Cushings syndrome,Effects of glucocorticoid,Effects on metabolism Effects on immunologic function and inflammatory Effects on musculoskeletal and connective tissues Effects on fluid and electrolyte homeostasis Neuropsychiatric and behavioral effects Gastrointestinal effects Developmental effects,Clinical features,Obesity (The increased fat distribution is not generalized) Moon-shaped face and plethoric Purple striae Hypertension IGT Osteoporosis Hypokalemic alkalosis,Suspected Cushings synd.,Plasma cortisol Urinary free cortisol Urinary 17-OHCS ,Low dose dexamethasone suppression test 2.0mg/day2days,50% reduce from basal,50% reduce from basal,NORMAL,Cushings Synd.,High dose dexamethasone suppression test 8.0mg/day2days,50% reduce from basal,50% reduce from basal,Probable Cushings Disease,Adrenal Disease Ectopic ACTH Synd.,Suspected Cushings synd.,Plasma ACTH ,Adrenal Disease Ectopic ACTH Synd,Plasma ACTH,Increased,Low,Probable Ectopic ACTH Synd.,Probable Adrenal Disease,Tumor Search,CT /MRI Scan of Adrenals,positive,negative,ECTOPIC ACTH SYNDROME,normal,adrenal mass,Consider Adrenonodular Hyperplasia, Other Disorders,urinary 17-KS Plasma DHEA,17-KS DHEA ,ADRENAL CARCINOMA,DHEA 17-KS ,ADRENAL ADENOMA,Nyctohemeral rhythm,Neural stimuli,CRH,ACTH,Cortisol Cortisol (CBG bound) (free),Physiological and Metabolic effects,Negative feedback,Plasma,Hypothalamus,Anterior pituitary,Adrenal cortex,Inactivation by reduction and conjugation,Liver,Unchanged cortisol (measured as urinary free cortisol),Tetrahydrocortisol Tetrahydrocortisone Cortols,Cortolones (measurd as urinary 17-OHCS),Urine,The hypothalamic-pituitary-adrenal axis,hypothalamus,pituitary,adrenal,Drugs: Cyproheptadine Metergoline Bromocryptine,Adrenalectomy,Surgery: Transsphenoidal microsurgery Radiation: 60Co linear accelerator,Drug: o,pDDD(mitotane) Metyrapone Aninoglutethmide ketokonazole,CRH,ACTH,CS,Surgery Radiation,TREATMENT,