1. Cushing’s syndrome

2. Most common cause of Cushing’s syndrome?

4. Aetiology Exogenous – corticosteroids Endogenous – pituitary adenoma secreting ACTH (Cushing’s disease) - ectopic ACTH secretion from cancer - excess adrenal secretion

5. Signs and symptoms Buffalo hump Easy bruising Cataracts Larger appetite Obesity Moonface Euphoria Thin arms & legs Hypertension/ Hyperglycaemia Avascular necrosis of femoral head Skin thinning Osteoporosis Negative nitrogen balance Emotional liability

6. Investigations FBC (raised WCC) and U&E (check for hypokalaemia) 24 hour urinary free cortisol 24 hour dexamethasone test OR High dose dexamethasone test Adrenal CT or MRI, Pituitary MRI, Chest X-ray for carcinoma of bronchus

7. Management of Cushing’s disease Tumour resection Pituitary radiotherapy Drugs that suppress cortisol

8. Bonus marks management Think about the side effects of steroids and how they can be managed/prevented - Gastroprotection - Bone protections - Glucose tolerance test - Blood pressure monitoring