Cushing Syndrome Diagnostic Workup
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- čas přidán 5. 09. 2024
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THANK YOU! This was amazing. Like you said, it is simple but needs to be reviewed.
I always remember that ACTH always points to where it is coming from.
↑ ACTH--> points upward. Pituitary.
↓ ACTH--> points downward. Adrenal.
Thank you 😊
That is too good
Thanks diana
I love you Diana
ACTH is high , could be from Pituitary or Ectopic tumor
What about if there is a tumor in Hypothalamus secreting lots of CRH?
Ectopic ACTH can be from
1- small cell carcinoma of lung
2- carcinoid tumor
3- medullary carcinoma of thyroid
4- iselt cell tumers of the pancreas
It's associated with multiple endocrine neoplasm : pancreas, pituitary, parathyroid & others.
@@ThatsWhy- who else reads his username and his comment together
Excellent! Just made it simple. 1) Anterior Pituitary. 2) Small cell lung cancer, medullary ca thyroid, carcinoid gut, pancreatic tumour, thymus gland tumour.
Note that in early stages of Cushing's, urine test might not show up as abnormal. Dexamethasone test is gonna be more sensitive to that. Plus as a patient, it's a lot easier to take a tablet and come in the next morning, than to pee in a cup for 24 hours and keep the pee in the fridge.
How can I do my 2mg dexamethasone test ?
Cause my 1 mg test is positive 2.5mictrgra
Collecting a twenty-four-hour urine for any reason is a real pain. The patient forgets to same some urine, forget--do I throw out the first urine or the last urine? The patients, nurses, housekeeping, and visitors knock over the bottle and then you have to start all over again.
Especially when you struggle with autism/ADHD and keep failing the urine collection because you cannot focus yourself enough to pee in it for 24hrs.
They just don’t take us into consideration.
I’m European and they refuse to even send me to an endocrinologist before the urine sample, and acted rude and condescending when I mentioned other tests or that I wanted to see an endocrinologist directly.
It’s so tiring when you’re battling with multiple conditions and no one seems to want to help.
you made this so simple and nice. don't stop what you're doing!
I will never stop...Thank you so much for your encouragement:)
Medicosis Perfectionalis thank you so much !
I wish American Endocrinologists knew half of this. Thank you - I have been thoroughly educating myself to speed up my own diagnosis. I have absolutely zero doubt.
You rock!
Thank you so much!
Bronchial carcinoid ,pancreatic ,thymic tumours , small cell carcinoma lung ,pheochromocytoma ,medullary ca thyroid
Much love to you my man, so concise, clear. Took me almost a day and a half to read what you put in 9 minutes hahaha
Excellent 👏👏
You are the best teacher. The way you explain the topic is amazing. God bless you
Thank you!
"Which tumors can be a source of ectopic ACTH?"
In 50% it's small cell lung carcinoma; carcinoids (lung, gut, ovary, pancreas, thymus), pancreatic islet cell tumor, thyroid medullary carcinoma, pheochromocytoma.
Excellent!
I'm studying clinical laboratory science and your videos are a huge help!
Awesome 👏
Thank you so much for watching!
Thanks
I’ve self diagnosed at age 33 after suffering since age 17. I suffered with a massive cardiac fistula and 8.8cm aneurysm in 2016 and it was dissected. Assumed to be congenital. Nope, Cushings.
Diagnosis confirmed w Dr, now seeking source (pituitary or adrenal?)
I am just SO TIRED OF SUFFERING
anterior pituatory.
Ectopic tumor; Small cell lung carcinoma mostly.
Excellent
What about if it’s cyclical cushings? I’ve known several people that eventually have tumors removed from either the pituitary or adrenals that didn’t always demonstrate abnormal tests during initial testing.
Lynette Diaz I know a lot people with cushings and the most have it cyclical...
Thank you very much. You make this topics very simple and easy to understand
Thank you!
This was absolutely amazing! I finally get it now - thank you so much! Subscribed!
Welcome to Medicosis...I am extremely delighted to hear that!
-Small cell carcinoma of the lungs,
-Pheochromocytoma,
-Thymic carcinoid,
-Ovarian tumors.
thank you .........for your best videos
I appreciate you!
Not true my dayghter didnt supress om 1mg and then supressed to the cut off 4mg. She has cushings and getting surgery Friday .
1.) Bronchial, Abdominal Carcinoma
2.) Small Cell Lung Ca
3.) Thymoma
Clear and concise! Well done sir 👍
Thanks 🙏
Can you please help me by sharing?
Thank you for the great content. I appreciate your efforts. One suggestion I have is to consider adjusting the tone of your voice in your videos, as it can sometimes come across as slightly off-putting or even annoying for some…
Other than that great content again 🙏
You saved my life
Thank you 🙏
The best video of cushings diagnostic work up. Much love sir! ❤️
Thank you 🙏
You are excellent teacher
I learned many thing from your teaching
Please send me some videos about internal medicine endocrynology
Greatest simplified and easily memorable Diagnosis of Cushing's syndrome...THANK YOU SO MUCH! .I'm definitely subscribing
Thank you 🙏
Thank youu so much medicosis you're a life saver! Now here are the the tumors that could cause ectopic ACTH secretion: small cells lung cancer, pancreatic cancer, thymic cancer, digestive cancer.
Am I missing one? Thank youu again!
Thanks alot Dr
When will you visit 🇪🇬??
My doctor called me a hypochondriac to my face. He ran cortisol urine test anyway, and it came back high. Surprise surprise. I have an appointment with him in a couple days to go over next steps.
Sir thank you so much i finally understand and you made it simple !
My pleasure 😇
Thank you so much for watching!
Good luck!
Can you please help me by sharing?
@@MedicosisPerfectionalis Of course. I shared it with my friends subbed and rang the bell haha !
Haha 😂
Thank you so much, dear :)
I appreciate it!
Not a doctor or studying to be one but my endocrinologist has had me tested for Cushing's and it came back as high. My results were 10 😕 so I started some googling and this makes it much easier to understand the process. I hope I can get some answers soon. Coming up on 6 years of dealing with crazy symptoms 😥
Hey what's ur result...how u r
I had Cushings disease, 2011 surgery done. Now back this month at endocrinologist to check or rule out cushing's reoccurrence. I have about 15-16 signs and symptoms (from the 32 signs and symptoms I had in 2011 cushing's disease time).
My recent labs are confusing. They are:
1st appointment time/random cortisol(1pm blood draw) =low corticol, acth low normal.
24 hr urine cortisol normal,
2 of the midnight saliva test ="slightly high" per the Endocrinologist,
8 am cortisol pre 11 pm dexamethasone suppression test=5.2 ( below mormal).
8 am next day (after 11 pm dexamethasone suppression dose ( =5.3). Not sure if pharmacy filled wrong medicine in place of the dexamethasone dose or not. Will be checking with pharmacy in next few days.
Waiting for MRI results from yesterday.
Today my arms hurt more than usual. And your way of presenting is so sleepy and depressing.
It's not as easy to diagnose the condition as you make it sound like. No offense.
That’s not true. They can come back negative a couple of times before they test abnormal. Cortisol fluctuates. There’s no such thing as a false positive. This man needs to stop talking about this.
A lot of info was good. However you are wrong about the testing..
ACTH is secreted from the anterior pituitary. Small cell lung cancer is an example of ectopic ACTH producing tumor.
Excellent
Thanks 😃
My pleasure!
Thanks for this!
Will the dex test catch CYCLICAL cushings?
Sometimes patients are cyclical and they're not always in a high sometimes it takes more testing to catch a high. Not everyone with Cushing's doesn't suppress on the dexamethasone suppression test either
He has the same accent as the boy who used to play clarinet next to me in middle school haha, that boy was v smart too.
is it possible a blood test could miss cushings?
It’s possible
> ohh this is soooooo acurate((((((( thanks for making life easier!!
Thank you 😊
Amazing explanation ,it helps a lot 🌷🌷🌷🌷🌷شكرا
Tumors are bronchial carcinoid , small cell carcinoma
Thanks! This was amazing
Thank you 😊
Many thanks medicosis
My pleasure 😇
Thank you so much🌺 you are a life saver 😍
You’re very welcome 😊
I didn’t do anything!
very useful. thank you so much
My pleasure 😇
Great Teaching sir
Thanks 🙏
I love your videos, THANKS!!
My pleasure 😇
Thank you very much
My pleasure!
Anterior part adenohypohysis
Correct!
This is very good thank you.!
And you’re very welcome! Thanks for watching!
It's the anterior part of the pituitary
Yes
1st qstn -anterior pituitary
qstn at the end -small cell carcinoma of the lung
Thanks
You’re very welcome
Waw, this is amazing thank you
Thank you 🙏
MY Studing partner , thank u agin and again
anterior
lung cancer
👍👍
Small cell lung cancer, medullary thyroid cancer, carcinoid tumors, tumors of thymus gland, tumors of pancreas
Medicosis, when are you going to publish a review book for medical Board exam takers?
Thank you ☺️
I don’t know 🤷♂️ yet!
Thankss
Some small cell lung carcinomas are associated with ectopic ACTH secretion
Yes
small cell carcinoma of lung and carcinoid of lung
Anterior pituitary release ACTH...other malignancies.. like metastasis.. secondaries.
Excellent
Why does pituatary obeys if its secreted by the tumor independently
I don’t understand.
Where’s the tumor located?
@@MedicosisPerfectionalisif high dose dexamethasone doesn't suppress cortisol produced by zona fasciculata tumor then why pituatary suppress it's acth production in case of pituatary adenoma?
Thank you so much!
My pleasure 😇
Thank you ,and good job
ACTH is released from anterior pitutary
Small cell carcinoma is the answer
Already comment in anothers videos u may think im a little bit crazy but this friday is my semiology exam, because of the pandemic i have not lessons at all, not even by zoom or meet. Im from argentina, your videos help me so much to understand! Sorry for the bad english hahahah
Also you made me laught a lot! You´re hilarious
Your English is excellent and you’re such a wonderful person!
Thank you 😊
Cyclical/Episodic Cushings ?
Excellent. Amazing
Thank you 🙏
Anterior pituitary
anterior pituitary,
the answer for the question is lung tumors
That was very nice and I FINALLY understand it now
Excellent
Anterio pituitary gland produces ACTH.
Excellent
Thank you so much dear dr 😌😍
Thanks 🙏
Anterior pituitary adenohypophysis!!
thank you for the great lecture
do you have video like this for Addison disease ?
Thank you 🙏
Unfortunately, I don’t!
great presentation
anterior pituitary
small cell lung Ca
Why cant we check the cortisol level directly in blood to know about cushing syndrome
It fluctuates greatly!
So, it will be higher in day than night.
Small cell lung cancer and medullary carcinoma of thyroid gland.
Paraneoplastic ACTH secration
Small cell carcinoma of the lung
Bronchial carcenoids
Thank you 😊 🌺🌺
I’m a 22 year old male and I had a 10-11pm 3 day saliva test completed with normal results but still have high ACTH (123 pg/mL). I also had a pituitary MRI done which revealed a tumor. Could I still have Cushing with normal-ish cortisol levels? I had slightly elevated cortisol in the morning revealed through blood work, but my endocrinologist said Cushings wasn’t the diagnosis after my saliva test. I’ve also had mild fat gain in my abdomen and chest (I started out very fit with very low body fat as I work out pretty aggressively), developed gynecomastia, fatigue, blurred vision, increased stomach and facial hair, mood changes, possible very small buffalo hump (can’t see it but I can kind of feel it, unsure if it’s new or not), and potentially lower sex drive although it depends on the month as it sometimes feels quite high. Otherwise pretty normal, I don’t at all look like I have Cushings with the moon face, stretch marks, large stomach, etc. Do you have any idea what this could be? Every doctor I’ve seen has no idea. I also have high free testosterone, high estrogen, high prolactin, slightly low FSH, and high TSH
Do you remember what your cortisol blood test was?
I like your explanation keep going👍
Thank you 🙏
Amazing content once again!
Thanks a ton!
Thanks!
My pleasure 😇
answer 1 anterior pituitary
answer 2 small cell cancer of lungs
Excellent
In ACTH depended cushing ,there is decrease in ACTH by giving dexamethasone , so my question is why decrease in ACTH by exogenous dexathamethasone although there is problem in pituitary so how pituitary decrease ACTH if there is adenoma or other problems it is supposed to be not decrease by exogenous dexamethasone
Hi. Nice video. What do you mean by 24 hr uribe? To be collected at intervals in 24 hrs or after 24 hours?
Finally..thanx a ton
My pleasure 😇
anterior pituitary
Yes!
Thanks bro
My pleasure 😇
Best lecture
Thank you 🙏
you are awesome
Thank you!
small cell carcinoma of lungs can cause ectopic ACTH
Excellent
Ectopic tumor ACTH Syndrom (bronchial carcinoid , small cell lung carcinoma , and other neuroendocrain tumor )
How does a macro adenoma that blocks the stalk cause Cushing disease. Won't you be blocking the stalk causing less CRH to the pituitary so less ACTH is released? @medicosis
فخر العرب 🇪🇬❤️
Anterior adenohypophysis
Phaeochromocytoma
Finally I get it !!! Thank you , subscribed
Thanks 🙏
My granddaughter is 20 years old. She was diagnosed at about 4 years old with Asperger's. Up until she was about 16 she was very small for her age, very slender. When she turned 16 she started gaining weight. But the weight is in her belly and her round face. Her belly is very round and her face is very round. It was never like this up until 5 years ago. Her face and her belly just look abnormal. She is five and a half feet tall with long dark curls and porcelain skin. I describe her simply because she is so down on herself. She's beautiful but her round face looks abnormal.b She's depressed about it. The doctor in our small hometown did a test on her and said no she does not have Cushing. She did one little test on her and that was it. About 2 years ago she lost 9 lbs. but she still had that very round face and very round stomach. Could you please tell me where to turn to help her?
Can u plz tel me y the Ectopic Cushing syndrome are not obeying the dexamethasone suppression test...