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Adrenal: Cushings Syndrome Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Adrenal ❯ Cushings Syndrome

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  • Cushing Syndrome: Clinical Findings
    • Central obesity fat accumulation in trunk, supraclavicular, and dorsocervical regions (i.e., buffalo hump), and around face (i.e., moon facies); mediastinal lipomatosis
    • Skin thinning and friability
    • Osteoporosis
    • Impaired immune system
    • Proximal muscle weakness
  • Cushing Syndrome due to
 Endogenous Cushing Syndrome
    • Administration of glucocorticoids (iatrogenic CS)
    • Administration of synthetic ACTH
    • Administration of medroxyprogesterone
    • Cushing Syndrome due to
 ACTH-Dependent CS (80% of Endogenous Causes)
    • Pituitary-tumor producing ACTH (Cushing disease) (80%)
    • Ectopic ACTH-producing tumor (20%)
    • Corticotropin-releasing hormone producing tumor (< 1%)
  • Cushing Syndrome due to
 ACTH-Independent CS (20% of Endogenous Causes)
    • Adrenal lesions producing cortisol autonomously
    • Adrenal adenoma (60%)
    • Adrenocortical carcinoma (40%)
    • Primary pigmented nodular adrenal disease (< 1%)
    • ACTH-independent macronodular adrenocortical hyperplasia (< 1%)
  • Cushings Syndrome: CT Findings
    • Adrenal adenoma (60%)
    • Adrenocortical carcinoma (40%)
    • Primary pigmented nodular adrenal disease (< 1%)
    • ACTH-independent macronodular adrenocortical hyperplasia (< 1%)
  • Cushings Syndrome: CT Findings
    Adrenocortical carcinoma—ACCs are rare often-aggressive tumors and account for approximately 40% of adrenal causes of CS. ACCs have an estimated annual incidence of two cases per million people with an estimated 5-year overall survival rate of 15–44%. ACC tends to occur in the fourth or fifth decades of life and only extremely rarely in children
  • Cushings Syndrome: CT Findings
    Adrenal Carcinoma accounts for approximately 40% of adrenal causes of CS and usually appears as a unilateral large (mean size, 9 cm; range, 2–25 cm) heterogeneously enhancing soft-tissue mass, frequently with intratumoral necrosis or hemorrhage, with microscopic or coarse calci cations present in 30% of cases.
  • Adrenal Masses
    -Adenoma
    -Myelolipoma
    -Metastases
    -Pheochromocytoma
    -Adrenal Cortical Carcinoma
    -Lymphoma
  • Cushing’s Syndrome

    Hypercortisolism
    -Increased fat (upper body, neck)
    -Fragile bones and skin
    -Hypertension

    Causes
    -Adrenal adenoma or hyperplasia
    -Pituitary tumor
    -Ectopic ACTH secretion (lung, carcinoid)
  • Conn Syndrome

    Hyperaldosteronism
    -Hypertension
    -Hypokalemia, hypernatremia
    -Metabolic alkalosis
    -Neuromuscular symptoms

    Causes
    -Aldosterone producing adenoma
    -Bilateral adrenal hyperplasia

 

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