Medical history (history of illness) represents an important component in the diagnosis of Cushing’s disease. Family history Is there a frequent history of metabolic disease in your family? Social anamnesis Current medical history/systemic medical history (somatic and psychological complaints). Have you noticed any changes in your appearance (full moon face (moon face), bull neck or … Cushing’s Disease: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Obesity (obesity). Metabolic syndrome – clinical name for the symptom combination of obesity (overweight), hypertension (high blood pressure), elevated fasting glucose (fasting blood sugar) and fasting insulin serum levels (insulin resistance), and dyslipidemia (elevated VLDL triglycerides, decreased HDL cholesterol). Furthermore, a coagulation disorder (increased tendency to clotting), with an … Cushing’s Disease: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by Cushing’s disease: Eyes and eye appendages (H00-H59). Glaucoma (glaucoma) Cataract (cataract; clouding of the lens) Blood, blood-forming organs – immune system (D50-D90). Erythrocytosis – too many red blood cells (erythrocytes) in the blood. Leukocytosis – too many white blood cells … Cushing’s Disease: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination-including blood pressure, pulse, body weight, height [increased body weight; centrally emphasized obesity]; further: Inspection (viewing). Body proportions, face and skin [full moon face (moon face), bull neck or buffalo neck, truncal obesity; fingernails: thin and brittle, furunculosis – occurrence of … Cushing’s Disease: Examination
1st order laboratory parameters – obligatory laboratory tests. Hormone diagnostics Stage 1 Cortisol diurnal profile: 2-time determination of free cortisol in saliva between 11 pm and midnight or 2-time determination of free cortisol in 24 h collection urine [hypercortisolism: cortisol ↑; abolished diurnal rhythm of cortisol diurnal profile]. Dexamethasone short test/dexamethasone inhibition test (1 mg … Cushing’s Disease: Test and Diagnosis
Therapeutic target Normalization of serum cortisone levels. Therapy recommendations Primary surgical therapy (for indications, see “Surgical therapy” below); in rare cases, radiation therapy of the pituitary gland (e.g., for recurrence/recurrence of Cushing’s disease, in primarily inoperable patients); after surgery, substitution therapy (replacement therapy) with a cortisone drug. In NNR carcinoma treatment with: Cytostatics, adrenostatics In … Cushing’s Disease: Drug Therapy
To prevent Cushing’s disease, attention must be paid to reducing individual risk factors. Behavioral risk factors Chronic alcohol abuse/abuse → hypercortisolism → alcohol-induced pseudo-Cushing’s syndrome.
If surgery is not possible for a hypothalamic-pituitary adenoma, proton irradiation of the pituitary gland (hypophysis) can be performed.
The following symptoms and complaints may indicate Cushing’s disease (hypercortisolism): Leading symptoms Full moon face (moon face; facies lunata), bull neck or buffalo neck (buffalo neck), truncal obesity. Adynamia, easy exhaustibility, fatigue. Associated symptoms Arterial hypertension (high blood pressure) Atrophy of the genitals Depression Increased body weight Erythrocytosis – too many red blood cells (erythrocytes) … Cushing’s Disease: Symptoms, Complaints, Signs
Pathogenesis (disease development) Cushing’s disease is caused by hypercortisolism (overproduction of cortisol). This may be due to: Endogenous Cushing’s syndrome – this in turn can be subdivided into: ACTH-dependent Central Cushing’s syndrome (Cushing’s disease) – usually microadenoma of the anterior pituitary [about 65-70% of cases]. Ectopic ACTH secretion* (adrenocorticotropic hormone) – paraneoplastic; secretion of ACTH … Cushing’s Disease: Causes
General measures Alcohol restriction (abstaining from alcohol). Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for the underweight. BMI ≥ 25 → participation in a medically supervised weight … Cushing’s Disease: Therapy
Note: Diagnostic imaging before laboratory evidence of the disease is not indicated! Mandatory medical device diagnostics. Magnetic resonance imaging of the skull (cranial MRI or cMRI): thin-slice images of the sella turcica in coronal and sagittal slice direction in T2 and T1 weighting with and without contrast medium – if changes in the pituitary gland … Cushing’s Disease: Diagnostic Tests
