Cushing’s syndrome
Zhaoxiaojuan
Effects of glucocorticoid
Effects on metabolism
Effects on immunologic function and
inflammatory
Effects on musculoskeletal and connective
tissues
Effects on fluid and electrolyte homeostasis
Neuropsychiatric and behavioral effects
Gastrointestinal effects
Developmental effects
Clinical features
Obesity (The increased fat distribution is
not generalized)
Moon-shaped face and plethoric
Purple striae
Hypertension
IGT
Osteoporosis
Hypokalemic alkalosis
Suspected Cushing’s synd.
Plasma cortisol?
Urinary free cortisol?
Urinary 17-OHCS ?
Low dose dexamethasone suppression test
2.0mg/day?2days
>50% reduce from basal<50% reduce from basal
NORMALCushing’s Synd.
High dose dexamethasone suppression test
8.0mg/day?2days
<50% reduce from basal >50% reduce from basal
Probable
Cushing’s Disease
Adrenal Disease
Ectopic ACTH Synd.
Suspected Cushing’s synd.
Plasma ACTH ?
Adrenal Disease
Ectopic ACTH Synd
Plasma ACTH
Increased Low
Probable Ectopic ACTH Synd,Probable Adrenal Disease
Tumor Search CT /MRI Scan of Adrenals
positive negative
ECTOPIC
ACTH
SYNDROME
normal adrenal mass
Consider
Adrenonodular
Hyperplasia,
Other Disorders
urinary 17-KS
Plasma DHEA
17-KS?
DHEA ?
ADRENAL
CARCINOMA
DHEA??
17-KS ??
ADRENAL
ADENOMA
Nyctohemeral
rhythm
Neural stimuliCRH
ACTH
Cortisol ? Cortisol
(CBG bound) (free)
Physiological and
Metabolic effects
Negative
feedback
Plasma
Hypothalamus
Anterior pituitary
Adrenal cortex
Inactivation by
reduction and
conjugation
Liver
Unchanged cortisol
(measured as urinary
free cortisol)
Tetrahydrocortisol
Tetrahydrocortisone
Cortols,Cortolones
(measurd as urinary 17-OHCS)
Urine
The hypothalamic-pituitary-adrenal axis
hypothalamus
pituitary
adrenal
Drugs:
Cyproheptadine
Metergoline
Bromocryptine
Adrenalectomy
Surgery:
Transsphenoidal microsurgery
Radiation:
60Co
linear accelerator
Drug:
o,p’DDD(mitotane)
Metyrapone
Aninoglutethmide
ketokonazole
CRH
ACTH
CS
Surgery
Radiation
TREATMENT