Cushing’s syndrome is a collection of diseases of chronic glucocorticoid excess. Signs and symptoms include truncal obesity (95%), facial fullness (80%), diabetes (80%), amenorrhea (75%), hypertension (70%), proximal myopathy (65%), skin atrophy and bruising (60%), and osteoporosis (40%).
Patients who do not have a central/peripheral ACTH ratio of greater than 2-3 may have a false-negative result due to the technical vagaries of IPSS. However, a ratio less than 2 usually points to a pulmonary tumor and a thin section spiral CT of the chest with IV contrast is the next step in localization. If this is negative then an enhanced MRI scan, octreotide nuclear scan, and PET scan have all been shown to have important utility. Additionally, octreotide scan, if positive, yields a functional assessment as somatostatin receptors are often present on bronchial carcinoids and may predict a clinical response to octreotide therapy. All patients in whom a pulmonary target can be localized are referred for surgical resection. Secondline therapies include octreotide, ketoconazole, or bilateral adrenalectomy.
KeywordsTranssphenoidal Surgery Adrenal Adenoma Dexamethasone Suppression Test Bilateral Adrenalectomy Skin Atrophy
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