Cushing Disease and Cushing Syndrome
- Cushing syndrome is defined as excessive glucocorticoid exposure from exogenous (steroid medications) or less commonly from endogenous sources (pituitary, adrenal, pulmonary, etc.).
- Cushing disease is glucocorticoid excess due to excessive adrenocorticotropic hormone (ACTH) secretion from a pituitary tumor.
- System(s) affected: endocrine/metabolic, musculoskeletal, skin/exocrine, cardiovascular; neuropsychiatric
- Rare in infancy and childhood
- The most common presenting symptom is lack of growth and weight gain.
Pregnancy may exacerbate the disease.
- An estimated 10 to 15 cases per million people are affected yearly.
- Cushing disease most commonly affects adults aged 20 to 50 years and females.
- 2–5% prevalence reported in difficult-to-control diabetics with obesity and hypertension (HTN)
Etiology and Pathophysiology
- Cortisol is a steroid hormone produced by the zona fasciculata of the adrenal cortex. It is classically a catabolic hormone released during periods of stress. The excess causes increased free glucose, insulin resistance, and protein catabolism.
- Prolonged glucocorticoid use such as in asthma and chronic obstructive pulmonary disease is the most common exogenous source.
- Endogenous cause is either ACTH-dependent or ACTH-independent, as
- ACTH is typically secreted by the pituitary which stimulates adrenal release. As such, release of ACTH from any source will result in increased cortisol level.
- Multiple endocrine neoplasia (MEN)
- McCune-Albright syndrome (mutation of GNAS1 gene)
Prolonged use of corticosteroids
Avoid corticosteroid exposure.
Commonly Associated Conditions
Psychiatric disorders, diabetes, HTN, hypokalemia, infections, dyslipidemia, osteoporosis, and poor physical fitness
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