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Approach to Cushing's syndrome

This is a video on how to approach a patient with Cushing's syndrome This video was created using Google Slides. Graphics were created or adapted from Wikimedia Commons. ADDITIONAL TAGS: Approach to Cushing's syndrome Disease of chronic or prolonged hypercortisolism (excess cortisol) Commonly causes: Iatrogenic (excess use of corticosteroids) Hypersecretion of ACTH from a pituitary adenoma (Cushing’s disease) Adrenal cancer (adenoma or carcinoma) Adrenal hyperplasia secondary to ectopic ACTH or CRH production (by small cell lung cancer, pancreatic, thymus, bronchial cancers) Not suppressed (cortisol nl/↑) Suppressed (cortisol ↓) Approach to Cushing's syndrome Clinical presentation of Cushing’s symptoms 24 hour free urine cortisol AND Low dose (1mg) o/n dexamethasone suppression test ↑ urine cortisol AND Not suppressed (cortisol unchanged) Suppressed (cortisol ↓), normal result Not Cushing’s syndrome Suspect Cushing’s syndrome Measure plasma ACTH levels ACTH ↓ ACTH nl or ↑ Suspect adrenal tumor. Confirm with CT/MRI and resect Suspect extra- adrenal tumor (ACTH-dependent Cushing’s syndrome) High dose (8mg) dexameth. suppression test Ectopic ACTH. CT/MRI abdomen (pancreatic cancer), chest (lung ca) Cushing’s disease; ACTH from pituitary tumor. Confirm with MRI and resect transsphenoidally Clinical presentation of Cushing’s symptoms Approach to Cushing's syndrome wasting Mikael Häggström, CC0, via Wikimedia Commons Approach to Cushing's syndrome Clinical presentation of Cushing’s symptoms 24 hour free urine cortisol AND Low dose (1mg) o/n dexameth. suppression test ↑ urine cortisol AND Not suppressed (cortisol unchanged) Suppressed (cortisol ↓), normal result