DiagnosingCushingsdisease.-GoodHormoneHealth.ppt

Diagnosing Cushing’s Syndrome: Not as Easy as it Seems Theodore C. Friedman, M.D., Ph.D. Professor of Medicine-Charles Drew University Professor of Medicine-UCLA Magic Foundation Symposium on Cushing’s Syndrome February 22, 2009 Las Vegas, NV States of Glucocorticoid Excess ACTH-dependent States a. Pituitary Adenoma (Cushing’s Disease) 90-95% b. Ectopic ACTH Syndrome ACTH-independent States a. Adrenal adenoma b. Adrenal carcinoma Exogenous Sources Glucocorticoid intake Psychiatric Conditions (Pseudo-Cushing Disorders) a. Depression b. Alcoholism Pregnancy Pseudo-Cushing States High Cortisol Secretion Rate without Convincing Clinical Features of Cushing Syndrome Eucortisolemic Cushing Syndrome Clinical Manifestations of Cushing Syndrome without evidence of increased cortisol levels Exogenous glucocorticoid administration Episodic (periodic) Cushing syndrome-common Recently cured Cushing syndrome Need to Distinguish Early or Mild Cushing’s from Other Diseases Cushing’s is considered rare, but may not be that rare. It is vastly under diagnosed. Other diseases that have some symptoms/signs in common with Cushing’s (PCOS or Metabolic Syndrome) are more common, but present differently from Cushing’s. The treatment is different for these other diseases Thus, a strategy needs to be developed to diagnose Cushing’s syndrome. Is Cushing’s Syndrome Rare Probably under-diagnosed Catargi et al. JCEM 2003, 88:5808-200 consecutive overweight patients with type 2 diabetes, but no other stigmata of hypercortisolism. 4 (2%) patietns were found to have Cushing’s syndrome and another 7 are being evaluated. Kadioglu et al. Endo Society 2004 86: P2-455- 100 consecutive obese patients. Cushing’s syndrome was diagnosed in 11%. Nishikawa et al. Endo Society 2004 86: P3-437- 1020 patients with hypertension. 11 had Cushing’s syndrome and 10 had subclinical Cushing’s syndrome (2%). These studies may have missed mild Cushing’s syndrome and may actually be low. Maybe Cus