Cushing's Syndrome/Disease

Question 1

Define cushing’s syndrome

Answer 1

Glucocorticoid excess (due to any cause) - hypercortisolaemia

-Exogenous cause = steroid overuse

Question 2

Define Cushing’s Disease

Answer 2

Glucocorticoid excess due to a pituitary adrenocorticotrophic hormone (ACTH) producing tumour

Question 3

How are various causes of Cushing’s Syndrome split?

Answer 3

Exogenous
-Steroids, iatrogenic, excess alcohol, depression

-ACTH dependent = ACTH++ causes Cortisol ++
(Cushing’s disease, ectopic ACTH secretion, small cell lung cancer)

-ACTH independent = cortisol ++ despite ACTH –
(Autonomous cortisol secretion, adrenal adenoma/hyperplasia/carcinoma)

Question 4

What are the symptoms of CS?

Answer 4

Weight gain
Poor wound healing
Recurrent infections
Depression
Menstrual disturbances
Low libido
Hirsutism
Headache
Osteoporosis

Question 5

What are the clinical signs of CS?

Answer 5

Plethoric moon face
Buffalo hump
Purple abdominal striae
Centripetal obesity
Proximal myopathy
Thinning of skin
Easy bruising
HTN
Acne
Diabetes

Question 6

What are the investigations for CS?

Answer 6

BLOODS

• Dexamethsone suppression test (1mg overnight = morning cortisol >50nmol/L)
• Serum glucose = elevated
• Late night salivary cortisol = elevated

IMAGING
-For potential tumours

Question 7

How is CS treated?

Answer 7

Taper off any exogenous steroid use

Surgery/chemo.radio for tumours

MIFEPRISTONE (glucocorticoid type II antagonist) - treats CI symptoms