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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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