Saturday, 17 December 2011

Cushing's syndrome

- Cushing's syndrome refers to the sustained overproduction of cortisol which causes centripetal obesity with moon face, Buffalo hump, hirsutism, recurrent infection, osteoporosis, hypokalemia, hyperglycemia, proximal myopathy, acne, striae and psychiatric disturbance
- 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

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