Cushing syndrome

Introduction

Cushing syndrome is a hormonal disorder which occurs when body has too much of the hormone cortisol over time 

-it more frequently affects women

-the most common cause of Cushing’s syndrome: use of glucocorticoids 

Symptoms & Signs 

General: fatigue, backache, headache, central obesity with a rounded, rosy face (moon face), a fat pad in the upper back between the clavicles (buffalo hump), protuberant abdomen  

CNS: irritability, emotional lability, depression, psychosis, insomnia   

Musculoskeletal: Proximal muscle weakness (Difficulty standing up from a seated position, or climbing stairs), osteopenia, osteoporosis 

Reproductive: Oligomenorrhea, amenorrhea, erectile dysfunction, infertility 

Cardiovascular: Hypertension, hypercoagulation 

Endocrine: Glucose intolerance, diabetes

Skin: purple striae, easy bruisability, hyperpigmentation, hirsutism

Diagnosis 

Labs: 24-hour urinary free cortisol and creatinine, Late-night (10–11 PM) salivary cortisol determinations, Petrosal sinus sampling, overnight dexamethasone suppression test, plasma ACTH level, plasma DHEAS (dehydroepiandrosterone sulfate (DHEAS) level

Imaging: CT of the adrenals, MRI of the pituitary

Treatment 

Medications: Spironolactone, eplerenone, flutamide, cabergoline, Pasireotide, Ketoconazole, Metyrapone, Mitotane 

Surgery: transsphenoidal selective resection of the pituitary adenoma (Pituitary Cushing disease), Adrenalectomy (Adrenal Cushing disease) 

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