Approach to Cushing's syndrome

This is a video on how to approach a patient with Cushing's syndrome

This video was created using Google Slides.
Graphics were created or adapted from Wikimedia Commons.

ADDITIONAL TAGS:
Approach to Cushing's syndrome
Disease of chronic or prolonged hypercortisolism (excess cortisol)
Commonly causes:
Iatrogenic (excess use of corticosteroids)
Hypersecretion of ACTH from a pituitary adenoma (Cushing’s disease)
Adrenal cancer (adenoma or carcinoma)
Adrenal hyperplasia secondary to ectopic ACTH or CRH production (by small cell lung cancer, pancreatic, thymus, bronchial cancers)
Not suppressed (cortisol nl/↑)
Suppressed (cortisol ↓)
Approach to Cushing's syndrome
Clinical presentation of Cushing’s symptoms
24 hour free urine cortisol
AND
Low dose (1mg) o/n dexamethasone suppression test
↑ urine cortisol
AND
Not suppressed (cortisol unchanged)
Suppressed (cortisol ↓), normal result
Not Cushing’s syndrome
Suspect Cushing’s syndrome
Measure plasma ACTH levels
ACTH ↓
ACTH nl or ↑
Suspect adrenal tumor. Confirm with CT/MRI and resect
Suspect extra- adrenal tumor (ACTH-dependent Cushing’s syndrome)
High dose (8mg) dexameth. suppression test
Ectopic ACTH. CT/MRI abdomen (pancreatic cancer), chest (lung ca)
Cushing’s disease; ACTH from pituitary tumor. Confirm with MRI and resect transsphenoidally
Clinical presentation of Cushing’s symptoms
Approach to Cushing's syndrome
wasting
Mikael Häggström, CC0, via Wikimedia Commons
Approach to Cushing's syndrome
Clinical presentation of Cushing’s symptoms
24 hour free urine cortisol
AND
Low dose (1mg) o/n dexameth. suppression test
↑ urine cortisol
AND
Not suppressed (cortisol unchanged)
Suppressed (cortisol ↓), normal result