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Truncal obesity, muscular weakness, vertebral compressed fractures, hypertension, and hirsutism are all present in a 48-year-old woman. She is taking no medications. Which of the following diseases is most likely to be the cause for these findings:
A Tuberculosis
B Extra-adrenal paraganglioma
C Multiple endocrine neoplasia, type I
D Small cell anaplastic carcinoma
E 21-hydroxylase enzyme deficiency
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poor woman has Cushings, but why ???????????????
IS she taking any steroids ?????????????
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"She is taking no medications."
a??? TB
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MEN type I is 3 P-Pituitary involvmnet, parathyroid and pancreas, so why she should hav eCushings??????
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21 hydroxylase...well the pt should be younger then 48, so not that
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small cell anaplastic carcinoma of the LUNGS ???
Yes could be beacsu ethat can secrete ECTOPIC ACTH that will stumulate cortisol an dwe will hav ewhat called CUSHING SYNDROME, not disease...
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21 hydroxylase patient would not have hypertension , nor elaveted cortisol
maybe small cell carcinoma?
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so with D=ECTOPIC CUSHINGS SYNDROME !!!!!!!!!!
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NOE EXTRADRENAL PARAGANGLIOMA WILL BE ASSOCIETED WITH EPI and NORI , not with cortisol,
My finla answer is DDDDDDDDDDDDDDDDDDD!!!!!!!!!!!!
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A term that refers to the manifestation of hypercortisolism
Causes Cushings:
Common (~ 99%)
Exogenous therapeutic glucocorticoids
Uncommon (~ <1%)
Anterior pituitary adenoma
Ectopic ACTH
Adrenal adenoma
Rare (~ <0.01%)
Adrenal carcinoma
Ectopic CRH
Alcoholic
Bilateral multinodular hyperplasia
Problematic Cushings
Alcoholic
Only a small proportion of alcoholics develop Cushing features: a genetic factor has been implicated. There is a poor correlation between clinical features and biochemical estimates of adrenal activity. The presence of concomitant depression or malnutrition may further complicate interpretation
Evidence for causes in its development include:
Acute ethanol administration activates the hypothalamo-pituitary-adrenal axis
Animal studies show that ethanol can decrease hypothalamic sensitivity to glucocorticoid feedback with a resulting hypersecretion of CRH
Liver effects of ethanol may decrease CBG synthesis and increase free Cortisol
Cyclical Cushing's
Spontaneously remitting and relapsing Cushing's is said to be more commonly seen in ACTH-dependent disease particularly carcinoid tumors secreting ACTH
Diagnosis may be difficult with unexpected or 'inappropriate' results to biochemical tests
Tumors producing ectopic ACTH or CRH
These cause particular problems when:
They are metastatic (e.g. small cell cancers), or
When they are small slow-growing occult carcinoids that cannot be localized
Do you want more on Cushings ???????/
