Cushing's syndrome: Difference between revisions
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*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> | *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== | ||
Revision as of 14:37, 10 February 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
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.