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 plethoricPurple striaeHypertensionIGT OsteoporosisHypokalemic alkalosis

Suspected Cushing’s synd.

Plasma cortisolUrinary free cortisolUrinary 17-OHCS

Low dose dexamethasone suppression test2.0mg/day2days

>50% reduce from basal<50% reduce from basal

NORMALCushing’s Synd.

High dose dexamethasone suppression test8.0mg/day2days

<50% reduce from basal >50% reduce from basal

ProbableCushing’s Disease

Adrenal DiseaseEctopic ACTH Synd.

Suspected Cushing’s synd.

Plasma ACTH

Adrenal DiseaseEctopic ACTH Synd

Adrenal DiseaseEctopic ACTH Synd

Plasma ACTH

Increased Low

Probable Ectopic ACTH Synd. Probable Adrenal Disease

Tumor Search CT /MRI Scan of Adrenals

positive negative

ECTOPICACTH

SYNDROME

normal adrenal mass

ConsiderAdrenonodular

Hyperplasia,Other Disorders

urinary 17-KSPlasma DHEA

17-KS DHEA

ADRENALCARCINOMA

DHEA 17-KS

ADRENALADENOMA

Nyctohemeral rhythm

Neural stimuliCRH

ACTH

Cortisol Cortisol(CBG bound) (free)

Physiological andMetabolic effects

Negativefeedback

Plasma

Hypothalamus

Anterior pituitary

Adrenal cortex

Inactivation by reduction and conjugation

Liver

Unchanged cortisol(measured as urinary free cortisol)

TetrahydrocortisolTetrahydrocortisoneCortols,Cortolones(measurd as urinary 17-OHCS)

Urine

The hypothalamic-pituitary-adrenal axis

hypothalamushypothalamus

pituitary

adrenal

Drugs: Cyproheptadine Metergoline Bromocryptine

Adrenalectomy

Surgery:Transsphenoidal microsurgeryRadiation: 60Co linear accelerator

Drug: o,p’DDD(mitotane) Metyrapone Aninoglutethmide ketokonazole

CRH

ACTH

CS

SurgeryRadiation

TREATMENT