24 Questions
What is the characteristic appearance of a patient with Cushing's syndrome?
A lemon on matchsticks appearance
What is a common skin manifestation of Cushing's syndrome?
Purpura
What is the purpose of the low-dose dexamethasone suppression test in diagnosing Cushing's syndrome?
To decrease cortisol levels
What is the next step in diagnosing Cushing's syndrome after a low-dose dexamethasone suppression test?
High-dose dexamethasone suppression test
What does a low ACTH level indicate in a patient with Cushing's syndrome?
Adrenal cause
What is the purpose of the CRH stimulation test in diagnosing Cushing's syndrome?
To differentiate between pituitary and ectopic causes
What is the purpose of bilateral inferior petrosal sinus sampling in diagnosing Cushing's syndrome?
To distinguish unclear cases of Cushing disease
What is a common endocrine manifestation of Cushing's syndrome?
Amenorrhea
What is the most common cause of Cushing's syndrome?
Pituitary Cushing's disease
What is the best treatment for pituitary Cushing's syndrome?
Microsurgical excision of the adenoma through the transsphenoidal route
What is the result of excess cortisol on carbohydrate metabolism?
Diabetogenic effects
What is the alternative treatment for pituitary Cushing's syndrome when the adenoma is small?
Implantation of radioactive yttrium-90
Which of the following is NOT a consequence of Cushing's syndrome?
Reduced subcutaneous fat in the trunk
What is the effect of cortisol on protein metabolism?
Catabolic effect
What is the treatment for adrenal Cushing's syndrome?
Adrenalectomy of the affected side
Which of the following is a characteristic of Cushing's disease?
Pituitary adenoma producing excess ACTH
Why is postoperative administration of cortisol necessary in Adrenal Cushing's syndrome?
Due to contralateral adrenal gland inhibition
What is the effect of cortisol on water and electrolyte balance?
Enhanced salt and water retention
What is the treatment for ectopic ACTH production?
Excision of the bronchial or pancreatic carcinoma
What is the usual demographic affected by Cushing's syndrome?
Young females
What is the main feature of Hyperaldosteronism?
Hypertension
Which of the following is a consequence of an adrenal adenoma?
Inhibition of contralateral adrenal gland
What is the cause of Primary Hyperaldosteronism (Conn's syndrome)?
Presence of a functioning adrenal cortical adenoma
What is the treatment for Conn's syndrome?
Surgical excision of the adrenal gland that carries the adenoma
Study Notes
Cushing's Syndrome
- Characterized by truncal obesity, moon face, and limb slimness, giving a "lemon on matchsticks" appearance
- Features protein catabolism, muscle weakness, thinning of skin, abdominal striae, and poor wound healing
- Associated with diabetes, hypertension, amenorrhea, and emotional lability
- Other features include increased capillary fragility, purpura, osteoporosis, acne, hirsutism, and loss of libido
Investigations
- Diurnal variation of cortisol levels is lost in Cushing's syndrome
- Radioimmunoassay of serum cortisol level is used for diagnosis
- Low-dose dexamethasone suppression test is used to confirm the diagnosis
- ACTH level is measured to determine the cause (pituitary or adrenal)
- High-dose dexamethasone test, CRH stimulation test, and bilateral inferior petrosal sinus sampling are used to distinguish between pituitary and ectopic sources
Treatment
- Pituitary Cushing's syndrome: microsurgical excision of the adenoma through the transsphenoidal route
- Adrenal Cushing's syndrome: adrenalectomy of the affected side
- Ectopic ACTH production: excision of the bronchial or pancreatic carcinoma, whenever possible
Hyperaldosteronism
- Caused by oversecretion of aldosterone from the adrenal cortex
- Primary hyperaldosteronism (Conn's syndrome) is caused by a functioning adrenal cortical adenoma
- Secondary hyperaldosteronism occurs with liver, renal, and cardiac diseases
- Retains sodium and water, and loses potassium
- Hypertension is the main feature, and rarely progresses to severe hypokalemic alkalosis, muscle weakness, tetany, and paraesthesia
- Diagnosis is suspected with low serum potassium and confirmed by high plasma aldosterone
- Treatment involves surgical excision of the adrenal gland carrying the adenoma, with laparoscopic adrenalectomy being a preferred option
This quiz covers the common symptoms of Cushing's syndrome, including physical characteristics and health complications. Test your knowledge of this hormonal disorder.
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