Excess amount of ACTH released lead to Cushing Syndrome
Cushing Syndrome
What is it?
A pituitary gland tumor (pituitary adenoma). A noncancerous (benign) tumor
of the pituitary gland, located at the base of the brain, secretes an excess
amount of ACTH, which in turn stimulates the adrenal glands to make more
cortisol. When this form of the syndrome develops, it's called Cushing disease.
Pathophysiology
Signs and symptoms
Women with Cushing syndrome
Hirsutism
Dysmenorrhea or Amenorrhea
Men with Cushing syndrome
Decreased libido
Decreased fertility
Erectile dysfunction
General S & S
Severe fatigue
Muscle weakness
Depression, anxiety and irritability
Loss of emotional control
Cognitive difficulties
New or worsened high blood pressure
Headache
Bone loss, leading to fractures over time
In children, impaired growth
Risk factors
Female
25-40 years old
Exogenous (Cushing’s syndrome):
Organ Transplant
Chemotherapy (Long term use of steroids).
Autoimmune diseases.
Asthma.
Allergies.
Chronic inflammatory diseases.
Obesity.
Hypertension.
Type II diabetes.
Diagnosis
Epidemiology
An estimated 10-15 per million people are affected every year.
Pituitary adenomas (Cushing’s disease) account for more
than 70 percent of cases in adults and about 60-70
percent of cases in children and adolescents.
Cushing’s syndrome most commonly affects adults ages 20-50
and is more prevalent in females, accounting for about 70
percent of all cases.
Management
Pharmacology
Medications to control excessive production of cortisol at the adrenal gland include ketoconazole
(Nizoral), mitotane (Lysodren) and metyrapone (Metopirone).
Mechanism of action
Clnical use
Replacement therapy
Immunosuppressive Therapy
Raised intracranial pressure
skin diseases
Cancer
Acceleration of fetal lung maturation
Contradications
Cushing’s syndrome
Dibetes mellitus
Heart failure
Renal failure
Adverse Effects
Surgery and its side effects
Procedure
To do this surgery, the neurosurgeon makes a small incision (cut) along the nasal septum.
Lateralization of the Middle turbinate, sphenoid ostium, Enlarging of the sphenoid ostium, sphenoid
sinus, partial Posterior vomer removal, The thinned anterior sella wall, Removal of the sphenoid
septum, Openning of the anterior sella wall, Incision of the dura, Cutting the soft tumor, Aspiration of
the tumor, Medial wall of the cavernous sinus, removal of what is left of tumor, repair.
Complications
Sinus headache and congestion for up to a week or 2 after surgery.
Brain damage, a stroke, or blindness if a nerve or artery is damaged
Meningitis, infections, leakage of cerebrospinal fluid from the nose