Uro/Endo week: Cushings, Addisons Flashcards
Cushings/Addisons
which has too much/little cortisol
Addison’s: too little cortisol
Cushing’s: too much cortisol
Pathophysiology of Addison’s
Destruction of entire adrenal cortex by antibodies
Pathophysiology of Cushing’s
differentiate among:
- Cushing’s disease
- Cushing’s syndrome
- pseudo-Cushing’s syndrome
Persistent elevated circulating glucocorticoid levels
Cushing’s disease: excess glucocorticoids due to inappropriate ACTH secretion from pituitary gland
Cushing’s syndrome: excess glucocorticoids from any other reason
pseudo-Cushing’s syndrome: from alcohol excess
Clinical features of Addison’s
- lethargy, depression
- anorexia, weight loss
- postural hypotension
- hyperpigmentation in: buccal mucosa, pressure points, skin creases, recent scars
Clinical features of Addisonian crisis (emergency)
- Vomiting
- Abdominal pain
- Profound weakness
- Hypoglycaemia
- Hypovolaemic shock
Clinical features of Cushing’s
- moon cause
- buffalo hump neck
- fat in trunk, abdomen-
- thin, easily bruised skin
- purple striae on skin
- hypertension
- osteoporosis
- acne, hirsutism
- polyuria, polydipsia
- poor libido
- depression, psychosis
- infrequent/absent periods
What causes hyperpigmentation in Addison’s
Stimulation of melanocytes by excess ACTH in primary hypoadrenalism
Increased levels of melanin stimulating hormone
What does cortisol control
Blood glucose (increases gluconeogenesis, metabolises fat, protein, carbohydrates)
What does aldosterone control
- Blood pressure
- Level of sodium in blood
4 causes of Cushings
- Exogenous drugs
- Pituitary adenoma
- Adrenal adenoma
- Ectopic ACTH - small cell lung cancer (most common)
What skin condition is Addison’s associated with
Vitiligo
Hyperpigmentation
What can precipitate an Addisonian crisis
Steroid medication withdrawal
