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