Cushings Syndrome

Britni Hebert
PGY 2
4/9/10

Notes located in presenter note section

below each slide.
 Outline

Presentation

Diagnosis

Diagnose Hypercortisolism

Isolate source

Therapy
Normal HPA
Physiology
 Presentation

Weight Gain

Glucose Intolerance

HTN

Hypokalemia

Proximal Muscle Weakness

Infections
Phenotype
Diagnosing Cushings
Step 1: Diagnosing
Hypercortisolism
3 first line tests

Low Dose Dexamethasone Suppression

Test

Late Night Salivary Cortisol

Urinary Cortisol
Step 2: Isolate Source

ACTH level

< 5 = ACTH Independent

>20 = ACTH Dependent

in ACTH Dependent Cushings (like our patient)

Isolate Source...
of ACTH
ie High Dose Dexamethasone

Confirm

Image
EAS by Source
EAS by Source
Treating Cushings
 Therapy

Surgery by source when possible

Adrenalectomy

Transphenoidal resection

Tumor Resection
 Therapy

Adrenal Enzyme Inhibitors

Ketoconazole first line

Aminoglutethimide

Metyrapone

Etomidate
 Therapy

Medical Adrenalectomy - Mitotane

Glucocorticoid Antagonists - Mifepristone

Somatostatin Analogues - Octreotide

Summary
 Summary

Marked HTN and Hypokalemia are

typical of ectopic ACTH secretion.

First Line therapy in unresectable

disease = Ketoconazole

CV, HTN, VTE and infection commonly

lead to death in the untreated
Cushingoid patient. The former does not
improve with therapy.
 Resources
Up To Date
Clinical Manifestations of Cushings Syndrome

Establishing the Diagnosis of Cushings Syndrome

Establishing the Cause of Cushings Syndrome

Overview of the Treatment of Cushings Syndrome

Diminishing Adrenal Cortisol Synthesis

Ectopic ACTH syndrome. Andrea M. Isidori; Andrea Lenzi,

DFM Department of Pathophysiology, "Sapienza" University of
Rome, Italy