Cushing Syndrome

Causes
1. ACTH
  1. Pituitary Dependent
    1. Cushing's Disease
  2. ACTH Administration
  3. Ectopic ACTH secreting Tumour
    1. Impaired GTT (Frank DM)
    2. HypoKalaemia
2. NON- ACTH
  1. Adrenal
    1. Carcinoma
    2. Adenoma
  2. Alcohol Induced "Psuedo-Cushing's"
    1. Cushingoid Appearance due to alcohol consumption
  3. Glucocorticoid administration
Excess corticoid secretion from adrenal glands
1. Normal histology
Diagnosis
1. Differential of Cause
  1. ACTH Dependent
    1. Ectopic
      Annotations:
      - Other tests. Radio-labelled otreotide to locate ectopic ACTH
      1. Plasma ACTH >200ng/L
      2. Frank Diabetes
      3. Hypokalaemia
      4. 48 Hr Dexamethasone Test (High Dose)
        Failure of Significant Cortisol Suppression.
      5. Chest X-Ray
        Bronchial Carcinoid
        CT-Lung, Mediastinum and Abdomen
    2. MRI/CT Scan
      1. Bilateral Adrenal Hyperplasia
    3. Pituitary
      Annotations:
      - Other Tests Catheterization of inferior petrosal sinus to measure ACTH for pituitary lesions.  
      1. Adenoma
        MRI/CT Scan
      2. Cushing Disease
        CRH Test
        Annotations:
        In response to exogenous CRH, Exaggerated ACTH and Cortisol Response is soon. 
  2. NON-ACTH
    1. Adrenal
      1. CT/MRI Scan
        Tumour
        48 Hr Dexamethasone Test (High Dose)
        Failure of Significant Cortisol Suppression.
        Adenoma
        Nodular Hyperplasia
Complications
1. Osteoporosis
2. Hypertension
3. Type 2 diabetes
4. Loss of muscle mass
Synthesis of adrenocortical hormones
Signs and Symptoms
Treatment
1. Adrenalectomy

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Cushing Syndrome

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