Adrenals Cushings clinical 1

2.2 CUSHING’S SYNDROME

Fig 32.3

      This syndrome is caused by excess endogenous or exogenous corticosteroids (glucocorticoids mainly). Nearly 80% of the endogenous variety is due to excess ACTH from the pituitary, leading to hyperplasia of the adrenal cortex. The rest of the lesions causing this syndrome are adenomas and carcinomas of the adrenal cortex. In some instances, there is a mixed picture of hyperadrenocorticism with some element of virilism.

      The typical patient show truncal obesity hypertrichosis (excess hair) and hypertension. The disease is commoner in females and affects all ages. The onset is gradual with lasitude and fatigability.

      The commonly observed clinical features seen in large number of cases are given in Table 32.1.

Table 32.1

Cushing’s Syndrome-Clinical Features In 711 Patients

_________________________________________________________________

      Central obesity               90%

      Hypertension                  87%

      Menstrual irregularity        80%

      Plethora                      80%

      Hirsuitism(in female)         79%

      Striae                        68%

      Weakness                      65%

      Osteoporosis                  64%

      Abnormal GTT                  55%

      Mental changes                42%

      Renal stones                  19%

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