CUSHING SYNDROME Murugiah, P., Devar, A., Mu Chui Hsia, M., Mani, R. and Yee Yan, W. Bachelor of Science (Hons) Biomedical Science Faculty of Science, University Tunku Abdul Rahman (UTAR) What is Cushing Syndrome?
Effects
Cushing syndrome (CS) is a disorder that occurs when your body has a high level of the hormone cortisol. It is also known as Hypercortisolism.
Incidence
Effects on Immune System
Effects on Calcium Metabolism
Cortisol decreases
Cushing Syndrome, 47, Total Population, 23,522,482,
- A Rare Disorder - According to the US census bereau (International Data base) 2004, it was estimated that out of 23,522,482 of Malaysian population, 47 were affected with the disorder.
Types & Causes - Pituitary/Adrenal Tumour CS - Paraneoplastic CS - Familial CS (Genetic Factor) - Iatrogenic CS (Exogenous Factor)
(Endogenous Factor)
Cortisol
immunity, inhibits actions of leukocytes, increase susceptibility to infections.
Effects on NaCl, H20 Regulation and BP
decreases
Increases blood pres-
calcium metabolism, reduces bone formation and predisposes risk towards osteoporosis
sure by increasing the sensitivity of the vasculature to epinephrine & norepinephrine
Effects on Skin, Muscle and Bone Breaks down muscle, connective tissue, in order to increase blood sugar in brain Increases abdominal and neck fat deposition
Inhibits thyroid hormone activation, inhibits conversions of thyroid hormones, leads to hypothyroidism
Diagnosis Tests Low dose dexamethasone supression test
Reference Range Using dexamethasone to determine fasting serum cortisol levels.
Urine free cortisol
Determination of free cortisol in 24-hour urine collection
Salivette device allows the patient to conveniently take their own Late night salivary cortisol sample at home at 11 p.m. Serum cortisol level
Symptoms
Effects on Other Hormones
Primarily used to diagnose states of cortisol excess or deficiency.
Below 5 mcg/dL (138 nmol/L) 8 - 77 µg per 24 hours 0.05 - 0.17 mcg/dL for adults and lesser for pre-pubertal children a.m.: 7-25 mcg/dL p.m.: 2-14 mcg/dL
Treatment
Red Cheeks Moon Facies
If your hypercotisolism is due to an excessive exogenous steroid intake
Bruises Easily
If your cortisol levels are still high Radiation may be used
Thin Limbs Poor Wound Healing Abdominal Striae
Your physician will advise you to stop or will reduce the dosage Surgery is the primary choice Drugs, if surgery is not an option
If your high cortisol production does not respond to the modification
Tumour is suspected
References
Central Fat Deposition Cortisol Circardian Rhythm
1. Adler, G. K., 2014. Cushing Syndrome Treatment & Management. [Online]. Available at: http://emedicine.medscape.com/ [Accessed 25 July 2014]. 2.Keren, F.D., 2007. Salivary Cortisol and the Laboratory Evaluation of Cushing’s Syndrome. [online] Available at: <http://www.wardelab.com[Accessed 24 July 2014]. 3.WebMD, 2014. Cushing’s Syndrome. [Online]. Available at: http://www.webmd. com/[Accessed 25 July 2014].
4. Wisse, B., 2013. Cushing syndrome. [online] Available at: <https://umm.edu/ health/medical/ency/articles/cushing-syndrome> [Accessed 24 July 2014]. 5. wmmangham, 2013. Adrenal Disorders I- Cushing Syndrome. [Online] Available at: http://www.cram.com [Accessed 24 July 2014]. 6. Ruchika Batwara, M., 2010. Cushing’s Syndrome and Hypertension. [Online] Available at: http://www.veomed.com/va050642692010 Accessed 24 July 2014].