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8 Cards in this Set
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Major S/S of Cushing's disease/syndrome:
Most common cause of Cushing's syndrome? Endogenous causes: |
fatigue, easy bruising, weight gain, striae on abdomen, "moon face", "buffalo hump", central obesity, hirsutism
exogenous use of glucocorticoids ACTH secretion by pituitary (Cushing's disease), or cortisol secretion from an adrenal tumor |
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Which cause is ACTH-independent?
ACTH-dependent? Different symptoms between chronic cortisol excess and sudden acute cortisol excess (ACTH malignant tumors): |
adrenal tumors (25%)
Cushing's disease (60%), ectopic ACTH disorders (15%) acute - weight loss, weakness, secondary diabetes, HTN, edema, hypokalemia chronic - bruisability, central obesity, striae, muscle weakness, fungal infections |
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Unique symptom of ACTH excess:
Two major screening tests for Cushing's: Three other causes of elevated urine cortisol: |
hyperpigmentation
24 urine cortisol, creatinine overnight dexamethasone suppression test - normal cortisol response <5 mg/dl in the morning depression, acute illness, alcoholism |
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Definitive tests for Cushing's syndrome:
ACTH-dependent hypercortisolism means which organs are involved? ACTH-independent? |
Urine free cortisol >300/24 h.
failure of normal suppression in low dose dex test - no suppression of 17-hydroxysteroids <4 mg or UFC <25 mg dependent - hypothal, pituitary independent - adrenal gland |
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Once you find a low ACTH, what test should you do next?
normal/elevated ACTH suggests: How to differentiate? What is an important tumor assessment exam? |
CT scan for tumor/nodules
Cushing's disease, ectopic ACTH production high dose dex test (2 mg QID for 2 days), or 8 mg overnight; morning cortisol suppressed >50%, then dx of Cushing's disease CT, MRI |
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Explain bilateral sampling for ACTH:
Which tumor type has decreased plasma ACTH? Which tumor responds to high-dose dex test? Which tumors respond to CRH challenge? |
simultaneous bilat inferior petrosal sinus/peripheral vein sampling for ACTH - ACTH ratio >3 for one side ad other indicates side of tumor
adrenal tumor pituitary microadenoma pituitary macro, microadenoma |
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Primary treatment of choice in Cushing's disease:
What do patients require after surgery? |
trans-sphenoidal removal - 80-90% effective
often need 6-12 months of glucocorticoid replacement |
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Treatment options for post-operative persistent Cushing's?
What is Nelson's syndrome? |
pituitary radiation, steroid blockers (ketoconazole, etc)
bilateral adrenalectomy/post-op radiation to prevent Nelson-Salassa syndrome small, progressive ACTH tumor with hyperpigmentation, extrasellar effect |
