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Cushing's Disease

Incidental findings Rheumatoid arthritis, scratch marks (PBC)
Signs Bruising, central obesity, moon-like facies, abdominal striae, proximal myopathy.
Differential diagnosis Cushings syndrome/disease
Tests U&E, glucose
24h urinary free cortisol
Low dose dexamethasome supression - failure of supression
High dose dexamethasome supression - supresses with pituitary tumour but not adrenal/ectopic tumours
Plasma ACTH +/- MR pit fossa +/- Inferior petrosal sinus sampling

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Causes


Exogenous steroids
Pituitary adenoma - Cushing's disease
Adrenal adenoma
Adrenal carcinoma
Ectopic ACTH (e.g. small cell cancer of lung)
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