bushings

Question 1

bushings syndrome signs

Answer 1

mon face 
chip punk cheeks 
buffalo hump 
acne 
hirtiuism 
hypernatremia 
hyperglycaemia 
osteoprois s
thin limbs 
think skin 
hypertension 
central obesity 
muscle atrophy - increased protein breakdown

Question 2

diagnosis for bushings

Answer 2

24 urinary cortisol - Normal <280nmol/24hr (remember to throw out the first morning urine as from the previous day )
1mg dexamethasone

Question 3

causes of bushings syndrome

Answer 3

adrenal tumour ectopic , pit

Question 4

Cushing disease

Answer 4

specifically the pituitary it refers too

Question 5

what does not obey

Answer 5

ectopic

Question 6

how to dx between ectopic and bushings disease

Answer 6

give a strong does of dexmathesone (medicos) OR CTRH test (lecture) check cortisol levels after 2 hours and with bushings disease it increases but not in ectopic

Question 7

phsyioligcal high levels of cortisol

Answer 7

6-8am and 3pm (morning) and lowest at midnight (should be <1/3 of the daytime cortisol level)

Question 8

nelson syndrome

Answer 8

Nelson syndrome can be caused by surgical removal of the adrenal glands on both sides of the body (bilateral adrenalectomy). Removal of the adrenal glands is a treatment for Cushing syndrome caused by a tumour

after the removal you get a pituitary adenoma secreting ACTH . because after cortisol levels go down,CRh from the hypothalamus increases which has a positive trophic effect on the tumour

symptoms

1. hypopiturtism
2. headaches
3. bitemporal hemianopia( gets them into a lot of accidents as they can’t see)
4. hyperpigmentation of the skin (due to increased ACTH)-due to melanoncte stimulating hormone but that doesn’t make sense as you have hypopitutism

tx- radiation

Question 9

tx of Cushings disease

Answer 9

Medical therapy to reduce cortisol excess is indicated before pituitary surgery or radiotherapy in Cushing’s disease in order to get the cortisol levels under control, help to reduce the tumour size and better prepare the steroid exposed tissues for invasive treatment.

Medications that can inhibit cortisol production may be used, such as Ketoconazole,
Mifepristone – when remission not occurred

Metyrapone- 1st line apparently on ques med

radiotherapy if after surgery still not improving

Question 10

causes of false +

Answer 10

obesity, stress

Question 11

labs for bushings

Answer 11

some people get cold

sodium - up - weight gain
potaasium - down - arrhythmia
get - glucose - up
cold- calcium down - osteoporosis