Cushing's syndrome /disease

Notes
  • This is caused by pituitary adenoma and sometimes bronchogenic carcinoma that produce excessive amounts of adrenocorticotropic hormone (ACTH), which in turn stimulates production of cortisol (glucocorticoid) by adrenal glands.
  • This condition can also be iatrogenic (caused by medications)
  • Glucocorticoids;

_Help maintain normal blood glucose concentrations by increasing gluconeogenesis

_Direct epinephrine to partially constrict blood vessels thus maintains the blood pressure.

_Have anti-inflammatory effects

Symptoms
  • Hypertension
  • Facial plethora
  • Supraclavicular fat pad
  • Weight gain
  • Truncal obesity
  • Thin arms and legs
  • Hyperpigmentation
  • Moon face
  • Diabetes mellitus
  • Diabetes insipidus
  • Buffalo hump
  • Headache
  • Erectile dysfunction in male
  • Increased risks of fracture
  • Depression
  • Irritability
  • Hirsutism
  • Skin striae
  • Easiness to bruise and slow healing of bruises
  • Increased risks of infections
  • Acne
  • Glucose intolerance
  • Hypokalemia
  • Menstrual disorder
  • Metabolic alkalosis
  • Proximal muscle weakness
  • Adrenal crisis
Diagnosis
  • Plasma cortisol levels
  • Urine cortisol levels
  • ACTH plasma levels
  • ACTH stimulation test
  • Dexamethasone suppression test
  • Imaging of pituitary and abdomen
  • Electrolytes
Differential
  • Obesity
  • Alcoholism
  • Anorexia or Bulimia Nervosa
  • Depression
  • Pseudo-Cushing Syndrome
Management
  • Pituitary and/or adrenomectomy
  • Chemotherapy
  • o,p-dichlorodiphenyldichloroethane at a dose of 6 -10g/day in case of advanced adrenocortical carcinoma.
  • High protein intake
  • Adrenal inhibitors such as metyrapone or ketoconazole (Tab 400mg OD to TID)
  • Somatostatin analogs, dopamine agonists (such as bromocriptine) or mifepristone
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