- Cushing’s Disease refers to ACTH secreting pituitary adenomas
- Signs of Cushing’s Syndrome/Disease include: Centripetal obesity, facial plethora, glucose intolerance, proximal weakness, hypertension, psychiatric changes, easy bruising, menstrual changes, acne, oily skin, impotence, abdominal striae, polydipsia/polyuria, hyperpigmentation, headache, osteoporosis, abdominal pain
- The hyperpigmentation is due to increased POMC production as precursor for ACTH and Melanocyte stimulating factor as a by-product
- Initial work-up for Cushing’s disease is 24 hour urine cortisol, dexamethasone suppression test, or pm salivary cortisol testing
- Use the high dose dexamethasone suppression test to distinguish between ectopic ACTH production versus pituitary ACTH production
- Pituitary Adenomas prevalence from most common to least common is: Lactototrophs, Nonfunctions, Somatotrophs, Corticotrophs
- For ACTH depending Cushing’s syndrome, the differential includes ACTH adenoma (68%), Ectopic ACTH (12%), ectopic CRH (<1%)
- Treatment for ACTH Adenomas is SURGICAL
- Must monitor very closely for Diabetes Insipidus after transphenoidal resection (there is a triphasic pattern of DI, SIADH, and DI – thanks Kefu for this pearl!)
SCVMC IM Chief Resident Blog 