Cushing's Syndrome

Question 1

In one sentence, explain Cushing’s syndrome to a patient

Answer 1

A collection of signs and symptoms of too much steroid, usually cortisol, in your body resulting in changes to your skin, weight, heart, and energy.

Question 2

Name 3 symptoms of Cushing’s syndrome

Answer 2

1. Mood changes
2. Easy bruising
3. Weakness
4. Weight gain
5. Amenorrhoea
6. Back pain

Question 3

Name 5 signs of Cushing’s syndrome

Answer 3

1. Truncal obesity
2. Hypertension
3. Glucose intolerance
4. Hirituism
5. Purple, abdominal striae
6. Osteoporosis
7. Moon-shaped face
8. Buffalo hump (thoracic kyphosis)
9. Myopathy
10. Hypertrichosis
11. Peripheral edema

Question 4

What is the most common method to screen for Cushing’s Syndrome?

Answer 4

Low-dose dexamethasone supression test

Question 5

Explain the low-dose dexamethasone supression test to a patient

Answer 5

You take a dexamethasone 1 mg pill at 11 pm, the next morning at 8 am you will have a blood sample drawn

Question 6

Explain the hypothalmic-pituitary-axis to a patient.

Answer 6

1. Hypothalamus secretes corticotropin releasing hormone
2. Anterior pituitary secretes adrenocorticotropic hormone
3. Adrenal gland secretes cortisol

Question 7

Normally, cortisol causes the anterior pituitary to secrete less adrenocorticotrophic hormone. Why?

Answer 7

Negative feedback loop.

Cortisol supresses CRH and ACTH release

Question 8

What is the most common iatrogenic cause for Cushing’s Syndrome?

Answer 8

Chronic, exogenous steroid use (eg. prednisone)

Question 9

You ordered a dexamethasone supression test, and it shows an elevated cortisol level.

What does this mean?

Answer 9

Adrenal or pituitary adenoma or ectopic adrenocorticopic hormone

Needs referral to endocrinology

Question 10

A low-dose dexamethasone suppression test shows decreased cortisol. What does this mean?

Answer 10

Normal finding; unlikely Cushing’s Syndrome