Adrenal Disorders

Cushing’s Syndrome (Hypercortisolism) (NEJM 2017;376:1451)

Cushing’s syndrome = cortisol excess
Cushing’s disease = Cushing’s syndrome 2° to pituitary ACTH hypersecretion

Etiologies of hypercortisolism

  • Most commonly iatrogenic caused by exogenous glucocorticoids (though underreported)
  • Cushing’s disease (60–70%): ACTH-secreting pituitary adenoma (usually microadenoma) or hyperplasia
  • Adrenal tumor (15–25%): adenoma or (rarely) carcinoma
  • Ectopic ACTH (5–10%): SCLC, carcinoid, islet cell tumors, medullary thyroid cancer, pheo

Clinical manifestations (Lancet 2006;367:13)

  • Nonspecific: glucose intolerance or DM, HTN, obesity, oligo- or amenorrhea, osteoporosis
  • More specific: central obesity w/ extremity wasting, dorsocervical fat pads, spont. bruising
  • Most specific: