cushings syndrome

Question 1

symptoms of cushings?

Answer 1

weight gain, change of appearance, depression, insomnia, amenorrhoea, poor libido, thin skin, hair growth, acne, slow growth in children, back pain, polyuria, dyspepsia

Question 2

signs?

Answer 2

moonface, frontal balding in females, pigmentation, skin infections, hypertension, osteoperosis, pathological fractures, buffalo hump, kyphosis, straie, oedema, proximal myopathy, glycosuria

Question 3

what is the important distinction to make in cushings?

Answer 3

those that are ACTH dependant and independent

Question 4

what happens in cushings disease

Answer 4

there is an increase in pituitary ACTH production

Question 5

why does an adrenal tumour cause suppressed ACTH?

Answer 5

negative feedback from cortisol

Question 6

diagnose cushings?

Answer 6

24-hour urinary free cortisol measurements

48-hour low does dexamethasone test

Question 7

cortisol high and ACTH is very low or even undetectable, what does this suggest?

Answer 7

adrenal tumour

Question 8

how to you investigate adrenal adenomas and carcinomas?

Answer 8

CT

Question 9

imaging method to identify pituitary tumour?

Answer 9

pituitary MRI

Question 10

in the high dose dexamethasone test, failure to suppress suggests?

Answer 10

adrenal tumour or ectopic production of ACTH

Question 11

what do you die with in cushings?

Answer 11

MI, hypertension, infection or heart failure

Question 12

two main options for treatment ?

Answer 12

surgery and radiotherapy

Question 13

the hypersecretion of cortisol should be controlled before the ‘proper’ treatment begins. what drug should be given?

Answer 13

metyrapone

Question 14

treatment of adrenal adenoma?

Answer 14

Should be resected after remission with drug treatment has been achieved

Question 15

treatment of adrenal carcinoma?

Answer 15

These are very aggressive and the prognosis is poor. Generally, if there are not widespread metastasis, then you should treat the primary tumour surgically. Radiotherapy may be beneficial to some patients.

Question 16

treatment of Ectopic ACTH tumours?

Answer 16

These should be removed wherever possible, and if not, then chemo and radiotherapy can be beneficial

Question 17

phaeochromocytoma is a neuroendocrine tumour of which part of the adrenal gland?

Answer 17

the medulla

Question 18

large quantities of which catecholamines are released?

Answer 18

lots of noradrenaline, adrenaline to a lesser extent

Question 19

phaeochromocytoma (NAH)

Answer 19

presents with severe headaches and hypertension

Question 20

why would you get cardiac tachycardias?

Answer 20

NA and adrenaline

Question 21

what 3 things are phaeochromocytomas associated with?

Answer 21

associated with MEN type II, neurofibromatosis and von Hippel-Lindau syndrome

Question 22

how do you confirm pahaeocromocytoma?

Answer 22

Confirmed by 3x 24-hour collection of urine catecholamines

Question 23

what is the initial best test to rule out phaechr…?

Answer 23

met adrenaline blood test

Question 24

what other symptoms would you expect ?

think adrenaline

Answer 24

A plethora of other symptoms, including flushing+unwell+wt loss (like in hyperthyroid), panic/anxiety, sweating, pallor, hyperglycaemia, pyrexia, abdominal pain …

Question 25

treatment of pheochromocytoma?

Answer 25

Stabilise patient: ALPHA-blockers (phenoxybenzamine) BEFORE beta-blockers, to prevent hypertensive crisis from unopposed alpha-stimulation.

Question 26

definitive surgical treatment ?

Answer 26

surgical resection of adrenal gland