Cushing's Syndrome

Question 1

causes of Cushings syndrome

Answer 1

excess steriods
cushings disease - pituitary adenoma producing ACTH
adrenal cushings (adrenal adenoma producing cortisol)
paraneoplastic cushings

Question 2

what is Cushing’s syndrome

Answer 2

excess cortisol

Question 3

how can Cushing’s syndrome present

Answer 3

central obesity, purple striae
weakness of limbs and thin arms
dorsocervical back pad, moon shaped face
fatigue, SOB
osteoporosis
more prone to infections
type 2 diabetes and high CVS risk

Question 4

what result would confirm Cushing’s syndrome on a low dose dexamethasone suppression test

Answer 4

high/ normal cortisol

Question 5

what does low cortisol as a result of the high dose suppression test suggest

Answer 5

Cushing’s disease
as enough steroid to suppress the pituitary gland even with an adenoma

Question 6

if there is normal cortisol on high dose suppression test what does this suggest

Answer 6

if ACTH is low: adrenal cushings
if ACTH is high: ectopic ACTH (paraneopastic)

Question 7

what investigations would you do if suspecting Cushing’s syndrome

Answer 7

24 hour free cortisol urine sample
dexamethasone suppression test
MRI of pituitary
CT of adrenals or CAP

Question 8

what are management options for Cushing’s syndrome

Answer 8

depends on underlying cause

steroid weaning
transsphenoidal pituitary adenomectomy
adernal steriod inhibitors