Cushing's syndrome
| Disorder of ↑ cortisol | |
|---|---|
| Etiology | Most common endogenous cause: pituitary adenoma Most common exogenous cause: Corticosteroids |
| Epidemiology | |
| Clinical presentation | - plethoric face - central obesity - hypertension - proximal myopathy - hirsutism, frontal alopecia - polycythaemia |
| Pathogenesis | |
| Diagnostic investigations | Dexamethasone suppression test - expect morning cortisol ↑ (>50 nm/L) Late night salivary cortisol (2300 to midnight) - expect ↑ 24h urinary free cortisol - usually require 2-3 samples Pituitary MRI - for pituitary adenoma |
| Management | Medical management: > somatostatin analogue (pasireotide), > a dopamine agonist (cabergoline), > a steroidogenesis inhibitor (osilodrostat, ketoconazole, OR > levoketoconazole, metyrapone, mitotane, and etomidate), OR > glucocorticoid receptor antagonist (mifepristone) |
Ddx:
- PCOS
- primary psychiatric disorders (although one wonders if it is not the opposite that is true)
- alcohol excess