Cushings Flashcards
What is Cushing’s Syndrome vs Cushing’s Disease?
- Cushings Syndrome = signs + symptoms after prolonged abn elevation of Cortisol
- Cushing’s Disease = an acc condition wer pituitary tumour secretes excessive ACTH
What are the causes of Cushing’s Syndrome? (4 things)
- Exogenous steroids
- Cushing’s Disease (pituitary adenoma releasing excess ACTH)
- Adrenal Adenoma (a hormone secreting adrenal tumour)
- Paraneoplastic Cushing’s
What are the titles of da CF of Cushing’s Syndrome? (3 things)
- Round in the middle with thin limbs
- High levels of stress hormone
- Extra fx
What are the Round in da middle w thin limbs CF of Cushing’s Syndrome? (5 things)
- Moon face
- Buffalo Hump (fat pad on upper back) (buffalo shouldaaa)
- Proximal limb muscle wasting
- Central Obesity
- Abdominal striae
What are the High levels of stress hormone CF of Cushing’s Syndrome? (5 things)
- Depression
- Insomnia
- Cardiac hypertrophy
- HTN
- Hyperglycaemia (Type 2 Diabetes)
What are the Extra fx CF of Cushing’s Syndrome? (2 things)
- Osteoporosis
- Easy bruising + poor skin healing
How do you investigate Cushing’s Syndrome? (2 things)
- Confirm diagnosis (raised plasma cortisol)
- Localise source by lab tests
What investigations should you do to diagnose Cushing’s Syndrome? (2 things)
- Overnight dexamethasone suppression test (Low then High dose tests)
- 24h urinary free cortisol
How is a LOW DOSE Overnight dexamethasone suppression test done?
- Give 1mg Dexamethasone @ midnight
- Check Serum Cortisol @ 8am
- Normally, Dexamethasone should supress the normal morning Cortisol spike
- Cortisol still high = Cushing’s Syndrome
Why is a HIGH DOSE Overnight dexamethasone suppression test done after the LOW DOSE one diagnosed Cushing’s Syndrome?
To find the underlying cause
How is a HIGH DOSE Overnight dexamethasone suppression test done?
What do the results show regarding Cortisol + ACTH suppression?
- Give 8 mg Dexamethasone @ midnight
- Check Serum Cortisol @ 8am
- Cortisol suppressed = Cushing’s Disease (pituitary adenoma) bc pituitary still responds to some -ve feedback
- Cortisol still high, ACTH suppressed = Adrenal Adenoma bc cortisol prod elswhere (not in pituitary), but ACTH suppressed bc -ve fdbk on hypothalamus + pituitary gland
- Cortisol high, ACTH high = Ectopic ACTH bc ACTH prod independant from hyp + pit
What is the disadvantage of doing a 24h urinary free cortisol test to diagnose Cushing’s Syndrome?
Doesn’t tell you underlying cause
What is the treatment for Cushing’s Syndrome? (4 things)
Depends on cause:
- Exogenous steroids = stop them if possible
- Cushing’s Disease = Remove pituitary tumour trans-sphenoidal (thru nose)
- Adrenal adenoma = Removal of adrenal gland
- Ectopic ACTH = Removal surgery if tumour hasn’t spread
