Podcast
Questions and Answers
What is a common skin feature associated with Cushing's syndrome?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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
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ACTH-dependent
- Pituitary adenoma (Cushing disease)
- Non pituitary neoplasm (ectopic ACTH)
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ACTH-independent
- Iatrogenic (glucocorticoid, megestrol acetate)
- Adrenal neoplasm (adenoma, carcinoma)
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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!
