Cushings

Front 1

what causes Cushings?

Back 1

TOO MUCH CORTISOL

Front 2

Common symptoms of Cushings?

Back 2

Easy bruising, abdominal fat, neck fat, legs/arms losing weight, WEAKNESS/FATIGUE, STRETCH MARKS

truncal obesity (plus loss of weight in arms), stretch marks, easy bruising

Front 3

plus other symptoms?

Back 3

facial plethora, hypertesniso, gluc. intolerance, irregular menses, impotence, fatigue, renal calculi, headache, osteopenies, psycho changes, hirsutism

Front 4

most common cushiness causes in order?

Back 4

iatrogenic
pituitary
adrenal
ectopic

Front 5

what is pituitary cushings called?

Back 5

cushings DISEASE

Front 6

WHAT AFFECT IS ADRENAL CUSHINGS?

Back 6

increased cortisol, decd ADH

Front 7

What is hyperplasia (pituitary cushings) cause for acth and court?

Back 7

high acth and high cortisol

Front 8

effect of ectopic tumour?

Back 8

high cort and acth high

Front 9

iatrogenic cushings readings?

Back 9

high cortisol, low acth

Front 10

What is the FIRST test for cushings?
second?

Back 10

24 hour glucose measuring twice, cortisol and creatinine

overnight dexmethanose 1mg...check for suppression...if cortisol not suppressed it cushings

Front 11

what two tests are good confirmatory tests?

Back 11

24 urine test for cortisol

low dose .5mg dexamthasone (if it does not suppress cortisol its cushings)

Front 12

LACK OF SUPPRESSION?

Back 12

CUSHINGS!

Front 13

Next step after cushings diagnosis is to measure what? what would it tell you

Back 13

acth. if acth high --> pituitary timor, or ectopic

if acth low- adrenal tumor

Front 14

how do u determine if it is ectopic or pituitary?

Back 14

administer a high dose dexamethanose test... if it responds to high dose, likely pituitary

if no suppression, it is ectopic since ectopic never responds to dexmethanose

could also do a CRH test, if it responds its pituitary

Front 15

if you can't see mass on adrenal what other test could you run to confirm?

Back 15

bilateral inferior petrolsal sinus samping...
if cortisol gradient >2 fold diff b/w central and peripheral, means adrenal problem

Front 16

what if no gradient after bilateral inferior petrosal sinus sampling?

Back 16

likely ectopic, should scan with mri, pet ct

Front 17

why don't we just measure cortisol/why do we use 24 hr measurements?

Back 17

cushings patients can have normal cortisol serum, 24 hr urine catches them elevated!

24 hr urine will appear normal in girls using the pill

Front 18

what will happen to cortisol reading when girls are on the pill (birth control). Why?

Back 18

it will read high in a cortisol test, but normal in a 24hr urine test.

it measures cortisol bound to globulin

Front 19

what percent of cortisol is bound to globulin?

what does 24 hr urine measure?

Back 19

90%

free AND bound globulin