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Questions and Answers
What is a common skin feature associated with Cushing's syndrome?
Which of the following is a clinical feature of Cushing's disease that affects sleep?
In terms of prevalence, which feature is most commonly associated with Cushing's syndrome?
What metabolic condition is seen in approximately 30% of patients with Cushing's disease?
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Which of the following laboratory findings is usually observed in patients with Cushing's syndrome?
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What is the relationship between Cushing's syndrome and venous thromboembolism?
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Which of the following is NOT typically associated with Cushing's syndrome?
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What percentage of patients with Cushing's syndrome experience menstrual disorders?
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What condition is defined as chronic glucocorticoid excess leading to a constellation of symptoms and physical features?
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Which of the following is characterized by chronic ACTH hypersecretion?
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Which type of Cushing syndrome is primarily caused by an adrenal neoplasm?
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What clinical feature is NOT typically associated with Cushing syndrome?
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What is a common presenting feature of Cushing's disease characterized by fat accumulation?
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Which condition involves excessive secretion of ACTH from a non-pituitary neoplasm?
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Which of the following would NOT be a relevant investigation in suspected Cushing syndrome?
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What differentiates Cushing syndrome from Cushing disease?
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Study Notes
What is Cushing Syndrome?
- Defined as chronic glucocorticoid excess, whatever the cause
- Symptoms and physical features are present
Causes
-
ACTH-dependent
- Pituitary adenoma (Cushing disease)
- Non pituitary neoplasm (ectopic ACTH)
-
ACTH-independent
- Iatrogenic (glucocorticoid, megestrol acetate)
- Adrenal neoplasm (adenoma, carcinoma)
-
Nodular adrenal hyperplasia
- Primary pigmented nodular adrenal disease (PPNAD)
- Massive macronodular adrenal hyperplasia
- Food dependent (GIP mediated)
- Factitious
Prevalence
-
ACTH dependent types of Cushing’s:
- Chronic ACTH hypersecretion,
- Results in hyperplasia of the adrenal zonae fasciculata and reticularis and, therefore, increased secretion of cortisol and androgens.
-
ACTH-independent Cushing syndrome:
- Caused by a primary adrenal neoplasm (adenoma or carcinoma) or nodular adrenal hyperplasia.
- The cortisol excess suppresses pituitary ACTH secretion.
-
Clinical Features of Cushing’s disease:
- Can be present for years before diagnosis
Clinical Features of Cushing’s disease:
-
Facial Appearance:
- Round plethoric complexion
- Acne and hirsutism,
- Thinning of scalp hair.
-
Weight Gain:
- Truncal obesity, buffalo hump, supraclavicular fat pads.
-
Skin:
- Thin and fragile due to loss of subcutaneous tissue
- Purple striae on abdomen, breasts, thighs, axillae
- Easy bruising
- Tinea versicolor
- Occasionally pigmentation due to ACTH.
- Proximal muscle weakness.
-
Mood disturbance:
- Labile, depression, insomnia, psychosis.
- Menstrual disturbance.
- Low libido and impotence.
- Venous thromboembolism: High incidence.
- Mortality: Overall mortality greater than of general population.
- Growth arrest: in children.
Associated Features:
- Hypertension: >50% due to mineralocorticoid effects of cortisol
- Impaired glucose tolerance/diabetes mellitus (30%).
- Osteopenia and osteoporosis (leading to fractures of spine and ribs).
- Vascular disease: due to metabolic syndrome.
- Susceptibility to infections.
Diagnosis
- Confirm clinical suspicion with biochemical studies
- General assessment of the patient regarding:
- Other illnesses
- Drugs and alcohol
- Psychiatric problems
Laboratory findings
-
CBC show:
- High normal hemoglobin, hematocrit, and red cell counts are usual; polycythemia is rare.
- The total white count is usually normal; however, both the percentage of lymphocytes and the total lymphocyte count may be subnormal.
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Description
This quiz provides an in-depth look at Cushing Syndrome, defined as chronic glucocorticoid excess regardless of the cause. You will explore the various causes, including ACTH-dependent and ACTH-independent types, as well as their prevalence and related symptoms. Test your knowledge about this complex endocrine disorder!
