CUSHING SYNDROME

Novia Annur Shabilla - 1510211056

Definition
 Chronic glucocorticoid excess, whatever its cause,
leads to the constellation of symptoms and physical
features.

 Adrenal Cushing’s syndrome may present as

unilateral or bilateral disease and can be acquired
or genetically determined.
Epidemiology
 It’s incidence has been estimated from 2 to 10
patients per million population per year.

 80% Cushing disease (♀ > ♂, 5:1, 20-40 years)

 10% tumor adrenal  50-80% benigna, ♀ > ♂

 ACTH dependent > ACTH independent

Etiology
Etiology
Etiology
Symptoms & Signs
 Weight gain  obesity  moon face, buffalo hump
 Hypertension
 Skin changes  hirsutism, plethora, striae, acne, minor
wounds and abrasions
 Musculoskeletal  osteopenia, weakness
 Neuropsychiatry  emotional lability, euphoria,
depression, psychosis
 Gonadal dysfunction  menstrual disorders, impotence,
decreased libido
 Metabolic  glucose intolerance, diabetes,
hyperlipidemia, polyuria, kidney stones
Diagnosis
 Anamnesis

 Physical Examination
 Laboratory findings
Dexamethasone Suppression Test
 The overnight 1-mg dexamethasone suppression
test is a valuable screening test in patients with
suspected hypercortisolism.

 Normal subjects should suppress plasma cortisol to

less than 1.8 μg/dL (50 nmol/L) following an
overnight 1-mg test.
Urine Free Cortisol
 The determination of urine free cortisol measured
by HPLC or LC/MS/MS in a 24-hour urine
collection.

 Urinary free cortisol is usually less than 50 μg/24 h

(<135 nmol/24 h) when measured by HPLC or LC/
MS/MS.
Late-night serum and salivary cortisol

 Levels are usually highest early in the morning and

decrease gradually throughout the day, reaching the
nadir in the late evening between 11:00 PM and
midnight.

 Several studies have demonstrated that an elevated

midnight plasma cortisol level (>5.2-7.0 μg/dL
[140-190 nmo1/L]) is highly accurate in
differentiating patients with Cushing syndrome.