Cushing's Syndrome

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Cushing's Syndrome

• due to excess corticosteroids either endogenous or exogenous
• Cushing's disease
  •  due to pituitary ACTH-secreting adenoma

Main Features

• central obesity
• hirsutism
• hypertension
• diabetes
• osteoporosis

Symptoms

• Weight Gain
  • central
• Change of appearance
• Depression
• Psychosis
• Insomnia
• Amenorrhoea / Oligomenorrhoea
• Reduced libido
• Thin skin / Easy Bruising
• Hair Growth / Acne
• Muscular Weakness
• Growth Arrest (children)
• Back Pain
• Polyuria / polydipsia

Examination

• observation
  • "moon face"
  • "buffalo hump"
  • plethoric
  • acne
  • hirsutism
  • frontal balding
  • truncal obesity
  • wasted limbs
  • buffalo hump
  • striae
  • thin skin
  • increased bruising
  • poor wound healing
  • oral candida
  • fractures
    • rib
    • pathological
  • oedema
• CVS
  •  ↑ blood pressure
• Neuro
  • proximal muscle weakness
• Psych
  • depression
  • psychosis
• "I would like to..."
  • dipstick urine
    • glycosuria
  • ask the patient if they are taking steroids

Other Effects

• osteoporosis

Causes

• iatrogenic
• raised ACTH
  • pituitary tumour
  • ectopic
• adrenal tumour

Treatment

• reduce exogenous steroids
• surgery

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