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Stephen Ou R2
May 17, 2013
Learning Objectives
Definitions
Cushings syndrome: constellation of
symptoms associated with cortisol excess.
Cushings disease: Cushings Syndrome due to
pituitary ACTH hypersecretion.
Clinical Manifestations
Most Specific
- Spontaneous
Bruising
- Proximal
Myopathy
Nonspecific
- Central obesity w/
extremity wasting
- Dorsocervical fat
pads (Buffalo
Hump
- Abdominal striae
- Round facies
(Moon Facies)
- DM
- Depression
- HTN
- Insomnia
- Obesity
- Psychosis
- Oligomenorrhea
- Impaired Cognition
- Osteoporosis
- Hirsutism
- Fungal Skin
Infections
- Nephrolithiasis
- Polyuria
Clinical Manifestations
of Cushings Syndrome
Facial Plethora i.e. Moon Facies
Pregnancy
Etoh dependence
Morbid Obesity
Depression
Poorly controlled Diabetes
Physical stress/Malnutrition/Chronic Exercise
Case Vignette
A 67 year old woman is evaluated weight gain, hypertension and T2DM
over the last 2 years. She has also developed muscle weakness of the
lower extremities over the last 6 months. Physical exam is notable for a
BP of 154/92, facial hirsutism, obesity, abdominal striae, proximal
weakness and peripheral edema. Laboratory studies notable for
potassium of 2.9 meq/L. Which of the following diagnostic tests should
be performed next?
A.
B.
C.
D.
E.
Adrenal CT
C- peptide measurement
Glutamic acid decarboxylase antibody titer
Pancreatic MRI
24-hour urine free cortisol excretion.
Case Vignette
A 67 year old woman is evaluated for a 2-day history of severe muscle
weakness of the bilateral upper extremities. She has also experienced
significant weight gain, developed hypertension and T2DM over the last 2
years. She also developed muscle weakness of the lower extremities 6
months ago. Physical exam is notable for a BP of 154/92, facial hirsutism,
central obesity, abdominal striae, proximal weakness and peripheral
edema. Laboratory studies notable for potassium of 2.9 meq/L. Which of
the following diagnostic tests should be performed next?
A.
B.
C.
D.
E.
Adrenal CT
Hemoglobin A1c
Glutamic acid decarboxylase antibody titer
Pancreatic MRI
24-hour urine free cortisol excretion.
References
UpToDate: sections on cushings syndrome
Epidemiology and clinical manifestations of Cushings syndrome
Establishing the diagnosis of Cushings syndrome
Establishing the cause of Cushings Syndrome