Cushing Syndrome

Cushing Syndrome :( Glucocorticoid Excess) • Cortisol function: 1- maintain BP by converting Norepi → epi, 2- antiinflammatory, 3- Na retention, and K excretion, 4- hyperglycemia by ↑ gluconeogenesis, and ↓ glucose uptake by the cells • Exogenous therapy (most common) > 21 days • Bilateral adrenal hyperplasia due to ACTH from pituitary adenoma or nonendocrine tumor (lung, kidney, pancreas) A→ possible difficult A/W, mucosa easily traumatize B→ OSA C→ HTN, volume overload D→ steroids (stress dose), avoid etomidate, titrate NDMR N → emotional, psycosis M → DM, ↓K, met alk, Addison crisis MSK→ osteopenia, muscle wasting Immun → infection Post bilateral adrenalectomy may need mineralocorticoid replacement in day 5, give 0.05–0.1 mg·day–1 of fludrocortisone