Síndrome de Cushing
Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- pletora facial
- preenchimento supraclavicular
- estrias violáceas
- ausência de gestação
- irregularidades menstruais
- ausência de desnutrição
- ausência de alcoolismo
- ausência de estresse fisiológico
- desaceleração do crescimento linear em crianças
Other diagnostic factors
- sexo feminino
- hipertensão
- intolerância à glicose ou diabetes mellitus
- osteoporose prematura ou fraturas não explicadas
- ganho de peso e obesidade central
- acne
- sintomas psiquiátricos
- diminuição da libido
- facilidade de formação de hematomas
- fraqueza
- arredondamento facial
- adiposidade na região dorsocervical
- nefrolitíase inexplicada
- evento venotrombólico
- virilização
Risk factors
- uso de corticosteroide exógeno
- adenoma hipofisário
- adenoma adrenal
- carcinoma adrenal
- tumores neuroendócrinos
- carcinoma torácico ou broncogênico
Diagnostic investigations
1st investigations to order
- teste de gravidez na urina
- glicose sérica
- cortisol salivar noturno
- teste de supressão noturna com dexametasona 1 mg
- cortisol urinário livre de 24 horas
- teste de supressão com dexametasona 2 mg (baixa dose) por 48 horas
Investigations to consider
- hormônio adrenocorticotrófico (ACTH) plasmático matinal
- nível de sulfato de prasterona (DHEA-S) plasmático
- ressonância nuclear magnética (RNM) da hipófise
- imagem adrenal
- teste de supressão com dexametasona de alta dose
- amostra de sangue dos seios petrosos inferiores
- TC do tórax, abdome e pelve
- RNM do tórax, abdome e pelve
- tomografia por emissão de pósitrons com fluordesoxiglucose (FDG-PET) ou FDG-PET-CT
- exame com octreotida
- PET/TC com gálio (Ga)-68 DOTATATE
Treatment algorithm
Doença de Cushing (adenoma hipofisário secretor de hormônio adrenocorticotrófico [ACTH])
síndrome de secreção ectópica do hormônio adrenocorticotrópico (ACTH) ou do hormônio liberador de corticotropina (CRH)
independente de hormônio adrenocorticotrópico (ACTH) devido a carcinoma ou adenoma adrenal unilateral
independente de hormônio adrenocorticotrópico (ACTH) devido a doença adrenal bilateral (hiperplasia ou adenoma)
secreção autônoma leve de cortisol (anteriormente conhecida como síndrome de Cushing subclínica)
Contributors
Authors
Maria Fleseriu, MD, FACE
Professor of Medicine (Endocrinology) and Neurological Surgery
Director
Pituitary Center
Oregon Health & Science University
Portland
OR
Disclosures
MF is on the Endocrine Society's Board of Directors. She holds a research grant to the university for clinical studies as principal investigator for Crinetics and Sparrow Pharmaceuticals, and is an occasional scientific consultant for Crinetics, Recordati, Sparrow Pharmaceuticals, and Xeris Pharmaceuticals. MF is an author of several references cited in this topic.
Acknowledgements
Dr Maria Fleseriu would like to gratefully acknowledge Dr Ty Carroll and Dr James Findling, contributors to a previous version of this topic.
Disclosures
TC is an author of a number of references cited in this topic. He is an investigator in clinical trials sponsored by Corcept. JF is an author of a number of references cited in this topic. He is a consultant for, and investigator in, clinical trials sponsored by Corcept and Novartis.
Peer reviewers
Paul M. Stewart, FRCP FMedSci
Professor of Medicine
Director of Research
College of Medical and Dental Sciences
University of Birmingham
Honorary Consultant Physician
Queen Elizabeth Hospital
Birmingham
UK
Disclosures
PMS declares that he has no competing interests.
Antoine Tabarin, MD
Head
Department of Endocrinology
University Hospital of Bordeaux
Pessac
France
Disclosures
AT declares that he has no competing interests.
Liliana Contrersas, MD
Chief
Endocrine Research Department
Instituto de Investigaciones Médicas A. Lanari
University of Buenos Aires and IDIM-CONICET
Buenos Aires
Argentina
Disclosures
LC declares that she has no competing interests.
Philip R. Orlander, MD
Professor of Medicine
Director
Division of Endocrinology, Diabetes & Metabolism
University of Texas Medical School
Houston
TX
Disclosures
PRO declares that he has no competing interests.
Mouhammed Amir Habra, MD, FACP, FACE
Assistant Professor
Department of Endocrine Neoplasia and Hormonal Disorders
Division of Internal Medicine
University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
MAH declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Fleseriu M, Auchus R, Bancos I, et al. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol. 2021 Dec;9(12):847-75.Full text Abstract
Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Aug;100(8):2807-31.Full text Abstract
Feelders RA, Newell-Price J, Pivonello R, et al. Advances in the medical treatment of Cushing's syndrome. Lancet Diabetes Endocrinol. 2019 Apr;7(4):300-12. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Obesidade
- Síndrome metabólica
- Aldosteronismo primário
More DifferentialsGuidelines
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- Clinical practice guideline on the management of adrenal incidentalomas
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