Cushing’s, Addison’s and Acromegaly Cushing’s Syndrome
Date conversion 05.02.2017 Size 7 Kb.
Syndrome: excessive activation of glucocorticoid receptors.
Disease: excessive ACTH due to pituitary adenoma.
ACTH-dependent pituitary adenoma, ectopic ACTH, iatrogenic.
ACTH-independent iatrogenic, adrenal adenoma/carcinoma.
Pseudo-Cushing’s EtOH excess, major depressive disorder, 1 obesity
Clinical features: hair thinning, hirsuitism, psychosis, acne, plethora, cataracts, mild exophthalmos, moon face, peptic ulcers, vertebral #, hypertension, hyperglycaemia, central adiposity, menstrual disturbance, striae, decreased skin thickness, osteoporosis, proximal myopathy, infections, poor wound healing, bruising, impaired immune response.
Bedside cap glucose, BP.
Bloods dexamethasone suppression test, CRH test, serum cortisol.
Imaging MRI brain, CXR, CT AP/adrenals.
Others inferior venous petrosal sampling, urinary free cortisol.
Conservative patient education, reduce oral steroid therapy if possible.
Medical ketoconazole/metyrapone (steroid synthesis).
Surgical trans-sphenoidal resection of pituitary.
Definition: a syndrome resulting from inadequate secretion of corticosteroid hormones from progressive destruction of the adrenal cortex.
Causes: “ADDISON” – Autoimmune, Degenerative, Drugs, Infective, Secondary, Other, Neoplasia.
Clinical features: bronze pigmentation of skin, tiredness, hypoglycaemia, postural hypotension, changes in distribution of body hair, weight loss, GI disturbance. Associated with type 1 diabetes, pernicious anaemia, autoimmune thyroid disease and vitiligo.
Bedside lying/standing BP, capillary glucose.
Bloods U&Es, synacthen test, plasma renin, aldosterone, HIV test.
Imaging AXR, CT/MRI adrenals.
Glucocorticoid replacement – hydrocortisone BD.
Mineralocorticoid replacement – fludrocortisone OD.
Addisonian crisis (shock, hypotension, abdo pain, N&V, Na +/K +) – ABCDE, correct volume depletion, replace glucocorticoids, correct metabolic abnormalities, treat underlying cause.
Definition: a condition caused by excessive growth hormone secretion.
Causes: most commonly, pituitary adenoma.
Clinical features: headache, skull growth (prominent supraorbital ridge with large frontal sinuses), enlargement of lips, nose and tongue, prognathism, cardiomyopathy, increased sweating, thickened skin, hepatomegaly, type 2 diabetes, enlargement of hands, carpal tunnel syndrome, myopathy, enlargement of feet, visual field changes, diplopia.
Bedside collateral hx, serial photographs, BP, ECG.
Bloods serum GH, OGTT, serum IGF-1.
Imaging CT/MRI brain, echo.
Conservative patient education.
Medical (second line) somatostatin analogues (octreotide, lanreotide), dopamine agonists, GH receptor anatagonists (pegvisomant).
Surgery (first line) trans-sphenoidal debulking of tumour.
Radiotherapy if acromegaly persists after surgery.
The database is protected by copyright ©dentisty.org 2016