Cushing's syndrome

• What is Cushing's syndrome?

  Excessive cortisol
• What are the 2 causes of Cushing's?

  Endogenous

  Exogenous (iatrogenic)
• What are some examples of endogenous causes of Cushing's?

  Excess secretion

  Pituitary gland tumour

  Lung/pancreatic tumour (excess ACTH)
• What causes pseudo-Cushing's?

  Severe depression

  Alcohol excess
• How do you differentiate Cushing's and pseudo-Cushing's?

  Insulin stress test
• What tests does pseudo-Cushing's cause a false +ve in?

  Dexamethasone suppression test

  24hr cortisol
• What are some symptoms of Cushing's?

  Thinning of skin/hair

  Easy bruising

  Memory and concentration issues
• What are some conditions associated with Cushing's?

  HTN

  T2DM

  Osteoporosis

  Dyslipidaemia

  Cardiac hypertrophy
• What are some causes of Cushing's?

  Adrenal carcinoma

  Exogenous steroid use

  Pituitary/adrenal adenoma
• What bedside investigations are done for Cushing's?

  24hr urine free cortisol

  Bedtime salivary cortisol

  Overnight dexamethasone suppression
• What do different cortisol and ACTH test results mean for Cushing's

  A) Not suppressed

  B) Suppressed

  C) Cushing's due to other causes

  D) Suppressed

  E) Suppressed

  F) Cushing's disease

  G) Not suppressed

  H) Not suppressed

  I) Ectopic ACTH syndrome

  
• What scans are done for Cushing's?

  CT

  MRI
• What blood tests are done for Cushing's and what do they show?

  Hypokalaemic metabolic alkalosis

  Impaired GGT

  9am/12am plasma ACTH (low = adrenal adenoma)
• How is Cushing's managed?

  Metyrapone

  Removal of tumour/adrenal glands
• What are some signs of Cushing's?

  Moon face

  Central fat distribution

  Abdo striae

  Enlarged fat on upper back (buffalo hump)

  Muscle wasting/weakness
• What mental health conditions are associated with Cushing's?

  Anxiety

  Insomina

  Psychosis

  Depression