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Flashcards in Cushings Deck (12):
1

what is cushings

chronic excess cortisol and loss of normal feedback and circadian rhythm

2

what is the commonest cause

iatrogenic- steroids used in high doses for RA etc

3

what can the endogenous causes be split into

ACTH dependent and independent

4

what are the conditions of ACTH dependent

Cushings disease (pituitary adenoma); ectopic ACTH production (SCLC, carcinoid tumours); nearly ectopic CRF production (thyroid, prostate)

5

what are the specific features of ectopic ACTH dependent production

pigmentation (from high ACTH), hypokalaemic metabolic acidosis, weight loss, hyperglycaemia. classical features absent

6

what are the conditions of ACTH independent production

adrenal adenoma/carcinoma; adrenal nodular hyperplasia; iatrogenic; rare- Carney complex

7

symptoms

weight gain; mood change- depression, lethargy etc; proximal weakness; gonadal dysfunction; acne

8

signs

upper body obesity, central obesity, plethoric moon face; skin and muscle atrophy; bruises; purple abdo striae; osteoporosis; incr BP; incr glucose; poor healing; supra clavicular fat

9

tests

1st- overnight dexamethasone (doesn't suppress cortisol levels in cushings)- 1mg PO at midnight measure cortisol at 8am. 24h urinary free cortisol. 2nd- 48h dexamethasone test. 3rd- localisation

10

test- localisation (where is the lesion)

measure ACTH if independent it will be low if dependent (pituitary/ectopic) then will be high. CT/MRI, CXR, octreotide scan, venous samplings (petrosal veins)

11

if ACTH is detectable do a high dose suppression test or a CR hormone test what will happen to cortisol in pituitary disease

cortisol incr with pituitary disease but not with ectopic production

12

what does untreated Cushings lead to

increased vascular mortality