Cushing Syndrome

Question 1

1. Signs and symptoms that develop after prolonged abnormal elevation of cortisol.

Answer 1

1. Cushing syndrome

Question 2

A condition where a pituitary adenoma secretes excessive ACTH?

Answer 2

1. Cushing’s disease

Question 3

Cushing’s disease causes Cushing’s syndrome, but Cushing syndrome is not always?

Answer 3

1. Cushing disease

Question 4

What are features of Cushing syndrome?

Answer 4

1. Round moon face
2. central obesity
3. abdominal striae
4. buffalo hump
5. proximal limb wasting

Question 5

What do high levels of the stress hormone cause what symptoms?

Answer 5

1. HTN
2. Cardiac hypertrophy
3. Type 2 DM
4. Depression
5. Insomnia

Question 6

As a result of Cushing Syndrome what are some of the side effects patients may experience?

Answer 6

1. Osteoporosis

2. Easily bruising and poor skin healing

Question 7

What are causes of Cushing’s Syndrome?

Answer 7

1. Exogenous steroids
2. Pituitary adenoma
3. Adrenal adenoma a hormones’ stimulating tumor of the adrenal glands
4. Paraneoplastic Cushing cause by a cancer

Question 8

Excess in release of ACTH from a cancer not of the pituitary and stimulates excessive cortisol release. ATCH from somewhere other than the pituitary is called?

Answer 8

1. Ectopic ATCH

Question 9

1. What type of cancer causes excessive secretion of ACTH

Answer 9

1. Most common cause of ACTH secreting cancer is Small cell lung cancer

Question 10

What is the test of choice for diagnosing Cushing’s Syndrome?

Answer 10

1. Dexamethasone suppression test

Question 11

What is the purpose of the low Dexamethasone Suppression test?

Answer 11

1. The patient is given a low dose of dexamethasone, if the test is normal Cushing’s is excluded.

Question 12

What is the purpose of giving low dose Dexamethasone to diagnose Cushing’s disease

Answer 12

1. The patient is given a low dexamethasone, a normal response is for the Dexamethasone to suppress the release of cortisol by effective negative feedback on the hypothalamus and pituitary.

Question 13

How does the pituitary and hypothalamus gland respond to Dexamethasone?

Answer 13

1. The hypothalamus responds by reducing CRH output. The Pituitary responds by reducing ACTH output. The lower the CRH and ACTH levels result in a low cortisol level

Question 14

If during a dexamethasone test if the cortisol is not suppressed is the test normal

Answer 14

1. Abnormal

Question 15

When is the high dose Dexamethasone test performed?

Answer 15

1. After an abnormal low dose test

Question 16

1. The pituitary still shows some response to negative feedback and 8 mg of dexamethasone is enough to suppress cortisol

Answer 16

1. Cushing’s Disease

Question 17

When would cortisol production be independent from the pituitary?

Answer 17

1. Adrenal adenoma

Question 18

If ACTH production is not suppressed during the dexamethasone suppression test what does this mean?

Answer 18

1. ACTH is ectopic from either a small cell lung cancer

Question 19

If the patient has a pituitary adenoma what happens with Cortisol and ACTH

Answer 19

1. Suppressed

Question 20

1. If the patient has an adrenal adenoma, what happens with Cortisol and ACTH during the suppression test?

Answer 20

1. Cortisol is not suppressed

2. ACTH is suppressed

Question 21

If the patient has ectopic production of ATCH what happens with the cortisol and ACTH levels during the suppression test?

Answer 21

1. Neither cortisol or ACTH is suppressed

Question 22

What is an alternative to a Dexamethasone suppression test?

Answer 22

1. 24 hour urinary free cortisol.

Question 23

A condition in which the adrenal glands do not produce enough Cortisol and Aldoesterone?

Answer 23

1. Addison’s disease

Question 24

This specific condition, occurs when the adrenal glands have been damaged resulting in the reduction of the secretion of cortisol and aldosterone.

Answer 24

1. Primary adrenal insufficiency.

Question 25

Inadequate production of ACTH stimulating the adrenal glands resulting in low cortisol release, this is a result of loss or damage to the pituitary gland. Either due to surgery, loss of blood flow or radiotherapy and Sheehan's syndrome.

Answer 25

1. Secondary adrenal insufficiency

Question 26

This can result from patients being on long term oral steroids, inadequate release of CRH by the hypothalamus, when the exogenous steroids are suddenly withdrawn the hypothalamus does not wake up fast enough and the endogenous steroids are not adequately produced.

Answer 26

1. Tertiary adrenal insufficiency

Question 27

What are symptoms of adrenal insufficiency?

Answer 27

1. Fatigue 2. Nausea 3. Cramps 4. Abdominal pain 5. Reduced libido

Question 28

What are some signs of adrenal insufficiency?

Answer 28

1. Bronze hyperpigmentation to the skin | 2. postural hypotension

Question 29

What is the test of choice for diagnosing adrenal insufficiency?

Answer 29

1. Short synacthen test

Question 30

With this type of adrenal insufficiency, the ATCH level is high as the pituitary gland is trying hard to stimulate the adrenal gland without any negative feedback in the absence of cortisol

Answer 30

1. Primary adrenal failure

Question 31

The ACTFCH level is low because the adrenal glands are not producing cortisol as they are not being stimulated by ACTH

Answer 31

1. Secondary adrenal failiure

Question 32

This test is performed in the am when the adrenal glands are fresh. The patient is given synacthen, blood cortisol levels are measured at 30 and 60 minutes after administration, the ATCH will stimulate health adrenal glands to produce cortisol and the cortisol level should double. A failure of the cortisol to rise indicates what? And what is the test called.

Answer 32

1. Primary adrenal insufficiency (Addison's Disease) | 2. Short Synacthen test.

Question 33

What happens with adrenal atrophy?

Answer 33

1. The prolonged ACTh eventually gets the adrenals going again and cortisol rises

Question 34

What is hydrocortisone?

Answer 34

1. Glucocorticoid hormone used to replace cortisol.

Question 35

What is Fludrocortisone?

Answer 35

1. Minercorticoid hormone used to replace aldosterone if aldosterone is also insufficient

Question 36

When are doses of steroids' double for patients with adrenal insufficiency?

Answer 36

1. During an illness

Question 37

``` What is the condition called when an absence of steroid hormones leads to a life threatening presentation with: Reduced consciousness hypotension hypoglycemia hyponatremia hyperkalemia ```

Answer 37

1. Addisonian crisis

Question 38

How is Addisonian crisis managed?

Answer 38

1. Intensive monitoring 2. parenteral steroids 3. IV fluid resuscitation 4. Correct hypoglycemia 5. careful monitoring of fluid and electrolyte balance

Question 39

This is a key biochemical clue of adrenal insufficiency and sometimes the only presenting feature?

Answer 39

1. Hyponatremia

Question 40

Elevation of this electrolyte is possible with adrenal insufficiency?

Answer 40

1. Hyperkalemia