11: Cushing's syndrome, hypopituitarism and diabetes insipidus Flashcards Preview

Endocrine Week 3 2017/18 > 11: Cushing's syndrome, hypopituitarism and diabetes insipidus > Flashcards

Flashcards in 11: Cushing's syndrome, hypopituitarism and diabetes insipidus Deck (21)
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1

 What hormones are produced in excess in Cushing's syndrome?

ACTH excess causing

Cortisol, aldosterone and androgen excess

2

The body doesn't have a lot of stored carbohydrate (glycogen) - what is used instead in chronic cortisol excess (e.g in Cushing's syndrome)?

Protein - causing myopathy, osteoporosis, thinning of skin

3

What occurs due to hyperglycaemia in Cushing's syndrome?

Diabetes

4

Why do patients with Cushing's syndrome develop central obesity?

Rapid access fat deposits

5

Cushing's syndrome also produces ___ symptoms.

psychological

6

What other hormones are produced in excess due to cortisol excess in Cushing's syndrome?

Cortiosteroids - causing hypertension, oedema?

Androgen - acne, hirsuitism, virilism

7

What signs and symptoms of Cushing's would allow you to differentiate it from uncomplicated obesity?

Thin skin

Proximal myopathy

Osteoporosis (obesity usually STRENGTHENS bones due to increase weight bearing; do not confuse with arthropathy)

8

What phrase is used to describe the appearance of a patient with Cushing's syndrome?

Lemon on matchsticks

9

As Cushing's involves excess cortisol, what test is used to diagnose it?

Dexamethasone suppression test

cortisol is a steroid - administer high dose of steroids to see if body suppresses it by negative feedback

10

How is a dexamethasone test done?

Overnight suppression test

If cortisol is < 50nmol/L the next morning, normal

If > 100, abnormal

11

As cortisol secretion has a Circadian rhythm, what other test can be done to diagnose Cushing's?

Diurnal variation test

should vary, in Cushing's it is constant

12

What is the most common cause of Cushing's disease?

Pituitary adenoma

13

pituitary - " disease

anything else - " syndrome

14

What are three causes of Cushing's syndrome?

Adrenal adenoma

Ectopic ACTH production by tumours

Alcohol, depression and steroids (false positive screening tests)

15

Which types of steroid medication can cause pseudo-Cushing's syndrome?

Dexamethasone, prednisolone

Topical, INH

16

How is pituitary Cushing's disease treated?

Pituitary surgery (hypophysectomy, transsphenoidal approach)

Bilateral adrenalectomy if it recurs

17

How is adrenal Cushing's syndrome treated?

Adrenalectomy

18

How is ectopic Cushing's syndrome treated?

Remove source

or Bilaternal adrenalectomy

19

If the pituitary gland doesn't produce enough hormone, what deficiencies will you get?

Growth hormone deficiency

Hypothyroidism (TSH)

Hypogonadism (LH & FSH)

Hypoadrenal (ACTH)

Prolactin deficiency has no symptoms

Diabetes insipidus (ADH)

20

What type of dynamic test would be done for hypopituitarism (i.e deficiency of hormones)?

Stimulation tests

21

What test is done for adrenal insufficiency in both hypopituitarism and Addison's disease?

Synacthen test