Cushing Diabetes

Differential diagnoses include diabetes mellitus and metabolic syndrome because patients with these conditions share several similar characteristics with Cushing s syndrome patients (e.g., obesity, hypertension, hyperlipidemia, hyperglycemia, and insulin resistance). In women, the presentations of hirsutism, menstrual abnormalities, and insulin resistance are similar to those of polycystic ovary syndrome. Cushing s syndrome can be differentiated from these conditions by identifying the classic signs and symptoms of truncal obesity, "moon faces" with facial plethora, a "buffalo hump" and supraclavicular fat pads, red-purple skin striae, and proximal muscle weakness. 

Uncommon causes of diabetes (1% to 2% of cases) include endocrine disorders (e.g., acromegaly, Cushing s syndrome), gestational diabetes mellitus (GDM), diseases of the exocrine pancreas (e.g., pancreatitis), and medications (e.g., glucocorticoids, pentamidine, niacin, and a-interferon). 

Hyperthyroidism Hyperparathyroidism Hypogonadism Cushing s syndrome Alcohol abuse Diabetes... 

Endocrine disorders Adrenal Addison s disease and Cushing s disease Diabetes mellitus Parathyroid hyper-/hypo-Reproductive ovary/testicle failure Thyroid hyper-/hypo-... 

Speciai risk Use with caution in the following situations Nonspecific ulcerative colitis if there is a probability of impending perforation, abscess, or other pyogenic infection diverticulitis fresh intestinal anastomoses hypertension CHF thromboembolitic tendencies thrombophlebitis osteoporosis exanthema Cushing syndrome antibiotic-resistant infections convulsive disorders metastatic carcinoma myasthenia gravis vaccinia varicella diabetes mellitus hypothyroidism, cirrhosis (enhanced effect of corticosteroids). 

Endocrine system (Cushing s disease, Addison s disease, carcinoid syndrome, diabetes, hyperthyroidism. Grave s disease, hypothyroidism)... 

Corticosteroids should be used cautiously in the presence of congestive heart failure, myocardial infarction, hypertension, diabetes mellitus, epilepsy, glaucoma, hepatic disorders, osteoporosis, peptic ulceration, and renal impairment. Children are more susceptible to these adverse effects. To avoid cardiovascular collapse, steroids must be given slowly by intravenous injection. Large doses produce Cushing s syndrome (with moon face and sometimes hirsutism). 

Endocrinopathies Excessive production of insulin counterregulatory hormones can cause diabetes mellitus. Examples include excessive production of growth hormone (acromegaly), cortisol (Cushing s syndrome), epinephrine (pheochromocytoma), and glucagon (glucago-noma). 

Congenital adrenal hyperplasia Congestive heart failure Chromosome disorders Chromosome mosaicism Chromosome translocation Copper excess Cri-du-chat syndrome Crouzon s syndrome Cushing s syndrome Cyanide poisoning Cystic fibrosis Diabetes insipidus Diabetes mellitus Dinitrophenol poisoning Diphtheria... 

Type 1 DM idiopathic is a nonimmune form of diabetes frequently seen in minorities with intermittent insulin requirements. The prevalence of type 1 DM has been increasing over the last one hundred years. Maturity onset diabetes of youth (MODY), which has an identifiable genetic defect in the glucokinase gene, and endocrine disorders such as acromegaly and Cushing s syndrome, can be secondary causes of DM. These unusual etiologies, however, only account for 1% to 2% of the total cases of type 2 DM. See the section on other forms of diabetes mellitus later in this chapter for further discussion. 

The rationale for treating Cushing s syndrome is to reduce the morbidity and mortality resulting from disorders such as diabetes mellitus, cardiovascular disease, and electrolyte abnormalities. 

This patient presents with many of the classic findings of Cushing syndrome. Adrenal hyperplasia can be caused by excessive stimulation from ACTH (pituitary or ectopic production) or from a primary adrenal problem such as adenomas/ carcinomas. In addition to above symptoms, patients with Cushing syndrome are also at risk for osteoporosis and diabetes mellitus (DM). The diagnosis is confirmed with elevated cortisol levels after a dexamethasone suppression test. Treatment depends on the underlying etiology and is often surgical. 

---