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Cushing's syndrome (symptoms (general: central weight gain moon face …
Cushing's syndrome
Cushing's disease
pituitary gland releases too much ACTH therefore too much cortisol produced
causes
pituitary adenoma
hyperplasia of pit gland
aka pituitary-dependent hyperadrenalism
if treated by bilateral adrenalectomy, risk of Nelson's disease
other causes
exogenous Cushing's syndrome
adrenal adenoma
ectopic cushing syndrome
symptoms
general: central weight gain
moon face
hair growth/acne
thin skin/easily bruising
mental:depression
psychosis
insomnia
muscular weakness
back pain
amenorrhoea/oligmenorrhoea
poor libido
growth arrest in children
polyuria/polydipsia
signs
general: plethora, moon face, hypertension, buffalo hump,
central obesity, depression/psychosis, glycosuria, oedema, diabetes
skin: thin skin, hirsutism, acne, bruising, poor wound healing, skin infections, striae, pigmentation
MSK: osteoporosis, patho fractures (e.g. vertebrae and ribs), kyphosis, rib fractures
prox myopathy: prox muscle wasting
Rx
drugs
cortisol inhibitors
wean steroid medications (sudden withdrawal -> adrenal crisis)
surgery
transphenoidal resection of pituitary gland (cushing's disease)
surgical resection (adrenal adenoma)