- 4 main causes
i) exogenous corticosteroids
ii) Cushing's disease (pituitary adenoma secreting ACTH)
iii) ectopic ACTH production - hypokalemic alkalosis is typical. Caused by small cell lung CA
iv) adrenal adenoma
- In the dexamethasone suppression test, normal individuals suppress cortisol level to less than 50nmol/L
- Incomplete suppression of cortisol following high dose of dexamethasone (2mg QID for 48hours) is typical of Cushing's disease (gold standard is inferior petrosal sinus sampling)
- Metyrapone is an inhibitor of 11 beta hydroxylase, inhibit the conversion of 11 deoxycortisol to cortisol, can be used in treatment of CS
1 comment:
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