Chapter 49: Cushing Syndrome

Question 1

Name the corticosteroid that is usually excessive in persons with Cushing syndrome.

Answer 1

Cortisol

Question 2

Describe the most common cause of Cushing syndrome.

Answer 2

Iatrogenic administration of exogenous corticosteroids.

IN OTHER WORDS → when you give medication that is a corticosteroid like our pal Prednisone. That’s literally it. Give prednisone. Get excess cortisol. Now you have cushing’s syndrome.

Question 3

Cite which organs might develop tumors that produce ACTH which gives rise to Cushing syndrome.

Answer 3

*About 85% of the cases of endogenous Cushing syndrome are due to an ACTH secreting pituitary adenoma
*Less common: Adrenal tumors. Ectopic ACTH production by tumors (usually of the lung or pancreas) outside of the hypothalamic-pituitary-adrenal axis.

Question 4

Describe clinical manifestations of excess glucocorticoids

five

Answer 4

Hyperglycemia
muscle wasting
bone matrix loss causing osteoporosis
low collagen leading to thin, easily bruised skin
delayed wound healing

Question 5

Describe clinical manifestations of excess mineralocorticosteroids 2

Answer 5

hypokalemia
HTN

Question 6

Describe clinical manifestations of excess adrenal androgens 3

Answer 6

severe acne
male characteristic in females (facial hair)
female characteristics in men (gynecomastia)

Question 7

Review Table 49.16, Manifestations of Adrenocortical Dysfunction- Cushing vs Addison’s. (appearance, cardio, GI, immune, psyc, skin,

Answer 7

General appearance:
Glucocorticoids
*CS: truncal obesity, thin extremities, round moon face, fat deposits on back of neck, buffalo hump
*AD: wt loss, emaciated

Cardio:
*CS: hypervolemia, HTN, edema of LEs
*AD: HoTN, vasodilation

GI:
CS: increased pepsin secretion, risk for peptic ulcer disease, anorexia
AD: anorexia, n/v, abd cramping, diarrhea

Immune:
CS: inhibition of immune response, suppression of allergic reaction
AD: coexisting autoimmune diseases

Psyc:
CS: euphoria, irritable, depression, insomnia, anxiety
AD: depression, exhaustion, irritable, confusion, delusion

Skin:
CS: thin, fragile,purplish/red striae, bruising, red cheeks, acne, increased body hair
AD: bronzed smokey hyperpigmentation of the face, neck, hands, vitiligo, alopecia

Question 8

Cite 4 test used to confirm increased plasma cortisol levels which helps in diagnosing Cushing syndrome.

Answer 8

*midnight or late night salivary cortisol
*low dose dexamethasone suppression test
*24 hour urine cortisol (>100mcg/24hr)
*urine levels of 17 - ketosteroids may be high

Question 9

Explain what is the primary goal of treating Cushing syndrome and the importance of determining the underlying cause. (4tx)

Answer 9

goal: normalize hormone secretion
*tx depends on cause:
1. surgical removal or irradiation of pituitary adenoma
2. adrenalectomy for adrenal tumors or hyperplasia
3. removal of ACTH-secretion tumors
4. if cause is too much cortisol: gradually discontinue therapy, decrease dose, or convert to an alternate-day dosing

Question 10

Describe the treatment of ACTH-producing tumors.

Answer 10

surgical removal

Question 11

Discuss the discontinuation or reduction of prolonged use of corticosteroids and pertinent patient teaching.

Answer 11

4. if cause is too much cortisol: gradually discontinue therapy, decrease dose, or convert to an alternate-day dosing