Endocrinology & MetabolicPending review

Cushing's Syndrome

A state of cortisol excess, most often from prescribed steroids, that drives protein catabolism, gluconeogenesis and fat redistribution in patterns predictable directly from cortisol's normal actions taken too far.

First principles

Cushing's syndrome is cortisol excess from any source, and the commonest cause is the drug cupboard

Before considering endogenous causes, the most frequent cause of Cushing's syndrome encountered clinically is exogenous corticosteroid therapy prescribed for another condition. Endogenous causes are split by whether ACTH is driving the adrenal (ACTH-dependent: a pituitary corticotroph adenoma, called Cushing's disease, or an ectopic ACTH-secreting tumour) or the adrenal is secreting autonomously (ACTH-independent: an adrenal adenoma or carcinoma). This distinction, whether ACTH is driving the adrenal or bypassing it, is what the whole diagnostic pathway is built to answer.

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Educational content pending clinical review. Not medical advice.