Pituitary Adenoma 3 - Cushing's syndrome

Question 1

Cushing’s syndrome.
Cushing’s syndrome describes the symptoms of increased circulating
?.
lt occurs most commonly from ? administration of ?.
? forms of the syndrome are rare

Answer 1

glucocorticoid
exogenous
steroids
spontaneous

Question 2

ACTH dependent causes;
o ? disease.
—–• Increased ACTH from the ?: 65%.
o ? ACTH.
—–• Non-pituitary ACTH secreting tumour: 10%.
————• Classically ?-cell ? cancer.

Answer 2

cushing’s
pituitary
ectopic
small cell lung cancer

Question 3

ACTH independent causes;
o Excess ? ? production.
—• Due to an ? tumour or ? hyperplasia - 25%.
—• Subsequent physiological ACTH ?.

Answer 3

adrenal cortisol
adrenal
nodular
suppression

Question 4

Symptoms;

? ? gain.
Change of ?.
?.
?.
Poor ?.
? skin / easy ?.
? hair growth / acne.
? symptoms.

Answer 4

central weight
appearance
depression
insomnia
libido
thin
bruising
excess
diabetes

Question 5

Signs;

? face.
Frontal ?.
?.
Hypertension.
Pathological ?.
'? hump'
? myopathy.

Answer 5

moon
balding
striae
fractures
buffalo
proximal

Question 6

There may also be ? due to the mineralocorticoid activity of ?.
A cushingoid appearance can also be caused by excess ? .

Answer 6

hypokalaemia
cortisol
alcohol

Question 7

Diagnosis;

Confirm raised ?.
Overnight ? ? test.
o ? test.
o 1mg oral ? given at ?.
o Serum ? checked before, and then at ?am.
• Normal: negative feedback leads to ? level

Answer 7

cortisol
dexamethasone suppression
OP
dexamethasone
midnight
cortisol
8
cortisol
50
suppress
cortisol

Question 8

Other screening tests to confirm Cushing’s syndrome are a 48h ? ? test, 24 hour ? free ? or ? ? level.
If any of the above tests are abnormal, ? tests are required.
Plasma ?: if undetectable, ? cause is likely.
o Proceed to ? ?.

Answer 8

dexamethasone suppression
urinary free cortisol
midnight cortisol
localization
ACTH
adrenal
adrenal CT

Question 9

If ACTH is detectable, ? vs. ? sources must be separated;
o ? dose ? ? test.
–• ? 2mg/6h PO for ?d.
–• Measure plasma and ? ? at ? and ? hours.
–• ? / ? suppression indicates Cushing’s disease.
—–• The pituitary maintains some ?control.
—–• ? of the sella turcica required.
–• ? suppression indicates an ectopic source.
–• ? / find the primary ?.

Answer 9

ectopic
pituitary
high
dexa supp
dex
2
urinary cortisol
0
48
complete/partial
feedback
MRI
no
CXR
tumour

Question 10

Dx
An alternative is the ? ? hormone test, where ??H is given, and ? is measured at ? hours.
o Raised with ? disease but not with ? disease

Answer 10

corticotrophic releasing
CR
cortisol
2
pituitary
ectopic

Question 11

The main management of pituitary adenomas is ? ? - apart from with ?

? should not be delayed, as prolonged ? ? compression can lead to a permanent loss of ?

Answer 11

transphenoidal surgery
prolactinoma
surgery
optic chiasm
vision