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    Cushing's Syndrome

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    Kuan Ng
    Cushing's syndrome is caused by prolonged high levels of cortisol and can be due to exogenous or endogenous factors. The main symptoms are Cushingoid features like obesity, diabetes, hypertension, and immunosuppression. Diagnosis involves tests that measure cortisol levels which should not be suppressed after low dose dexamethasone administration or should be high in saliva or serum samples taken overnight. Determining the cause of hypercortisolism is important for treatment, which may involve surgery to remove tumors or treatment of underlying conditions leading to excess cortisol production.

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    Cushing's Syndrome

    Uploaded by

    Kuan Ng
    30 views2 pages
    Cushing's syndrome is caused by prolonged high levels of cortisol and can be due to exogenous or endogenous factors. The main symptoms are Cushingoid features like obesity, diabetes, hypertension, and immunosuppression. Diagnosis involves tests that measure cortisol levels which should not be suppressed after low dose dexamethasone administration or should be high in saliva or serum samples taken overnight. Determining the cause of hypercortisolism is important for treatment, which may involve surgery to remove tumors or treatment of underlying conditions leading to excess cortisol production.

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    Cushing's syndrome is caused by prolonged high levels of cortisol and can be due to exogenous or endogenous factors. The main symptoms are Cushingoid features like obesity, diabetes, hypertension, and immunosuppression. Diagnosis involves tests that measure cortisol levels which should not be suppressed after low dose dexamethasone administration or should be high in saliva or serum samples taken overnight. Determining the cause of hypercortisolism is important for treatment, which may involve surgery to remove tumors or treatment of underlying conditions leading to excess cortisol production.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    30 views2 pages

    Cushing's Syndrome

    Uploaded by

    Kuan Ng
    Cushing's syndrome is caused by prolonged high levels of cortisol and can be due to exogenous or endogenous factors. The main symptoms are Cushingoid features like obesity, diabetes, hypertension, and immunosuppression. Diagnosis involves tests that measure cortisol levels which should not be suppressed after low dose dexamethasone administration or should be high in saliva or serum samples taken overnight. Determining the cause of hypercortisolism is important for treatment, which may involve surgery to remove tumors or treatment of underlying conditions leading to excess cortisol production.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Cushing’s syndrome

    Cushing’s syndrome refers to any causes of hypercortisolism.


    Cushing’s disease specifically refers to 2n hypercortisolism due to excess ACTH by
    pituitary adenoma. 

    Etiology
    1. Exogenous (iatrogenic)
     MCC of hypercortisolism
     Due to prolonged glucocorticoid thx
     Some traditional meds or tonics/jamu contains potent steroids usually for joint
    pain → steroid-withdrawal arthralgia
    2. Endogenous 
    o Primary hypercortisolism = ACTH independent
     Adrenal gland makes too much cortisol → ACTH suppression
     Adrenal adenoma, carcinoma, macronodular adrenal
    hyperplasia  
    o Secondary hypercortisolism = due to high ACTH
    a. Pituitary ACTH production = CUSHING’S DISEASE
    o Pituitary adenoma → ACTH secretion 
    b. Ectopic ACTH production 
    o Paraneoplastic syndrome → ACTH secretion
     SCLC
     RCC

    Clinical features
    CUSHINGOID
     Cataracts
     Ulcers
     Skin (striae, bruising, thinning, ulcer)
    o Impaired collagen synthesis → skin thinning
     Hirsutism
     HTN: often w hypokalemia and met alkalosis 
    o High cortisol increases sensitivity of peripheral vessels to catecholamines
    o At very high level, cortisol cross-react with mineralocorticoid receptors
    (aldosterone is not increased) → increased water and sodium retention with
    increased potassium excretion
     Infections
     Necrosis (femur head) - Due to inhibition of calcitriol synthesis by cortisol.
     Glycosuria
     Obesity, osteoporosis
     Immunosuppression
     Diabetes
    o Diabetogenic effect of glucocorticoid → insulin resistance
     Muscle weakness with thin extremities - cortisol breaks down muscles to produce
    amino acids for gluconeogenesis
     Moon facies, buffalo hump, truncal obesity - high insulin (due to high glucose)
    increases fat storage centrally
    o Supraclavicular fat pads are quite specific 
     Hyperpigmentation- in secondary hypercortisolism only!!! 
    o Esp in non-exposed area (palm creases, oral cavity)
    o Excess ACTH → MSH is cleaved from same precursor as ACTH →
    overproduce melanin
     Dyslipidemia - Cortisol increases lipolysis
     Decreased libido, irregular menstruation - due to inhibition of gonadotropin release

    Diagnosis 
    Lab test
     Hypernatremia, hypokalemia, met alkalosis (Due to the mineralocorticoid effect of
    cortisol: ↑ water and sodium retention, ↑ K+ excretion, ↑ H+ excretion)
     Hyperglycemia- due to stimulation of gluconeogenesis enzymes (e.g., glucose-6-
    phosphatase) and inhibition of glucose uptake in peripheral tissue
     Hyperlipidemia
     Leukocytosis (neutrophils*)
     Serum androgen: testosterone, DHEAS, androstenedione increased in F,
    testosterone decreased in M.
     PRL, FSH, LH and pituitary fx 

    To diagnose hypercortisolism 
    **Diurnal cortisol = low in midnight, high in morning (that’s why we measure midnight
    sample for screening, and early morning sample for dexa test!)
     ↑ 24hr urine cortisol: most accurate, but hard to do in clinical setting
     ↑ early morning serum cortisol following low dose dexamethasone test (1mg)
    o A normal person w/o hypercortisolism will be suppressed at <50nmol/l
     Midnight salivary or serum cortisol
     Random cortisol is not useful except in exogenous Cushing’s when very low levels
    found (traditional meds can contain dexa)
    o

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