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Cushing's syndrome

The mind map of Cushing's syndrome, a disease caused by excessive secretion of glucocorticoids (cortisol) from the adrenal glands due to various causes, shares knowledge of its classification, clinical manifestations, pathogenesis, and differential diagnostic examinations.

Edited at 2023-10-26 22:39:51

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Cushing's syndrome

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Outline

Cushing's syndrome

definition

A condition caused by the adrenal glands secreting too much glucocorticoid (cortisol) due to various causes.

Classification

1. ACTH-dependent Cushing’s syndrome

①Cushing's disease (pituitary tumor) [most common]

②Translocation ACTH syndrome: tumors other than the pituitary gland and epinephrine secrete large amounts of ACTH (small cell lung cancer is the most common)

③Ectopic corticotropin-releasing hormone (CRH) syndrome: ectopic secretion by tumors

2. ACTH-independent Cushing’s syndrome

①Adrenocortical adenoma

②Adrenocortical carcinoma

severe Cushing's syndrome

③ Bilateral micronodular or macronodular hyperplasia of the adrenal glands that is not dependent on ACTH

Pigmentation, pigmented spots and blue nevus on trunk skin, conjunctiva, sclera, skin, breast, testicles, atrial myxoma, testicular tumors - Carney syndrome.

Clinical manifestations and pathogenesis

① Appearance: Central obesity, moon face, carp mouth, buffalo back, supraclavicular fat pad, hanging abdomen, relatively thin limbs, and sanguine appearance [Typical]

Glucocorticoids ↑ lead to abnormal fat, blood sugar, and protein metabolism. Abnormal fat metabolism is manifested by increased peripheral consumption, decreased central consumption, and increased synthesis - central obesity, moon face, buffalo back, carp mouth, supraclavicular fossa fat pad , hanging abdomen. Sanguity is due to thin skin, easily visible capillaries, increased red blood cell count and hemoglobin.

②Skin manifestations: Purple lines and ecchymoses on the lower abdomen, inner and outer thighs [Typical]

Fat deposition is excessive, skin becomes thinner, protein decomposition is increased, skin elastic fibers are broken, and pigmentation is deposited.

Thin skin and increased capillary fragility

③Cardiovascular manifestations: hypertension, hypokalemia alkalosis, edema [severe]

In addition to secreting glucocorticoids, the adrenal glands also secrete mineralocorticoids (aldosterols), so glucocorticoids have some aldosterone effects, retaining water, sodium and excreting potassium, so there will be high blood pressure, edema, low potassium, and then on the cell membrane Hydrogen-potassium exchange, leading to alkalosis

④Weakened resistance to infection

Glucocorticoids weaken immunity and make lung infections more common.

⑤Sexual dysfunction: women - decreased/irregular/absent menstruation; acne is common. Be wary of adrenocortical cancer if you have obvious virilization (breast atrophy, hirsutism, clitoromegaly). Decreased libido in men, shrinkage of penis, and softening of testicles

Excessive production of adrenal androgens and inhibitory effect of cortisol on pituitary gonadotropin

⑥Metabolic disorders: sterol diabetes

A large amount of cortisol promotes hepatic gluconeogenesis, has a hunger-resistant insulin effect, and reduces the utilization of glucose by peripheral tissues.

Differential Diagnostic Examination

Qualitative diagnosis (differentiation of obesity (with hypertension) and Cushing's

17-OHS, 17-KS, blood and urine cortisol [glucocorticoid metabolites]

cushing↑, obesity (-)

low dose dexamethasone suppression test

Cushing has no effect, not even for pituitary tumors, because it is a tumor after all and will not be inhibited by small doses. Obesity will inhibit the secretion of ACTH and then inhibit the secretion of TPZJS, and the basal secretion will decrease by 50%.

Blood cortisol circadian rhythm: Cushing's normal circadian rhythm disappears, obesity does not

Quantitative diagnosis

High-dose dexamethasone suppression test

ACTH secretion is inhibited in Cushing's disease. The rest cannot

① Adrenocortical tumors: Adrenocortical tumors inhibit the secretion of pituitary ACTH to a great extent, so there will not be much change when the dose is increased. Then the tumor will definitely not care about you and will still secrete TPZJS when it should.

② Ectopic ACTH syndrome: If you are no longer on that axis, the tumor will not care about you and will continue to secrete

③Cushing's disease: High-dose dexamethasone can inhibit the secretion of ACTH by pituitary tumors to a certain extent, thereby inhibiting the secretion of TPZJS.

Plasma ACTH measurement

Pituitary Cushing's disease: Slightly higher than normal in the morning and not as low as normal at night

Gastroinhibitory ACTH syndrome: significantly increased

Adrenal tumors: reduced (negative feedback regulation)

ACTH stimulation test

Pituitary Cushing's disease: response, higher than normal

Adrenal sebaceous adenoma: half and half respond

Adrenal sebaceous gland cancer: most do not respond

Ectopic ACTH: There is a reaction (it is also controlled by ACTH)

One axis principle

Adrenal ultrasound, CT, MRI

Cushing's disease, ectopic ACTH, enlargement of the adrenal glands on both sides, and adrenal tumors showing tumors.

Accurate Diagnosis of Pituitary Cushing's Disease

X-ray of sella turcica

Die'an area tomography, CT, MRI