Hypercortisolism Amboss Style

Question 1

Etiology of Cushing syndrome

Answer 1

Prolonged glucocorticoid therapy → hypercortisolism → decreased ACTH → bilateral adrenal atrophy

Question 2

Most common cause of hypercortisolism

Answer 2

Exogenous (iatrogenic) Cushing syndrome

Question 3

Primary hypercortisolism (ACTH-independent Cushing syndrome) Causes

Answer 3

Autonomous overproduction of cortisol by the adrenal gland → ACTH suppression → atrophy of the contralateral adrenal gland
*Adrenal adenomas
*Adrenal carcinoma
*Macronodular adrenal hyperplasia

Question 4

Secondary hypercortisolism Pituitary ACTH production (Cushing disease) causes

Answer 4

Pituitary adenomas → ACTH secretion → bilateral adrenal gland hyperplasia

Question 5

Ectopic ACTH production is it primary or secondary? Causes?

Answer 5

*Paraneoplastic syndrome → ↑ ACTH secretion → bilateral adrenal gland hyperplasia
*Carcinomas include:
Small cell lung cancer
Renal cell carcinoma
Pancreatic or bronchial carcinoid tumors
Pheochromocytoma
Medullary thyroid carcinom

Question 6

Clinical features of Cushing syndrome

Answer 6

Purple Abd striae
Hirsutism
Hyperpigmentation
Flushing
Wound healing slow
Depression
Moon facies and dorsocervical fat pad
HTN secondary
DM
Obesity

Question 7

Lab studies will show in Cushing Sym

Answer 7

Hypernatremia
Hypokalemia
Metabolic alkalosis

Question 8

Testing for hypercortisolism primary hypercortisolism

Answer 8

Low dose dexamethasone suppression no change cortisol
High doses dexamethasone suppression no change cortisol
CRH and desmopression stimulation test no change in ACTH or cortisol

Question 9

Ectopic ACTH secretion with be ↓ ↑

Answer 9

↑

Question 10

DD Cushing Disease

Answer 10

ACTH ↑
LDD nothing
HDD ↓ cortisol
CRH and desmopression ↑ACTH Cortisol ↑

Question 11

Treatment Cushing syndrome

Answer 11

Enzyme inhibitors (e.g., metyrapone, ketoconazole) suppress cortisol synthesis, while glucocorticoid antagonists block the action of cortisol in peripheral tissues.