Cushing's Syndrome Flashcards
What is Cushings Syndrome?
A clinical state produced by chronic Glucocorticoid excess and loss of normal feedback mechanisms of the Hypothalamus to the adrenals
What do glucocorticoids do?
They affect Carbohydrate, Lipid and Protein metabolism
What do mineralocorticoids do?
They affect Na+/K+ balance
How are Glucocorticoids normally controlled?
Corticotroping releasing factor is secreted from the Hypothalamus which stimulates ACTH secretion from the pituitary which stimulates Cortisol Production
What are the 2 main causes of Cushings?
- Oral steroid use
2. Pituitary Adenoma
Is it common?
No, 10-15 per million are affected
Who is affected?
Higher incidence seen in diabetes, obesity, hypertension and osteoporosis
Risk Factors (3)
Female, 25-40 years old, lung cancer (ectopic ACTH)
Symptoms (11)
Weight gain, depression, lethargy, irritability, psychosis, proximal weakness, gonadal dysfunction, irregular menses, hirsutism, erectile dysfunction, acne
Signs (9)
Moon face, buffalo hump, skin/muscle atrophy, bruises, purple abdominal striae, osteoporosis, hypertension, diabetes, poor healing
Investigations (6)
24 Hour urinary cortisol tests, Overnight Dexamethasone Suppression tests, MRI for Adenoma/lung cancer, TFTs, FBC, U&E
Differentials? (1)
Pseudo cushings caused by anxiety, chronic alcohol consumption, obesity, diabetes and HIV
Treatment (3)
If iatrogenic, stop oral steroids, Surgical removal of adenoma, adrenolytic drugs e.g Metyrapone, Ketoconazole
Are there any complications? (8)
Metabolic syndrome, hypertension, diabetes, obesity, hyperlipidaemia, coagulopathy, osteoporosis, immunosuppression
Prognosis
Untreated cushing’s has high vascular mortality
