Cushing Syndrome

By: Hassan Habeeb Al-AmerBy: Hassan Habeeb Al-Amer

Objectives;1- Definition and Classification Cushing Syndrome.

2- Clinical features of Cushing Syndrome.

3- Investigations for Cushing Syndrome.

4- Treatment of Cushing Syndrome.

Introduction

Anatomy, Histology and Physiology

Epinephrine,norepinephrine

Androgens

Glucocorticoids

Mineralocorticoids

Cushing’s syndrome

Cushing’s syndrome (CS) is composed of symptoms and signs associated with prolonged exposure to inappropriately high levels of plasma glucocorticoids.

- Exogenous glucocorticoid intake is the most common cause of CS.

- The endogenous causes are divided into ACTH-dependent and ACTH-independent CS.

Clinical features of Cushing Syndrome

Investigations for Cushing Syndrome

Treatment ofCushing Syndrome

Medical Treatment

Metyrapone, an 11β-hydroxylase blocker, which is given in doses of 750 mg to 4 g daily in 3–4 divided doses.

Ketoconazole (200 mg three times daily) is also used and is synergistic with metyrapone.

Cushing’s disease - ACTH dependent (pituitary) Cushing Syndrome

- Trans-sphenoidal removal of the tumor

Cushing’s disease - ACTH dependent (pituitary) Cushing Syndrome

- External pituitary irradiation

Cushing’s disease - ACTH dependent (pituitary) Cushing Syndrome

- Medical therapy to reduce ACTH (e.g. bromocriptine, cabergoline, cyproheptadine, somatostatin analogues such as pasireotide) is rarely effective. There is some evidence that aggressive corticotroph adenomas may respond to temozolomide chemotherapy.

Bilateral adrenalectomy is an effective last resort if other measures fail to control the disease. This can be performed laparoscopically.

- Goldman's Cecil Medicine, 24th Edition

- Kumar and Clark's Clinical Medicine 8th Ed

- Current Clinical Medicine 6th Ed

- The Netter Collection of Medical Illustrationsm, The

Endocrine System. Volume 2

References;

Thank you

Done by:Hassan Habeeb Al-Amer

~Bu Ali~

Done by:Hassan Habeeb Al-Amer

~Bu Ali~