Endocrinology: Cushing Syndrome and Disease

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Questions and Answers

Which clinical feature is most commonly associated with Cushing's disease?

Menstrual disorders (correct)

Proximal muscle weakness (correct)

Low libido (correct)

Osteopenia (correct)

What is the prevalence percentage of obesity in patients with Cushing's syndrome?

80%

70%

90% (correct)

85%

Which of the following is associated with a high incidence of Cushing's syndrome?

Venous thromboembolism (correct)

Kidney stones

Hyperthyroidism

Hypoglycemia

In which condition is easy bruising a notable clinical feature?

Cushing's disease Signup and view all the answers

What laboratory finding is typically observed in patients with Cushing's syndrome?

High normal hemoglobin Signup and view all the answers

What percentage of Cushing's syndrome patients experiences insomnia?

85% Signup and view all the answers

What is a common skin manifestation in patients with Cushing's disease?

Striae Signup and view all the answers

Which metabolic complication is frequently linked to Cushing's syndrome?

Hyperlipidemia Signup and view all the answers

Which of the following is a characteristic of ACTH-dependent Cushing syndrome?

Chronic ACTH hypersecretion Signup and view all the answers

Which clinical feature is commonly associated with Cushing syndrome?

Buffalo hump and truncal obesity Signup and view all the answers

What is the primary cause of Cushing disease?

Excessive ACTH secretion from a pituitary tumor Signup and view all the answers

What distinguishes ACTH-independent Cushing syndrome from ACTH-dependent types?

It involves primary adrenal neoplasm or hyperplasia Signup and view all the answers

Which of the following is NOT a cause of ACTH-independent Cushing syndrome?

Pituitary adenoma Signup and view all the answers

What is one of the presenting features of Cushing syndrome?

Facial plethoric complexion Signup and view all the answers

What is the role of cortisol in ACTH-independent Cushing syndrome?

Inhibits the secretion of ACTH from the pituitary gland Signup and view all the answers

Which classification of Cushing syndrome involves ectopic ACTH syndrome?

ACTH-dependent Signup and view all the answers

Study Notes

### Cushing Syndrome

Chronic glucocorticoid excess
Leads to a constellation of symptoms and physical features
Can be caused by various factors

### Cushing Disease

A specific type of Cushing syndrome
Due to excessive pituitary ACTH secretion from a pituitary tumor

Classification

Can be either ACTH-dependent or ACTH-independent

ACTH-Dependent

Caused by chronic ACTH hypersecretion
Leads to hyperplasia of the adrenal zonae fasciculata and reticularis
Causing increased secretion of cortisol and androgens
Can be due to either pituitary adenoma (Cushing disease) or non-pituitary neoplasm (ectopic ACTH)

ACTH-Independent

Caused by a primary adrenal neoplasm or nodular adrenal hyperplasia
Cortisol excess suppresses pituitary ACTH secretion
Can be caused by iatrogenic factors (glucocorticoid, megestrol acetate), adrenal neoplasm (adenoma, carcinoma), nodular adrenal hyperplasia, or factitious
Nodular adrenal hyperplasia can be due to:
- Primary pigmented nodular adrenal disease (PPNAD)
- Massive macronodular adrenal hyperplasia
- Food dependent (GIP mediated)

Clinical Features

May be present for several years prior to diagnosis
May not always be florid, but clinical suspicion should be high
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
High incidence of venous thromboembolism
Overall mortality greater than of general population (by a factor of 6)
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

Clinical suspicion of Cushing syndrome must be confirmed with biochemical studies
General assessment of patients regarding the presence of other illnesses, drugs, alcohol, and psychiatric problems is needed

Laboratory Findings

CBC:
- High normal hemoglobin, hematocrit, and red cell counts are usual
- Polycythemia is rare
- Total white count is usually normal
- Percentage of lymphocytes and total lymphocyte count may be subnormal

Clinical Features Prevalence

General:
- Obesity (90%)
- Hypertension (85%)
Musculoskeletal:
- Osteopenia (80%)
- Weakness (65%)
Gonadal dysfunction:
- Menstrual disorders (70%)
- Impotence, decreased libido (85%)
Skin:
- Plethora (70%)
- Hirsutism (75%)
- Striae (50%)
- Acne (35%)
- Bruising (35%)
Neuropsychiatric:
- Emotional lability (85%)
- Euphoria (85%)
- Depression (85%)
- Psychosis (85%)
Metabolic:
- Glucose intolerance (75%)
- Diabetes (20%)
- Hyperlipidemia (70%)
- Polyuria (30%)
- Kidney stones (15%)

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Description

This quiz explores the concepts of Cushing Syndrome and Cushing Disease, including their causes, classifications, and the mechanisms behind ACTH-dependent and ACTH-independent forms. Understand the effects of glucocorticoid excess and the pathophysiology involved. Test your knowledge on adrenal disorders and the physiology of hormone regulation.