Pre PACES Podcast #61 Cushing's syndrome
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May 21, 2023 Dr Sajini Wijetilleka, a dual-accredited consultant in endocrinology, diabetes and acute medicine. She breaks down Cushing's syndrome causes and signs. Short, practical talk on bedside findings, steroid-induced versus endogenous disease, targeted investigations and imaging. Plus a fun detour into Sri Lankan food and a quick quiz.
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Think Beyond Obvious Mimics
- Differential includes adrenal tumours, carcinoid syndromes and pituitary lesions; acromegaly can mimic pituitary disease so targeted pituitary tests matter.
- Sajini highlights carcinoid symptoms like flushing that can overlap with Cushing's presentations.
Use Dexamethasone Tests To Confirm Diagnosis
- Confirm hypercortisolism before imaging using screening tests: overnight 1 mg dexamethasone suppression or low-dose 48-hour dexamethasone as first-line.
- Sajini prefers overnight dexamethasone at 11pm with serum cortisol at 9am, and notes urine free cortisol needs multiple collections to avoid missing mild disease.
Prepare Patients And Pause Confounding Medications
- Stop interfering therapies before testing: HRT, OCP, steroid creams, inhalers and oral steroids where possible, and be aware of drugs that alter hepatic cortisol clearance.
- Sajini instructs measuring baseline ACTH to classify ACTH-dependent vs independent; low ACTH suggests adrenal cause.