Cushing's Syndrome and Disease

last authored:
last reviewed:

 

 

Introduction

Cushing's syndrome refers to any situation of excess cortisol. Cushing's disease refers specifically to a pituitary tumour secreting ACTH.

 

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.

return to top

 

 

 

Causes and Risk Factors

 

ACTH independent causes include:

ACTH dependent causes include:

return to top

 

 

 

Pathophysiology

 

Adrenal tumours can be treated with surgery.

Pituitary adenomas can be cured much of the time.

ectopic sources of ACTH can be surgically removed if possible.

return to top

 

 

 

Signs and Symptoms

Cushing's should be considered if people have:

 

appearance

skin

musculoskeletal

cardiovascular

metabolic

 

gonadal dysfunction

 

other

mental health changes

  • history
  • physical exam

History

 

Physical Exam

 

return to top

 

 

 

Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

Cortisol excess can be demonstrated by:

  • 24 hour urine free cortisol (4x normal cortisol levels is diagnostic, though false +ves and -ves)
  • low dose dex suppression test
    • demonstrates resistance to suppression
    • better sensitivity, but lower specificity
  • diurnal cortisol rhythm

There are some things about false positive tests I don't know.

Diagnostic Imaging

 

return to top

 

 

 

Differential Diagnosis

pseudo-cushing's syndrome can result from mild physiologic hypercortisolism:

return to top

 

 

 

Treatments

 

return to top

 

 

 

Consequences and Course

 

return to top

 

 

 

Resources and References

 

return to top

 

 

 

Topic Development

created:

authors:

editors:

reviewers:

 

return to top