Patho Final Notes

Hypospadia and Epispadias

• Definition:
  • Congenital abnormalities of the penis found in newborns.
• Hypospadias:
  • Meatus develops on the ventral (underneath) part of the penis.
• Epispadias:
  • Rare defect where the meatus develops on the dorsal (upper) part of the penis.
• Diagnosis:
  • Physical examination.
• Clinical Manifestations:
  • Abnormal position of the urethral meatus (top or bottom).
• Treatment:
  • Surgical repair.

Hydrocele, Varicocele, and Spermatocele

• Varicocele:
  • Enlargement of the veins in the scrotum.
  • May cause fertility issues.
• Hydrocele:
  • Fluid-filled sac surrounding the testes.
  • Common in newborns.
  • May result from trauma or inflammation in older boys or men.
  • Possible causes: infection, tumor, or inguinal hernia.
• Spermatocele:
  • Epididymis cyst.
  • Usually painless and noncancerous.
  • Located on the epididymis.
• Clinical Manifestations:
  • Varicocele: Enlarged veins in the scrotum.
  • Hydrocele: Fluid-filled sac surrounding the testes.
  • Spermatocele: Visible cyst on the epididymis.
• Diagnosis:
  • Physical exam
• Treatment:
  • None typically needed.

Benign Prostatic Hyperplasia (BPH)

• Definition: Nonmalignant enlargement of the prostate gland.
• Etiology and Pathogenesis:
  • ↑estrogen with aging or higher estrogen than testosterone leads to BPH.
  • ↑sensitivity to dihydrotestosterone (DHT), which mediates prostatic growth.
• Pathophysiology:
  • Enlarged prostate compresses the urethra.
  • Causes incomplete emptying of the bladder.
• Clinical Manifestations:
  • Difficulty starting the flow of urine, even with straining.
  • Hematuria.
  • Weak urine flow.
  • Multiple interruptions of urine flow.
  • Feeling of bladder fullness.
  • Nocturia.
  • Dribbling once urination is complete.
• Diagnosis:
  • Digital Rectal Exam (DRE).
  • PSA level.
• Treatment:
  • Watchful waiting.
  • Avoidance of excess fluids in the evening.
  • 5-alpha-reductase inhibitors.
  • Alpha blockers.
  • Intermittent catheterization as needed.
  • Transurethral resection of the prostate (TURP).

Prostate Cancer

• Etiology and Pathogenesis:
  • Second most common cancer in men.
  • The peripheral zone is most susceptible.
  • Tumors tend to develop on the periphery of the gland and are not obstructive.
  • Tumors go unnoticed until pain occurs.
  • Metastasis to lymph nodes and lungs, then other organs.
  • Usually curable when localized and responds well to treatment even when widespread.
• Clinical Manifestations:
  • Local prostate cancer may be asymptomatic.
  • Frequent urination.
  • Weak urine flow.
  • Urinary frequency, especially at night.
  • Blood in the semen.
  • Erectile dysfunction.
  • Dysuria (painful urination).
  • Discomfort while sitting.
• Diagnosis:
  • Gleason Scoring System:
    • Grade 1 (well differentiated) to Grade 5 (poorly differentiated with poor prognosis).
    • Tissue samples taken from two different sites and are graded separately.
• Treatment:
  • Surgery:
    • Radical Prostatectomy: Surgical removal of the prostate and seminal vesicles; pelvic lymph nodes may be removed if necessary.
  • Radiation:
    • Non-surgical option for clients wanting to avoid surgery.
  • Other treatments:
    • Cryotherapy (liquid nitrogen used to freeze the prostate).
    • Ablative hormone therapy (testosterone suppression for bone metastases).
    • Chemotherapy.

Prostatitis

• Etiology and Pathogenesis:
  • Acute bacterial: Least common; caused by gram-negative bacteria.
  • Chronic bacterial: Often with recurrent UTIs.
  • Chronic/Chronic pelvic pain syndrome: Most common; inflammatory or noninflammatory; may be autoimmune response.
  • Asymptomatic inflammatory: Inflammation without genitourinary symptoms.
• Clinical Manifestations:
  • Fever, chills, arthralgia, low back pain, pelvic pain, perineal fullness, dysuria, urinary frequency and urgency (usually at night), painful ejaculation, foul-smelling urine, hematuria, or semen-tinged urine.
• Diagnosis:
  • Digital rectal examination (DRE).
  • Urinalysis, urine culture, semen analysis.
  • CT.
  • Needle biopsy.
• Treatment:
  • Antibiotics.
  • Anticholinergics.
  • Alpha blockers.
  • Stool softeners.
  • Analgesics.
  • Muscle relaxants.
  • Antipyretics.

Testicular Torsion

• Etiology and Pathogenesis:
  • Spermatic cord twists within the testicle, cutting off blood supply to the ipsilateral testis.
  • Medical emergency.
  • Intravaginal: The tunica vaginalis is genetically set too high, allowing the spermatic cord to rotate.
  • Extravaginal: The tunica vaginalis is not yet firmly secured; the tunica vaginalis and spermatic cord twist as a unit; most often occurs in newborns.
• Clinical Manifestations:
  • Severe unilateral scrotal pain followed by swelling.
  • 1/3 of clients experience nausea and vomiting.
  • In newborns, presents as a firm, hard, scrotal mass that is fixed to the scrotal skin.
• Diagnosis:
  • History and physical exam.
  • TWIST scoring: testis swelling, hard testis, absent cremasteric reflex, nausea and vomiting, high-riding testes.
• Treatment:
  • Surgical repair must happen within 6 hours of the onset of symptoms in order to salvage the testicle.

Peyronie's Disease

• Description:
  • Caused by a fibrous plaque that affects the tunica albuginea, causing the penis to curve or bend.
• Etiology:
  • Unknown, but may involve prior injury to the penis or an autoimmune disease.
• Clinical Manifestations:
  • Painful, bent, or curved penis.
  • Painful erections.
• Diagnosis:
  • Physical examination.
• Treatment:
  • May resolve on its own.
  • Oral or injected medications.
  • Ultrasound to break up plaque.
  • Surgery is a last resort.

Testicular Cancer

• Etiology:
  • Exact cause unknown.
  • Believed that primordial cells do not develop properly.
• Risk Factors:
  • History of mumps infection, low birth weight, trauma to the testes, a family history of testicular cancer, cryptochordism (missing one or both of the testes), age, congenital abnormalities, white ethnicity.
• Clinical Manifestations:
  • Dull ache in the groin.
  • Painless lump that may have swelling, enlargement, or hardening of the testes.
  • Gynecomastia.
  • With metastasis, men may have shortness of breath, masses of the neck, or back pain.
• Diagnosis:
  • Palpation of the testes, abdomen, and lymph nodes.
  • Testicular ultrasound.
  • CT.
  • Staging (I-IV).
• Treatment:
  • Radical orchiectomy (removal of the testicle).
  • Chemotherapy.
  • Radiation.

Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD)

• Acute kidney injury (AKI):
  • Rapid decrease in kidney function.
• Chronic kidney disease (CKD):
  • Loss of kidney function over time.
• End-stage renal disease (ESRD):
  • Occurs if CKD is not treated, results from a failure of the body to remove waste products.
• Assessment:
  • Look for creatinine, albumin (protein), and GFR.

Polycystic Ovary Syndrome (PCOS)

• Etiology and Pathogenesis:
  • Results from an abnormal function of the hypothalamic-pituitary-ovarian axis.
  • Elevated hormones or androgens cause symptoms.
• Clinical Manifestations:
  • Menstrual dysfunction.
  • Anovulation.
  • Hyperandrogenism (hirsutism and acne).
  • Additional symptoms: infertility, irregular menses, obesity, metabolic syndrome, diabetes, obstructive sleep apnea (OSA).
• Diagnosis:
  • Physical exam (excess facial hair, acne).
  • Exclusion of other disorders.
• Treatment:
  • OCPs for hyperandrogenism, hirsutism, and acne.
  • Clomiphene for infertility.

Menopause, Menarche & Breast Cancer Risk Factors

• Breast cancer risk factors:
  • Age
  • Gender
  • Family history in a 1st-degree relative under the age of 50.
  • BRCA1 or BRCA2 gene mutation.
  • Menarche before age 12.
  • Menopause after age 55.
  • Previous breast issues such as BBD or breast cancer/cystic breasts.

Prolactinemia and Galactorrhea

• Normal during pregnancy.
• Normal 6 months after pregnancy.
• Normal in a newborn; usually goes away.

Breast Cancer

• Etiology and Pathogenesis:
  • Proliferation of breast cells that do not die at a normal rate.
  • Cancer occurs in normal cells with damaged DNA that do not die.
  • Classification is based on the presence or absence of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 (HER2).
  • Most common malignancy in women in the United States.
  • Associated with ovarian hormonal function, high-fat diet, family history, and a possible link to hormone replacement therapy (HRT).
• Clinical Manifestations:
  • May be asymptomatic in early disease.
  • Changes in size or shape of breast, skin changes (dimpling, inverted nipple, thickening of skin, red and scaly rash).
  • Blood-tinged nipple discharge, red and scaly nipples, ulceration of breast tissue.
  • Mass felt in breast or axillary tissue that is hard, fixed, and nonmobile.
• Diagnosis:
  • Mammogram, ultrasound, biopsies, hormone receptor assay.
  • Staging using TNM: 0-IV.
• Treatment:
  • Based on staging.
  • Surgery (lumpectomy or mastectomy).
  • Radiation.
  • Chemotherapy.

Dysmenorrhea

• Etiology and Pathogenesis:
  • Primary: Painful menstrual cycle in the absence of pelvic disease.
  • Secondary: Result of underlying disease, such as endometriosis or PID.
  • Pain from primary is caused by increased prostaglandin levels.
• Clinical Manifestations:
  • Primary: Usually occurs within 6 months of menarche.
    • High-intensity cramping with menstruation.
    • Low back pain with radiation to the upper back or thighs.
  • Secondary:
    • Usually in the 20s or 30s.
    • Heavy, irregular flow; painful intercourse; vaginal discharge; poor response to medication.
• Diagnosis:
  • History and physical.
    • Primary: No labs.
    • Secondary: Labs to rule out infection or pregnancy.
• Treatment:
  • Pain management with NSAIDs, oral contraceptive pills (OCPs), and lifestyle management.

Premenstrual Syndrome (PMS)

• Etiology and Pathogenesis:
  • Definitive cause unknown; possible serotonin deficiency OR prostaglandin.
  • Deficiencies of magnesium or calcium.
  • Other theories: alterations in endorphins and rapid hormonal shifts.
• Clinical Manifestations:
  • Emotional symptoms: mood swings, irritability, anxiety, social withdrawal, poor concentration, insomnia, changes in sexual desire, depression.
  • Physical symptoms: increased thirst, food cravings, breast tenderness, bloating, weight gain, headache, fatigue, swelling of hands and feet, skin or GI problems, abdominal pain.
• Management:
  • Confirmation of symptoms.
  • Diet: adding complex carbohydrates and calcium-rich foods; avoiding sugar, caffeine, alcohol.
  • SSRIs may improve mood.
  • NSAIDs for pain.

Cervical Cancer

• Etiology and Pathogenesis:
  • Third most common cancer in women worldwide.
  • In almost all cases, HPV is the cause.
• Risk Factors:
  • Sexual contact at a young age, multiple sex partners, history of STIs.
• Clinical Manifestations:
  • Abnormal vaginal bleeding, malodorous discharge, dysuria, general abdominal pain.
• Diagnosis:
  • Pap smear.
• Treatment:
  • Biopsy, chemotherapy, or radiation.

The Menstrual Cycle

• Ovarian Cycle:
  • Follicular Phase: Days 1-14, involves the growth of follicles.
  • Ovulation: Occurs around Day 14.
  • Luteal Phase: Days 14-28, involves the corpus luteum.
• Hormones:
  • Anterior Pituitary Hormones: Luteinizing hormone (LH) and Follicle-Stimulating Hormone (FSH).
  • Ovarian Hormones: Estradiol and Progesterone.
• Uterine Cycle:
  • Menses: Occurs around Days 1-7 (average 5 days), involves blood and endometrial lining being shed.
  • The sperm survival rate is around 3-4 days.

Ovarian Cysts

• Follicular cysts:
  • Form during the follicular phase; form when the ovum fails to be released.
• Corpus luteal cysts:
  • Form in the absence of pregnancy; the corpus luteum fails to dissolve after 14 days.
• Lutein cysts:
  • Form from excessive amounts of HCG and result from multiple gestations or ovarian hyperstimulation.
• Clinical Manifestations:
  • Pelvic or abdominal pain.
  • Painful intercourse.
  • Abnormal menstruation.
  • Sensation of abdominal pressure.
  • Polyuria or urgency of urination.
  • Abdominal distention.
  • Reduction of appetite or feeling full without eating.
• Diagnosis:
  • Physical exam, ultrasound, and labs.
  • CA-125 lab to rule out malignancy.
• Treatment:
  • OCPs or laparoscopy for larger cysts.

Human Papillomavirus (HPV)

• Etiology and Pathogenesis:
  • Most prevalent of all STIs, with nearly 80 million active infections in the U.S.
  • Virus usually goes undetected because most who are infected are asymptomatic.
• Pathogenesis/Virology:
  • HPV infects the basal cell layer of stratified squamous epithelium and stimulates cellular proliferation.
  • Infected cells display a wide range of changes, ranging from benign hyperplasia to invasive carcinoma.
  • Lesions that are not cleared by the immune system often persist for several decades before being detected.
• High-risk types versus low-risk types:
  • High-risk types: HPV-16, HPV-18, HPV-31, HPV-33, HPV-45; associated with the development of anogenital cancers.
  • Low-risk types: HPV-6 and HPV-11; induce only benign genital warts.
• Clinical Manifestations:
  • Genital warts; only 1% of sexually active Americans have this manifestation.
  • Most are asymptomatic.
• Diagnosis:
  • Pap smear.
  • Polymerase chain reaction testing.
• STI versus STD:
  • STI: Infections resulting from sexual contact; may be from bacteria, viruses, fungi, or parasites; most are readily cured.
  • STD: STIs that cannot be readily cured - HPV.
• Treatment:
  • 0. 5% podophyllotoxin solution or gel applied topically to the lesions twice a day for 3 consecutive days, followed by 4 days without treatment.
  • Imiquimod 5% cream.
  • Cryotherapy and liquid nitrogen.
• Prevention:
  • HPV 3-dose vaccine starting at age 10-12 years.

Herpes Simplex Virus (HSV)

• Description:
  • Two forms: HSV-1 and HSV-2.
  • Both are associated with genital infection, but HSV-1 is a more common cause of cold sores around the mouth, and HSV-2 for genital warts.
  • Both types may exist with the infected individual being asymptomatic.
• Pathogenesis/Virology:
  • HSV enters the nerve cells and resides in the basal ganglia, protecting the virus from being cleared by the immune system.
  • Usually latent in the nerve cell and is reactivated by physical or psychologic stress.
  • Estimated that one in every six individuals age 14-49 has been exposed to HSV.
• Clinical Manifestations:
  • Orofacial: red papules that develop into vesicles in a short period of time; pain or burning sensation usually occurs before papule appearance.
  • Genital: Small vesicles accompanied by pain; fever, malaise, and headache usually occur before vesicle appearance.
• Diagnosis:
  • Primary infections are generally asymptomatic.
• Treatment:
  • Antiviral therapy.

Chlamydia

• Etiology:
  • Caused by bacterium Chlamydia trachomatis.
  • High rate of maternal transmission at birth, causing neonatal pneumonia or conjunctivitis.
  • Most common bacterial STI in the U.S. and usually found in combination with gonorrhea.
• Pathogenesis:
  • Infects mainly the genital tract, with affinity for columnar epithelial cells.
  • Initial exposure causes inflammatory response, tissue damage, and production of antibodies.
  • Although the body produces antibodies, it does not protect from reinfection.
  • Bacterium depends on the host for nutrients, but produces its own DNA and RNA.
  • Damage to tissue causes scarring of the reproductive system in both males and females.
• Clinical Manifestations:
  • Most are asymptomatic.
  • Males: dysuria and urethral drainage that is yellow in color.
  • Females: vaginal discharge, abnormal vaginal bleeding, dysuria (pain with intercourse).
• Diagnosis:
  • Urine sample culture.
  • Vaginal swabs.
• Treatment:
  • Single dose azithromycin or doxycycline for 1 week.
  • All partners treated.

Gonorrhea

• Etiology:
  • Caused by bacterium Neisseria gonorrhoeae, a gram-negative bacterium.
  • Pyogenic bacterium: associated with the development and expression of pus.
  • Approximately 900,000 new cases in the U.S. every year and is usually a coinfection with chlamydia.
• Pathogenesis:
  • Surface pili (small extensions on the surface of the membrane) prevents phagocytosis.
  • Protease located on pili facilitates attachment of bacterium to the wall of the urethra or vagina.
  • Can also attach to sperm, allowing for effective transmission.
• Clinical Manifestations:
  • Most are asymptomatic.
  • Males: dysuria and purulent penile discharge.
  • Females: dysuria, purulent vaginal discharge, pain with intercourse.
• Diagnosis:
  • Urine sample culture.
• Treatment:
  • Two antibiotics: an IM injection of ceftriaxone and an oral dose of azithromycin.
  • All partners treated.

Syphilis

• Etiology:
  • Caused by three main spirochetes, in particular, Treponema pallidum, a double-membrane anaerobic bacterium with helical cells.
  • Approximately 63,000 new cases in the U.S. each year.
  • Men who have sex with other men account for 80% of all new cases.
• Pathogenesis:
  • After infection, spirochetes rapidly disseminate systemically, traveling through the blood and lymphatic systems.
  • There is an incubation period of about 3 weeks and can range from 10-90 days.
  • During incubation, spirochetes penetrate the CNS leading to an inflammatory response.
  • Without treatment, it will progress through primary, secondary, latent, and tertiary stages, and will result in death without treatment.
• Clinical Manifestations:
  • Primary: Development of a lesion, or chancre.
  • Secondary:
    • Alopecia
    • Fever
    • Arthralgia
    • Lymphadenopathy
    • Rash: mostly on the soles of the feet or palms of the hand.
  • Latent: Asymptomatic period.
  • Tertiary:
    • Accumulation of damage of arterial lining and nervous system.
    • Aortic aneurysm, meningitis, confusion, visual disturbance, hearing loss.
• Diagnosis:
  • History and physical.
  • Serologic testing.
• Treatment:
  • IM penicillin.
  • Alternative: cephalosporin and erythromycin.
  • All partners treated.

Trichomoniasis

• Etiology and Pathogenesis:
  • Transmitted by protozoan Trichomonas vaginalis.
  • 8 million new cases yearly in the U.S.
  • May infect host by itself but usually coincides with other STIs.
  • Increased risk for developing HIV.
• Clinical Manifestations:
  • Mostly asymptomatic.
  • Vulvar itching, burning, soreness, redness.
  • White, gray-green, or yellow discharge.
  • Musty or fishy-smelling discharge.
  • "Strawberry cervix": cervical petechiae and friable cervix.
  • Dysuria and dyspareunia.
  • Males: purulent discharge, dysuria, testicular pain, lower abdominal pain.
• Diagnosis:
  • Wet mount microscopy.
  • pH testing of vaginal or seminal fluid.
• Treatment:
  • Oral metronidazole.
  • All partners treated.

Pubic Lice (Pediculosis Pubis)

• Etiology:
  • Transmitted by Pthirus pubis.
  • Also known as crabs or pubic lice.
  • Ectoparasite (living outside the body).
  • The female louse lays up to three to six eggs daily.
  • Louse use large claws to grasp onto hair of the groin, perianal and/or axillary areas of the body.
  • Nits (eggs) attach to hair shafts or clothing fibers, making treatment difficult.
• Clinical Manifestations:
  • Pruritus.
  • Excoriation from itching.
  • Maculae ceruleae: bluish-gray macule on skin caused by louse bite.
• Diagnosis:
  • Microscopy of louse.
• Treatment:
  • OTC permethrin (usually 1%) lotion.
  • A second treatment should be done 9 days after the first to kill new nits.
  • All clothing and linens washed in hot water.
  • All items not able to be washed need to be disposed of or placed in the freezer for at least 2 weeks.

Hyperthyroidism

• Definition: Also called thyrotoxicosis; synthesis and release of excessive thyroid hormone.
• Etiology and pathogenesis:
  • Graves disease
  • Multinodular goiters
  • Toxic adenomas
  • Iodine-induced hyperthyroidism
  • Thyrotoxicosis factitia
• Clinical signs:
  • Tachycardia
  • Atrial fibrillation
  • Fine tremors
  • Proximal muscle weakness
  • Goiter
  • Warm moist skin
  • Hyperreflexia
  • Lid lag or retraction
  • Stare
  • Hair loss
• Clinical symptoms:
  • Anxiety
  • Heat intolerance
  • Dyspnea on exertion
  • Palpitations
  • Palmar erythema
  • Weakness and fatigue
  • Weight loss with increased appetite
  • Diarrhea
• Diagnosis
  • Suppressed serum TSH with elevated serum FT4
  • Thyroid peroxidase antibodies
  • RAIU test
  • Radionuclide scan

Secondary Hyperthyroidism

• Causes
  • TSH-secreting pituitary adenoma
• Clinical manifestations
  • Symptoms of hyperthyroidism
  • Tumor mass causes symptoms related to obstruction
• Diagnosis
  • Hyperthyroidism with diffuse goiter and without signs and symptoms of Graves disease
  • High or normal serum free T4 and T3
  • Elevated serum TSH

Hypothyroidism

• Definition:
  • Inadequate production of thyroid hormones.
• Effects:
  • Destruction or injury to thyroid.
  • Inhibition of thyroid hormone synthesis.
  • Hypothalamic or pituitary disorders.
  • Resistance to thyroid hormone.
• Etiology and pathogenesis:
  • Hashimoto thyroiditis
    • Diminished production of T3 and T4
• Clinical manifestations:
  • Weakness, fatigue, lethargy, somnolence, mental slowness.
  • Muscle soreness cold intolerance, mood changes.
  • Goiter dry cold skin, hair loss.
  • Weight gain, constipation.
  • Delay in the relaxation phase of deep tendon reflexes.
  • Sinus bradycardia.
• Diagnosis:
  • Serum FT4
  • TSH concentrations
  • Thyroid autoantibodies

Secondary Hypothyroidism

• Etiology:
  • Caused by TSH deficiency.
  • Results from injury to the anterior pituitary gland.

Tertiary Hypothyroidism

• Etiology:
  • Caused by TRH deficiency.
  • Results from damage to the hypothalamus or hypothalamic-pituitary portal blood flow.
• Clinical manifestations:
  • Thinning of hair, dry skin, weight gain.
  • Joint pain, muscle weakness, cold intolerance.
  • Fatigue and depression.
  • Menstrual disorders.
• Diagnosis:
  • MRI evaluation of the hypothalamus and pituitary.

Goiters

• Abnormal growth of thyroid gland.
• Nodular or diffuse.
• Normal, decreased, or increased thyroid hormone production.
• Nontoxic diffuse goiters: simple goiters; no overt hyperthyroidism or hypothyroidism.
• Nontoxic multinodular goiters: growth factors, normal TSH.
• Endemic goiter: iodine deficiency; increased TSH.
• Chronic autoimmune (Hashimoto) thyroiditis: hypothyroidism.
• Toxic multinodular goiter (Graves disease): hyperthyroidism.
• Causes worldwide: iodine deficiency. United States: Multinodular goiter, Hashimoto thyroiditis, Graves disease.
• Diagnosis
  • Physical examination through palpation.
  • Neck assessed for masses or cervical adenopathy.
  • Clinical symptoms.
  • Biochemical testing.

Hyperparathyroidism

• Primary hyperparathyroidism:
  • Generalized disorder of calcium, phosphate, and bone metabolism.
  • Results from increased secretion of PTH.
• Secondary hyperparathyroidism:
  • Diffuse hyperplasia of parathyroid glands due to external cause.
• Tertiary hyperparathyroidism:
  • Results from excessive sustained release of PTH.
• Clinical manifestations:
  • Primary: elevated serum calcium; weakness, fatigue, weight loss; neuropsychiatric, neuromuscular, cardiac, renal, skeletal, GI manifestations.
  • Secondary: osteomalacia; renal osteodystrophy.
  • Tertiary: history of secondary hyperparathyroidism.
• Diagnosis:
  • Serum PTH and serum calcium tests.
  • Radiologic studies.
• Treatment:
  • Surgery.

Hypoparathyroidism

• Decreased production of PTH
• Most common cause- surgery.
• Other causes- autoimmune, familial, idiopathic
• Clinical Manifestations
  • Hypocalcemia and hypophosphatemia
  • Increased neuromuscular excitability
  • Tetany
• Diagnosis
  • Serum calcium decreased and serum phosphate

Cushing Syndrome

• Results from chronic exposure to excess glucocorticoids exogenous pharmacologic doses of corticosteroids; endogenous source of cortisol Cushing disease.
• ACTH-dependent Cushing syndrome from pituitary corticotropic adenoma.
• Excessive ACTH results in excessive stimulation of the adrenal cortex. Leads to adrenal cortical hyperplasia and excessive production of glucocorticoids
• Clinical manifestations progressive redistribution of fat abdomen, face, neck; dermatologic; skin atrophy; fragile skin.
• Metabolic impaired glucose tolerance; reproductive menstrual abnormalities; hirsutism.
• Musculoskeletal myopathy; osteosteoporosis bone neuro-psychiatric labile mood; depression; anxiety features of a patient with Cushing disease.
• Diagnosis:
  • Establishing presence of hypercortisolism
  • Classifying as ACTH-dependent or ACTH-independent Determining the source of ACTH in ACTH-dependent form
• Treatment-resection of ACTH-secreting tumor; radiotherapy; lifetime replacement of glucocorticoids latrogenic Cushing syndrome gradual withdrawal of medications
• ACTH independent Cushing syndrome: adrenalectomy ACTH-secreting tumors resection when possible Metastatic disease: medications