Zusammenfassung der Ressource
Cushing's syndrome
- glucocorticoid excess
- usually a S/E of long-term glucocorticoid Rx
- for nephrotic syn
- for asthma
- in past, severe bronchopulmonary dysplasia
- -> reduced height & osteopenia
- cos corticosteroids are potent growth suppressors
- reduce risk of this S/E of
systemic corticosteroid by
taking them in morning on
alternate days
- rare causes
- ACTH-driven
- pituitary adenoma
- usually in older kids
- ectopic ACTH-making tumours
- almost never occur in kids
- ACTH-independent
- adrenocortical tumours
(benign or malignant)
- virilisation can occur w/ these
- occur in young kids
- must differentiate this from
obesity from dietary excess
- obesity from dietary
excess often height>
average
- obesity from Cushing's syn
- short children w/ growth failure
- Diag
- possible loss of
normal diurnal
variation of cortisol
(high in am, low at
midnight= normal)
- in Cushing's syn
midnight [cortisol]
conc also high
- failure to suppress
plasma 0900h cortisol
levels after
dexamtethasone admin
- high 24h urine free cortisol
- adrenal tumours
- CT or MRI
of abdo
- usually unilateral
- pituitary adenoma
- MRI brain scan
- Mx
- adrenal tumours
- usually unilat
- adrenalectomy
- radiotherapy
if indicated
- pituitary adenomas
- trans-sphenoidal resection is best
- radiotherapy
- clinical features
- growth failure/short stature
- face & trunk obesity
- red cheeks
- hirsutism
- striae
- hypertension
- bruising
- carbohydrate intolerance
- muscle
wasting &
weakness
- osteopenia
- psychological
probs