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Cushing’s Syndrome (Examination (Face (Moon face: “Cushingoid facies”,…

- - - - Visual fields: bitemporal hemianopia
        
        Respiratory exam: wheeze, fine crackles
- - - - Steroids: commonest by far
      - Adrenal adenoma / carcinoma / hyperplasia
      - Carney complex :question:
    - - Cushing’s disease
      - SCLC
  - - - 24h urinary free cortisol
      - Loss of diurnal variation: ↑ midnight cortisol
      - Low dose-dexamethasone suppression test
    - - ACTH levels
        
        ↑: pituitary adenoma or ectopic ACTH
        
        ↓: iatrogenic or adrenal
      - High-dose dexamethasone suppression test
        
        50% cortisol suppression if pituitary adenoma
      - MRI pituitary fossa ± whole body CT
        
        Bilateral inferior petrosal sinus vein sampling
        
        Distinguish between ectopic ACTH and CD