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Cushing Syndrome, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Cushing disease: Pituitary adenoma producing excess adrenocorticotropic hormone (ACTH)

  • Cushing syndrome: Excessive glucocorticoid effects

Risk Factors

Genetics

  • Multiple endocrine neoplas...

Diagnosis

Signs and Symptoms

  • The most important aspect of Cushing syndrome in the ED is recognizing the potential for addisonian (adrenal) crisis during periods of stress.

  • Although nonemergent, the earl...

Treatment

Pre-Hospital

  • Acute addisonian (adrenal) crisis under stress may develop with iatrogenic Cushing syndrome

  • Patients may have extremely labile behavior with violent behavior

  • Leading causes of deat...

Follow-Up

Disposition

Admission Criteria

  • Complications that require admission such as:

    • MI

    • Stroke

    • Sepsis

    • Pathologic fracture

    • Uncontrolled DM

    • Psychiatric emergency

  • Impending addisonian (adrenal) crisis

Discharge Criteria

Pearls and Pitfalls

  • Keep a high index of suspicion in the physiologically stressed patient by history or from body habitus and for the need to prevent against addisonian crisis

  • Suspect Cushing disease ...

Additional Reading

  • Andreoli  T, Carpenter  C. Cecil Essentials of Medicine. 8th ed. Philadelphia, PA: Saunders-Elsevier; 2010.

  • Gilbert  R, Lim  EM. The diagnosis of Cushing syndrome: An endocrine soc...

Codes

ICD9

255.0 Cushing's syndrome 

ICD10

  • E24.0 Pituitary-dependent Cushing's disease

  • E24.2 Drug-induced Cushing's syndrome

  • E24.9 Cushing's syndrome, unspecified

  • E24.8 Other Cushing's syndrome

  • E24.3 Ectopic...

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