Cushing's syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Hypercortisolism producing an array of non-specific symptoms | *Hypercortisolism producing an array of non-specific symptoms<ref>Nieman LK. Causes and pathophysiology of Cushing’s syndrome. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.</ref> | ||
*Exclude exogenous glucocorticoids and pregnancy | *Exclude exogenous glucocorticoids and pregnancy | ||
*Called "Cushing disease" if caused by pituitary tumor | |||
==Clinical Features== | ==Clinical Features== | ||
*Cutaneous: easy bruising, friable, striae, hyperpigmentation | *Cardiovascular: [[Hypertension]] | ||
*Cutaneous: easy bruising, friable, striae, [[rash|hyperpigmentation]], poor wound healing | |||
*Endocrine | *Endocrine | ||
**Androgen excess causing hirsutism, oily skin, increased libido | **Androgen excess causing hirsutism, amenorrhea, oily skin, increased libido | ||
**Glucose intolerance | **[[hyperglycemia|Glucose intolerance]] | ||
**Obesity | |||
*Metabolic: progressive [[The Obese Patient|obesity]] (esp. buffalo hump and supraclavicular fat pads obscuring clavicles) | *Metabolic: progressive [[The Obese Patient|obesity]] (esp. buffalo hump and supraclavicular fat pads obscuring clavicles) | ||
* | *Musculoskeletal: proximal muscle atrophy, [[weakness]], osteoporosis | ||
*Ophthalmologic: cataracts, increased intraocular pressure | *Ophthalmologic: cataracts, increased [[intraocular pressure]] | ||
*Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania | |||
==Differential Diagnosis== | |||
*Iatrogenic | |||
*Pituitary adenoma | |||
*Adrenal tumor | |||
*Adrenal hyperplasia | |||
*Ectopic ACTH secretion | |||
==Evaluation== | ==Evaluation== | ||
*Outpatient: 24h urinary free cortisol or dexamethasone suppression test | *Outpatient: 24h urinary free cortisol or dexamethasone suppression test | ||
==Management== | |||
*Treat complications (e.g. [[hyperglycemia]]) as appropriate | |||
*Typically outpatient/non-ED management | |||
==Disposition== | |||
*Typically discharge | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Endocrinology]] | ||
Latest revision as of 22:01, 12 September 2021
Background
- Hypercortisolism producing an array of non-specific symptoms[1]
- Exclude exogenous glucocorticoids and pregnancy
- Called "Cushing disease" if caused by pituitary tumor
Clinical Features
- Cardiovascular: Hypertension
- Cutaneous: easy bruising, friable, striae, hyperpigmentation, poor wound healing
- Endocrine
- Androgen excess causing hirsutism, amenorrhea, oily skin, increased libido
- Glucose intolerance
- Obesity
- Metabolic: progressive obesity (esp. buffalo hump and supraclavicular fat pads obscuring clavicles)
- Musculoskeletal: proximal muscle atrophy, weakness, osteoporosis
- Ophthalmologic: cataracts, increased intraocular pressure
- Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania
Differential Diagnosis
- Iatrogenic
- Pituitary adenoma
- Adrenal tumor
- Adrenal hyperplasia
- Ectopic ACTH secretion
Evaluation
- Outpatient: 24h urinary free cortisol or dexamethasone suppression test
Management
- Treat complications (e.g. hyperglycemia) as appropriate
- Typically outpatient/non-ED management
Disposition
- Typically discharge
References
- ↑ Nieman LK. Causes and pathophysiology of Cushing’s syndrome. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.