Cushing’s, Addison’s and Acromegaly. Dr Edward Hutchison FY1 (Geriatrics). Phase II Objectives. 3.21: Investigations – Request appropriately the more common tests of thyroid, adrenal and pituitary gland function, seeking advice where necessary. 3.23: Adrenal gland hormones
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Cushing’s, Addison’s and Acromegaly
Dr Edward Hutchison FY1 (Geriatrics)
…disease or syndrome?
Excessive activation of glucocorticoid receptors.
Excessive production of ACTH caused by a pituitary adenoma.
Over to you…
Untreated Cushing’s disease has a 50% 5 year mortality
(Or adrenal insufficiency, to be more correct).
A syndrome resulting from inadequate secretion of corticosteroid hormones from progressive destruction of the adrenal cortex.
– autoimmune (90% of cases)
– neoplasia (metastases)
– degenerative (amyloid)
– drugs (e.g. ketoconazole)
– infective (TB, HIV)
– secondary (ACTH, hypopituitism)
– other (e.g. adrenal bleeding)
Over to you…
250µg synacthen IM
Positive test (ruling out Addisons):
Plasma cortisol >460nmol/L at 30 minutes
Serum cortisol at 0 minutes
Serum cortisol at 30 minutes