Cushing's syndrome differential diagnosis: Difference between revisions
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Cushing's syndrome must be differentiated from other causes of irregular menses and hirsutism. | Cushing's syndrome must be differentiated from other causes of irregular menses and hirsutism. | ||
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|[[Pregnancy]] | |[[Pregnancy]] | ||
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* Pregnancy always | * Pregnancy should always be excluded in a patient with a history of [[amenorrhea]] | ||
* Features include amenorrhea or oligomenorrhea, abnormal uterine bleeding, nausea/vomiting, cravings, weight gain (although not in the early stages and not if vomiting), polyuria, abdominal cramps and constipation, fatigue, dizziness/lightheadedness, and increased pigmentation (moles, nipples) | * Features include [[amenorrhea]] or [[oligomenorrhea]], abnormal [[uterine]] bleeding, nausea/[[vomiting]], cravings, weight gain (although not in the early stages and not if vomiting), [[polyuria]], abdominal cramps and constipation, fatigue, dizziness/lightheadedness, and increased [[pigmentation]] (moles, nipples) | ||
* Uterine enlargement is detectable on abdominal examination at approximately 14 weeks of gestation | * [[Uterine]] enlargement is detectable on [[abdominal]] examination at approximately 14 weeks of gestation | ||
* Ectopic pregnancy may cause oligomenorrhea, amenorrhea, or abnormal uterine bleeding with abdominal pain and sometimes subtle or absent physical symptoms and signs of pregnancy | * [[Ectopic]] pregnancy may cause [[oligomenorrhea]], [[amenorrhea]], or abnormal [[uterine]] bleeding with abdominal pain and sometimes subtle or absent physical symptoms and signs of pregnancy | ||
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|Hypothalamic amenorrhea | |[[Hypothalamic]] [[amenorrhea]] | ||
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* Diagnosis of exclusion | * Diagnosis of exclusion | ||
* Seen in athletes, people on crash diets, patients with significant systemic illness, and those experiencing undue stress or anxiety | * Seen in athletes, people on crash diets, patients with significant [[systemic]] illness, and those experiencing undue stress or anxiety | ||
* Predisposing features are as follows weight loss, particularly if features of anorexia nervosa are present or the BMI is <19 kg/m2 | * Predisposing features are as follows weight loss, particularly if features of anorexia nervosa are present or the BMI is <19 kg/m2 | ||
* Recent administration of depot medroxyprogesterone, which may suppress ovarian activity for 6 months to a year | * Recent administration of depot [[Medroxyprogesterone (patient information)|medroxyprogesterone]], which may suppress [[ovarian]] activity for 6 months to a year | ||
* Use of dopamine agonists (eg, antidepressants) and major tranquilizers | * Use of [[dopamine]] [[agonists]] (eg, [[antidepressants]]) and major tranquilizers | ||
* Hyperthyroidism | * [[Hyperthyroidism]] | ||
* In patients with weight loss related to anorexia nervosa, fine hair growth (lanugo) may occur all over the body, but it differs from hirsutism in its fineness and wide distribution | * In patients with weight loss related to [[anorexia nervosa]], fine hair growth (lanugo) may occur all over the body, but it differs from [[hirsutism]] in its fineness and wide distribution | ||
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|[[Primary amenorrhea]] | |[[Primary amenorrhea]] | ||
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* Causes include reproductive system abnormalities, chromosomal abnormalities, or delayed puberty | * Causes include reproductive system abnormalities, [[chromosomal]] abnormalities, or delayed [[puberty]] | ||
* If secondary sexual characteristics are present, an anatomic abnormality (eg, imperforate hymen, which is rare) should be considered | * If [[secondary sexual characteristics]] are present, an anatomic abnormality (eg, imperforate [[hymen]], which is rare) should be considered | ||
* If secondary sexual characteristics are absent, a chromosomal abnormality (eg, Turner syndrome ) or delayed puberty should be considered | * If [[secondary sexual characteristics]] are absent, a [[chromosomal]] abnormality (eg, Turner syndrome ) or delayed puberty should be considered | ||
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|[[Cushing's syndrome|Cushing syndrome]] | |[[Cushing's syndrome|Cushing syndrome]] | ||
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* Cushing syndrome is due to excessive glucocorticoid secretion from the adrenal glands, either primarily or secondary to stimulation from pituitary or ectopic hormones; can also be caused by exogenous steroid use | * Cushing syndrome is due to excessive [[glucocorticoid]] secretion from the [[adrenal glands]], either primarily or secondary to stimulation from [[pituitary]] or [[ectopic]] hormones; can also be caused by [[exogenous]] [[steroid]] use | ||
* Features include hypertension, weight gain (central distribution), acne, and abdominal striae Patients have low plasma sodium levels and elevated plasma cortisol levels on dexamethasone suppression testing | * Features include [[hypertension]], weight gain (central distribution), [[acne]], and abdominal striae. Patients have low plasma sodium levels and elevated plasma [[Cortisol level|cortisol]] levels on [[Dexamethasone suppression test|dexamethasone suppression testing]] | ||
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|[[Hyperprolactinemia]] | |[[Hyperprolactinemia]] | ||
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==References== | ==References== | ||
Revision as of 13:23, 23 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]
Overview
Cushing's syndrome must be differentiated from other diseases that cause hypertension, obesity, and hyperandrogenism, such as Metabolic syndrome X and pseudo-Cushing's syndrome.
Differentiating Cushing's syndrome from Other Diseases
The table below summarizes the findings that differentiate Cushing's disease from other conditions that may cause hypertension, hyperandrogenism, and obesity. Facial plethora, skin changes, osteoporosis, nephrolithiasis and neuropsychiatric conditions should raise the concern for Cushing's syndrome.[1][2][3][4]
Other differentialsCushing's syndrome must be differentiated from diseases that cause virilization and hirsutism in female:[5][6][7]
Less common differentialsCushing's syndrome should also be differentiated from other causes of hyperprolactinemia that may present as galactorrhea, amenorrhea, (in females) and infertility (in both males and females) including:
Cushing's syndrome must be differentiated from other causes of irregular menses and hirsutism.
Cushing's syndrome must be differentiated from other adrenal tumors such as adrenocortical adenoma, adrenal metastasis, and adrenal medullary tumors.
References
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