Cushing’s Disease

FACTS

Cushing’s Disease = Cushings Syndrome 2/2 pituitary adenoma

HISTORY


PMHx: HTN, osteoporosis, amenorrhea

PHYSICAL EXAM

easy bruising
hirsutism
proximal muscle weakness
facial plethora or “moon facies,” purple striae on the body, and a “buffalo hump” on the back of the neck and shoulders.

IMAGING

 
A/P
Diagnostics
24h urine cortisol (Gold standard)
PM serum cortisol
midnight salivary cortisol
Inferior petrosal sinus sampling (IPSS):
  • sample ACTH from petrosal veins (drain pituitary gland)
  • compare ACTH with systemic blood levels to determine pituitary vs. ectopic ACTH production
  • also establishes laterality of ACTH production (R vs L) which is useful if microadenoma not structurally obvious on imaging