Cushing's syndrome: Difference between revisions
Kingrajinix (talk | contribs) (Created page with "right|thumb|300px ==Definition== This is the collection of symptoms caused by '''high cortisol levels'''. Cushing's disease is a specific cause of t...") |
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The main one is '''long-term steroid treatment'''. Make you sure you watch out for these symptoms in patients who have been on steroids for a long time. | The main one is '''long-term steroid treatment'''. Make you sure you watch out for these symptoms in patients who have been on steroids for a long time. | ||
==Clinical Features== | ==Clinical Features== | ||
See [[steroid side effects]] for | See [[steroid side effects]] for an amusing picture. They like asking this one in exams. This is a good mnemonic - '''CUSHINGOID''' | ||
*'''C'''ataracts | *'''C'''ataracts | ||
*'''U'''lcers | *'''U'''lcers | ||
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*'''D'''iabetes | *'''D'''iabetes | ||
Others include MOOOOOONFACE & buffalo hump. (MedRevise's personal favourites. [[Bitemproal hemianopia]] would suggest [[Cushing's disease]] | Others include MOOOOOONFACE & buffalo hump. (MedRevise's personal favourites. [[Bitemproal hemianopia]] would suggest [[Cushing's disease]] | ||
==Investigations== | ==Investigations== | ||
*9am cortisol - cortisol fluctuates throughout the day so it has to be taken at 9am | *9am cortisol - cortisol fluctuates throughout the day so it has to be taken at 9am |
Revision as of 10:48, 7 February 2012
Definition
This is the collection of symptoms caused by high cortisol levels.
Cushing's disease is a specific cause of this (a pituitary tumour). Don't get the two mixed up.
Epidemiology
Usually, it's the result of long-term steroid use. Less commonly, it's one of the other causes detailed below.
Pathophysiology
Too much glucocorticoid. This can be: iatrogenic - long-term steroid therapy; or it can be a disease process:
- pituitary (Cushing's disease) - a tumour in the pituitary gland. Increased ACTH production
- adrenal - tumour or hyperplasia of the adrenal gland
- paraneoplastic - tumours elsewhere in the body, like small cell lung cancer which produce ACTH through an unknown aetiology
Risk Factors
The main one is long-term steroid treatment. Make you sure you watch out for these symptoms in patients who have been on steroids for a long time.
Clinical Features
See steroid side effects for an amusing picture. They like asking this one in exams. This is a good mnemonic - CUSHINGOID
- Cataracts
- Ulcers
- Skin: striae, thinning, bruising
- Hypertension/ Hirsutism/ Hyperglycemia
- Infections
- Necrosis, avascular necrosis of the femoral head
- Glycosuria
- Osteoporosis, obesity
- Immunosuppression
- Diabetes
Others include MOOOOOONFACE & buffalo hump. (MedRevise's personal favourites. Bitemproal hemianopia would suggest Cushing's disease
Investigations
- 9am cortisol - cortisol fluctuates throughout the day so it has to be taken at 9am
- More accurate are:
- Dexamethasone suppression test
- 24 hour urinary cortisol
Management
Depends very much on the cause. In iatrogenic - stop the steroids. If it's tumour - cut it out depending on where it is.