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Endocrinology

Endocrinology. Cushing’s syndrome. Most common cause of Cushing’s syndrome?. Aetiology. Exogenous – corticosteroids Endogenous – pituitary adenoma secreting ACTH (Cushing’s disease ) - ectopic ACTH secretion from cancer

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Endocrinology

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  1. Endocrinology Cushing’s syndrome

  2. Most common cause of Cushing’s syndrome?

  3. Aetiology • Exogenous – corticosteroids • Endogenous – pituitary adenoma secreting ACTH (Cushing’s disease) - ectopic ACTH secretion from cancer - excess adrenal secretion

  4. Signs and symptoms Buffalo humpEasy bruisingCataractsLarger appetiteObesityMoonfaceEuphoriaThin arms & legsHypertension/ HyperglycaemiaAvascular necrosis of femoral headSkin thinningOsteoporosisNegative nitrogen balanceEmotional liability

  5. Investigations • FBC (raised WCC) and U&E (check for hypokalaemia) • 24 hour urinary free cortisol • 24 hour dexamethasone test OR High dose dexamethasone test • Adrenal CT or MRI, Pituitary MRI, Chest X-ray for carcinoma of bronchus

  6. Management of Cushing’s disease • Tumour resection • Pituitary radiotherapy • Drugs that suppress cortisol

  7. Bonus marks management Think about the side effects of steroids and how they can be managed/prevented • Gastroprotection • Bone protections • Glucose tolerance test • Blood pressure monitoring

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