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Cushing Syndrome: A Review.

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Cushing syndrome, caused by prolonged high cortisol, affects 2-8 per million annually. Treatment involves surgery, medication, or radiation to manage this endocrine disorder.

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Area of Science:

  • Endocrinology
  • Internal Medicine

Background:

  • Cushing syndrome involves prolonged elevated plasma cortisol not due to physiological reasons.
  • While exogenous steroid use is common, endogenous cortisol overproduction affects 2-8 per million annually.
  • Associated conditions include hyperglycemia, hypertension, weight gain, and mood disorders.

Purpose of the Study:

  • To define Cushing syndrome and its causes.
  • To outline diagnostic approaches for hypercortisolism.
  • To detail management strategies for Cushing syndrome.

Main Methods:

  • Screening involves 24-hour urinary free cortisol, late-night salivary cortisol, or dexamethasone suppression tests.
  • Plasma corticotropin levels differentiate adrenal vs. pituitary causes.
  • Imaging (MRI, petrosal sinus sampling, adrenal/body scans) identifies tumor sources.

Main Results:

  • Cushing disease, a pituitary tumor cause, accounts for 60-70% of endogenous cases.
  • Characteristic signs include skin changes (plethora, striae) and metabolic issues (hyperglycemia, hypertension).
  • Diagnostic evaluation rules out exogenous steroids and localizes cortisol overproduction.

Conclusions:

  • First-line treatment for endogenous Cushing syndrome is surgical tumor removal.
  • Medications, radiation, or bilateral adrenalectomy are options for non-responsive cases.
  • Effective management requires addressing the source of cortisol excess.