What hormones are produced in excess in Cushing's syndrome?
ACTH excess causing
Cortisol, aldosterone and androgen excess
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
What occurs due to hyperglycaemia in Cushing's syndrome?
Why do patients with Cushing's syndrome develop central obesity?
Rapid access fat deposits
Cushing's syndrome also produces ___ symptoms.
What other hormones are produced in excess due to cortisol excess in Cushing's syndrome?
Cortiosteroids - causing hypertension, oedema?
Androgen - acne, hirsuitism, virilism
What signs and symptoms of Cushing's would allow you to differentiate it from uncomplicated obesity?
Osteoporosis (obesity usually STRENGTHENS bones due to increase weight bearing; do not confuse with arthropathy)
What phrase is used to describe the appearance of a patient with Cushing's syndrome?
Lemon on matchsticks
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
How is a dexamethasone test done?
Overnight suppression test
If cortisol is < 50nmol/L the next morning, normal
If > 100, abnormal
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
What is the most common cause of Cushing's disease?
pituitary - " disease
anything else - " syndrome
What are three causes of Cushing's syndrome?
Ectopic ACTH production by tumours
Alcohol, depression and steroids (false positive screening tests)
Which types of steroid medication can cause pseudo-Cushing's syndrome?
How is pituitary Cushing's disease treated?
Pituitary surgery (hypophysectomy, transsphenoidal approach)
Bilateral adrenalectomy if it recurs
How is adrenal Cushing's syndrome treated?
How is ectopic Cushing's syndrome treated?
or Bilaternal adrenalectomy
If the pituitary gland doesn't produce enough hormone, what deficiencies will you get?
Growth hormone deficiency
Hypogonadism (LH & FSH)
Prolactin deficiency has no symptoms
Diabetes insipidus (ADH)
What type of dynamic test would be done for hypopituitarism (i.e deficiency of hormones)?
What test is done for adrenal insufficiency in both hypopituitarism and Addison's disease?