Cushings Syndrome

Question 0

Cushing Syndrome Etiology

Answer 0

2 major complication
Perforated viscera and opportunistic fungal infections
Female hi make ratio is 5:1 for Adrenal or pituitary tumor
Ectopic ACTH production is mor freq in males
PEAK AGE IS 25-40

Question 1

Cushing Syndrome

Hypercorticolism

Answer 1

3 major forms

1. Original excessive production of ACTH
2. Andrenal form benign or malignant adrenal tumor
3. Ectopic Crushing caused by non-pituitary ACTH secreting tumor * small cell carcinoma of the lung
   - long term theraphy with glucocorticoids

Question 2

Plasma cortisol test

Answer 2

Measure of serum cortisol

Blood collected at two separate times and the values are compared. The PM value should be 1/3 to 2/3 of the AM value

Question 3

Decamethasone Supression (Cortisol Suppression )

Answer 3

Andrenal hyperfunction and its cause

• Prolonged
• Rapid

Question 4

Decamethasone Suppression interfering factors

Answer 4

Stress, barbiturates, estrogens, oral contraceptives, Dilantin, aldactone, steroids tetracycline

Question 5

Dexamethasone Supression TEST

Answer 5

Before -Baseline weight
During
Prolonged test
*baseline 24 urine for corticosteroids (17 hydroxy corticosteroids)
Day 3 admin a low dose of DS PO
Day 5 admin a high dose of DS PO
ONLY DISCARD THE 1st urine specific on day 1 keep on ice

Question 6

DS TEST -Rapid

Answer 6

1. PO does of DS at 11pm
2. Provide a good nights rest sedatives only if needed
3. 8am draw plasma cortisol
4. If no Suppression occurs admin a high dose of DS to suppress ACTH

Question 7

DS TEST AFTER

Answer 7

Eval for gastric irritation
Assess for steroid induced SE’s
Send specimens to lab promptly

Question 8

DS RESULTS

BILATERAL ADRENAL HYPERPLASIA

Answer 8

Low DOSE: NO CHANGE

HIGH DOSE : > 50% reduction of plasma cortisol and 17 OCHS

Question 9

ADRENAL ADENOMA OR CARCINOMA

Answer 9

Low dose: no change

High dose: no change

Question 10

Entropic ACTH PRODUCING TUMOR

Answer 10

Low dose : no change

High dose: no change