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8 Cards in this Set
- Front
- Back
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Clinical features cushings? (3 groups)
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Head: hirsuitism, hair loss, acne, rosie cheeks (plethora), moon face, cataracts, exopthalmus, psychosis
Abd: peptic ulcer, hyperglycaemia, central obesity, striae, menstrual disturbance, decreased skin thickness Lower limbs: # NOF, osteoporosis, poor wound healing, bruising, wasting proximal mm, |
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Tests cushings (2)
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Overnight dexamthasone suppression: normally this suppresses ACTH and thus cortisol by a -ve feedback loop. However in cushings there is a failure to do so.
24hr urinary free cortisol (norm <280nmol/24hrs) |
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Causes of a cushingoid presentation (4)
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Ectopic prod ACTH E.G. small cell lung cancer
Ectopic CRH; prostate Ca + thyroid Ca Steroid treatment Pituitary adenoma - secreting ACTH (microadenoma)i.e. cushings disease |
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Rx cushings disease
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Bilat adrenectomy if the source of ACTH or CRH cannot be found
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Addisons disease is
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Adrenal insufficiency
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Symptoms addisons (15)
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Fatigue, weakness, anorexia, weight loss, dizziness, fainting, myalgia, arthralgia, depression, psychosis, nausea, vomiting, diarrhoea, constipation, hyperpigmentation
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Tests (4)
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1) Synacthen test
Give short ACTH stimulation test and Addisons is excluded if cortisol rises > 550 nmol/L. Addisons is confirmed if there is a failure of cortisol to rise 2) Random cortisol - remember may be in normal range, but inappropriately low for such an ill patient 3) ACTH level - low in ACTH deficiency (secondary fail) or high in addisons with a low cortisol 4) U+E's : due to low mineralocorticoid (e.g. aldosterone) therefore hyponatraemia, hyoerkalaemia |
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Rx: addisons
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Hydrocortisone (cortisol replacement)
Cortisone Fludrocortisone (if mineralocorticoid insufficiency) |
