Cushing's syndrome: Difference between revisions
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*Hypercortisolism producing an array of non-specific symptoms | *Hypercortisolism producing an array of non-specific symptoms | ||
*Exclude exogenous glucocorticoids and pregnancy | *Exclude exogenous glucocorticoids and pregnancy | ||
==Clinical Features== | ==Clinical Features== | ||
*Cutaneous: easy bruising, friable, striae, hyperpigmentation | *Cutaneous: easy bruising, friable, striae, [[rash|hyperpigmentation]] | ||
*Endocrine | *Endocrine | ||
**Androgen excess causing hirsutism, oily skin, increased libido | **Androgen excess causing hirsutism, oily skin, increased libido | ||
**Glucose intolerance | **[[hyperglycemia|Glucose intolerance]] | ||
*Metabolic: progressive [[The Obese Patient|obesity]] (esp. buffalo hump and supraclavicular fat pads obscuring clavicles) | *Metabolic: progressive [[The Obese Patient|obesity]] (esp. buffalo hump and supraclavicular fat pads obscuring clavicles) | ||
*Muscle: proximal muscle atrophy, weakness | *Muscle: proximal muscle atrophy, [[weakness]] | ||
*Ophthalmologic: cataracts, increased intraocular pressure | *Ophthalmologic: cataracts, increased [[intraocular pressure]] | ||
*Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania | *Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania | ||
==Differential Diagnosis== | |||
==Evaluation== | ==Evaluation== | ||
*Outpatient: 24h urinary free cortisol or dexamethasone suppression test | *Outpatient: 24h urinary free cortisol or dexamethasone suppression test | ||
==Management== | |||
*Treat complications (e.g. [[hyperglycemia]]) as appropriate | |||
*Typically outpatient/non-ED management | |||
==Disposition== | |||
*Typically discharge | |||
==References== | ==References== | ||
Revision as of 15:33, 28 September 2019
Background
- Hypercortisolism producing an array of non-specific symptoms
- Exclude exogenous glucocorticoids and pregnancy
Clinical Features
- Cutaneous: easy bruising, friable, striae, hyperpigmentation
- Endocrine
- Androgen excess causing hirsutism, oily skin, increased libido
- Glucose intolerance
- Metabolic: progressive obesity (esp. buffalo hump and supraclavicular fat pads obscuring clavicles)
- Muscle: proximal muscle atrophy, weakness
- Ophthalmologic: cataracts, increased intraocular pressure
- Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania
Differential Diagnosis
Evaluation
- Outpatient: 24h urinary free cortisol or dexamethasone suppression test
Management
- Treat complications (e.g. hyperglycemia) as appropriate
- Typically outpatient/non-ED management
Disposition
- Typically discharge
References
UpToDate