A 42-year-old woman presented with high blood pressure, fatigue, back pain, and bruising. Based on her symptoms and physical exam findings, the doctor suspected Cushing's syndrome. Tests would be ordered to confirm the diagnosis, including blood tests and imaging studies. Cushing's syndrome occurs when there are high levels of cortisol in the body, which can be caused by medications or tumors. It impairs the body by causing weight gain, muscle weakness, high blood pressure, and other issues if left untreated. Cushing's disease is a type of Cushing's syndrome specifically caused by a pituitary tumor that increases ACTH and cortisol levels.

1. National Pirogov Memorial Medical University, Vinnytsya
Department of Social Medicine and Organization of public health
services
Principles of evidence-based medicine
Answers to individual tasks
5th year student, group -88 B
Name-RITIK
2022.

2. Case 1

3. Simulate a clinical case in which you are a doctor and you are approached by an imaginary
patient with the need to diagnose the disease and receive recommendations for further
treatment:
1 - Write down his main complaints and anamnesis.
2 - Indicate what previous diagnoses/treatment/prognosis you can think of based on the information provided
to you by the patient.
3 - Describe how you plan to confirm the preliminary diagnosis using the material provided to you in the form of
guidelines.
4 - Formulate a clarified question that will help you find evidence based information.
5- Describe exactly how, where and what information you are looking for. How Cushing syndrome impair the
body activity?
6 - What’s the difference between Cushing’s syndrome (Hypercortisolism) and Cushing’s disease?

4. Case 1
1 - Write down his main complaints and anamnesis (3-4
sentences).
1. The woman is 42 years old. Height 160 cm. Weight 92 kg. The
patient came to the family doctor with complaints that her
blood pressure rises to 190/110 mmHg every day, along with
feeling of tiredness and fatigue , backache and on examination
found that bluish-red stretch mark on skin with hump btw the
shoulders and she had fracture of left arm 2 months ago

5. Case 1
2. Indicate what previous diagnoses/treatment/prognosis you can
think of based on the information provided to you by the patient.
2. Preliminary diagnosis: cushing syndrome
(Hypercortisolisms), Obesity, muscle wasting ,osteoporosis,
purple striae and hypertension.
Body mass index = 35.9.
Treatment; ketoconazole, mitotane, (decrease ACTH production in
the pituitary gland)

6. Case 1
3. Describe how you plan to confirm the preliminary diagnosis
using the material provided to you in the form of guidelines.
3. Using the recommended sources for information, I will look for
published results of clinical trials that will help determine which
diagnostic tests should be prescribed for the patient and what
treatment.

7. Case 1
4. Formulate a clarified question that will help you find evidence
based information.
4.
• How to differentiate cushing syndrome from PCOS?
• What examinations should be prescribed to confirm the diagnosis: CUSHING SYNDROME?
• How does CUSHING SYNDROME progress?
• How to determine the total risk of complications?
• What drug is the drug of choice for the treatment of CUSHING SYNDROME in women with DM T-2?
• What drug is the drug of choice for the treatment CUSHING SYNDROME in obese women?
• Is CUSHING SYNDROME a terminal Illness?

8. 1. Unlike PCOS, Cushing syndrome
is associated with the presence of moon
facies, a buffalo hump, abdominal striae,
and muscle wasting. .
2. Blood ACTH test, Corticotropin-
releasing hormone(CRH), High-dose
dexamethasone suppression test,
Imaging studies.
3. Idiopathic cause( steroid
misuses)
4. Bone loss(osteoporosis) ,
Hypertension, hyperglycemia
5. Mifepristone (Korlym, Mifeprex)
is approved for people with Cushing
syndrome who have type 2 diabetes or
glucose intolerance.
6. ketoconazole, mitotane
(Lysodren) and metyrapone
(Metopirone)
7. Today, virtually all people with
Cushing's syndrome can be treated
effectively, and many can be cured.
Because Cushing's syndrome is
potentially fatal if untreated,

9. Case 1
5. Describe exactly how, where and what information you are
looking for.
Cushing’s syndrome (hypercortisolism) happens when there’s extra cortisol in your body. Cortisol, the “stress
hormone,” is vital to regulating your blood sugar and turning food into energy. Unfortunately, too much of it caused
by a medication or a tumor can cause weight gain, muscle weakness and more. Cushing’s syndrome can be fatal if
untreated
Your body releases extra cortisol during times of stress, helping out by:
Increasing your heart rate.
Increasing your blood pressure.
Managing your blood glucose.
Managing your respiration.
Increasing your muscle tension.

10. Case 1
5. How Cushing syndrome impair the body activity?
Left untreated, Cushing syndrome can result in exaggerated facial roundness,
weight gain around the midsection and upper back,full moon shaped face,
buffalo hump, thinning of your arms and legs, easy bruising and stretch
marks. Cushing syndrome occurs when your body has too much of the hormone
cortisol over time.

11. What’s the difference between Cushing’s syndrome
(Hypercortisolism) and Cushing’s disease?
• Cushing’s disease is a type of Cushing’s syndrome.
Cushing’s disease is caused by a benign tumor located in
the pituitary gland that secretes too much ACTH
(adrenocorticotropic hormone), which in turn increases
cortisol.
• Out of patients with Cushing’s syndrome, Cushing’s
disease accounts for more than 70% of cases in adults
and about 60% to 70% of cases in children and
adolescents.