DIFFERENT ASPECTS OF CUSHING SYNDROMEFROM DIAGNOSIS TO TREATMENT

DIFFERENT ASPECTS OF CUSHING SYNDROME
FROM DIAGNOSIS TO TREATMENT

Fatemeh Rahmani.MD

Research Institute of Endocrine science

Shahid Beheshti University of Medical Science

    Agenda

   •Case presentation 1

   •Clinical manifestation

   •Classification

   •Diagnostic tests

   •Case presentation 2

   •Case presentation 3

   •Treatment

Case  1

A 34-y old man is referred because of weight gain(13.6 kg) over the past 3 years  without skin changes

 or muscle weakness.

PMH: HTN,epilepsy ,a recent diagnosis of IGT.

DH: lamotrigine,captopril , atorvastatin.

PH/E:central obesity,few pale striae over the abdominal wall but no other skin changes, no proximal

          myopathy,  Bp is 150/90  and BMI is 38 kg/m2

Laboratory test results:

       •Na=138 mEq/L (136-142 mEq/L)                  •TSH =2.4 mIU/L (0.5-5.0mIU/L)

       •K=4.9 mEq/L (3.5-5 mEq/L)                           •FreeT4=1.3 ng/dl (0.8-1.8 ng/dl)

       •Cr=0.9 mg/dl (0.7-1.3mg/dl)               

       •Glucose=175mg/dl

       •overnight dexamethason supression test =14mcg/dl

Which of the following is the most appropriate next investigation?

      A)Perform adrenal CT

       B)Perform pituitary MRI

       C)Perform a 2-day low-dose dexamethasone supression test

       D)Stop lamotrigine and perform another 1-mg  ODST

Clinical features

  ●Obesity

  ●Reproductive organs

  ●Psychiatric Features

  ●Bone

  ●Skin

  ●Muscle

  ●Cardiovascular features

  ●Infections

  ●Metabolic and Endocrine features