Adrenal and Gonads - CS1: Cushings

Question 1

What is the primary cause of Cushing’s Syndrome?

Answer 1

Cushing’s Syndrome is caused by prolonged exposure to high levels of cortisol. This can result from a pituitary tumor (Cushing’s disease), adrenal tumors, or the use of steroids

Question 2

What are the common symptoms of Cushing’s Syndrome?

Answer 2

Symptoms include trunk obesity (buffalo hump, moon face), excessive thirst, muscle weakness, and high blood pressure.

Question 3

How is Cushing’s Syndrome diagnosed?

Answer 3

Diagnosis typically involves a 24-hour urinary free cortisol test, dexamethasone suppression test, and imaging (MRI or CT) to identify tumors.

Question 4

What are the treatment options for Cushing’s Syndrome?

Answer 4

Treatment includes surgical removal of tumors (pituitary or adrenal), medication to suppress cortisol production, or adjusting steroid use if it’s iatrogenic (caused by medication).

Question 5

What blood tests are used to diagnose Cushing’s syndrome? (x4)

Answer 5

24-Hour Urinary Free Cortisol Test: Elevated cortisol in urine suggests Cushing’s.

Low-Dose Dexamethasone Suppression Test: Cortisol not suppressed after dexamethasone indicates Cushing’s.

ACTH Levels: Low ACTH = adrenal tumour; High ACTH = pituitary tumour or ectopic ACTH.

Late-Night Salivary Cortisol Test: High cortisol at night suggests Cushing’s.

Question 6

Meet Carly, a 35-year-old woman with Cushing’s syndrome. Carly’s journey to diagnosis starts with her feeling more tired than usual and noticing weight gain around her abdomen and face—a classic sign of Cushing’s. She’s also been thirsty all the time and has difficulty handling stress, a sign that her body’s cortisol levels are out of control.

Answer 6

24-Hour Urinary Free Cortisol Test: Carly goes to the lab for a test that measures cortisol in her urine over 24 hours. The result comes back high, indicating her body is producing too much cortisol. This suggests Cushing’s syndrome.

Low-Dose Dexamethasone Suppression Test: To confirm, Carly takes a low dose of dexamethasone, which normally suppresses cortisol production. But Carly’s cortisol remains high, which tells the doctors that her pituitary or adrenal glands are overworking. This test is crucial in confirming that Carly has Cushing’s syndrome, not just a stress response.

ACTH Levels: The doctors now measure ACTH (a hormone that stimulates cortisol production). Carly’s result shows high ACTH, suggesting her pituitary gland is producing too much ACTH, likely because of a pituitary tumour, known as Cushing’s disease.

Late-Night Salivary Cortisol Test: To be sure, they test Carly’s cortisol levels late at night. Normally, cortisol should be low, but Carly’s result shows it’s still high, confirming that her body is out of sync with its natural rhythm.

Question 7

Symptoms of Cushing’s Disease

Answer 7

Central obesity (buffalo hump, moon face)

Muscle weakness

Thin skin, easy bruising

Purple striae (stretch marks)

Hypertension (high blood pressure)

Hyperglycemia (high blood sugar)

Osteoporosis (bone thinning)

Mood changes (irritability, depression, anxiety)

Fatigue and poor sleep

Increased appetite and thirst

Question 8

Treatment for Cushing’s Disease

Answer 8

Surgical removal of the tumour (most effective for pituitary adenomas or adrenal tumours)

Radiation therapy (if surgery is not an option or to remove residual tumour cells)

Medications:

Ketoconazole or Metyrapone (to inhibit cortisol production)

Pasireotide (if caused by a pituitary adenoma)

Mifepristone (for managing cortisol effects in some cases)

Lifestyle changes to manage side effects like weight gain and blood pressure

Adrenalectomy (in case of an adrenal tumour)