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Printable Handouts
Navigable Slide Index
- Introduction
- My personal disclaimer of trying to understand CS since I was a medical student
- Hypercortisolism can present in many ways
- Important discriminatory features
- Why is it so important to diagnose early and effectively treat CS?
- Active CS and those in remission have higher mortality rates
- Case 1: 38-year-old female (1)
- Case 1: 38-year-old female (2)
- Case 1: 38-year-old female (3)
- Utility of late-night salivary cortisol for diagnosis of CS
- Variability of day-to-day late night salivary cortisols in CD
- Why is diagnosing CS so challenging?
- Examples of other causes of hypercortisolism
- Important pearls when obtaining a history from a patient with possible CS
- Fagan’s nomogram to estimate the post-test probability of CS for selected tests
- Principles of testing for CS
- Challenges associated with interpreting screening tests
- Which screening test for which patient?
- Pearls of testing for CS
- Case 2: 46-year-old female
- Cyclical CS
- Cyclical CS confirmed with a cyclical pattern of 4 days using sequential urine and salivary samples
- Cyclical CS after pituitary surgery
- Back to case 2: 46-year-old female
- Case 3: 42-year-old male
- Case 3: MRI image at presentation
- Case 3: IPSS data
- Hypercoagulability in CS
- Who, how and when to anticoagulate in CS?
- Back to case 3: 42-year-old male (1)
- Can we predict HPA axis recovery? It depends
- Time to HPA axis recovery after successful surgery depends on the etiology
- Case 3: 42-year-old male (3-year follow-up clinic visit)
- Predictors of long-term outcomes after TSS
- Glucocorticoid requirement duration predictive of recurrence
- Management of recurrence or persistent CD
- Medical therapy for CD: treatment targets and currently available treatment options
- Current treatment options all have limitations (1)
- Current treatment options all have limitations (2)
- Back to case 3: 42-year-old male (2)
- Case 4: 31-year-old female (1)
- Case 4: 31-year-old female (2)
- Case 4: 31-year-old female (3)
- When to consider bilateral adrenalectomy?
- How to handle contraception in women with CD?
- Case 5: 47-year-old male
- Case 5: IPSS data
- Case 5: surgery and postoperative notes
- Case 5: postoperative course
- CD and negative MRI: a diagnostic and therapeutic challenge
- Why should patients with “likely” CS and a “normal” MRI be still considered for surgery?
- Key points (1)
- Key points (2)
- “You will never diagnose CS if you do not screen patients”
Topics Covered
- Cushing syndrome (CS)
- Cyclical CS
- late-night salivary cortisol
- Challenges associated with screening tests for CS
- Pituitary surgery
- Current treatment options all have limitations
Talk Citation
Yuen, K.C. (2024, March 31). Management of Cushing syndrome: the tough questions [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 7, 2024, from https://doi.org/10.69645/HEME3186.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Yuen received research grants to Barrow Neurological Institute from Corcept, Chiesi and Sparrow; served as an occasional advisory board member for Recordati and Xeris; and is an occasional speaker for Recordati.
A selection of talks on Cardiovascular & Metabolic
Transcript
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0:00
Hello. My name is Kevin Yuen.
I'm a Professor of medicine
and Medical Director at
the Barrow Neurological
Institute in Phoenix, Arizona.
Today my talk to
you is entitled,
Management of Cushing
Syndrome: The tough Questions.
0:18
I'd like to start off
with by giving you
my personal disclaimer
of trying to
understand Cushing's
syndrome since
I was a medical student.
It is pretty common
that people who are
unskilled and unaware of
their own abilities
often in this study
they found that the self
inflated assessments
tends to be quite frequent.
You can see here that when I
first learned about
Cushing's syndrome,
I thought I knew everything.
It turns out that,
in fact, the more I learn,
the more it became more
complicated for me.
At that point in time,
there's a valley of despair
where I'm never going
to understand this.
But eventually, over
time, the more I learned,
it starts to make sense
and eventually it
is a complicated condition,
no question about it.
That's why I'm presenting
this talk to you.
Hopefully, to demystify and
improve the understanding
of this very complicated,
yet interesting and
challenging disease.
1:20
Hypercortisolism can actually
present in many ways.
You can see here in
the figures below that
there is a variety of
presentation in the patient.
It can range from
less severe where
the biochemical
abnormalities for
cortisol secretion
is less severe.
Patients may actually
not experience
much in the way of
clinical symptomatology to
severe hypercortisolism
where cortisol levels are
generally tend to
be very high and
patients can present with
the classic features
of moon phase,
buffalo hump, striae as you
can see in the figure below.