Podcast
Questions and Answers
Which of the following is NOT a reason why Cushing's syndrome can be difficult to recognize?
Which of the following is NOT a reason why Cushing's syndrome can be difficult to recognize?
What is the primary goal of treatment for Cushing's syndrome?
What is the primary goal of treatment for Cushing's syndrome?
Which of the following is NOT a symptom that might be used to help diagnose Cushing's syndrome?
Which of the following is NOT a symptom that might be used to help diagnose Cushing's syndrome?
What is the best way to assess the severity and progression of Cushing's syndrome?
What is the best way to assess the severity and progression of Cushing's syndrome?
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Which of the following is NOT a test commonly used to screen for Cushing's syndrome?
Which of the following is NOT a test commonly used to screen for Cushing's syndrome?
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What is the role of dexamethasone in diagnosing Cushing's syndrome?
What is the role of dexamethasone in diagnosing Cushing's syndrome?
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What are the two main causes of Cushing's syndrome?
What are the two main causes of Cushing's syndrome?
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If a patient has Cushing's syndrome, what is the ideal treatment approach?
If a patient has Cushing's syndrome, what is the ideal treatment approach?
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What is the main treatment option for a patient diagnosed with Cushing's syndrome?
What is the main treatment option for a patient diagnosed with Cushing's syndrome?
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What is the most common initial approach to diagnosing Cushing's syndrome?
What is the most common initial approach to diagnosing Cushing's syndrome?
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What is NOT one of the comorbidities potentially associated with Cushing's syndrome?
What is NOT one of the comorbidities potentially associated with Cushing's syndrome?
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What is the main reason for early diagnosis of Cushing's syndrome?
What is the main reason for early diagnosis of Cushing's syndrome?
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What is the importance of determining the cause of Cushing's syndrome?
What is the importance of determining the cause of Cushing's syndrome?
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What happens if surgery is not a viable option for treating Cushing's syndrome?
What happens if surgery is not a viable option for treating Cushing's syndrome?
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What does the term "bilateral adrenalectomy" refer to?
What does the term "bilateral adrenalectomy" refer to?
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Which of these is NOT a reason why Cushing's syndrome can be considered a potentially lethal disorder?
Which of these is NOT a reason why Cushing's syndrome can be considered a potentially lethal disorder?
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Which symptom is commonly associated with Cushing’s syndrome in children?
Which symptom is commonly associated with Cushing’s syndrome in children?
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What does abnormal adipose tissue distribution in Cushing’s syndrome often affect?
What does abnormal adipose tissue distribution in Cushing’s syndrome often affect?
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What is a common sleep-related symptom of Cushing’s syndrome?
What is a common sleep-related symptom of Cushing’s syndrome?
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Which characteristic of striae is particularly significant in Cushing’s syndrome?
Which characteristic of striae is particularly significant in Cushing’s syndrome?
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Why is it important for subspecialists to look for features outside their subject matter expertise when diagnosing Cushing’s syndrome?
Why is it important for subspecialists to look for features outside their subject matter expertise when diagnosing Cushing’s syndrome?
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Study Notes
Cushing's Syndrome Diagnosis and Management
- Cushing's syndrome is a potentially life-threatening disorder caused by high levels of cortisol.
- Early diagnosis is crucial to prevent further health problems and reduce mortality.
- It can be difficult to recognize as symptoms are common, such as weight gain and hypertension.
- Diagnosis involves screening tests such as timed measurement of urine, serum or salivary cortisol, before and after dexamethasone administration. Each test has limitations, thus the choice of tests must be tailored to individual patient needs.
- Once diagnosed, surgical removal of the abnormal tumor or tissue is often the optimal treatment.
- Medical treatment or bilateral adrenalectomy is necessary if surgery is not possible or in case of recurrence or metastasis to normalize cortisol levels.
- Clinical features often suggest the syndrome (see Table 1 in the article). These include fatigue, weight gain in specific areas, and skin changes.
- The features may cluster in one diagnosis, so subspecialists should look for features outside their area of expertise.
- The diagnosis is more likely in individuals showing early-onset symptoms of osteoporosis, fractures or hypertension.
- Cushing's syndrome needs to be considered if symptoms occur together within a few months or if signs and symptoms increase over time.
- Important to rule out exogenous steroid use (medications/products) which can cause similar symptoms.
- Screening tests include 24-hour urine free cortisol (UFC) excretion, late-night/bedtime salivary cortisol, and the 1 mg overnight dexamethasone suppression test (DST).
- Cortisol measurement can be via immunoassay (e.g., radioimmunoassay [RIA]) or structurally-based assay (e.g., high performance liquid chromatography or mass spectrometry [MS/MS]). The latter are more specific.
- Mild cases of the syndrome may be detected with bedtime salivary cortisol when other tests are normal.
- Mildly abnormal results may be found in other conditions, leading to misdiagnosis if not carefully considered.
- The causes of Cushing's syndrome are ACTH excess (from pituitary or non-pituitary tumors) and ACTH-independent primary adrenal overproduction. This is determined via ACTH measurements.
- Treatment in severe cases may involve combination therapy for quicker symptom improvement.
- Surgical removal of an abnormal tumor is the preferred approach.
- Alternative treatments (e.g., steroidogenesis inhibitors or glucocorticoid antagonists) aim to block cortisol action or synthesis.
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Description
This quiz explores the diagnosis and management of Cushing's syndrome, a disorder caused by excessive cortisol levels. Learn about the screening tests, clinical features, and treatment options, including surgery and medical interventions. Understanding these factors is essential for effective patient care.
