CUSHING SYNDROME

 





DEFINITION:-

Cushing syndrome is a clinical condition that result from chronic exposure to excess corticosteroid particularly glucocorticoid.  

CAUSE:-

  • Administer of exogenous corticosteroids. Ex- Prednisone
  • Adrenal tumor & actopic ACTH production by tumor. Outside the hypothalamic pituitary adrenal axis. ( Hyperplasia of adrenal cortex.)

CLINICAL MANIFESTATION:-

  • Weight gain due to accumulation of adipose tissue in trunk, face & survical spine.
  • Hyperglycaemia due to glucose intolerance associated with cortisol induced insulin resistance& increase gluconeogenesis by the liver
  • Muscle wasting cause weakness in extremities.
  • Loss of bone matrix leads to osteoporosis & beck pain
  • Loss of collagen make skin weaker & thinner & easily bruises.
  • Catabolic process leads to a delay in wound healing, irritability, anxiety, euphoria
  • Mineralocorticoid excess cause hypertension secondary to fluid retaintion
  • Adrenal androgen excess cause severe acne, virilisation in women & feminization in man, mental disorder, gyenacomastia & importance seen.

DIAGNOSIS:-

  •  History collection
  • Physical examination
  • 24 hour urine collection for free cortisol . urine cortisol level higher then normal  range 80-120 mcg/24 hour indicate Cushing syndrome.
  • Urine level of 17 ketosteroid elevated
  • CT & MRI of pituitary & adrenal gland
  • Leukocytosis
  • Lymphopenia
  • Hypokalemia & alkalosis seen in ectopic ACTH syndrome & adrenal carcinoma.

TREATMENT:-

GOAL:- Normal hormone production & reduce complication

Surgical removal of pituitary tumor using trans sphenoidal approach.

 

 


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