AACN AGACNP Review

Cushing's Syndrome/Disease Addison's disease cortisol excess typically caused by pituitary adenoma 60-70% of cases. Central obesity w/ extremity wasting. dorsocervical fat pad. rounded facies. spontaneous bruising. purple striae hyperpigmentation poor wound healing/ skin infections. Dexamethasone suppression test. 1mg dexamethasone at 2300 hours and measure serum cortisol at 0800. Remove sources of excess and manage consequences ( HTN, hypokalemia, hy- perglycemia.) Primary Caused by damage to the adrenal cortex (autoimmune, TB, metastatic disease, deposition diseases, and drug induced) leading to a decrease in cortisol production. Secondary Caused by pituitary failure to release ACTH (in any hypopituitary disorder) causing a decrease in cortisol production. Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol production from induced corticosteroid suppression.