Chronic excess of cortisol. Cushing's Disease (pituitary tumor) vs. Syndrome (exogenous steroids, adrenal tumor).

Central obesity, moon face, buffalo hump, supraclavicular fat pads, purple striae, thin skin, easy bruising.

Hyperglycemia (steroid-induced diabetes), hypokalemia, hypernatremia, metabolic alkalosis, osteoporosis.

Immunosuppression due to cortisol's anti-inflammatory effects. Increased risk of infection, often without fever.

Gold standard diagnostic test. Elevated levels confirm hypercortisolism.

Dexamethasone Suppression

Low-dose: no suppression = Cushing's. High-dose: suppresses if pituitary origin (Cushing's Disease), not if adrenal/ectopic.

Hirsutism (excessive hair growth), acne, and facial plethora (redness) due to increased androgens.

Hypertension from sodium/water retention. Increased risk for heart failure and stroke.

Musculoskeletal Effect

Proximal muscle weakness and wasting. Osteoporosis leading to pathologic fractures (e.g., vertebral compression).

Emotional lability, irritability, depression, psychosis ("steroid psychosis").

Transsphenoidal hypophysectomy for Cushing's Disease. Adrenalectomy for adrenal tumors.

Acute adrenal insufficiency (Addisonian crisis) if steroid replacement is inadequate. Requires immediate IV hydrocortisone.

An antifungal that inhibits cortisol synthesis, used pre-op or if surgery isn't an option.

Protect from infection (private room, hand hygiene, avoid sick visitors). Monitor for subtle signs.

Protect fragile skin from injury. Use paper tape, turn carefully, provide pressure-relieving surfaces.

If cause is exogenous steroids, they must be tapered slowly to avoid adrenal crisis.

Low-sodium, high-potassium, high-protein, high-calcium/Vitamin D diet. Limit simple carbohydrates for glucose control.

Frequent monitoring for hyperglycemia. May require insulin or oral hypoglycemics.

Expect delayed wound healing. Monitor surgical incisions closely for dehiscence or infection.

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Cushing's

Question	Answer
Patho	Chronic excess of cortisol. Cushing's Disease (pituitary tumor) vs. Syndrome (exogenous steroids, adrenal tumor).
Classic Findings	Central obesity, moon face, buffalo hump, supraclavicular fat pads, purple striae, thin skin, easy bruising.
Metabolic Findings	Hyperglycemia (steroid-induced diabetes), hypokalemia, hypernatremia, metabolic alkalosis, osteoporosis.
Immune Effects	Immunosuppression due to cortisol's anti-inflammatory effects. Increased risk of infection, often without fever.
24-hr Cortisol	Gold standard diagnostic test. Elevated levels confirm hypercortisolism.
Dexamethasone Suppression	Low-dose: no suppression = Cushing's. High-dose: suppresses if pituitary origin (Cushing's Disease), not if adrenal/ectopic.
Skin Effects	Hirsutism (excessive hair growth), acne, and facial plethora (redness) due to increased androgens.
Cardiovascular Risk	Hypertension from sodium/water retention. Increased risk for heart failure and stroke.
Musculoskeletal Effect	Proximal muscle weakness and wasting. Osteoporosis leading to pathologic fractures (e.g., vertebral compression).
Psych Symptoms	Emotional lability, irritability, depression, psychosis ("steroid psychosis").
Surgical Treatment	Transsphenoidal hypophysectomy for Cushing's Disease. Adrenalectomy for adrenal tumors.
Post-op Complication	Acute adrenal insufficiency (Addisonian crisis) if steroid replacement is inadequate. Requires immediate IV hydrocortisone.
Ketoconazole	An antifungal that inhibits cortisol synthesis, used pre-op or if surgery isn't an option.
Infection	Protect from infection (private room, hand hygiene, avoid sick visitors). Monitor for subtle signs.
Skin Integrity	Protect fragile skin from injury. Use paper tape, turn carefully, provide pressure-relieving surfaces.
Tapering Steroids	If cause is exogenous steroids, they must be tapered slowly to avoid adrenal crisis.
Dietary Management	Low-sodium, high-potassium, high-protein, high-calcium/Vitamin D diet. Limit simple carbohydrates for glucose control.
Blood Glucose	Frequent monitoring for hyperglycemia. May require insulin or oral hypoglycemics.
Wound Healing	Expect delayed wound healing. Monitor surgical incisions closely for dehiscence or infection.

Created by: Wasurenboh

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