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hey guys today we're going to talk about
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cushion syndrome and we know that
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cushion syndrome is due to increased
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levels of cortisol in our body so I
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think it's better to first talk about
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cortisol a little bit and then proceed
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to the Cushing uh to cushion syndrome so
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as we know hypothalamus releases
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corticotropin uh releasing hormone or CR
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which has a positive effect on the
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anterior pituitary now anteria pituitary
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releases act or adrenocorticotropic
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hormone which that has a positive effect
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on adrenal cortex and to be more
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specific the Zona
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falada now this causes uh increased
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production and secretion of cortisol now
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if we have too much cortisol in our body
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what happens is that cortisol would
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negative feedback the hypothalamus
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causing
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inhibition uh of CR so there's no more
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CR being released which eventually leads
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to decreased secretion of act as well so
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this is how we maintain cortisol level
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in our body now we can talk about some
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of the important things that cortisol
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does to our body and this lonic should
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help us remember those BB i i g which
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stands for big and uh we should also
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remind ourselves that cortisol is known
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as a stress hormone so if your body is
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under stress cortisol is going to be uh
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synthesized and secreted okay and this
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stress could be anything if you're
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hungry or if you have an infection any
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type of stress okay so for instance if
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you have low blood pressure cortisol
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will cause increase of alpha 1 receptors
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as we know they um these alpha 1
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receptors when they're stimulated they
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cause vas of constriction so if you have
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low blood pressure um Alpha 1 receptors
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will cause vas of constriction bringing
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your blood pressure back to normal so
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cortisol actually uh maintains your
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blood pressure it also inh liit bone
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formation it it is an
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anti-inflammatory it decreases your
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immune function and it increases
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gluconeogenesis lipolysis and
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proteolysis so now we can talk about
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some of the cushion syndrome uh symptoms
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the first thing is
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hypertension we just talked about um how
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cortisol increases the alpha 1 receptors
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so um a lot of cortisol is going to
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increase a lot of alpha 1 receptors so
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obviously it's going to lead to
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hypertension we said in uh that cortisol
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inhibits bone formation so if it
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inhibits bone formation it's going to
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cause
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osteoporosis we also said that it is an
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Al anti-inflammatory and it suppresses
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your uh immune system so these are some
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of the important things that it does to
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suppress your immune system it inhibits
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the phospholes A2 it will inhibit the
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interlukin 2 and it also inhibits
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histamin release from the mass cells
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okay and uh other specific things are
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muscle weakness withinin extremities now
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we just said that c uh cortisol causes
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protolysis and the reason it does that
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is to to get some amino acids okay to be
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used for glucon Genesis so it needs to
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break down the muscle and muscles are
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made of proteins and uh there's a lot of
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proteins in the muscles so once you
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break those down um you're going to make
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a lot of amino acids um other things are
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moon faces Buffalo humps and trunco
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obesity um we said that cortisol causes
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increase of glucose so if you have
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increase of glucose you're obviously
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going to have high insulin okay so if
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you have high insulin the insulin will
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actually causes fat storage okay so
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that's why these people have those
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Buffalo humps that's why their face is
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uh round like a moon and they have
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trunkal obesity another thing it does it
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causes abdominal Shri which means that
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which is due to impaired collagen
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snthesis so you have thinning of skin so
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these are pretty much stretch marks that
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you can see in some individuals now
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there are different ways for cushion
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syndromes to develop and number one
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cause is exogenous steroids so if
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someone's taking a lot of steroids what
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happens is that these steroids which are
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pretty much same thing as cortisol will
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negative feedback the uh hypothalamus
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and eventually negative feedback like
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the pituitary so there's going to be
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decreased secretion of act from the
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anterior pituitary now if there's no act
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available the adrenal glands will not
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get stimulated and they're not working
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so they become
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atrophied the second reason is primary
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adrenal adenoma in this case one of the
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adrenal glands has the adenoma so it's
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secreting a lot of cortisol so that
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cortisol now is going a negative
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feedback to hypo Thalamus and then the
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anterior pituitary then leading to
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decrease act production from the
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anterior pituitary now the normal
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adrenal gland is the one that's going to
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go uh that's going to become atrophied
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because the one with the adoma is going
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to go under hyperplasia because it's
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working a lot it has adoma so it doesn't
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matter if there's a available or not so
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in this case going to be unilateral
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adrenal atrophy compared to Exogen
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steroids with which had bilateral Adeno
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atrophy so this is how you would
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distinguish between these two the next
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reason is act secreting pituitary adoma
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in this case the problem is the
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pituitary itself it's secreting too much
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ACTH okay so too much act will stimulate
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both adrenal glands and both adrenal
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glands are going to go under bilateral
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hyperplasia cuz now they're working a
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lot more so they're also going to
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secrete a lot of cortis but there won't
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be any negative feedback in this case
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because pituitary is going to has denoma
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so it doesn't really matter if there is
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any uh negative feedback it's still
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going to secrete a lot of act the next
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reason is paraneoplastic act secretion
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for example small cell carcinoma of the
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lungs Now problem here is the tumor
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somewhere else is secreting too much
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act and this also going to lead to
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bilateral hyperplasia of both adrenal
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glands because now they're working more
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okay so in order to differentiate
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between these two we can give the
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patient high dose of dexamethasone
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because they both are presenting with
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bilateral hyperplasia and increased act
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so we got to differentiate between these
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two and what high dose of dexamethazone
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does it suppresses the ACT secrant
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pituitary adoma but not the
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paraneoplastic ACT secretion and a way
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to remember this is that small carcinoma
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of the lungs if you were to compare it
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with the pituitary adenoma are a lot
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worse okay so it's a lot harder to
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control smaller carcinoma of the lungs
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than it is to pituitary adenoma so this
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is a way you you can think about it I
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hope this helps you guys please
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subscribe like the video if you liked it
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and post comments if you have any
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questions please feel free to ask me um
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good luck to you all
