Cushing’s Syndrome

Phenotype
Diagnosing Cushings
 Step 1: Diagnosing >>> Hypercortisolism
3 first line tests :
 Low Dose Dexamethasone
Suppression Test
 Late Night Salivary Cortisol
 Urinary Cortisol

 Step 2: Isolate Source

 ACTH level
o < 5 = ACTH Independent
o >20 = ACTH Dependent

Therapy
 Surgery by source when possible
 Adrenalectomy
 Transphenoidal resection
 Tumor Resection
 Adrenal Enzyme Inhibitors
 Ketoconazole – first line
 Aminoglutethimide
 Metyrapone
  Etomidate
 Medical Adrenalectomy – Mitotane
 Glucocorticoid Antagonists – Mifepristone
 Somatostatin Analogues – Octreotide