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CUSHING'S SYNDROME - Coggle Diagram
CUSHING'S SYNDROME
Definition
A disorder caused by chronic exposure to excessive glucocorticoids, particularly cortisol.
Clinical presentation
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Hirsutism (in females), acne
Pathophysiology
Endogenous causes:
Ectopic ACTH syndrome: ACTH from non-pituitary tumors (e.g., small cell lung cancer).
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Leads to protein catabolism, gluconeogenesis, lipolysis, and immunosuppression.
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Investigations
Confirmation and localization: ACTH level (distinguish ACTH-dependent vs. independent), High-dose dexamethasone suppression test, MRI of the pituitary, CT of adrenals or chest (if ectopic source suspected)
Blood tests: Hyperglycemia, Hypokalemia (especially in ectopic ACTH syndrome),Leukocytosis with eosinopenia
Screening tests: Low-dose dexamethasone suppression test,24-hour urinary free cortisol, Late-night salivary cortisol
Treatment
Ectopic ACTH tumors: locate and remove the source, or medical management if not resectable
Ketoconazole, metyrapone, mifepristone (inhibit cortisol production/action)
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Examination findings
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Facial fullness, acne, facial plethora
Skin thinning, bruises, poor wound healing
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Signs of virilization in females (deep voice, increased body hair)
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