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Cushing's Syndrome Characteristics

Cushion
Picmonic
Cushing syndrome occurs due to increased glucocorticoids and is a result of either exogenous or endogenous causes. Exogenous causes include iatrogenic glucocorticoid intake. Endogenous causes include 1° adrenal disease, along with pituitary conditions (Cushing Disease) and paraneoplastic conditions.
8 KEY FACTS
More Common in Women
Women

Women are more affected with Cushing syndrome than men, at a ratio of 4:1. This is often because of Cushing disease, due to pituitary adenoma.

EXOGENOUS CAUSE (TAKEN IN FROM OUTSIDE)
Glucocorticoids
Glue-quarter-on-steroids

Exogenous administration of glucocorticoids can results in iatrogenic Cushing syndrome, which is the most common cause of Cushing syndrome.

ENDOGENOUS CAUSES
Decreased ACTH
Down-arrow Air-Conditioning

Of the endogenous causes of Cushing Syndrome, decreased ACTH occurs due to primary adrenal issues. ACTH is low due to negative feedback from increased corticoids.

Primary Adrenal Disease
1° Foam-finger Diseased Adrenal Gland

This can be either adrenal hyperplasia, adenoma or carcinoma. It is characterized by hypercortisolism, due to secretion from the adrenals, and low ACTH. As these are 1° adrenal disorders, cortisol secretion is always elevated and does not respond to high or low-dose dexomethasone suppression tests.

Increased ACTH
Up-arrow Air-Conditioning

Of the endogenous causes of Cushing Syndrome, increased ACTH levels point to a diagnosis of either an ACTH-secreting pituitary adenoma (Cushing Disease) or paraneoplastic ACTH secretion.

Pituitary Adenoma (Cushing's Disease)
Pit-bull-terrier Add(+)gnome on Diseased Cushion

This is the most common cause of endogenous Cushing syndrome. It is usually due to a ACTH-producing pituitary micro adenoma. This presentation, involving the pituitary, is known as Cushing Disease.

Paraneoplastic: Small Cell Carcinoma
Parachuting-neanderthal-plastic bag with Small Car-gnome.

Small cell carcinoma of the lung, in a paraneoplastic manner, can secrete ACTH. This subsequently yields high cortisol levels, which are not suppressed by low or high dose dexamethasone suppression tests.

CRF-releasing Tumors
Tumor releasing CRying-Fat-kid

This is a rare cause of Cushing syndrome that can result in pituitary hyperplasia and increased ACTH secretion.

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