Cushing's disease neuro case presentation open office
Cushing’s diseaseOverview of hypothalamic-pituitary axis andhormones.Assessment of anterior pituitary function (basicbiochemical tests).MRI and visual field assessment in patients withHPA disease
Pituitary gland – Anatomy & FunctionThe pituitary gland is a pea-sized gland at the base of the brain,divided into anterior/posterior lobes, and secretes varioushormones. Hypothala mic Target Pituitary Feedback Regulator Gland Hormone Hormone y Hormone Thyroid TRH TSH T4 T3 gland Gonad LHRH LH E2, T Inhibin, Gonad LHRH FSH E2, T Many GHRH, GH IGF-1 organs SMS Breast PIF Prolactin ? CRH, Adrenal ACTH Cortisol ADH
Cushing’s disease - IntroductionCushing’s disease vs. syndromeCushing’s syndrome = group of symptoms thatoccur during ↑↑↑excess cortisol productiondue to:exogenous e.g. steroid medicationendogenous causespituitary gland adenoma – Cushing’s diseaseAdrenal gland adenoma/carcinomaectopic ACTH tumours e.g. small cell lung cancer
Cushing’s disease = mostcommon formof endogenous Cushing’ssyndrome.It is caused by a pituitarygland tumour thatsecretes excessiveamounts of ACTH. Thistype of tumor is
Pituitary Tumors:hormone-secreting or non-secreting; most are benign;may cause visual disturbances and headaches as theygrow and compress surrounding tissues; often results inexcessive amounts of one pituitary hormone anddecreases in others.Signs and symptoms: Pituitary tumors may manifestwith signs and symptoms related to pituitaryhypofunction, specific hormone(s) hypersecretion,and/or mass effect. Impingement on the chiasm or itsbranches by a pituitary tumor may result in visual fielddefects; the most common is bitemporalhemianopsiaLateral extension of the pituitary mass to the cavernoussinuses may result in diplopia, ptosis, or altered facialsensation.Among the cranial nerves, the third nerve isthe most commonly affected.
EpidemiologyIncidence of endogenous Cushing syndrome isabout 13 cases per million individuals/yr. Ofthese cases, approximately:70% are due to Cushing disease, i.e. a pituitary ACTH-producing tumor15% to ectopic ACTH15% to a primary adrenal tumor.
"normal" diurnal variation =cortisol peaks 8 a.m. andhalves around 4 p.m. Bymidnight cortisol should beabout zero or close to it withblood and salivary levels.Cushings = circadian rhythmis lost, "flat" diurnal levels ofcortisol, or even higher levelsat night instead of in themorning.
Signs & Symptomsdepression and mood swingsmoon faceweight gain around the trunk (central obesity)proximal myopathyEasy bruising, thin skinStriae (purple)Hypertension and mild diabetesOligo-/Amenorrhoea femalesimpotence - malesdecrease in sex driveIncreased hair growth (hirsutism)
Cushing disease : headaches, polyuria, nocturia,visual problems, or galactorrhea.If sufficient mass effect from the tumor ispresent on the anterior pituitary,hyposomatotropism, hypothyroidism,hyperprolactinemia or hypoprolactinemia, andhypogonadism may develop.