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Cushing Syndrome - Causes, Symptoms, Diagnosis, Treatment & Diagnostic Workup - USMLE 

MedNerd - Dr. Waqas Fazal
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Cushing Syndrome - Causes, Symptoms, Diagnosis, Treatment & Diagnostic Workup - USMLE
Cushing Syndrome & Cushing disease are highly tested topics in exams. cushing syndrome Diagnostic workup & diagnostic alogritham are fully explained in this video.it also explains symptoms, causes, and pathophysiology of cushing disease and cushing syndrome.Cushing syndrome can be treated when its appropriate cause has been found out by its diagnostic workup.
The diagnosis of Cushing syndrome requires demonstration of inappropriately high level of cortisol in the serum or urine. The levels should be measured when cortisol, according to its physiologic circadian rhythm, is supposed to be suppressed, that is, late evening or when a patient is given exogenous glucocorticoids.
This concept gives rise to the following tests, which have been recommended as screening tests for Cushing syndrome:
Midnight serum or salivary cortisol
24-hour urine free cortisol
Low dose dexamethasone suppression test
Exogenous glucocorticoid use around time of testing must be addressed and excluded to ensure the accuracy of the test result's interpretation.
Urinary free cortisol (UFC) determination has been widely used as an initial screening tool for Cushing syndrome because it provides measurement of cortisol over a 24-hour period. A valid result depends on adequate collection of the specimen. Urinary creatinine excretion can be used to assess the reliability of the collection. 24-Hour urine creatinine excretion should be 20-25 mg/kg (lean body weight) in adult males younger than 50 years of age and 15-20 mg/kg (lean body weight) in adult females younger than 50 years. However, in elderly patients, creatinine excretion gradually declines over time, which makes this estimation less accurate than that for younger individuals. Urine free cortisol values higher than 3 times the upper limit of normal are highly suggestive of Cushing syndrome. Values higher than the normal reference range but less than 3times the upper limit of normal are inconclusive. Values within this range may indicate pseudo-Cushing syndrome or Cushing syndrome and require further testing. Multiple collections are necessary because patients with disease may have values that fall within the normal range. #CushingSyndrome #Cushingdisease
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27 авг 2020

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Комментарии : 42   
@Nat524Ricci
@Nat524Ricci 2 года назад
Just a tip for the dexamethasone suppression test, in cyclical or episodic patients who are experiencing normal or low cortisol secretion, they will suppress. It is important to repeat or rely upon blood, saliva and urine in patients whom are episodic. I spent 17 years undiagnosed. Going for pituitary surgery very soon 💜 the QOL is horrific, plz keep in mind. Onset age 16/17 (maybe earlier) diagnosed age 34 🤯 began seeking Endocrine care in 2005.
@belindaricci5254
@belindaricci5254 2 года назад
I suppressed on 1mg dex, but salivary Late nights are 8-10-600x normal. Have pit Cushings. Do not dismiss textbook patients who suppress on 1mg dex. Just means pit source. MANY of us w pituitary source suppress!
@brothersmind3415
@brothersmind3415 2 года назад
Thanks.well done.
@debigdogk9563
@debigdogk9563 Год назад
Great teacher, thank you for teaching and sharing ❤❤❤❤❤
@We-wrld
@We-wrld 3 месяца назад
Thank you doc for the lecture keep up good work
@benettryan4048
@benettryan4048 4 года назад
You made it supereasy.thank you
@MedNerdDrWaqasFazal
@MedNerdDrWaqasFazal 3 года назад
Thank you bennet 😊
@seenathp9404
@seenathp9404 Год назад
Thank you so much sir😍 excellent presentation👍helped me alot
@umararshad5126
@umararshad5126 6 месяцев назад
JazakAllah Sir You are a gem 💎
@javedmutavalli9452
@javedmutavalli9452 Год назад
Thank u so much.
@srushtipatil6739
@srushtipatil6739 20 дней назад
Very helpful sir
@umerfarooq4592
@umerfarooq4592 Год назад
You are gem sir😎
@nadeemstoreahmedlecture404
@nadeemstoreahmedlecture404 Год назад
Nice sir
@dr.usmanawan3596
@dr.usmanawan3596 3 года назад
Excellent content.
@MedNerdDrWaqasFazal
@MedNerdDrWaqasFazal 3 года назад
Thank you Dr. Usman
@shayanazizkhattak5776
@shayanazizkhattak5776 3 года назад
Thank you so much! This will help me in my final year exam.
@MedNerdDrWaqasFazal
@MedNerdDrWaqasFazal 3 года назад
You're welcome Shayan!!Good luck for your exams. You'll ace it with flying colors Inshallah. 🙂
@madlenj.4644
@madlenj.4644 Год назад
@@MedNerdDrWaqasFazal 12:49 leftlower corner MRI pituatary ->your picture shows if the adenoma is smaller than 6mm than: Interferior petrosalsius sampling! My Adenomain the pituatary is 3x3mm..so..yes its smaller than 6mm, and my cortisol was supressed through 1mg dexa...it went from 226 µg/l to 144µg/l. With or without Dexa..my ACTH stayed 19 ng/l. What do you think it could be? And why there needs to be IPSS if the Adenoma is smaller than 6mm? Does this also applyfor Dexatest with 1mg? Need your thoughts on that please.
@Payal6118
@Payal6118 9 месяцев назад
Thankyou sir
@dailymedicinewithdrtanzeel
@dailymedicinewithdrtanzeel 4 года назад
Nicely done
@MedNerdDrWaqasFazal
@MedNerdDrWaqasFazal 3 года назад
Thank you Dr. Tanzeel
@daanyaalkhan8520
@daanyaalkhan8520 4 года назад
Very nice 👍🏻👍🏻
@MedNerdDrWaqasFazal
@MedNerdDrWaqasFazal 3 года назад
Thank you daanyaal 😊
@SarkisKlinik
@SarkisKlinik Год назад
Hi,why iatrogenic cushing syndrome brings to generalized odema ? how to treat it ,which medication to use?is spironolactone ok for that or you better to use furosemide??
@belindaricci5254
@belindaricci5254 2 года назад
I suppressed on 1mg dexamethasone to 0.5 and STILL HAVE PITUITARY CUSHINGS DISEASE CONFIRMED. Test isn’t 100%
@jacquelinecoudret5497
@jacquelinecoudret5497 Год назад
Same happened to me Belinda. Then the tumor grew and I got secondary addison's disease. 12 years of medical gaslighting and finally getting treatment and surgery soon. This dexa test is very faulty
@dr.ramshanazeerahmed
@dr.ramshanazeerahmed Год назад
Short and crisp.
@anthony7737
@anthony7737 2 года назад
I'm wondering about something. If I could get some advice. I am having a blood cortisol test AM and PM. If i come home after the AM test and sleep for 2 hours, would that affect the PM test results? Thanks for any help that could be offered
@dtk7728
@dtk7728 2 года назад
Do u have training centre for internal medicine in india, I am interested
@BelalHameed
@BelalHameed 3 года назад
Behtareen!! 👍🏻
@MedNerdDrWaqasFazal
@MedNerdDrWaqasFazal 3 года назад
Thank you Bilal bhai ❤️
@thedreamydoctormd
@thedreamydoctormd Год назад
Reason for proximal myopathy.? Why distal muscles are not involved?
@vikramjeetsingh8459
@vikramjeetsingh8459 5 месяцев назад
What is the reference range of 1mg dexamethasone for cortisol test give me a figure
@subatsabhattarai7662
@subatsabhattarai7662 4 месяца назад
why didn't we check for ACTH level instead to rule out pituitary adenoma?
@artworksbyayan
@artworksbyayan 4 месяца назад
Acth is increased in case of pituitary adenoma as u said but it can also be secreted by ectopic cancerous growth like lung cancer. So checking acth levels will only differentiate between cushings disease and cushings syndrome. However, HDDS test will rule out this contradiction. So high dose of dexa will only suppress cortisol production if its origin I'd pituitary adenoma.
@clubtv3924
@clubtv3924 3 года назад
Level😍 make videos on rheumatology and neurology
@MedNerdDrWaqasFazal
@MedNerdDrWaqasFazal 3 года назад
Thank you Aizad! I'll surely make videos on Neuro and rheumatology too. 😊
@saqibbehttani7143
@saqibbehttani7143 4 года назад
👍👍
@yashzee
@yashzee Год назад
Treatment? I am suffering with lower back pain can't stand up on legs Cataract, FatFace , Stomach becomes very fat please help me I want treatment
@brunoarekhandia4722
@brunoarekhandia4722 2 года назад
Thank you but I do not agree with your explanation on IPS sampling. BIPSS is actually done to confirm Cushing's disease, because pituitary MRI is less sensitive for that condition.
@ksp9506
@ksp9506 2 года назад
I guess mri brain is primary modality it's non invasive easily available nd if on mri pituitary mass is not seen or dexa suppression scan cortisol is not supressed 50% then after u have to go for petrosal sinus sampling it's invasive nd used in last resort so in my opinion mri is considered ioc
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