Cushing Syndrome - Causes, Symptoms, Diagnosis, Treatment & Diagnostic Workup - USMLE
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- เผยแพร่เมื่อ 6 ก.ย. 2024
- Cushing Syndrome - Causes, Symptoms, Diagnosis, Treatment & Diagnostic Workup - USMLE
Cushing Syndrome & Cushing disease are highly tested topics in exams. cushing syndrome Diagnostic workup & diagnostic alogritham are fully explained in this video.it also explains symptoms, causes, and pathophysiology of cushing disease and cushing syndrome.Cushing syndrome can be treated when its appropriate cause has been found out by its diagnostic workup.
The diagnosis of Cushing syndrome requires demonstration of inappropriately high level of cortisol in the serum or urine. The levels should be measured when cortisol, according to its physiologic circadian rhythm, is supposed to be suppressed, that is, late evening or when a patient is given exogenous glucocorticoids.
This concept gives rise to the following tests, which have been recommended as screening tests for Cushing syndrome:
Midnight serum or salivary cortisol
24-hour urine free cortisol
Low dose dexamethasone suppression test
Exogenous glucocorticoid use around time of testing must be addressed and excluded to ensure the accuracy of the test result's interpretation.
Urinary free cortisol (UFC) determination has been widely used as an initial screening tool for Cushing syndrome because it provides measurement of cortisol over a 24-hour period. A valid result depends on adequate collection of the specimen. Urinary creatinine excretion can be used to assess the reliability of the collection. 24-Hour urine creatinine excretion should be 20-25 mg/kg (lean body weight) in adult males younger than 50 years of age and 15-20 mg/kg (lean body weight) in adult females younger than 50 years. However, in elderly patients, creatinine excretion gradually declines over time, which makes this estimation less accurate than that for younger individuals. Urine free cortisol values higher than 3 times the upper limit of normal are highly suggestive of Cushing syndrome. Values higher than the normal reference range but less than 3times the upper limit of normal are inconclusive. Values within this range may indicate pseudo-Cushing syndrome or Cushing syndrome and require further testing. Multiple collections are necessary because patients with disease may have values that fall within the normal range. #CushingSyndrome #Cushingdisease
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Just a tip for the dexamethasone suppression test, in cyclical or episodic patients who are experiencing normal or low cortisol secretion, they will suppress. It is important to repeat or rely upon blood, saliva and urine in patients whom are episodic. I spent 17 years undiagnosed. Going for pituitary surgery very soon 💜 the QOL is horrific, plz keep in mind.
Onset age 16/17 (maybe earlier) diagnosed age 34 🤯 began seeking Endocrine care in 2005.
I am 2nd year medical student. My next question is out of curiosity and I mean no ill-will. You mention a pituitary surgery implying you may have a tumour, I wondered if you were diagnosed with Cushing’s disease? We learn that the disease and syndrome are separate as the disease is caused by pituitary releasing too much ACTH. So for the demethasone suppression test, a high dose is what differentiates the two. I didn’t know it was possible for a patient to experience cyclical or episodic cortisol release because we learn that that rhythm is lost in the majority of patients. Your case is interesting and Ill keep it in mind. I hope you are feeing much better and that the surgery went well! I don’t expect to hear back as I am 2 years late but still, all the best! ❤
I suppressed on 1mg dex, but salivary Late nights are 8-10-600x normal. Have pit Cushings. Do not dismiss textbook patients who suppress on 1mg dex. Just means pit source. MANY of us w pituitary source suppress!
I suppressed on 1mg dexamethasone to 0.5 and STILL HAVE PITUITARY CUSHINGS DISEASE CONFIRMED. Test isn’t 100%
Same happened to me Belinda. Then the tumor grew and I got secondary addison's disease. 12 years of medical gaslighting and finally getting treatment and surgery soon. This dexa test is very faulty
You made it supereasy.thank you
Thank you bennet 😊
Thank you so much! This will help me in my final year exam.
You're welcome Shayan!!Good luck for your exams. You'll ace it with flying colors Inshallah. 🙂
@@MedNerdDrWaqasFazal 12:49 leftlower corner MRI pituatary ->your picture shows if the adenoma is smaller than 6mm than: Interferior petrosalsius sampling!
My Adenomain the pituatary is 3x3mm..so..yes its smaller than 6mm, and my cortisol was supressed through 1mg dexa...it went from 226 µg/l to 144µg/l. With or without Dexa..my ACTH stayed 19 ng/l.
What do you think it could be?
And why there needs to be IPSS if the Adenoma is smaller than 6mm? Does this also applyfor Dexatest with 1mg?
Need your thoughts on that please.
Thank you doc for the lecture keep up good work
Very helpful sir
why didn't we check for ACTH level instead to rule out pituitary adenoma?
Acth is increased in case of pituitary adenoma as u said but it can also be secreted by ectopic cancerous growth like lung cancer. So checking acth levels will only differentiate between cushings disease and cushings syndrome. However, HDDS test will rule out this contradiction. So high dose of dexa will only suppress cortisol production if its origin I'd pituitary adenoma.
Short and crisp.
JazakAllah
Sir You are a gem 💎
Great teacher, thank you for teaching and sharing ❤❤❤❤❤
Thanks.well done.
Reason for proximal myopathy.? Why distal muscles are not involved?
Very nice 👍🏻👍🏻
Thank you daanyaal 😊
Nicely done
Thank you Dr. Tanzeel
Level😍 make videos on rheumatology and neurology
Thank you Aizad! I'll surely make videos on Neuro and rheumatology too. 😊
Excellent content.
Thank you Dr. Usman
Thank you so much sir😍 excellent presentation👍helped me alot
Behtareen!! 👍🏻
Thank you Bilal bhai ❤️
What is the reference range of 1mg dexamethasone for cortisol test give me a figure
Thank you but I do not agree with your explanation on IPS sampling. BIPSS is actually done to confirm Cushing's disease, because pituitary MRI is less sensitive for that condition.
I guess mri brain is primary modality it's non invasive easily available nd if on mri pituitary mass is not seen or dexa suppression scan cortisol is not supressed 50% then after u have to go for petrosal sinus sampling it's invasive nd used in last resort so in my opinion mri is considered ioc
Thank u so much.
Treatment?
I am suffering with lower back pain can't stand up on legs
Cataract, FatFace , Stomach becomes very fat please help me I want treatment
Nice sir
Hi,why iatrogenic cushing syndrome brings to generalized odema ? how to treat it ,which medication to use?is spironolactone ok for that or you better to use furosemide??
Do u have training centre for internal medicine in india, I am interested
You are gem sir😎
I'm wondering about something. If I could get some advice. I am having a blood cortisol test AM and PM. If i come home after the AM test and sleep for 2 hours, would that affect the PM test results? Thanks for any help that could be offered
Thankyou sir
👍👍