What is Cushing's syndrome? What causes it & what does it then cause if untreated?
Excessive glucocorticoid activity. Primary cause: adrenal (autonomous secretion of cortisol), low ACTH, high cortisol. Secondary: pituitary or ectopic (excessive production of ACTH), high ACTH & cortisol, tumor cells not as responsive to -ve feedback
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What are the symptoms of Cushing's syndrome?
Altered fat deposition (truncal obesity), excess androgen production, breakdown of protein/muscle wasting, loss of collagen/immunosuppression (poor wound healing), mental changes, excess mineralcorticoids, hyperglycaemia, insulin resistance
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How is Cushing's syndrome diagnosed?
Elevated plasma cortisol levels, loss of diurnal rhythm of cortisol release, ACTH levels indicate primary/secondary (decrease/increase)
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What dynamic tests help diagnose Cushing's syndrome?
Low does DEX test (synthetic glucocorticoid, lack of suppression indicates autonomous secretion), high dose DEX (will suppress pituitary ACTH, not affect adrenal tumour or ectopic source), CRH test (exaggerated response in Cushing's, non in ectopic)
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What is the treatment for Cushing's syndrome?
Surgery, radiotherapy, drugs that inhibit steroidogenesis (pre-operative preparation for surgery or palliative, rarely long term therapy)
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What is Conn's syndrome? What does it result in?
Primary hyperaldosteronism. Results in initial retention of sodium & hence increased water retention with increased K elimination -> hypokalaemia, weakness -> renal damage -> polyuria. Hypertension main clinical finding
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What is Addison's disease? What hormonal changes are seen? How is it diagnosed?
Primary adrenal insufficiency (failure), gradual destruction of adrenal tissue, often autoimmune or by HIV/TB. Low aldosterone, low coritsol, low androgens but elevated ACTH. Diagnosis: decreased cortisol, increased ACTH, adrenal auto-antibodies
Life-long hormone replacement, glucocorticoid (hydrocortisone) & mineralocorticoid (fludrocortisone). Higher doses of glucocorticoids given during times of illness or major stress e.g. surgery
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What is congenital adrenal hyperplasia (CAH)?
Inherited defect in an enzyme involved in the production of cortisol and aldosterone. Several possible types, >90% of CAH due to deficiency of 21 beta-hydroxylase. Decreased levels of aldosterone & cortisol, accumulation of androgens
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What is the effect of Addison's disease on the endocrine axis? Treatment?
Decreased -ve feedback inhibition -> excess ACTH release. Treatment: hormone replacement, plastic surgery in sever cases
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Other cards in this set
Card 2
Front
What are the symptoms of Cushing's syndrome?
Back
Altered fat deposition (truncal obesity), excess androgen production, breakdown of protein/muscle wasting, loss of collagen/immunosuppression (poor wound healing), mental changes, excess mineralcorticoids, hyperglycaemia, insulin resistance
Card 3
Front
How is Cushing's syndrome diagnosed?
Back
Card 4
Front
What dynamic tests help diagnose Cushing's syndrome?
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