Introduction to Cushing’s Syndrome – Adrenal Gland

by Carlo Raj, MD

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    Let’s first take a look at our first spectrum of pathology here with cortisol and this brings us to, and I’m going to be very specific here, this is Cushing’s syndrome. What part of this is specific? The syndrome versus disease. Yes, there are two different diagnosis. Well, by that I mean, the diagnosis is hypercortisolism for both syndrome and disease, but then disease and syndrome will tell you how cortisol is being-being excessively created. Who’s your patient with Cushing’s syndrome in general? Central obesity, because of that obesity, you’ll notice the purple striae. What’s striae mean? Stretching of the skin. You take a look at the face, looks like a puffy moon facies, facial plethora; acne; hirsutism. Understand that Cushing syndrome, if it is being developed as a pathology in the adrenal cortex, would increase all of your adrenocortical hormones. Is that clear? So, you will be increasing your aldosterone, you will be increasing, as our topic refers to cortisol, and also increases your androgen. What’s hirsutism mean? Hair-like or man-like hair distribution and acne all part of increased androgen, right, androgen production. Cervico-dorsal fat accumulation, this is then referred to… take a look at your patient in the area by the trapezius on the neck region, that’s your buffalo hump. Easy bruising, thinned skin; muscle wasting especially of the extremities. You cannot ever miss a picture of a patient that has excessive cortisol. Welcome to hypercortisolism, here we have Cushing’s syndrome. Before we move on, you will be responsible for four different places or four different methods by which your patient is going to increase cortisol levels. The most common in the US, iatrogenic we’ll talk about; number two maybe from the adrenal cortex; number three from the anterior pituitary producing too much ACTH and that would be...

    About the Lecture

    The lecture Introduction to Cushing’s Syndrome – Adrenal Gland by Carlo Raj, MD is from the course Adrenal Gland Disorders.

    Included Quiz Questions

    1. Muscle hypertrophy
    2. Moon facies
    3. Cervico-dorsal fat accumulation
    4. Central obesity
    5. Easy bruising
    1. Insulin resistance secondary to increased cortisol
    2. Glucose intolerance due to central obesity
    3. Central obesity leading to insulin resistance
    4. Increased inflammatory markers leading to insulin resistance
    5. Decreased gluconeogenesis leading to central obesity
    1. Pituitary hypersecretion of ACTH
    2. Iatrogenic
    3. Adrenal hypersecretion of cortisol
    4. Ectopic hypersecretion of ACTH
    5. Ectopic hypersecretion of cortisol
    1. Increased serum cortisol in the morning
    2. Decreased serum cortisol in the morning
    3. Increased serum cortisol at night
    4. Decreased serum cortisol midday
    5. Increased serum cortisol midday
    1. Small cell carcinoma of the lung
    2. Mucus secreting pancreatic carcinoma
    3. Adrenal adenoma
    4. Pituitary hyperplasia
    5. Clear cell renal carcinoma
    1. Cortisol producing adrenal tumor
    2. Pituitary adenoma
    3. Mucus secreting pancreatic carcinoma
    4. Small cell carcinoma of the lung
    5. Clear cell renal carcinoma

    Author of lecture Introduction to Cushing’s Syndrome – Adrenal Gland

     Carlo Raj, MD

    Carlo Raj, MD

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    Wonderfully explained
    By Hamed S. on 22. February 2017 for Introduction to Cushing’s Syndrome – Adrenal Gland

    One of the best talks I have come across describing the algorithm for diagnosis of cushings (superior to Kaplan and med study internal medicine lectures). It would have also been good to discuss the advantages/disadvantages of 24 hr urine collections vs low dose dexamethasone suppression test. Seriously good work though Dr Raj!