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ACTH (-)
(+) Cortisol
Cortisol Circadian Rhythm
Clinical findings I
Hypertension
Coetaneous wasting
Cervical (dorsal) fat pad fat pads.
Facial rounding with plethora
Supra-clavicular fullness
Proximal myopathy
Striae
Thin skin
About Cushing
Cushings
Hypercortisolism
syndrome
Cushings Syndrome
Etiology
Cushings Syndrome Causes
ACTH-independent
Adrenal Adenoma or Carcinoma
Adrenal hyperplasia (Micro- and macro-)
Glucocorticoids administration
Causes of Cushing's
syndrome
The most common cause of
hypercortisolism is ingestion of prescribed
medication, usually for Non-Endocrine
disease.
Oral
Injected
Topical
Inhaled glucocorticoids
Exogenous
Iatrogenic CRH Hydrocortiso
Cushings ne
Syndrome (+)
(-)
ACTH (-)
(-) Cortisol
ACTH-
CRH
dependent (+)
Cushings
disease
ACTH (-)
(+) Cortisol
CRH
Adrenocortical tumour
(+)
(+)
Ectopic ACTH secreting tumour
Cortisol
ACTH (+)
CRH Ectopic CRH
Ectopic CRH secreting tumour
(+)
producing tumour
ACTH (+)
(+) Cortisol
Cushings Syndrome
Clinical features
General
Central obesity Endocrine/Metabolic
Proximal muscle weakness Hypokalemic alkalosis
HTN Hypokalemia
Headaches Osteopenia
Hypogonadism
Glucose intolerance
Hyperlipidemia
Dermatologic Hyperhomocysteinemia
Wide purple striae Kidney stones
Spontaneous ecchymoses Polyuria
Facial plethora Hypercoagulability
Hyperpigmentation
Acne, hirsutism
Fungal skin infections
Neuropsychiatric
Insomnia
Depression, frank psychosis
Impaired cognition and short-
term memory
Cushings Syndrome
Clinical features
Cushing Syndrome AND
Skin
Dermatologic manifestations of
Cushings syndrome include violaceous
striae, ecchymoses, hyperpigmenta-
tion, oily skin, acne, and facial plethora.
Striae are the result of scarring from
dermal tears, and they appear purple
because the underlying vasculature be-
comes apparent as the skin becomes
increasingly thin.
Cushing AND skin
Violaceous striae and ecchymoses
are caused by deficient colla- gen
synthesis, resulting in thin and fragile
skin.
Patients often report easy bruising,
which is caused by weakness of
vessel walls and the surrounding con-
nective tissue.
ACTH binds to melanocyte-
stimulating hormone, causing
Diagnosis of Cushing
syndrome
Does the patient have Cushing's
syndrome?
Determining if the Cushing's
syndrome is corticotropin (ACTH)-
dependent or (ACTH)-independent.
Determining the source of the ACTH
in ACTH-dependent Cushing's
syndrome.
Cushing AND
musculoskeletal
Musculoskeletal
Excess glucocorticoids can suppress muscle
protein synthesis, which atrophies the
muscles.
Osteoporosis can also develop with long-
standing Cushings syndrome, and fractures,
including vertebral fractures, may result.
Osteoporosis results from inhibition of bone
formation and suppression of calcium
absorption from the intestine, both of which
are effects of excess glucocorticoids
Cushing AND Gonadal Dysfunction..