Cushing's Syndrome

• Pathophysiology:

  • Excess of glucocorticoids
• Etiologies:

  • Adrenal adenoma
  • Pituitary adenoma or Cushing disease
  • An ectopic carcinoma that causes paraneoplastic syndrome
  • Iatrogenic conditions
• Manifestations:

  • Moon face (round and puffy)
  • Heavy trunk
  • Buffalo hump
  • Waisting of muscle in the limbs
  • Fragile skin that may have red streaks
  • Hirsutism
  • Osteoporosis and decreased protein synthesis
  • Increased gluconeogenesis and insulin resistance
  • Retention of sodium and water, leading to hypertension, edema, and possible hyperkalemia
  • Suppression of the immune response and the inflammatory response
  • Stimulation of erythrocyte production
  • Emotional lability and euphoria
  • Hypertension
  • Glucose intolerance
  • Fatigue
  • Weakness
• Risk Factors:

  • Female sex
  • Adrenal or pituitary tumors
  • Long-term therapy with glucocorticoids
• Diagnosis:

  • Measure free or unbound cortisol in 24 hour urine sample
  • Blood or saliva test late at night
  • Low-dose Dexamethasone suppression test
  • Confirm with imaging studies