cushing s syndrome

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CUSHINGS SYNDROME

Roldan, Scorch Dominique

Romero, John Reden

Sanchez, Tracy Joy


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DEFINITION

Hormonal disorder caused by

prolonged exposure of the bodys

tissues to high levels of the

hormone cortisol.

Refers to excess cortisol of anyetiology

Also known as hypercortisolism


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FREQUENCY

Relatively rare

Most commonly affects

adults aged 20 to 50.

Women are three times

more likely to develop thesyndrome than men.

PREDISPOSING

FACTOR

Obesity

Type II diabetes

Individuals with poorly

controlled blood sugar

High blood pressure,


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CHARACTERISTIC FEATURES

Moon FaceTruncal obesity and thinextremities


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CHARACTERISTIC FEATURES

Buffalo humpPink or purple stretchmarks (striae)


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OTHER SIGNS

Thinning of scalp hair

Acne

Increased facial hair in women

(hirsutism)

Thinning, fragile skin that

bruises easily

Slow healing of cuts, insect bites

and infections


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PATHOPHYSIOLOGY

Can be classified as:Endogenous Cushings syndrome

Iatrogenic/Exogenous Cushings syndrome


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Hypothalamus Anterior Pituitary Gland

Cortisol Adrenal Glands

CRH

ACTH

Cortisol


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CortisolHypothalamus Anterior Pituitary Gland


CRH

ACTH

A pituitary gland tumor

(pituitary adenoma)

A noncancerous (benign) tumor of the

pituitary gland, located at the base of

the brain

secretes an excess amount of ACTH,

which in turn stimulates the adrenal

glands to make more cortisol.

When this form of the syndrome

develops, it's called Cushing disease.


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An ectopic ACTH-secreting tumor.

The tumor develops in an organ that normally

does not produce ACTH.

The tumor will begin to secrete cortisol inexcess.

These tumors, which can be noncancerous

(benign) or cancerous (malignant), are usually

found in the lungs, pancreas, thyroid or thymus

gland.

CortisolHypothalamus Anterior Pituitary Gland


CRH

ACTH


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Can be classified as: Iatrogenic/Exogenous Cushings syndrome

Related to the use of corticosteroid medication

PATHOPHYSIOLOGY


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Corticosteroids contain a synthetic (man-made) version of the cortisol hormone.

reduce inflammation in the body and suppresses the immune system

Oral - The risk of developing

Cushings syndrome is higher

Autoimmune disease (Rheumatoid

arthritis & Lupus)

To prevent your body from

rejecting a transplanted organ

Topical

Atopic eczema


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Corticosteroids contain a synthetic (man-made) version of the cortisol hormone.

reduce inflammation in the body and suppresses the immune system

Injectable

Joint pain

Bursitis

Back pain

Inhaled

Asthma


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Because the doses required to treat

these conditions are often higher than

the amount of cortisol your bodynormally needs each day, the effects of

excess cortisol can occur.


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SYMPTOMSWomen with Cushing syndromemay experi

Irregular or absent menstrual periods

Men with Cushing syndromemay experience

Decreased libido

Decreased fertility

Erectile dysfunction

Other signs and symptomsinclude:

Fatigue

Muscle weakness

Depression, anxiety and irritability

Loss of emotional control

Cognitive difficulties

New or worsened high blood pressure

Glucose intolerance

Bone loss (osteoporosis)


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COMPLICATIONS

Bone loss (osteoporosis) unusual

bone fractures, such as rib fractures and fracturesof the bones in the feet

Glucose Intolerance Diabetes

Pituitary Adenoma Panhypopituitarism


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DIAGNOSIS 24-hour urinary free cortisol level.

Midnight plasma cortisol measurements

Late-night salivary cortisol measurements.

Low-dose dexamethasone suppression test (LDDST).

Imaging Test


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24-hour urinary free cortisol level.

a persons urine is collected several times over

a 24-hour period and tested for cortisol.

Levels higher than 50 to 100 micrograms a day

for an adult suggest Cushings syndrome.

Midnight plasma cortisol measurement

measures cortisol concentrations in the blood.

Cortisol production is normally suppressed at night,

but in Cushings syndrome, this suppression doesnt

occur.

If the cortisol level is more than 50 nanomoles per

liter (nmol/L), Cushings syndrome is suspected.

DIAGNOSIS


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Late-night cortisol measurement

Low-dose dexamethasonesuppression test (LDDST). In the LDDST, a person is given a low dose of

dexamethasone, a synthetic glucocorticoid, by mouthevery 6 hours for 2 days.

Urine is collected before dexamethasone is administeredand several times on each day of the test.

Cortisol and other glucocorticoids signal the pituitary torelease less ACTH, so the normal response after takingdexamethasone is a drop in blood and urine cortisollevels.

If cortisol levels do not drop, Cushings syndrome issuspected.

DIAGNOSIS


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Imaging Test

Computerized tomography

scans or magnetic

resonance imaging scans

can provide images of your

pituitary and adrenal

glands to detectabnormalities, such as

tumors.

DIAGNOSIS


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TREATMENT Reducing corticosteroid use

Cortisol-Inhibiting Medications

Surgery

Radiotherapy


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Reducing Corticosteroid use

Cortisol- Inhibiting Medications

are used on a long-term basis in

people unwilling or unable to havesurgery.

Most Widely used (Ketoconazole

and Metyrapone)

TREATMENT


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Surgery Removal of tumor

Removal of one of the adrenal glands

Radiotherapy

may be recommended if pituitary gland

surgery is unsuccessful or if you

are unable to have surgery. It involves

using high-energy X-rays to shrink the

tumour.

TREATMENT

cushing s syndrome

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