east facts about Cushing's disease

1. By
Mohammad Gamal Khalifa
Assist. Lecturer of Internal Medicine ,
Diabetes and Endocrinology .
Faculty of Medicine, Zagazig University

3. Cortex :
Z.Glomerulosa
>>>>Aldosterone
Z. Fasciculata >>>>>Cortisol
Z. Reticularis
>>>>>Androgens
Medulla :
CA

5.  Cortisol level show diurnal
variation
highest at morning
decrease by evening
reach lowest level at mid night

6. **Metabolic :
CHO…… anti insulin action >> Diabetogenic
Fat >> ketogenic and libolysis
protein >>>> catabolic
**Increase vascular sensitivity to CA >>>> HPN
**Water and electrolyte : na retention and k
excretion .
** Stomach : increase pepsin and gastric acidity
** Blood : >>> decrease esinophils and
lymphocytes and increase neutrophils and RBCs

7.  ** Anti inflamm, anti allergic >>>> decrease
histamine release .
**Anti stress : stress >> release CRH>>>
ACTH >> cortisol
** stimulate BM >> release RBCS , …
** androgen like action

11.  Age : 30 >> 40 years .
Female > male
Not inherted
** Disturbances in fat metabolism “ abnormal
deposition and weight gain “
Face …… Moon face “ rounded - bloated - cheeks
dropping of angle of the mouth.
Inter scapular : Buffalo- hump
Abdominal : Truncal or central obesity .” lemon
on match sticks”

12.  **Disturbances of CHO : Hyperglycemia
Steroid diabetes “ insulin resistant diabetes
“
**Disturbances in protein metabolism
Stria Rubra
Delayed wound healing and bruises
proximal myopathy
osteoprosis and pathological fracture of ribs.
**Disturbances of fluid and electrolytes
increase Na and water retention , polyurea ,
edema

13.  Plethoric facies due to polycythemia
** Androgenic effect :ACTH>> adrenal
androgen production
male …. excess body hairs , fall of frontal
hair “ baldness.
Female …. Amenorhea , hirsutism
** Psychological problems
** Skin infection , Acne without comedons
and pigmentation “ ACTH depenant cases “

19.  1- Non specific : suggest High cortisol level
High blood sugar ,Hypokalemia , hypernatremia
CBC… lymphopenia , neutrophilia , polycythemia.
2- 24 hs urinary free cortisol level …. High
3- plasma cortisol level … high and loss of
circadian rhytm
4 – Screening with Standard Low Dexamethasone
suppression test “ LDST”
5- Overnight high dose dexamethasone
suppression test …… differentiate between
adrenal , pituitary and ectopic ACTH

20.  6 – ACTH level : high in pituitary adenoma
and ectopic ACTH and low in adrenal cushing
.
NB : ACTH can be measured in venous blood
obtained by catheterization of inf. Petrosal
sinus… high level compared with that of
prepheral blood indicate pituitary cause…
7-MRI pituitary ….. Pit. adenoma .
8- Chest x ray anf CT scan ….. Bronchogenic
carcinoma .

28. Thank
You