cushing syndrome and disease

• cushing syndrome is an illness resulting from excess cortisol secretion or resulting from exogenous glucocorticoid administration.
• cushing disease is a hypercortisolism resulting from too much secretion of ACTH-secreting pituitary tumour
• investigations: we do low dose overnight dexamethasone(corticosteroids) suppression test. or we can use betamethasone-1mg
• so for investigations: give dexamethasone 1mg,oral,at 23:00,in the morning after breakfast at 08:00 measure cortisol levels. in normal people cortisol will be suppressed and the cortisol level will be <50nmol/L. in cushing, cortisol levels will be >50nmol/L
• cushing syndrome is a primary hypercorticolism, here the adrenal glands is the problem secreting too much cortisol. cause can be adrenal adenoma
• cushing disease is a secondary hypercorticolism. here the problem is the pituitary pumping a lot of ACTH that will stimulate the adrenal glands to stimulate too much cortisol. sometimes we can have ectopic secretion of ACTH from tumour in the body
• if we have high levels of multiple hormones like high prolactin,high TSH,high growth hormone plus high ACTH just know the patient has pituitary microadenoma
• clinical finding of cushing include: buffalo hump at the back,moon face-swelling face, abdominal obesity with stretch marks due to skin atrophy
• complications of cushing include: 1)secondary hypertension-cortisol cause vasoconstriction. 2)DM-cortisol increase blood glucose 3)osteoporosis-cortisol makes bones weaker 4)high risk of infection-cortisol cause immunesuppression 5)encephalopathy
• treatment: 1)if cushing sydrome was caused by patient taking too much steroid, they need to reduce steroid intake. 2)if cushing is due to adrenal adenoma, give patient ketoconazole or remone adrenal adenoma by surgery-adrenalectomy. for cushing disease give ketoconazole