Adrenal
Cushing's Disease
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Cushing's Disease
, Cushing's Syndrome, Cushing Disease, Cushing Syndrome
Etiologies
Iatrogenic
Steroid therapy (most common cause)
Central Cause
Pituitary Adenoma
Adrenal Cause
Adrenal Adenoma
Adrenal Hyperplasia
Adrenal Malignancy (15%)
Ectopic Source
Malignancy (Small Cell Carcinoma of the lung: 15%)
Symptoms
Mood changes (depression and euphoria)
Easy
Bruising
Weakness
Weight gain
Amenorrhea
Back pain
Signs
Truncal
Obesity
(90%)
Hypertension
(85% when Cushing Disease is caused by tumors, 20% when iatrogenic)
Glucose Intolerance
(80%)
Hirsutism
(70%)
Wide, purple abdominal and thigh striae (65%)
Osteoporosis
(55%)
Moon facies
Buffalo hump (Thoracic kyphosis)
Myopathy
Plethoric face
Supraclavicular fat pad development
Hypertrichosis
Peripheral Edema
Hypertension
Labs
Screening Test
24-hour Urinary free cortisol level
(preferred)
Urine 17-Ketosteroid excretion
Urine 17-Hydroxysteroid excretion
Serum Cortisol
Low dose
Dexamethasone Suppression Test
Dexamethasone
1 mg at 11pm
Plasma
Cortisol
in following 8 AM
Night-time
Saliva
ry
Cortisol
testing
Distinguish between pituitary, adrenal or ectopic cause
Plasma
ACTH
High dose
Dexamethasone Suppression Test
(8 mg)
Radiology
CT or MRI Cone down Sella Turcica
Pituitary Adenoma
CT Abdomen
Adrenal Adenoma
Management
Exogenous Cushing Syndrome (Iatrogenic Cushing Syndrome, most common cause)
Stop
Corticosteroid
s or decrease dose
Change steroid dosing to every other day with drug holiday
Endogenous Cushing Syndrome
Surgically excise adenoma (in pituitary or adrenal)
References
Magiakou (2006) Best Pract Res Clin Endocrinol Metab 20(3): 467-82 [PubMed]
Orth (1995) N Engl J Med 332:791-803 [PubMed]
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