Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Cushing's syndrome ↑cortisol > Flashcards

Cushing's syndrome ↑cortisol Flashcards

1
Q

Cushing’s syndrome basically just means what?

A

too much cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aetiology of ↑Cortisol can be split into what two causes?

A

ACTH dependent and ACTH independent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ACTH independent causes of ↑cortisol?

-3

A

Iatrogenic
Tumour in adrenal gland itself
Carney complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

↑cortisol in blood is called what?

A

hypercortisolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ACTH independent cause of ↑cortisol is primary or secondary?

A

1°

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ACTH independent causes of ↑cortisol:

ACTH levels?

why?

A

↓ACTH

lots of -ve feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACTH dependent causes of ↑cortisol?

-2

A

Cushing’s disease

ectopic ACTH production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ACTH dependent causes of ↑cortisol:

ACTH levels?

A

↑ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

common cause of ectopic ACTH production?

A

small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define cushing’s disease?

A

tumour in pituitary gland, makes ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Risk Factors for hypercortisolism?

A

steroid use
Tumour in pituitary (cushing’s)
small cell lung cancer
adrenal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

hypercortisolism:

how is sex effected?

A

low libido

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

hypercortisolism:

how will the pt look?
-5

A 
Big round face – moon 
Lemon on a stick
Stretch marks  
Buffalo hump 
Bruised skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

hypercortisolism:

MSK symptom?

A

Muscles feel weak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

hypercortisolism:

psych symptom?

A

Psychotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hypercortisolism

immune symptom?

A

more infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

hypercortisolism:

main NEWS chart change?

A

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hypercortisolism:

how do U+Es change?
-1 main change

A

Hypokalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

hypercortisolism:

how does ABG change?
-1

A

Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

2 Main Tests to check hypercortisolism?

A

Overnight Dexamethasone suppression test

24hr urinary free cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

suspected hypercortisolism.

1st line Ix?

positive result?

A

Overnight Dexamethasone suppression test

morning cortisol spike still there

22
Q

outline overnight dexamethasone suppression test?

step by step

A
  1. Measure ACTH levels
  2. Give dexamethasone at bedtime
  3. Measure cortisol in morning
  4. Compare to ACTH levels, ↓↑ACTH directs you to cause
23
Q

Normal and abnormal result for overnight dexamethasone suppression test?

A 
Normal = dexamethasone does -ve feedback so no cortisol spike in the morning 
Abnormal = cortisol levels stay high/ spike present
24
Q

pt has abnormal dexamethasone suppression test.
when measured, ACTH low.

what are the two main causes for these results?

how could you Ix these causes further?

A

Cause is problem at adrenal glands - CT adrenal glands

or iatrogenic drugs - Review meds

25
Q

pt has abnormal dexamethasone suppression test.
when measured, ACTH high.

what Ix do you do next?

A

high dose dexamethasone test

26
Q

pt has abnormal ON dexamethasone suppression test.
ACTH high.

high dose dexamethasone test = cortisol suppressed

what is likely cause?

how do you Ix this cause further?

A

Cushing’s (pituitary adenoma)

MRI brain

27
Q

with Cushing’s, why on high dose dexamethasone test is cortisol suppressed?

A

Cushing’s has some -ve feedback left,

thus lots of dexamethasone will cause -ve feedback and cortisol goes down.

28
Q

pt has abnormal ON dexamethasone suppression test.
ACTH high.

high dose dexamethasone test = cortisol not suppressed, still very high

what is likely cause?

how do you Ix this cause further?

A

SC Lung Cancer

CT chest

29
Q

with SCLC, why on high dose dexamethasone test is cortisol not suppressed?

A

because SC Lung Cancer has no negative feedback at all,

so High dose dexamethasone does nothing (cortisol stays high)

30
Q

in normal person, cortisol levels in the morning?

A

high

31
Q

in normal person, cortisol levels at night?

A

low

32
Q

in hypercortisolism why does fat deposit in abdomen and upper back?
-4

A

o changes how you metabolise fat
o increases cholesterol levels
o Impaired glucose tolerance +↑BG levels – glucose stored as fat
o Cortisol is stress hormone, when body stressed it thinks it needs to stock up on food because it’s unsure when next food source will come, so ↑energy storage

33
Q

in hypercortisolism,

why do you get stretch marks?

A

Fat deposits around abdomen

34
Q

in hypercortisolism,

person has big belly with stick legs,

what do you call this feature?

A

lemon on a stick

35
Q

in hypercortisolism,

person has fat pad on back of neck,

what do you call this feature?

A

buffalo hump

36
Q

in hypercortisolism,

why are there bruises?

A

Skin very fragile

37
Q

in hypercortisolism,

why is there metabolic alkalosis?

A

K+ excreted (Hypokalaemia) > metabolic alkalosis

38
Q

What is Cushing’s disease?

A

cause of high cortisol is adenoma in pituitary gland

39
Q

in Cushing’s disease is there -ve feedback?

A

some negative feedback, but little.

40
Q

in Cushing’s disease how can you trigger negative feedback?

A

give high dose of dexamethasone

41
Q

Complications of ↑cortisol on MSK esp in females?

-1

A

↑cortisol > bone resorption > osteoporosis

42
Q

Complications of ↑cortisol on electrolytes?

what can this lead to?

A

↑Na+ resorbed > HTN

43
Q

Complications of ↑cortisol on glucose?

what can this lead to?

A

↑BG

T2DM

44
Q

what can trigger Pseudo-Cushing’s?

A

alcohol excess or severe depression

45
Q

1st line treatment for Cushing’s disease?

what method is used to do this, basically how do you get to the pituitary?

A

resect pituitary

transsphenoidal - through nose

46
Q

2nd line treatment for Cushing’s disease?

A

radiotherapy

47
Q

hypercortisolism due to SCLC?

1st line treatment for most people?

A

chemoradiotherapy

48
Q

hypercortisolism due to iatrogenic steroid overuse.

1st line treatment?

A

review need for meds

49
Q

hypercortisolism due to adrenal tumour.

mainstay Mx?
-2

A

resect tumour or adrenalectomy

50
Q

define adrenalectomy?

A

remove whole adrenal gland

51
Q

difference between hypercortisolism generally and Cushing’s disease?

A

Cushing’s disease is hypercortisolism due to pituitary adenoma.

hypercortisolism generally can have multiple causes.

Endocrinology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions