CUSHINGS SYNDROME

Roldan, Scorch Dominique

Romero, John Reden
Sanchez, Tracy Joy

DEFINITION

Hormonal disorder caused by

prolonged exposure of the bodys
tissues to high levels of the
hormone cortisol.

Refers to excess cortisol of any

etiology

Also known as hypercortisolism

PREDISPOSING
FACTOR

FREQUENCY

Obesity

Relatively rare

Type II diabetes

Individuals with poorly

controlled blood sugar

Most commonly affects

adults aged 20 to 50.

Women are three times

more likely to develop the
syndrome than men.

High blood pressure,

CHARACTERISTIC FEATURES
Moon Face

Truncal obesity and thin

extremities

CHARACTERISTIC FEATURES
Buffalo hump

Pink or purple stretch

marks (striae)

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

PATHOPHYSIOLOGY
Can be classified as:
Endogenous Cushings syndrome
Iatrogenic/Exogenous Cushings syndrome

PATHOPHYSIOLOGY
Can be classified as:
Endogenous Cushings syndrome

caused by the body producing more cortisol than it

needs.

Cortisol
Hypothalamus

CRH

Anterior Pituitary Gland

ACTH
Cortisol

Adrenal Glands

Cortisol
Hypothalamus

CRH

Anterior Pituitary Gland

ACTH

Cortisol

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.

Adrenal Glands

Cortisol
Hypothalamus

CRH

Anterior Pituitary Gland

ACTH

Cortisol

Adrenal Glands

Primary Adrenal Gland Disease

excess cortisol secretion that doesn't depend on

stimulation from ACTH and is associated with
disorders of the adrenal glands.

The most common of these disorders

noncancerous tumor of the adrenal cortex, called an

adrenal adenoma.

Cancerous tumors of the adrenal cortex (adrenocortical

carcinomas)

benign, nodular enlargement of both adrenal glands.

Cortisol
Hypothalamus

CRH

Anterior Pituitary Gland

ACTH

Cortisol

Adrenal Glands

An ectopic ACTH-secreting tumor.

The tumor develops in an organ that normally

does not produce ACTH.

The tumor will begin to secrete cortisol in

excess.

These tumors, which can be noncancerous

(benign) or cancerous (malignant), are usually
found in the lungs, pancreas, thyroid or thymus
gland.

PATHOPHYSIOLOGY
Can be classified as:
Iatrogenic/Exogenous Cushings syndrome

Related to the use of corticosteroid medication

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

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

Because the doses required to treat

these conditions are often higher than
the amount of cortisol your body
normally needs each day, the effects of
excess cortisol can occur.

SYMPTOMS
Women with Cushing syndrome may experience:
Irregular or absent menstrual periods
Men with Cushing syndrome may experience:

Decreased libido

Decreased fertility

Erectile dysfunction
Other signs and symptoms include:

Fatigue
Muscle weakness
Depression, anxiety and irritability
Loss of emotional control
Cognitive difficulties
New or worsened high blood pressure
Glucose intolerance
Bone loss (osteoporosis)

COMPLICATIONS

Bone loss (osteoporosis)

unusual
bone fractures, such as rib fractures and fractures
of the bones in the feet

Glucose Intolerance

Pituitary Adenoma

Diabetes
Panhypopituitarism

DIAGNOSIS

24-hour urinary free cortisol level.

Midnight plasma cortisol measurements

Late-night salivary cortisol measurements.

Low-dose dexamethasone suppression test (LDDST).

Imaging Test

DIAGNOSIS

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

Late-night cortisol measurement

Low-dose dexamethasone
suppression test (LDDST).

In the LDDST, a person is given a low dose of

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

Urine is collected before dexamethasone is administered

and several times on each day of the test.

Cortisol and other glucocorticoids signal the pituitary to

release less ACTH, so the normal response after taking
dexamethasone is a drop in blood and urine cortisol
levels.

If cortisol levels do not drop, Cushings syndrome is

suspected.

DIAGNOSIS

Imaging Test

Computerized tomography
scans or magnetic
resonance imaging scans
can provide images of your
pituitary and adrenal
glands to detect
abnormalities, such as
tumors.

TREATMENT

Reducing corticosteroid use

Cortisol-Inhibiting Medications

Surgery

Radiotherapy

TREATMENT

Reducing Corticosteroid use

Cortisol- Inhibiting Medications

are used on a long-term basis in

people unwilling or unable to have
surgery.

Most Widely used (Ketoconazole

and Metyrapone)

TREATMENT

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.