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Cushing's Disease - Coggle Diagram

- - - - Cortisol also helps regulate blood pressure, reduce inflammation, allow the heart to regulate and function normally.
        
        When there is an overproduction of cortisol, this can be related to pituitary gland tumor, an ACTH secreting tumor, primary adrenal gland disease, or an inherited familial cushing's syndrome.
        
        Pituitary gland tumors called adenomas are a main reason for overproduction of cortisol. When there is a tumor, the pituitary gland over secretes adrenocorticotropic hormone (ACTH), causing the adrenal glands to over produce cortisol.
- - - - 75-80% of Chushings disease are caused by ACTH overproduction from pituitary adenoma tumor.
        
        15-20% of Chushing's Disease is due to non-pituitary tumors (ectopic ACTH syndrome).
- - - - Pituitary tumors: The majority of cases of Cushing's disease are caused by the presence of a benign pituitary tumor.
        
        Genetic predisposition: Some people may have a genetic predisposition to developing Cushing's disease, although the exact genes involved are not fully understood.
        
        Other medical conditions: Certain medical conditions, such as obesity, type 2 diabetes, and high blood pressure, may increase the risk of developing Cushing's disease.
- - - - Low-dose dexamethasone suppression test: This is a test that gives a low dose of a steroid "dexamethasone" to measure cortisol levels.
        
        High-dose dexamethasone suppression test: This test gives a large level of dexamethasone steroid to measure the cortisol levels.
        
        ACTH stimulation test: This is a test that gives adrenocorticotropic hormone (ACTH) to visualize how the body responds to ACTH. ACTH is the hormone that stimulates the production of cortisol.
        
        Imaging tests such as CT scan or MRI. This can scan for tumors or any abnormalities in the adrenal and pituitary gland.
        
        CRH stimulation test: Corticotropin-releasing hormone stimulates the pituitary gland to produce ACTH. This test will inject a small amount of CRH to understand how the body will respond to ACTH.
- - - - Medications can be used to control the cortisol levels such as ketoconazole, metyrapone, and mitotane, however these drugs are not a treatment to the disease.
        
        Ketoconazole is used for long term control of hypercortisolism. It is used to inhibit the production of adrenal 11 beta-hydroxylase and 17,20-lyase, and it, in some unknown way, prevents the expected rise in ACTH secretion.
        
        Metyrapone is used to control cortisol levels. It has a rapid onset. Metyrapone prevents cortisol synthesis by inhibiting 11 β-hydroxylase, the enzyme responsible for the conversion of deoxy cortisol to cortisol.
        
        Mitotane is used to treat cortisol producing adrenal carcinomas because taken up by both healthy and malignant tissue and causes a wide array of toxicities.
        
        Weight loss and stress reduction such as exercising and diet management can help manage symptoms and reduce cortisol levels.
- - - - Skin changes: when cortisol is in excess in the body skin thinning, bruising, acne, infection, poor wound healing, purple striae or stretchmarks on the abdomen and thighs appear due to weight gain.
        
        Mood changes: Excess cortisol can cause mood swings, irritability, mania, major depression, and anxiety
        
        High blood pressure is a significant correlation with high cortisol levels which causes irregularities of regulating plasma volumes, peripheral vascular resistance, and cardiac output, which leads to heart disease and stroke.
        
        Diabetes: Hypercortisolism can interferer with the insulin production in the pancreas leading to high blood sugar levels and diagnosis and development of diabetes.
        
        Menstrual irregularities: Infrequent or absent menstrual periods, or problems with fertility is common with women who have Cushing's Disease.
        
        Reduced libido: Men with Cushing's can have a low testosterone level leading to decrease in libido and impotence.
        
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