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endocrinology > Cushing's Syndrome > Flashcards

Cushing's Syndrome Flashcards

1
Q

What are the three criteria for Cushing’s Syndrome?

A

Chronic glucocorticoid excess, Loss of normal HPA axis feedback mechanisms, Loss of circadian rhythm of cortisol secretion

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2
Q

What are ACTH dependent causes of CS?

A

Cushing’s disease (pituitary adenoma), Ectopic ACTH secretion

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3
Q

What are 2 ACTH independent causes of CS?

A

Iatrogenic (Steroids), Adrenal adenoma

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4
Q

In what type of Cushing’s is ACTH raised?

A

ACTH dependent

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5
Q

What does ACTH stand for?

A

Adrenocorticotropic hormone

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6
Q

How does ACTH dependent Cushing’s occur?

A

Increased ACTH leads to more cortisol and androgens being produced by the adrenal cortex

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7
Q

What is cortisol?

A

Cortisol is a glucocorticoid that affects carbohydrate, lipid and protein metabolism

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8
Q

What are androgens?

A

Androgens are converted into testosterone and dihydrotestosterone

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9
Q

How do steroids cause CS?

A

Steroids contain glucocorticoids that can mimic the effects of cortisol

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10
Q

How do adrenal adenomas/carcinomas cause CS?

A

They can secrete cortisol

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11
Q

What are some key presentations of CS?

A

Central obesity, plethoric complexion, weight gain, purple abdominal striae, mood change, moon face, proximal muscle weakness, gastric ulcers, osteoporosis, hirsutism

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12
Q

What can be an issue with testing random plasma cortisol?

A

Illness, time of day, and stress can influence results

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13
Q

What is the first line investigation?

A

Random plasma cortisol

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14
Q

What would the results of a 48h dexamethasone suppression test?

A

Failure to suppress in CS

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15
Q

What do you do if plasma ACTH is untetectable?

A

Look for an adrenal tumour

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16
Q

What do you do if ACTH is detectable?

A

High dose suppression test to distinguish between ectopic and pituitary

17
Q

What do you do if cortisol responds to manipulation?

A

Image the pituitary

18
Q

What do you do if cortisol doesn’t respond to manipulation?

A

Look for source of ectopic ACTH production

19
Q

How do you manage iatrogenic CS?

A

Stop medication if possible

20
Q

How do you manage adrenal adenoma CS?

A

Adrenalectomy

21
Q

How do you manage ectopic ACTH production CS?

A

Surgery if tumour is located and hasn’t spread

22
Q

What are some complications of CS?

A

CVD, HTN, DM, Osteoporosis

23
Q

What would the results of a 48h high-dose dexamethasone suppression test be?

A

Pituitary causes are suppressed, other causes have no or part suppression

24
Q

What do you do if random plasma cortisol is high?

A

Overnight dexamethasone suppression test and urinary free cortisol

25
Q

What do you do if overnight dexamethasone suppression test and urinary free cortisol is positve?

A

Test plasma ACTH

endocrinology (18 decks)

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