Case Study 52: Cushing Syndrome

Sara Sauers
1. Of the vital signs listed above, which of them has to be of most concern to the
patient’s PCP?
The patient’s temperature is WNL, respirations are slightly low, pulse is normal, but
blood pressure is hypertensive at 185/105mm/Hg which is very concerning.
2. Assuming that the patient has hypercortisolism, briefly explain the pathophysiology of
the abnormal vital sign noted in question 1.
Cortisol regulates blood pressure, with hypercortisolism there is an increased level of
cortisol which increases blood pressure.
3. Is this patient technically underweight, overweight, obese, or is her weight considered
healthy and normal?

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According to her height and weight her BMI is 27.5, which means she is overweight.

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4. Assuming that M.K. has hypercortisolism, what are two possible causes of this

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patient’s persistent, dull head pain?

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Her persistent head pain could be related to her hypertension or the possibility of a

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tumor on her pituitary gland.
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5. What is the significance in the patient’s report that she is not taking any medication
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other than a daily multivitamin pill and ibuprofen?
Corticosteroids are linked to the development of Cushing Syndrome, since she has not
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taken steroids there is no possibility that it is related to steroids.

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6. Identify the nine abnormal laboratory test results in table 52.1.

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Serum K+ is low, fasting serum glucose is high, plasma ACTH is high, serum cortisol is
high, urinary free cortisol is high, pH arterial whole blood is high, serum testosterone is
high, neutrophils are high, and lymphocytes are low.
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7. Why is serum glucose elevated?

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She has hyperglycemia because there is reduced secretion of glucagon like peptide,
glucose dependent insulinotropic polypeptide and insulin.
8. Explain the pathophysiology that underlies polydipsia in this patient.
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One of the contributing factors to polydipsia is from hyperglycemia and a symptom of

hyperglycemia is polydipsia.
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9. Do laboratory test results suggest that hypercortisolism in M.K. is ACTH-dependent or

ACTH-independent?
ACTH-dependent.
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10. What is the significance of the serum K+ concentration and the pH of the arterial
blood?
The patient is experiencing metabolic alkalosis.

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 11. Note that hyperpigmentation of the skin and gingiva was a physical finding in this
patient. Is this clinical manifestation more characteristic of ACTH dependent or ACTH
independent Cushing syndrome?
ACTH-dependent because there is an increased production of ACTH in the body which
causes the hyperpigmentation and gingiva.
12. Which imaging techniques might be critical to establishing a specific cause of
hypertortisolism in this patient?
A CT scan of the head to determine if the patient has a tumor on her pituitary gland or
adrenal gland in relation to the increase of ACTH.
13. What type of menstrual abnormality would be suspected in this patient and which
abnormal laboratory test result is consistent with this type of abnormality?
Women with Cushing Syndrome either have no period or irregular periods related to the
high levels of adrenal gland hormones to suppress the normal pituitary hormones LH
and FSH which regulate periods and ovulation.

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14. What is the treatment of choice for curing hypercortisolism in this patient?

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The ideal treatment would be to remove the tumor.

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15. Patient Case Figure 52.1 shows that an enlarged sella turcica is a potential clinical

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manifestation of Cushing syndrome/disease. Explain the association.
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The pituitary gland is located on the sella turcica and when it is enlarged it can be
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attributed to a tumor on the pituitary gland.
16. Why is cardiac hypertrophy shown as a clinical manifestation of Cushing syndrome in
Patient Case Figure 52.1?
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Cardiac hypertrophy occurs often in people with Cushing Syndrome because of weight
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gain and hypertension.

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