Uploaded byGOPALA KRISHNAM RAJU AMBATI
Cushings syndrome
This document summarizes Cushing's disease and syndrome, their causes, clinical features, classifications, and investigations. Cushing's disease is caused by a pituitary problem and results in excess cortisol production from the adrenal glands. It is more common in women, while Cushing's syndrome, which can be caused by tumors outside the pituitary gland, is more common in men. Clinical features include obesity, skin changes, menstrual irregularities, and psychological issues. Investigations include late night salivary cortisol tests, 24-hour urine free cortisol tests, and low-dose dexamethasone suppression tests to differentiate causes and guide treatment.
More Related Content
Similar to Cushings syndrome
![ONFH[AVN HIP] -TRIPLE REGIME -A NOVAL SURGICAL CONCEPT .pptx](https://cdn.slidesharecdn.com/ss_thumbnails/onfhavnhip2026koaconcalicutdrgokuldevdrmashraf-260210064517-213ec005-thumbnail.jpg?width=640&height=640&fit=bounds)
![PERI-PROSTHETIC FRACTURE NAIL-PLATE CONSTRUCT [NPC].pptx](https://cdn.slidesharecdn.com/ss_thumbnails/drarunkumardrmohamedashrafperiprostheticfrasturenail-plateconstructnpc-260209164459-7e9d15a1-thumbnail.jpg?width=640&height=640&fit=bounds)
Cushings syndrome
- 1. CUSHINGS GR EXCESS • Cushingdisease is caused by pituitary problem and cushing syndrome is caused by ectopic acth • cushings disease is seen in 2 to 3 in million • cushings disease is more common in women • ectopic acth is more common in men CAUSES • exogenous steroids as inhalants , injection , tablets , creams • ritonavir decreases steroid clearance clinical features :: • obesity , plethora , moon face and hirsutism • fat deposits seen on spine , supra clavicular fossa , temporal regions & epidural space • menstrual irregularities • loss of libido • vellus hypertrichosis • hypogonadotrophic hypogonadism • agitated depression , lethargy , paranoia and overt psychosis • osteoporotic vertbral collapse • osteonecrosis of femoral and humeral heads • renal caliculi • skin thinning , liddle sign & easy bruising • acne and papular lesions over face chest & back • myopathy of lower limbs & shoulder girdle • myopathy tested by crouching position • hypertension • reactivation of tb • skin and nails fungal infections • bowel perforation • wound infections • glucose intolerance • increased cholesterol and triglyceride levels • hypokalemic alkalosis(ectopic acth) • decreased GH secretion • increased intraocular pressure PHYSIOLOGICAL HYPERCORTISOLISM WITH FEATURES OF CS • pregnancy • obesity • psychological stress • poorly controlled diabetes • aloholism CREATED BY -Dr.GOPALA KRISHNAM RAJU @ D r_gkr
- 2. CUSHINGS PHYSIOLOGICAL HYPERCORTISOLISM WITHOUTFEATURES OF CS • physical stress • malnutrition • intense chronic exercise • hypothalamic amenorrhea • high CBG • GR resistance classification • ACTH dependant • ACTH independent ACTH dependant • 70% cases are due to this • ZF & ZR widening seen • 85 to 90% cases are due to monoclonal pituitary adenoma • basophil hyperplasia seen in 9 to 33 % cases • majority of tumors are microadenomas and 10% are macroadenomas • hallmark feature is resistant ACTH secretion to normal GR inhibition • increasedACTH pulse amplitude with loss of normal circadian rhythm • 15 % cases are due to non pituitary tumors • may be due to bronchus cancer and carcinoids and pancreas cancer • ACTH and cortisol are very high • bronchial medullary and prostate cancer produces CRH and ACTH • due to high ACTH there is MAH confusing as primary adrenal tumor ACTH independent • 65% of childrens with cushings have adrenal cause • adenomas cause gradual course but carcinoma causes rapid course • patients complain of abdominal or loin pain • females show virilisation , hirsutism , clitoromegaly , breast atrophy , deep voice , temporal recession , and severe acne • in pure cortisol secreting tumors there is no hirsutism • primary pigmented nooduular adrenal hyperplasia • mc cune albright syndrome • AIMAH • exogenous GR CREATED BY -Dr.GOPALA KRISHNAM RAJU @ D r_gkr
- 3. CUSHINGS INVESTIGATIONS • LATE NIGHTSALIVARY CORTISOL • URINARY FREE CORTISOL • LOW DOSE DEXA SUPPRESSION TEST • for low index of suspicion we do either 24hr UFC or LDSST • for high index of suspicion we do 2 tests • women with hypothalamic amenorrhea has high 24hr UFC • men doing intense exercise have high cortisol and ACTH levels • 24hr UFC is a inegrated measure of serum free cortisol • Salivary cortisol increase with age cardiovascular disorders and in diabetes • LDDST – 1mg at 11pm and cortisol at 8am should be <1.8/50 • 8am cortisol and 0.5mg dexa QID for 2 days and again cortisol at 8am should be <1.8/50 • phenytoin and rifamapicin decreases dexa clearance • patients with adrenal incidentalomas have normal urine cortisol but high salivary cortisol • late night cortisol > 7.5 is CS • in pregnancy 24hr UFC or late night salivary cortisol is best • adrenal incidentalomas 1mg DST best • in renal patients 1mg DST best CREATED BY -Dr.GOPALA KRISHNAM RAJU @ D r_gkr