Cushing's syndrome: Difference between revisions
| Line 17: | Line 17: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Iatrogenic | *Iatrogenic | ||
Pituitary adenoma | *Pituitary adenoma | ||
Adrenal tumor | *Adrenal tumor | ||
Adrenal hyperplasia | *Adrenal hyperplasia | ||
Ectopic ACTH secretion | *Ectopic ACTH secretion | ||
==Evaluation== | ==Evaluation== | ||
Latest revision as of 22:01, 12 September 2021
Background
- Hypercortisolism producing an array of non-specific symptoms[1]
- Exclude exogenous glucocorticoids and pregnancy
- Called "Cushing disease" if caused by pituitary tumor
Clinical Features
- Cardiovascular: Hypertension
- Cutaneous: easy bruising, friable, striae, hyperpigmentation, poor wound healing
- Endocrine
- Androgen excess causing hirsutism, amenorrhea, oily skin, increased libido
- Glucose intolerance
- Obesity
- Metabolic: progressive obesity (esp. buffalo hump and supraclavicular fat pads obscuring clavicles)
- Musculoskeletal: proximal muscle atrophy, weakness, osteoporosis
- Ophthalmologic: cataracts, increased intraocular pressure
- Psychologic: emotional lability, depression, irritability, anxiety, panic attacks, mild paranoia and mania
Differential Diagnosis
- Iatrogenic
- Pituitary adenoma
- Adrenal tumor
- Adrenal hyperplasia
- Ectopic ACTH secretion
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
- ↑ Nieman LK. Causes and pathophysiology of Cushing’s syndrome. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.