Cushing's Syndrome

Front 1

What is present in Cushing's syndrome?

Back 1

Increased glucocorticoid

Front 2

What causes Cushings syndrome?

Back 2

Synthetic steroids
ACTH administration
ACTH-dependent - pituitary, ACTH producing tumours
Non-ACTH dependent causes - adrenal adenomas, adrenal carcinoma
Alcohol induced pseudo-cushings syndrome

Front 3

What causes Cushing's disease?

Back 3

Pituitary dependent cause of increased ACTH

Front 4

What are the signs of Cushing's?

Back 4

Central Weight gain
Appearance change
Depression
Insomnia
Amenorrhoea
Poor libido
Thin skin/easy bruising
Hair growth/acne
Muscle weakness
back pain
Polyuria/polydipsia
Psychosis

Front 5

What are the symptoms of Cushings?

Back 5

Moon face
Plethora
Depression/psychosis
Acne
Hirsuitism
Frontal balding in females
Thin skin
Bruising
Poor wound healing
Pigmentation
Skin infections
Hypertension
Osteoporosis
Fractures
Kyphosis
Central obesity
Striae
Rib fracture
Oedema
Proximal myopathy
Proximal muscle wasting
Glycosuria

Front 6

How is Cushing's diagnosed?

Back 6

48 hour low dose dexamethasone test - cant suppress plasma cortisol to <50nmol/L
24 hour urinary free cortisol measurement - if repeatedly normal the unlikely
High midnight cortisol level >100nmol/L
Insulin stress test
Desmopressin stimulation test
CRH test

Front 7

How is the cause of Cushing's found?

Back 7

Adrenal CT/MRI - adenomas or carcinomas
Pituitary MRI
Plasma potassium level - hypokalaemia in ectopic ACTH levels
High-dose dexamethasone - if not suppressed indicated ectopic source or ACTH or adrenal tumour
Plasma ACTH levels - low ACTH on 2+ occasions indicates non-ACTH dependent cause
CRH test - exaggerated ACTH and cortisol response to exogenous CRH suggests pituitary dependent Cushing's
CXR - Carcinoma of bronchus or bronchial carcinoid

Front 8

What is the treatment of Cushing's?

Back 8

Cortisol hypersecretion control
Metyrapone
Ketoconazole