-night salivary cortisol measurements.
3. Low-dose dexamethasone suppression test.

Question 11

What are the potential complications of untreated Cushings?

Answer 11

1. Bone loss and fractures (think longterm corticosteroid use?)
2. Muscle loss and weakness
3. High blood pressure
4. T2 diabetes
5. Infections
6. Kidney stones