CUSHINGS SYNDROME CUSHINGS DISEASE

PATHOPHYSIOLOGY

describes the array of signs Rare condition exhibit greater

and symptoms resulting from than 90% suppression
excess glucocorticoid compared with none with
production or prolonged ectopic disease. Ectopic
exogenous steroid use. The ACTH
most secretion from carcinoid
common causes of Cushing’s tumors might suppress with
syndrome are high-dose dexamethasone.
ACTH-secreting pituitary Thus, the sensitivity was
adenoma known as great�er than 60% and the
Cushings’s disease (68%), specificity was 100% for
autonomous cortisol Cushing’s
production from an adrenal disease.
tumor
(17%), and ectopic ACTH or
CRH production (15%).

CLINICAL MANIFESTATIONS

HYPERCORTISOLISM ACTH HYPERSECRETION

Overproduction of CRH or investigated
ACTH, excess adrenal by simultaneous sampling of
glucocorticoid secretion, and blood from the inferior
exogenous intake petrosal sinus and a
peripheral vein both before
and after
stimulation of the pituitary
gland with CRH.

CLINICAL FINDINGS

cortisol excess, loss of weight gain, truncal obesity,

diurnal rhythm, and striae, hypertension, glucose
suppression resistance. intolerance and infections.
Exogenous glucocorticoid Cranial nerve II may be
administration must be affected by enlarging pituitary
excluded. A universal adenomas, cranial nerves III,
diagnostic algorithm IV and VI may also be
for Cushing’s syndrome has affected.
not been established for the
following reasons:
1. ACTH and cortisol are
secreted
in bursts and excess
secretion may occur
 episodically.
2. Each patient has unique
metabolism, metabolites, and
metabolic clearance rates.
3. Stimulation and
suppression thresholds often
vary (non-suppressible
lesions can occasionally be
suppressed, and normal
patients can display
suppression resistance)
4. Compliance and accuracy
issues regarding sample
collection and processing are
common

References:
American Family Physician (2000). Cushing’s Syndrome and Cushing’s Disease.
https://www.aafp.org/pubs/afp/issues/2000/0901/p1133.html

Bishop, M. L., Fody, E. P., & Schoeff, L. E. (2013). Clinical chemistry: principles, techniques, and
correlations. 7th ed. Philadelphia, Wolters Kluwer Health/Hippincott Williams & Wilkins.
pp 460-464