A Physiologic Approach to Diagnosis of the Cushing Syndrome

Reviews17 June 2003A Physiologic Approach to Diagnosis of the Cushing SyndromeHershel Raff, PhD and James W. Findling, MDHershel Raff, PhDFrom St. Luke's Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin. and James W. Findling, MDFrom St. Luke's Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-12-200306170-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Principles*GeneralObesityHypertensionMetabolicDiabetes mellitus or impaired glucose toleranceHyperlipidemiaNephrolithiasisPolyuriaSkinPlethoraHirsutismStriaeAcneBruisingMusculoskeletalOsteopenia or osteoporosisProximal myopathyNeuropsychiatricDepressionCognitive impairmentEmotional labilityEuphoriaPsychosisGonadal dysfunctionOligomenorrhea or amenorrheaImpotence, decreased libidoImmune suppression (susceptible to opportunistic infection)*Notice that many of the features of the Cushing syndrome resemble those of the metabolic syndrome (e.g., obesity, hypertension, impaired glucose tolerance, hyperlipidemia, hirsutism, acne, and gonadal dysfunction).Pathophysiologic PrinciplesThe hypothalamicpituitaryadrenal axisControl of adrenal function and growthHypothalamic control of pituitary functionGlucocortcoid-negative feedbackCircadian rhythmThe stress responsePosttranslational processing of proopiomelanocortin to adrenocorticotropic hormoneCortisol plasma binding, metabolism, and excretionGlucocorticoid action11-hydroxysteroid dehydrogenase type 1 and 11-hydroxysteroid dehydrogenase type 2The relationship among obesity, impaired glucose tolerance or diabetes, hypertension, and gonadal dysfunction was initially ...References1. 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Findling, MDAffiliations: From St. Luke's Medical Center, Medical College of Wisconsin, Milwaukee, Wisconsin.Disclosures: None disclosed.Corresponding Author: Hershel Raff, PhD, Endocrinology and Diabetes, St. Luke's Medical Center, 2801 W KK River Parkway, Suite 245, Milwaukee, WI 53215; e-mail, [email protected]edu.Current Author Addresses: Drs. Raff and Findling: Endocrinology, St. Luke's Medical Center, Medical College of Wisconsin, 2801 W KK River Parkway, Suite 245, Milwaukee WI 53215. 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