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This is the collection of symptoms caused by high cortisol levels.
Too much glucocorticoid. This can be: iatrogenic - long-term steroid therapy; or it can be a disease process:
- pituitary (Cushing's disease) - a tumour in the pituitary gland. Increased ACTH production
- adrenal - tumour or hyperplasia of the adrenal gland
- paraneoplastic - tumours elsewhere in the body, like small cell lung cancer which produce ACTH through an unknown aetiology
The main one is long-term steroid treatment. Make you sure you watch out for these symptoms in patients who have been on steroids for a long time.
See steroid side effects for an amusing picture. They like asking this one in exams. This is a good mnemonic - CUSHINGOID
- Skin: striae, thinning, bruising
- Hypertension/ Hirsutism/ Hyperglycemia
- Necrosis, avascular necrosis of the femoral head
- Osteoporosis, obesity
- 9am cortisol - cortisol fluctuates throughout the day so it has to be taken at 9am
- More accurate are:
- Dexamethasone suppression test
- 24 hour urinary cortisol
Depends very much on the cause. In iatrogenic - stop the steroids. If it's tumour - cut it out depending on where it is.