DR Medhat MRCP

• Management of 1ry hyperaldosteronism :
1) Spironolactone (aldactone) : medical ttt of choice (aldosterone receptors _ _ )
2) Na + restriction.
3) TTT of the cause : e.g adrenalectomy in adrenal adenoma .
Cushing's Syndrome
- Clinical disorder resulting from prolonged exposure to high plasma cortisol level.
Causes :
Primary ↑ (= Cushing syndrome = ACTH independent causes):
1) Iatrogenic: steroids [the most common cause of cushing syndrome]
2) Adrenal adenoma (5-10%).
3) Adrenal carcinoma (rare).
4) Carney complex: (spotty skin pigmentation,atrial myxoma,endocrine
tumors , psammomatous melanotic schwannoma `PMS).
5) Micronodular adrenal dysplasia (very rare)
سؤال مهم : Pseudo-Cushing's 6)
o Mimics Cushing's (obesity/HTN/DM2/cushinoid face).
o Often due to alcohol excess or severe depression.
o Causes false +ve 24 hr urinary free cortisol (just above normal), but
low dose overnight dexamethasine suppression test is unremarkable
o Insulin stress test may be used to differentiate.
Secondary↑ (= ACTH dependent causes):
1) Cushing's disease (80%): pituitary tumour secreting ACTH →
adrenal hyperplasia.
2) Ectopic ACTH production (5-10%): e.g. Small cell lung cancer
- Cushing's disease (pituitary tumor) is the most common, non- iatrogenic, cause of
سؤال syndrome. Cushing's
سؤال - Small cell lung cancer accounts 50-75% of case of ectopic ACTH
سؤال : complex Carney
Autosomal dominant disease d.to inactivating mutation of protein kinase A on
chromosome 17.
NB : 1 feature + affection of 1 st
Diagnosis : 2 of the follwing
1) Spotty skin pigmentation.
degree relative is also
2) Atrial myxoma (murmer , mass in echo)
diagnostic for Carney complex
3) Endocrinal tumour: (1ry pigmented nodular adreno-cortical disease is the
commonest then serotoli cell tumors `↓ libido,impotence`,pituitary,thyr. Ad.)
4) Psammomatous melanotic schwanoma (PMS) : episodes of ms. weakness.