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Cushing'S Syndrome: DR - Isbandiyah SPPD Fkumm

Cushing's syndrome is caused by excessive cortisol production and can be due to pituitary, adrenal, or ectopic tumors. It is characterized by weight gain, easy bruising, high blood pressure, and diabetes. Diagnosis involves low-dose dexamethasone suppression and salivary cortisol tests. Treatment depends on the cause, and may include adrenal enzyme inhibitors, pituitary or adrenal surgery, or bilateral adrenalectomy. The goal is to control cortisol levels and remove tumor tissue when possible.

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Fatihatul Ilma
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36 views12 pages

Cushing'S Syndrome: DR - Isbandiyah SPPD Fkumm

Cushing's syndrome is caused by excessive cortisol production and can be due to pituitary, adrenal, or ectopic tumors. It is characterized by weight gain, easy bruising, high blood pressure, and diabetes. Diagnosis involves low-dose dexamethasone suppression and salivary cortisol tests. Treatment depends on the cause, and may include adrenal enzyme inhibitors, pituitary or adrenal surgery, or bilateral adrenalectomy. The goal is to control cortisol levels and remove tumor tissue when possible.

Uploaded by

Fatihatul Ilma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Cushing’s Syndrome

dr.Isbandiyah SpPD
FKUMM
Pituitary gland
Anterior and Posterior
Anterior hormones (FLAT-GP):
F – FSH
L – LH
A – ACTH
T – TSH
G – GH
P – Prolactin
Posterior hormones (OA) :
O – Oxytocin
A – ADH
Normal HPA Physiology
Disease vs. Syndrome
• Cushings Disease is the result of a pituitary tumour secreting
inappropriate ACTH
• Cushings Syndrome causes the same symptoms, but is caused by
overproduction of adrenal hormones. It encompasses all other forms
of Cushings

• Basically:
• Disease = increased cortisol from pituitary
• Syndrome = all other sources
etiology
Harvey Cushing in 1932

Endogenous Causes:
65% = pituitary
= Females 5:1 ratio and ages 25-40
25% = adrenals
10% = ectopic source (small cell lung ca), non-pituitary ACTH producing tumour

Exogenous Causes:
Iatrogenic Steroids (Asthma, RA, palliative)
Sign&Symptom

SWEDISH
S – Spinal tenderness
W – Weight gain
E – Easily bruise
D – Diabetes
I – Intercapsular fat pad
S – Striae
H – HTN
Step 1: Diagnosing
Hypercortisolism
3 first line tests

1. Low Dose Dexamethasone Suppression Test


2. Late Night Salivary Cortisol
3. Urinary Cortisol
Dexamethasone Suppression Test
• Overnight Low dose = Baseline reading, Dex 1mg given at 11pm, measure cortisol at
8am
• If cortisol low (<50nmol/L) = normal
• If cortisol high (>50nmol/L) = investigate further – Cushings syndrome
Step 2: Isolate Source

ACTH level
< 5 = ACTH Independent
>20 = ACTH Dependent
Therapy
Adrenal Enzyme Inhibitors
Ketoconazole – first line
Aminoglutethimide
Metyrapone
Etomidate

Medical therapy is used to:


• stabilize patients pre-op / reduce perioperative complications.
• primary therapy when patient’s refuse surgery
• surgery is not an option (metastatic malignancies)
Surgical Treatment
• Pituitary tumours:
• trans-sphenoidal microsurgery. Radiation therapy may be used as an adjunct for patients who
are not cured. Bilateral adrenalectomy may be necessary to control toxic cortisol levels.

• Adrenocortical tumours:
• require surgical removal – can develop Nelsons Syndrome

• Removal of neoplastic tissue is indicated for ectopic ACTH production. Metastatic spread
makes a surgical cure unlikely or impossible. Bilateral adrenalectomy is indicated if
necessary to control toxic cortisol levels.

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