21 Questions
What is the main function of the adrenal glands?
To produce hormones
What is the most common cause of ACTH-dependent Cushing’s syndrome?
Pituitary adenomas
What is a specific feature of Cushing’s syndrome?
Buffalo hump
What percentage of patients with Cushing’s syndrome experience hypertension?
75% to 85%
What test can help determine the etiology of hypercortisolism in Cushing’s syndrome?
All of the above
What is the goal of treatment for Cushing’s syndrome?
To limit morbidity and mortality and return the patient to a normal functional state
What is Addison’s disease?
Primary adrenal insufficiency
Which therapeutic option for Cushing's Syndrome can cause pituitary-dependent hormone deficiencies?
Combination therapy with metyrapone and aminoglutethimide
Which steroidogenic inhibitor can cause side effects like hypertension, sedation, and liver enzyme elevation?
Ketoconazole
Which therapeutic option is similar to ketoconazole but is only available in a parenteral formulation?
Etomidate
Which therapeutic option is a serotonergic antagonist that can decrease ACTH secretion, but should be reserved for non-surgical candidates who fail more conventional therapy?
Cyproheptadine
Which therapeutic option is a receptor antagonist that inhibits dexamethasone suppression and increases endogenous cortisol and ACTH values in normal subjects?
Mifepristone
Which therapeutic option has limited experience in Cushing's syndrome but is highly effective in reversing the manifestations of hypercortisolism?
Mifepristone
Which therapeutic option has not demonstrated consistent clinical efficacy for treating Cushing's syndrome, but combination therapy with these agents may prove more efficacious than any single agent?
Neuromodulatory agents
Which therapeutic option for Cushing's Syndrome can cause pituitary-dependent hormone deficiencies?
Pituitary irradiation
Which steroidogenic inhibitor can cause side effects like hypertension, sedation, and liver enzyme elevation?
Ketoconazole
Which therapeutic option can inhibit the production of cortisol and corticosterone, but can cause side effects like nausea, diarrhea, and CNS effects?
Mitotane
Which therapeutic option is a serotonergic antagonist that can decrease ACTH secretion and should be reserved for non-surgical candidates who fail more conventional therapy?
Cyproheptadine
Which therapeutic option is a receptor antagonist that inhibits dexamethasone suppression and increases endogenous cortisol and ACTH values in normal subjects?
Mifepristone
Which therapeutic option can be useful for acute hypercortisolemia awaiting surgery, but is only available in a parenteral formulation?
Etomidate
Which therapeutic option has not demonstrated consistent clinical efficacy for treating Cushing's Syndrome?
Combination therapy with neuromodulatory agents
Study Notes
Therapeutic options for Cushing's Syndrome
- Pituitary irradiation can improve symptoms in 50% of patients, but it can take 6-12 months to see improvement and can cause pituitary-dependent hormone deficiencies.
- Steroidogenic inhibitors like metyrapone, aminoglutethimide, and ketoconazole can inhibit cortisol synthesis, but they can cause side effects like hypertension, sedation, and liver enzyme elevation.
- Combination therapy with metyrapone and aminoglutethimide is more effective than either agent alone and has fewer side effects.
- Etomidate is similar to ketoconazole but is only available in a parenteral formulation, making it useful for acute hypercortisolemia awaiting surgery.
- Mitotane can inhibit the production of cortisol and corticosterone, but it can cause side effects like nausea, diarrhea, and CNS effects.
- Cyproheptadine is a serotonergic antagonist that can decrease ACTH secretion, but it should be reserved for non-surgical candidates who fail more conventional therapy.
- Tretinoin can reduce ACTH secretion, but its efficacy in humans is undetermined.
- Other neuromodulatory agents include bromocriptine, cabergoline, valproic acid, octreotide, and rosiglitazone.
- Mifepristone is a receptor antagonist that inhibits dexamethasone suppression and increases endogenous cortisol and ACTH values in normal subjects.
- Limited experience in Cushing's syndrome suggests that mifepristone is highly effective in reversing the manifestations of hypercortisolism.
- None of the neuromodulatory agents has demonstrated consistent clinical efficacy for treating Cushing's syndrome.
- Combination therapy with these agents may prove more efficacious than any single agent.
Test your knowledge on the adrenal glands and their functions with our quiz! From the production of hormones to their location in the body, this quiz covers it all. Whether you're a medical student or just curious about the human body, challenge yourself with our adrenal gland quiz. Don't forget to brush up on keywords like corticosteroids, aldosterone, and androgens before taking the quiz!
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