W2L1 Cushing Syn

Question 1

Def?

Answer 1

Disorder coz by high lvl cortisol (hypercortisolism) in bl(take glucocorticoid drugs, tumors that produce
cortisol/adrenocorticotropic hormone (ACTH)

Question 2

Cause

Answer 2

1. ACTH-depedent
   - inc ACTH
2. ACTH-indepedent
   - inc cortisol, ACTH xelevate but dec due -ve feedback

Question 3

Signs and symptoms

Answer 3

1. Endocrine and metabolic
   - sys: dm w dec gluc tolerance, fasting hyperglycemia, glycosuria
2. Musculoskeletal system
   - ms weak, pathologic fractures
3. Skin
   - purplish striae, fat pads above clavicles, upper back(buffalo hump), face(moon face)
4. GI sys
   - peptic ulcer= inc gastric secretions
5. CNS
   - iiritability & emotional lability
6. CVS
   - HTN,capillary weak
7. Immune sys
   - inf
8. Renal & urologic
   - Na & 2ry fluid retention
9. Reproductive sys
   - inc androgen production, sex dysfx

Question 4

Metabolic effectt

Answer 4

1. Carbo meta:
   - inc glycogenesis, inc glucogenesis
   * symptoms(polydypsia, polyuria)
   * signs(DM, hyperglycaemia, insulin resistance)
2. Increased protein catabolism
   - easy bruise, patho fracture, abd striae, proximal ms wasting & myopathy
3. Inc & redistribution body fat
   - central obese,moon face, buffalo hump
4. Mineralcorticoid effects
   - Na retention, edema

Question 5

Diagnosis

Answer 5

1. Initially, diag Cushing’s syndrome
   - inc cortisol lvl
2. Confirm diag
   - low dexa supp -salivary cortisol
3. High-dose dexamethasone suppress test
   - determine coz
4. Imaging
   - US, CT scan, MRI
5. IPSS(ACTH)
6. Bl test

Question 6

Treatment

Answer 6

Depend on reason cortisol excess

1. Surgery
   - Pitutary(transsphenoidal/transfrontal)
   - Suprarenal(Adenoma, Carcnoma, hyperplasia)
2. Radio
3. Medical ttt
   - Somatostatin analogs
   - Adrenal steroid inhibitors(Metyrapone, ketoconazole, etomidate)
   - Glucocorticoid receptor antagonist(Mifepristone
   - Adrenolytic agents(Mitotane)