Cushing's Disease

- Excess glucocorticoids produced by the adrenal gland (specifically in the endocrine cells of the zona fasciculata of the adrenal cortex)

Causes:

• ACTH secreting tumour
  (Pituitary or paraneoplastic)
• Adrenal tumour (glucocorticoid secreting)

Treatment:

Glucocorticoid therapy of chronic inflammatory conditions (iatrogenic)

Clinical features:

• "Cushingoid":
  -Obesity
  -Moon face
  -Buffalo hump
  -Reduced muscle mass in limbs
  -Stria
  -Increased hair growth

• Other features:
  -Osteoporosis
  -Insulin resistance
  -gluconeogenic effect of cortisol
  -Delayed healing/increased infection
  -Immune suppression
  -Reduced stress response; may require glucocorticoid therapy