Snapshot
- A 42-year-old obese woman who does not smoke presents with diastolic hypertension and menstrual irregularities. Physical exam shows a full, plethoric-appearing face, increased facial hair, truncal obesity, and purple striae around the abdomen. Scattered echymoses are present over the entire body. Labs show a Hgb of 18 g/dL and a WBC of 18,000/mm^3. The leukocyte differential shows an absolute neutrophillic leukocytosis. CXR is normal.
Introduction
- A condition that refers to the manifestations of hypercortisolism
- There are several types
- iatrogenic Cushing’s
- patients taking steroids is the most common cause of Cushing’s syndrome
- pituitary adenoma (Cushing’s disease)
- most common pathogenic cause (70%)
- majority of adenomas are benign
- adrenal Cushing’s
- adenoma of the adrenals
- ectopic Cushing’s
- ectopic ACTH secretion
- extremely high ACTH
- most commonly from small cell carcinoma of the lung
- iatrogenic Cushing’s
- less commonly thymic cancer
Presentation
- Symptoms
- depression and psychological changes
- oligomenorrhea
- growth retardation
- weakness
- catabolism of muscle for gluconeogenesis
- symptoms of diabetes (polydipsia, polyuria, and dysuria)
- Physical exam
- diastolic hypertension
- central obesity
- muscle wasting
- thin skin that easily bruises/purple abdominal striae
- due to weakening of collagen
- hirsutism
- moon facies
- buffalo hump
Evaluation
- Labs
- hyperglycemia
- cortisol is gluconeogenic
- hypokalemia
- at high concentrations cortisol can have partial activity at the aldosterone receptor
- screen for 24-hour free urinary cortisol as well as a serum cortisol level
- high positive and negative predictive value
- hyperglycemia