1 / 18

Cushing’s Syndrome

Cushing’s Syndrome. Britni Hebert PGY 2 4/9/10 Notes located in presenter note section below each slide. Outline. Presentation Diagnosis Diagnose Hypercortisolism Isolate source Therapy. Normal HPA Physiology. Presentation. Weight Gain Glucose Intolerance HTN Hypokalemia

guinevere-church
Download Presentation

Cushing’s Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cushing’s Syndrome • Britni Hebert • PGY 2 • 4/9/10 • Notes located in presenter note section below each slide.

  2. Outline • Presentation • Diagnosis • Diagnose Hypercortisolism • Isolate source • Therapy

  3. Normal HPA Physiology

  4. Presentation • Weight Gain • Glucose Intolerance • HTN • Hypokalemia • Proximal Muscle Weakness • Infections

  5. Phenotype

  6. Diagnosing Cushings

  7. Step 1: Diagnosing Hypercortisolism3 first line tests • Low Dose Dexamethasone Suppression Test • Late Night Salivary Cortisol • Urinary Cortisol

  8. Step 2: Isolate Source • ACTH level • < 5 = ACTH Independent • >20 = ACTH Dependent

  9. in ACTH Dependent Cushings (like our patient)Isolate Source... of ACTH • ie High Dose Dexamethasone • Confirm • Image

  10. EAS by Source

  11. EAS by Source

  12. Treating Cushings

  13. Therapy • Surgery by source when possible • Adrenalectomy • Transphenoidal resection • Tumor Resection

  14. Therapy • Adrenal Enzyme Inhibitors • Ketoconazole – first line • Aminoglutethimide • Metyrapone • Etomidate

  15. Therapy • Medical Adrenalectomy - Mitotane • Glucocorticoid Antagonists - Mifepristone • Somatostatin Analogues - Octreotide

  16. Summary

  17. Summary • Marked HTN and Hypokalemia are typical of ectopic ACTH secretion. • First Line therapy in unresectable disease = Ketoconazole • CV, HTN, VTE and infection commonly lead to death in the untreated Cushingoid patient. The former does not improve with therapy.

  18. Resources • Up To Date • Clinical Manifestations of Cushing’s Syndrome • Establishing the Diagnosis of Cushing’s Syndrome • Establishing the Cause of Cushing’s Syndrome • Overview of the Treatment of Cushing’s Syndrome • Diminishing Adrenal Cortisol Synthesis • Ectopic ACTH syndrome. Andrea M. Isidori; Andrea Lenzi, DFM – Department of Pathophysiology, "Sapienza" University of Rome, Italy

More Related