Cushing syndrome

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Cushing syndrome

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$Chapter 11 Adrenal Hyperfunction DIAGNOSIS DIAGNOSTIC IMAGING CT scan ▪ Abdominal CT scan to differentiate tumor from idiopathic hyperaldosteronism LAB RESULTS ▪ Adrenal vein sampling (CT scans do not detect lesions < 1cm/0.39in) TREATMENT SURGERY ▪ Unilateral adrenalectomy Figure 11.1 The gross pathological appearance of an adrenal cortical adenoma in an individual with Conn’s syndrome. CUSHING'S SYNDROME osms.it/cushings-syndrome PATHOLOGY & CAUSES ▪ Endocrine disorder caused by increased cortisol ▪ Can be endogenous (caused by cortisol production inside body)/exogenous (iatrogenic) ▪ Pseudo Cushing’s syndrome: estrogencontaining oral contraceptive pills → increased cortisol-binding globulin → increased total cortisol ▫ Active hormone total free cortisol levels found in a 24-hour urine sample normal CAUSES Primary ▪ Tumor in zona fasciculata of adrenal gland secretes cortisol ▪ Adenoma (benign)/adenocarcinoma (malignant) Secondary ▪ Iatrogenic ▫ Glucocorticoid steroid medications to treat inﬂammatory, autoimmune disorders (e.g. asthma, rheumatoid arthritis, eczema, immunosuppression); most common ▪ Pituitary adenoma (benign) ▫ Leads to excess adrenocorticotropic hormone (ACTH), adrenal cortisol secretion ▪ Adrenal Cushing’s disease ▫ Adrenal gland tumors/hyperplastic adrenal glands/nodular adrenal hyperplasia of adrenal glands produce excess cortisol ▪ Ectopic ACTH ▫ Increased ACTH secreted from benign bronchial carcinoid tumors/malignant oat-cell carcinoma COMPLICATIONS ▪ Metabolic syndrome, diabetes, infection due to immunosuppression, fragility fractures due to osteoporosis OSMOSIS.ORG 69$

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Cushing syndrome

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A 72-year-old man comes to the office because of increasing abdominal obesity for 6 months. He states that he has been eating the same amount, however, has noticed that his belly and face have become "plump." He has also noticed feeling more fatigued than usual, and having a redder face with new acne. His medical history includes small-cell lung cancer for which he is currently receiving treatment. His temperature is 36.8°C (98°F), pulse is 87/min, respirations are 18/min, and blood pressure is 154/92 mm Hg. Examination shows central obesity with supraclavicular fullness. There is also proximal muscle weakness. A random blood sugar level is elevated in the office. Which of the following is the most likely cause of this patient's increased abdominal fat?

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