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Endocrinology > Cushing's syndrome ↑cortisol > Flashcards

Cushing's syndrome ↑cortisol Flashcards

(51 cards)

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1
Q

Cushing’s syndrome basically just means what?

A

too much cortisol

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2
Q

Aetiology of ↑Cortisol can be split into what two causes?

A

ACTH dependent and ACTH independent

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3
Q

ACTH independent causes of ↑cortisol?

-3

A

Iatrogenic
Tumour in adrenal gland itself
Carney complex

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4
Q

↑cortisol in blood is called what?

A

hypercortisolism

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5
Q

ACTH independent cause of ↑cortisol is primary or secondary?

A

1°

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6
Q

ACTH independent causes of ↑cortisol:

ACTH levels?

why?

A

↓ACTH

lots of -ve feedback

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7
Q

ACTH dependent causes of ↑cortisol?

-2

A

Cushing’s disease

ectopic ACTH production

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8
Q

ACTH dependent causes of ↑cortisol:

ACTH levels?

A

↑ACTH

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9
Q

common cause of ectopic ACTH production?

A

small cell lung cancer

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10
Q

define cushing’s disease?

A

tumour in pituitary gland, makes ACTH

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11
Q

Risk Factors for hypercortisolism?

A

steroid use
Tumour in pituitary (cushing’s)
small cell lung cancer
adrenal gland

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12
Q

hypercortisolism:

how is sex effected?

A

low libido

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13
Q

hypercortisolism:

how will the pt look?
-5

A 
Big round face – moon 
Lemon on a stick
Stretch marks  
Buffalo hump 
Bruised skin
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14
Q

hypercortisolism:

MSK symptom?

A

Muscles feel weak

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15
Q

hypercortisolism:

psych symptom?

A

Psychotic

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16
Q

hypercortisolism

immune symptom?

A

more infections

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17
Q

hypercortisolism:

main NEWS chart change?

A

HTN

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18
Q

hypercortisolism:

how do U+Es change?
-1 main change

A

Hypokalaemia

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19
Q

hypercortisolism:

how does ABG change?
-1

A

Metabolic alkalosis

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20
Q

2 Main Tests to check hypercortisolism?

A

Overnight Dexamethasone suppression test

24hr urinary free cortisol

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21
Q

suspected hypercortisolism.

1st line Ix?

positive result?

Study These Flashcards
A

Overnight Dexamethasone suppression test

morning cortisol spike still there

22
Q

outline overnight dexamethasone suppression test?

step by step

Study These Flashcards
A
  1. Measure ACTH levels
  2. Give dexamethasone at bedtime
  3. Measure cortisol in morning
  4. Compare to ACTH levels, ↓↑ACTH directs you to cause
23
Q

Normal and abnormal result for overnight dexamethasone suppression test?

Study These Flashcards
A 
Normal = dexamethasone does -ve feedback so no cortisol spike in the morning 
Abnormal = cortisol levels stay high/ spike present
24
Q

pt has abnormal dexamethasone suppression test.
when measured, ACTH low.

what are the two main causes for these results?

how could you Ix these causes further?

Study These Flashcards
A

Cause is problem at adrenal glands - CT adrenal glands

or iatrogenic drugs - Review meds

25
pt has abnormal dexamethasone suppression test. when measured, ACTH high. what Ix do you do next?
high dose dexamethasone test
26
pt has abnormal ON dexamethasone suppression test. ACTH high. high dose dexamethasone test = cortisol suppressed what is likely cause? how do you Ix this cause further?
Cushing’s (pituitary adenoma) MRI brain
27
with Cushing’s, why on high dose dexamethasone test is cortisol suppressed?
Cushing’s has some -ve feedback left, | thus lots of dexamethasone will cause -ve feedback and cortisol goes down.
28
pt has abnormal ON dexamethasone suppression test. ACTH high. high dose dexamethasone test = cortisol not suppressed, still very high what is likely cause? how do you Ix this cause further?
SC Lung Cancer CT chest
29
with SCLC, why on high dose dexamethasone test is cortisol not suppressed?
because SC Lung Cancer has no negative feedback at all, | so High dose dexamethasone does nothing (cortisol stays high)
30
in normal person, cortisol levels in the morning?
high
31
in normal person, cortisol levels at night?
low
32
in hypercortisolism why does fat deposit in abdomen and upper back? -4
o changes how you metabolise fat o increases cholesterol levels o Impaired glucose tolerance +↑BG levels – glucose stored as fat o Cortisol is stress hormone, when body stressed it thinks it needs to stock up on food because it’s unsure when next food source will come, so ↑energy storage
33
in hypercortisolism, why do you get stretch marks?
Fat deposits around abdomen
34
in hypercortisolism, person has big belly with stick legs, what do you call this feature?
lemon on a stick
35
in hypercortisolism, person has fat pad on back of neck, what do you call this feature?
buffalo hump
36
in hypercortisolism, why are there bruises?
Skin very fragile
37
in hypercortisolism, why is there metabolic alkalosis?
K+ excreted (Hypokalaemia) > metabolic alkalosis
38
What is Cushing’s disease?
cause of high cortisol is adenoma in pituitary gland
39
in Cushing’s disease is there -ve feedback?
some negative feedback, but little.
40
in Cushing’s disease how can you trigger negative feedback?
give high dose of dexamethasone
41
Complications of ↑cortisol on MSK esp in females? | -1
↑cortisol > bone resorption > osteoporosis
42
Complications of ↑cortisol on electrolytes? what can this lead to?
↑Na+ resorbed > HTN
43
Complications of ↑cortisol on glucose? what can this lead to?
↑BG T2DM
44
what can trigger Pseudo-Cushing's?
alcohol excess or severe depression
45
1st line treatment for Cushing's disease? what method is used to do this, basically how do you get to the pituitary?
resect pituitary transsphenoidal - through nose
46
2nd line treatment for Cushing's disease?
radiotherapy
47
hypercortisolism due to SCLC? 1st line treatment for most people?
chemoradiotherapy
48
hypercortisolism due to iatrogenic steroid overuse. 1st line treatment?
review need for meds
49
hypercortisolism due to adrenal tumour. mainstay Mx? -2
resect tumour or adrenalectomy
50
define adrenalectomy?
remove whole adrenal gland
51
difference between hypercortisolism generally and Cushing's disease?
Cushing's disease is hypercortisolism due to pituitary adenoma. hypercortisolism generally can have multiple causes.

Endocrinology (16 decks)

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