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CUSHING'S SYNDROME
Cushing’s syndrome is a condition which is due to prolonged exposure of the body tissue to excess cortisol (glucocorticoid hormone).
Laboratory tests and radiological findings confirm diagnosis and determine the actual cause of Cushing's syndrome.
Endogenous adrenocorticotropic hormone (ACTH)-independent Cushing's syndrome has adrenal hypersecretion due to adrenal adenoma, adrenal carcinoma, micronodular hyperplasia, and macronodular hyperplasia.
Exogenous ACTH-independent Cushing's syndrome has adrenal hypersecretion due to iatrogenic causes (eg drug-induced, corticosteroid use).

Definition

Cushing’s syndrome is a condition which is due to prolonged exposure of the body tissue to excess cortisol (glucocorticoid hormone)

Etiology

Adrenocorticotropic Hormone (ACTH)-Independent Cushing's Syndrome

Endogenous ACTH-Independent Cushing’s Syndrome

  • Adrenal hypersecretion due to adrenal adenoma, adrenal carcinoma, micronodular hyperplasia, macronodular hyperplasia

Exogenous ACTH-independent Cushing’s syndrome

  • Adrenal hypersecretion due to iatrogenic causes (eg drug-induced, corticosteroid use)

Adrenocorticotropic Hormone (ACTH)-Dependent Cushing's Syndrome

Cushing’s Disease

  • Due to excessive secretion of adrenocorticotropic hormone by pituitary corticotroph tumor

Ectopic Adrenocorticotropic Hormone (ACTH)/Corticotropin-Releasing Hormone (CRH) syndromes

  • Ectopic adrenocorticotropic hormone syndrome is ectopic adrenocorticotropic hormone secretion due to small-cell lung carcinoma, associated with symptoms of hypertension, hypokalemia, edema, glucose intolerance
  • Ectopic corticotropin-releasing hormone syndrome is ectopic corticotropin-releasing hormone secretion due mostly to bronchial carcinoid tumors

Signs and Symptoms

  • Progressive obesity
    • Facial obesity manifested as "moon" face
    • Buffalo hump or dorsocervical fat pad
    • Enlarged fat pads in the supraclavicular fossae
    • Truncal obesity
    • Generalized obesity
  • Facial plethora
  • Wasting in the extremities
  • Acne
  • Easy bruising
  • Violaceous striae width >1 cm
  • Hirsutism (in women)
  • Proximal muscle weakness
  • Decreased libido and impotency (in men)
  • Infection
  • Depression/lethargy
  • Menstrual disorders

Associated Clinical Conditions

  • Osteoporosis
  • Hypertension
  • Diabetes mellitus/impaired glucose tolerance
  • Hyperlipidemia
  • Polycystic ovary syndrome (PCOS)
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